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Hamed SA, Hadad AFE. The effect of anticholinergic drugs on cognition of patients with Parkinson's disease: a cohort study from the Egyptian population. Expert Rev Clin Pharmacol 2024; 17:743-753. [PMID: 38781022 DOI: 10.1080/17512433.2024.2359955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Cognitive dysfunction is a non-motor manifestation of Parkinson's disease (PD). We aimed to determine the frequency and patterns of cognitive dysfunction in treated patients with PD and their predictors. RESEARCH DESIGN AND METHODS This study included 80 patients (male = 48; female = 32) and 30 healthy individuals. They underwent neuropsychiatric evaluations. Measurements included Beck's depression inventory - II (BDI-II), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). RESULTS Patients had mean age of 55.56 ± 9.06 yrs, duration of PD of 4.86 ± 2.71 yrs and Hoehn and Yahr Scoring of 2.19 ± 0.89. They were on levodopa/carbidopa therapy and adjuvant therapy with benztropine mesylate, an anticholinergic drug, (n = 51) or amantadine sulfate, a dopaminergic drug, (n = 29). Sixteen (20%) had moderate depressive symptoms. Mild and moderate cognitive impairments were reported in 38.8% and 28.8% (by MMSE) and 46.3% and 31.3% (by MoCA). Patients had lower global cognitive scoring (p = 0.0001) and scorings of different cognitive functions (naming, attention, language, abstraction, memory and orientation) than controls. Patients treated with benztropine had lower cognition than with amantadine. Correlation analyses showed that lower cognition was only associated with chronic PD and its treatment (p = 0.0001). CONCLUSIONS Cognitive dysfunction is common with PD (77.5%) particularly with anticholinergic drugs. De-prescription of anticholinergics is recommended for patients with PD.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
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Woo S, Noh Y, Koh SB, Lee SK, Il Lee J, Kim HH, Kim SY, Cho J, Kim C. Associations of ambient manganese exposure with brain gray matter thickness and white matter hyperintensities. Hypertens Res 2023; 46:1870-1879. [PMID: 37185603 DOI: 10.1038/s41440-023-01291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
Manganese (Mn) exposure is associated with increased risks of dementia and cerebrovascular disease. However, evidence regarding the impact of ambient Mn exposure on brain imaging markers is scarce. We aimed to investigate the association between ambient Mn exposure and brain imaging markers representing neurodegeneration and cerebrovascular lesions. We recruited a total of 936 adults (442 men and 494 women) without dementia, movement disorders, or stroke from the Republic of Korea. Ambient Mn concentrations were predicted at each participant's residential address using spatial modeling. Neurodegeneration-related brain imaging markers, such as the regional cortical thickness, were estimated using 3 T brain magnetic resonance images. White matter hyperintensity volume (an indicator of cerebrovascular lesions) was also obtained from a certain number of participants (n = 397). Linear regression analyses were conducted after adjusting for potential confounders. A log-transformed ambient Mn concentration was associated with thinner parietal (β = -0.02 mm; 95% confidence interval [CI], -0.05 to -0.01) and occipital cortices (β = -0.03 mm; 95% CI, -0.04 to -0.01) after correcting for multiple comparisons. These associations remained statistically significant in men. An increase in the ambient Mn concentration was also associated with a greater volume of deep white matter hyperintensity in men (β = 772.4 mm3, 95% CI: 36.9 to 1508.0). None of the associations were significant in women. Our findings suggest that ambient Mn exposure may induce cortical atrophy in the general adult population.
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Affiliation(s)
- Shinyoung Woo
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sang-Baek Koh
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Seung-Koo Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Il Lee
- Korea Testing and Research Institute, Gwacheon, Korea
| | - Ho Hyun Kim
- Department of Nano-chemical, biological and environmental engineering Seokyeong University, Seoul, Korea
| | - Sun- Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaelim Cho
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Republic of Korea.
| | - Changsoo Kim
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Republic of Korea.
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Montaser-Kouhsari L, Young CB, Poston KL. Neuroimaging approaches to cognition in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:257-286. [PMID: 35248197 DOI: 10.1016/bs.pbr.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While direct visualization of Lewy body accumulation within the brain is not yet possible in living Parkinson's disease patients, brain imaging studies offer insights into how the buildup of Lewy body pathology impacts different regions of the brain. Unlike biological biomarkers and purely behavioral research, these brain imaging studies therefore offer a unique opportunity to relate brain localization to cognitive function and dysfunction in living patients. Magnetic resonance imaging studies can reveal physical changes in brain structure as they relate to different cognitive domains and task specific impairments. Functional imaging studies use a combination of task and resting state magnetic resonance imaging, as well as positron emission tomography and single photon emission computed tomography, and can be used to determine changes in blood flow, neuronal activation and neurochemical changes in the brain associated with PD cognition and cognitive impairments. Other unique advantages to brain imaging studies are the ability to monitor changes in brain structure and function longitudinally as patients progress and the ability to study changes in brain function when patients are exposed to different pharmacological manipulations. This is particularly true when assessing the effects of dopaminergic replacement therapy on cognitive function in Parkinson's disease patients. Together, this chapter will describe imaging studies that have helped identify structural and functional brain changes associated with cognition, cognitive impairment, and dementia in Parkinson's disease.
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Affiliation(s)
- Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Christina B Young
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States; Department of Neurosurgery, Stanford University, Stanford, CA, United States.
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Luis-Martínez R, Di Marco R, Weis L, Cianci V, Pistonesi F, Baba A, Carecchio M, Biundo R, Tedesco C, Masiero S, Antonini A. Impact of social and mobility restrictions in Parkinson's disease during COVID-19 lockdown. BMC Neurol 2021; 21:332. [PMID: 34461838 PMCID: PMC8404403 DOI: 10.1186/s12883-021-02364-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The consequences of strict COVID-19 mobility restrictions on motor/non-motor features in Parkinson's disease (PD) have not been systematically studied but worse mobility and quality of life have been reported. To elucidate this question, 12 mild to moderate PD patients were assessed in March 2020 before and after two months of isolation as part of a clinical study that had to be interrupted due to the pandemic and the implementation of COVID19 mobility restrictions. METHODS Twelve patients were systematically evaluated before and after the lockdown period as part of a larger cohort that previously underwent thermal water rehabilitation. Clinical outcomes were the Body Mass index, the Mini-Balance Evaluation Systems Test, the MDS-Unified Parkinson's Disease Rating Scale part III, the 6 Minute Walking Test and the New Freezing of Gait Questionnaire. Global cognition was evaluated with the Montreal Cognitive Assessment scale. The impact of COVID-19 restrictions on quality of life and functional independence was evaluated with The Parkinson's disease Quality of life (PDQ-39), the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living questionnaires (IADL) and the Parkinson's disease cognitive functional rating scales (PD-CFRS). RESULTS After two months of isolation the Mini-BESTest score worsened (p=0.005), and four patients reported one or more falls during the lockdown. BMI increased (p=0.031) while the remaining clinical variables including quality of life did not change. CONCLUSION We observed moderate worsening at Mini-BESTest, greater risk of falls and increased body weight as consequence of prolonged immobility. We believe negative effects were partially softened since patients were in contact with our multidisciplinary team during the lockdown and had previously received training to respond to the needs of this emergency isolation. These findings highligh the importnace of patient-centered interventions in PD management.
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Affiliation(s)
- Raquel Luis-Martínez
- Department of Neurosciences, University of the Basque Country, (UPV/EHU), Leioa, Spain
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Roberto Di Marco
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Luca Weis
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Valeria Cianci
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Francesca Pistonesi
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Alfonc Baba
- Rehabilitation Unit, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Miryam Carecchio
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Roberta Biundo
- Department of General Psychology, University of Padova, Padova, Italy
| | - Chiara Tedesco
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy
| | - Stefano Masiero
- Physical Medicine and Rehabilitation School, University of Padova, Padova, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35138, Padua, Italy.
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5
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Zhang Y, Burock MA. Diffusion Tensor Imaging in Parkinson's Disease and Parkinsonian Syndrome: A Systematic Review. Front Neurol 2020; 11:531993. [PMID: 33101169 PMCID: PMC7546271 DOI: 10.3389/fneur.2020.531993] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
Diffusion tensor imaging (DTI) allows measuring fractional anisotropy and similar microstructural indices of the brain white matter. Lower than normal fractional anisotropy as well as higher than normal diffusivity is associated with loss of microstructural integrity and neurodegeneration. Previous DTI studies in Parkinson's disease (PD) have demonstrated abnormal fractional anisotropy in multiple white matter regions, particularly in the dopaminergic nuclei and dopaminergic pathways. However, DTI is not considered a diagnostic marker for the earliest Parkinson's disease since anisotropic alterations present a temporally divergent pattern during the earliest Parkinson's course. This article reviews a majority of clinically employed DTI studies in PD, and it aims to prove the utilities of DTI as a marker of diagnosing PD, correlating clinical symptomatology, tracking disease progression, and treatment effects. To address the challenge of DTI being a diagnostic marker for early PD, this article also provides a comparison of the results from a longitudinal, early stage, multicenter clinical cohort of Parkinson's research with previous publications. This review provides evidences of DTI as a promising marker for monitoring PD progression and classifying atypical PD types, and it also interprets the possible pathophysiologic processes under the complex pattern of fractional anisotropic changes in the first few years of PD. Recent technical advantages, limitations, and further research strategies of clinical DTI in PD are additionally discussed.
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Affiliation(s)
- Yu Zhang
- Department of Psychiatry, War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Marc A Burock
- Department of Psychiatry, Mainline Health, Bryn Mawr Hospital, Bryn Mawr, PA, United States
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Pizzagalli F, Auzias G, Yang Q, Mathias SR, Faskowitz J, Boyd JD, Amini A, Rivière D, McMahon KL, de Zubicaray GI, Martin NG, Mangin JF, Glahn DC, Blangero J, Wright MJ, Thompson PM, Kochunov P, Jahanshad N. The reliability and heritability of cortical folds and their genetic correlations across hemispheres. Commun Biol 2020; 3:510. [PMID: 32934300 PMCID: PMC7493906 DOI: 10.1038/s42003-020-01163-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/24/2020] [Indexed: 12/22/2022] Open
Abstract
Cortical folds help drive the parcellation of the human cortex into functionally specific regions. Variations in the length, depth, width, and surface area of these sulcal landmarks have been associated with disease, and may be genetically mediated. Before estimating the heritability of sulcal variation, the extent to which these metrics can be reliably extracted from in-vivo MRI must be established. Using four independent test-retest datasets, we found high reliability across the brain (intraclass correlation interquartile range: 0.65-0.85). Heritability estimates were derived for three family-based cohorts using variance components analysis and pooled (total N > 3000); the overall sulcal heritability pattern was correlated to that derived for a large population cohort (N > 9000) calculated using genomic complex trait analysis. Overall, sulcal width was the most heritable metric, and earlier forming sulci showed higher heritability. The inter-hemispheric genetic correlations were high, yet select sulci showed incomplete pleiotropy, suggesting hemisphere-specific genetic influences.
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Grants
- P41 EB015922 NIBIB NIH HHS
- R01 EB015611 NIBIB NIH HHS
- P01 AG026276 NIA NIH HHS
- R21 NS064534 NINDS NIH HHS
- R01 MH078111 NIMH NIH HHS
- R01 HD050735 NICHD NIH HHS
- R01 NS056307 NINDS NIH HHS
- R01 MH121246 NIMH NIH HHS
- P50 MH071616 NIMH NIH HHS
- R03 EB012461 NIBIB NIH HHS
- R01 AG059874 NIA NIH HHS
- U24 RR021382 NCRR NIH HHS
- P30 AG066444 NIA NIH HHS
- P01 AG003991 NIA NIH HHS
- P50 AG005681 NIA NIH HHS
- U54 EB020403 NIBIB NIH HHS
- R01 MH117601 NIMH NIH HHS
- U54 MH091657 NIMH NIH HHS
- R01 AG021910 NIA NIH HHS
- R01 MH078143 NIMH NIH HHS
- P41 RR015241 NCRR NIH HHS
- S10 OD023696 NIH HHS
- R01 MH083824 NIMH NIH HHS
- This research was funded in part by NIH ENIGMA Center grant U54 EB020403, supported by the Big Data to Knowledge (BD2K) Centers of Excellence program funded by a cross-NIH initiative. Additional grant support was provided by: R01 AG059874, R01 MH117601, R01 MH121246, and P41 EB015922. QTIM was supported by NIH R01 HD050735, and the NHMRC 486682, Australia; GOBS: Financial support for this study was provided by the National Institute of Mental Health grants MH078143 (PI: DC Glahn), MH078111 (PI: J Blangero), and MH083824 (PI: DC Glahn & J Blangero); HCP data were provided [in part] by the Human Connectome Project, WU-Minn Consortium (Principal Investigators: David Van Essen and Kamil Ugurbil; 1U54MH091657) funded by the 16 NIH Institutes and Centers that support the NIH Blueprint for Neuroscience Research; and by the McDonnell Center for Systems Neuroscience at Washington University; UK Biobank: This research was conducted using the UK Biobank Resource under Application Number ‘11559’; BrainVISA’s Morphologist software development received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation under Grant Agreement No 720270 & 785907 (Human Brain ProjectSGA1 & SGA2), and by the FRM DIC20161236445. OASIS: Cross-Sectional: Principal Investigators: D. Marcus, R. Buckner, J. Csernansky J. Morris; P50 AG05681, P01 AG03991, P01 AG026276, R01 AG021910, P20 MH071616, U24 RR021382. KKI was supported by NIH grants NCRR P41 RR015241 (Peter C.M. van Zijl), 1R01NS056307 (Jerry Prince), 1R21NS064534-01A109 (Bennett A. Landman/Jerry L. Prince), 1R03EB012461-01 (Bennett A. Landman). Neda Jahanshad and Paul Thompson are MPIs of a research project grant from Biogen, Inc. (PO 969323).
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Affiliation(s)
- Fabrizio Pizzagalli
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA.
| | - Guillaume Auzias
- Institut de Neurosciences de la Timone, UMR7289, Aix-Marseille Université & CNRS, Marseille, France
| | - Qifan Yang
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Samuel R Mathias
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Joshua Faskowitz
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Joshua D Boyd
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Armand Amini
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Denis Rivière
- Université Paris-Saclay, CEA, CNRS, Neurospin, Baobab, Gif-sur-Yvette, France
- CATI, Multicenter Neuroimaging Platform, Paris, France
| | - Katie L McMahon
- School of Clinical Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Greig I de Zubicaray
- Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4000, Australia
| | | | - Jean-François Mangin
- Université Paris-Saclay, CEA, CNRS, Neurospin, Baobab, Gif-sur-Yvette, France
- CATI, Multicenter Neuroimaging Platform, Paris, France
| | - David C Glahn
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - John Blangero
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, 4072, Australia
- Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA.
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Cognition Deficits in Parkinson's Disease: Mechanisms and Treatment. PARKINSONS DISEASE 2020; 2020:2076942. [PMID: 32269747 PMCID: PMC7128056 DOI: 10.1155/2020/2076942] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/08/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder mainly in middle-elderly population, which represents diverse nonmotor symptoms (NMS) besides such well-documented motor symptoms as bradykinesia, resting tremor, rigidity, and postural instability. With the advancement of aging trend worldwide, the global prevalence of PD is mounting up year after year. Nowadays, accumulating lines of studies have given a comprehensive and thorough coverage of motor symptoms in PD. Yet much less attention as compared has been paid to the nonmotor symptoms of PD, such as cognition deficits. Of note, a patient with PD who suffers from cognitive impairment may harbour a statistically significantly higher risk of progressing toward dementia, which negatively affects their life expectancy and daily functioning and overall lowers the global quality of life. Furthermore, it is a widely held view that cognitive dysfunction does not just occur in the late stage of PD. On the basis of numerous studies, mild cognitive impairment (MCI) is a harbinger of dementia in PD, which is observed as an intermediate state with considerable variability; some patients remain stable and some even revert to normal cognition. Considered that the timing, profile, and rate of cognitive impairment vary greatly among PD individuals, it is extremely urgent for researchers and clinicians alike to identify and predict future cognitive decline in this population. Simultaneously, early screening and canonical management of PD with cognitive deficits are very imperative to postpone the disease progression and improve the prognosis of patients. In our review, we focus on a description of cognitive decline in PD, expound emphatically the pathological mechanisms underlying cognition deficits in PD, then give a comprehensive overview of specific therapeutic strategies, and finally dissect what fresh insights may bring new exciting prospect for the subfield.
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Hameed S, Fuh JL, Senanarong V, Ebenezer EGM, Looi I, Dominguez JC, Park KW, Karanam AK, Simon O. Role of Fluid Biomarkers and PET Imaging in Early Diagnosis and its Clinical Implication in the Management of Alzheimer's Disease. J Alzheimers Dis Rep 2020; 4:21-37. [PMID: 32206755 PMCID: PMC7081089 DOI: 10.3233/adr-190143] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Clinical diagnosis of Alzheimer's disease (AD) is based on symptoms; however, the challenge is to diagnose AD at the preclinical stage with the application of biomarkers and initiate early treatment (still not widely available). Currently, cerebrospinal fluid (CSF) amyloid-β 42 (Aβ42) and tau are used in the clinical diagnosis of AD; nevertheless, blood biomarkers (Aβ42 and tau) are less predictive. Amyloid-positron emission tomography (PET) imaging is an advancement in technology that uses approved radioactive diagnostic agents (florbetapir, flutemetamol, or florbetaben) to estimate Aβ neuritic plaque density in adults with cognitive impairment evaluated for AD and other causes of cognitive decline. There is no cure for AD to date-the disease progression cannot be stopped or reversed; approved pharmacological agents (donepezil, galantamine, and rivastigmine; memantine) provide symptomatic treatment. However, the disease-modifying therapies are promising; aducanumab and CAD106 are in phase III trials for the early stages of AD. In conclusion, core CSF biomarkers reflect pathophysiology of AD in the early and late stages; the application of approved radiotracers have potential in amyloid-PET brain imaging to detect early AD.
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Affiliation(s)
- Shahul Hameed
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
- Duke NUS Medical School, Singapore
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Vorapun Senanarong
- Division of Neurology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Penang, Malaysia
- Department of Medicine, Hospital Seberang Jaya, Penang, Malaysia
| | | | - Kyung Won Park
- Department of Neurology and Cognitive Disorders and Dementia Center, Institute of Convergence Bio-Health, Dong-A University College of Medicine, Busan, Republic of Korea
| | | | - Oliver Simon
- Novartis (Singapore) Pte. Ltd., Singapore, Singapore
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9
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Spencer KA, Paul J, Brown KA, Ellerbrock T, Sohlberg MM. Cognitive Rehabilitation for Individuals With Parkinson's Disease: Developing and Piloting an External Aids Treatment Program. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1-19. [PMID: 31697899 DOI: 10.1044/2019_ajslp-19-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Cognitive deficits are common in Parkinson's disease (PD) and can have a detrimental effect on daily activities. To date, most cognitive treatments have had an impairment-based focus with primary outcome measures of formal neuropsychological test scores. Few, if any, studies have focused on functional improvement or patient-centered goals. Method Three individuals with idiopathic PD participated in an 8-week pilot treatment program to train for the use of compensatory external aids to achieve personalized goals. Goal attainment scaling was the primary outcome measure, which was independently judged by multiple raters at baseline, postintervention, and 1 month posttreatment and analyzed via T-score analysis. Descriptive measures, including self-report and spouse-report rating scales of cognitive functioning, were employed. Results All 3 participants improved in the majority of their laboratory and home goals posttreatment, as measured by goal attainment scaling, and maintained gains for the majority of goals 1 month posttreatment. Conclusions This is the 1st known study to implement an external aids treatment program with patient-centered goals for individuals with cognitive deficits from PD. Positive outcomes were likely influenced by 3 factors: (a) a theoretically motivated focus on external aids; (b) a well-documented, systematic approach to instruction; and (c) the personalization of goals. Supplemental Material https://doi.org/10.23641/asha.10093493.
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Affiliation(s)
- Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Jennifer Paul
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Katherine A Brown
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Taylor Ellerbrock
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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Fiorenzato E, Biundo R, Cecchin D, Frigo AC, Kim J, Weis L, Strafella AP, Antonini A. Brain Amyloid Contribution to Cognitive Dysfunction in Early-Stage Parkinson's Disease: The PPMI Dataset. J Alzheimers Dis 2019; 66:229-237. [PMID: 30282359 DOI: 10.3233/jad-180390] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The pathological processes underlying cognitive impairment in Parkinson's disease (PD) are heterogeneous and the contribution of cerebral amyloid deposits is poorly defined, particularly in the early stages of the disease. OBJECTIVE To investigate regional [18F]florbetaben binding to amyloid-β (Aβ) and its contribution to cognitive dysfunction in early stage PD. METHODS A multicenter cohort of 48 PD patients from the Parkinson's Progression Marker Initiative (PPMI) underwent [18F]florbetaben positron emission tomography (PET) scanning. Clinical features, including demographic characteristics, motor severity, cerebrospinal fluid (CSF), and cognitive testing were systematically assessed according to the PPMI study protocol. For the purpose of this study, we analyzed various neuropsychological tests assessing all cognitive functions. RESULTS There were 10/48 (21%) amyloid positive PD patients (PDAβ+). Increased [18F]florbetaben uptake in widespread cortical and subcortical regions was associated with poorer performance on global cognition, as assessed by Montreal Cognitive Assessment (MoCA), and impaired performance on Symbol Digit Modality test (SDMT). Further, we found that PDAβ+ patients had higher CSF total-tau/Aβ1 - 42 (p = 0.001) and phosphorylated-tau/Aβ1 - 42 in (p = 0.002) compared to amyloid-negative PD. CONCLUSION These findings suggest that multiple disease processes are associated with PD cognitive impairment and amyloid deposits may be observed already in early stages. However, prevalence of amyloid positivity is in the range of literature age-matched control population. Increased cortical and subcortical amyloid is associated with poor performance in attentive-executive domains while cognitive deficits at MoCA and SDMT may identify amyloid-related dysfunction in early PD.
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Affiliation(s)
| | | | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padua, Padua, Italy.,Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Jinhee Kim
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Toronto, ON, Canada.,Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Luca Weis
- Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
| | - Antonio P Strafella
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Toronto, ON, Canada.,Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Morton and Gloria Shulman Movement Disorder Unit and E.J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
| | - Angelo Antonini
- Department of Neurosciences, University of Padua, Padua, Italy
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Arshad Q, Bonsu A, Lobo R, Fluri AS, Sheriff R, Bain P, Pavese N, Bronstein AM. Biased numerical cognition impairs economic decision-making in Parkinson's disease. Ann Clin Transl Neurol 2017; 4:739-748. [PMID: 29046882 PMCID: PMC5634350 DOI: 10.1002/acn3.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Objective Previous findings suggest a context‐dependent bihemispheric allocation of numerical magnitude. Accordingly, we predicted that lateralized motor symptoms in Parkinson's disease (PD), which reflect hemispheric asymmetries, would induce systematic lateralized biases in numerical cognition and have a subsequent influence on decision‐making. Methods In 20 PD patients and matched healthy controls we assessed numerical cognition using a number‐pair bisection and random number generation task. Decision‐making was assessed using both the dictator game and a validated questionnaire. Results PD patients with predominant right‐sided motor symptoms exhibited pathological biases toward smaller numerical magnitudes and formulated less favorable prosocial choices during a neuroeconomics task (i.e., dictator game). Conversely, patients with left‐sided motor symptoms exhibited pathological biases toward larger numerical magnitudes and formulated more generous prosocial choices. Our account of context‐dependent hemispheric allocation of numerical magnitude in PD was corroborated by applying our data to a pre‐existing computational model and observing significant concordance. Notably, both numerical biasing and impaired decision‐making were correlated with motor asymmetry. Interpretation Accordingly, motor asymmetry and functional impairment of cognitive processes in PD can be functionally intertwined. To conclude, our findings demonstrate context‐dependent hemispheric allocation and encoding of numerical magnitude in PD and how biases in numerical magnitude allocation in Parkinsonian patients can correspondingly impair economic decision‐making.
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Affiliation(s)
- Qadeer Arshad
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom
| | - Angela Bonsu
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom
| | - Rhannon Lobo
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom
| | - Anne-Sophie Fluri
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom
| | - Rahuman Sheriff
- European Bioinformatics Institute EMBL-EBI Hinxton Cambridge CB10 1SD United Kingdom
| | - Peter Bain
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom
| | - Nicola Pavese
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom.,Institute of Neuroscience Newcastle University Tyne and Wear NE1 7RU United Kingdom
| | - Adolfo M Bronstein
- Division of Brain Sciences Imperial College Charing Cross Hospital Campus Fulham Palace Road London W6 8RF United Kingdom
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Tuite P. Brain Magnetic Resonance Imaging (MRI) as a Potential Biomarker for Parkinson's Disease (PD). Brain Sci 2017; 7:E68. [PMID: 28621758 PMCID: PMC5483641 DOI: 10.3390/brainsci7060068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) has the potential to serve as a biomarker for Parkinson's disease (PD). However, the type or types of biomarker it could provide remain to be determined. At this time there is not sufficient sensitivity or specificity for MRI to serve as an early diagnostic biomarker, i.e., it is unproven in its ability to determine if a single individual is normal, has mild PD, or has some other forms of degenerative parkinsonism. However there is accumulating evidence that MRI may be useful in staging and monitoring disease progression (staging biomarker), and also possibly as a means to monitor pathophysiological aspects of disease and associated response to treatments, i.e., theranostic marker. As there are increasing numbers of manuscripts that are dedicated to diffusion- and neuromelanin-based imaging methods, this review will focus on these topics cursorily and will delve into pharmacodynamic imaging as a means to get at theranostic aspects of PD.
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Affiliation(s)
- Paul Tuite
- Neurology Department, University of Minnesota, MMC 295, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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13
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Schrag A, Siddiqui UF, Anastasiou Z, Weintraub D, Schott JM. Clinical variables and biomarkers in prediction of cognitive impairment in patients with newly diagnosed Parkinson's disease: a cohort study. Lancet Neurol 2017; 16:66-75. [PMID: 27866858 PMCID: PMC5377592 DOI: 10.1016/s1474-4422(16)30328-3] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/20/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Parkinson's disease is associated with an increased incidence of cognitive impairment and dementia. Predicting who is at risk of cognitive decline early in the disease course has implications for clinical prognosis and for stratification of participants in clinical trials. We assessed the use of clinical information and biomarkers as predictive factors for cognitive decline in patients with newly diagnosed Parkinson's disease. METHODS The Parkinson's Progression Markers Initiative (PPMI) study is a cohort study in patients with newly diagnosed Parkinson's disease. We evaluated cognitive performance (Montreal Cognitive Assessment [MoCA] scores), demographic and clinical data, APOE status, and biomarkers (CSF and dopamine transporter [DAT] imaging results). Using change in MoCA scores over 2 years, MoCA scores at 2 years' follow-up, and a diagnosis of cognitive impairment (combined mild cognitive impairment or dementia) at 2 years as outcome measures, we assessed the predictive values of baseline clinical variables and separate or combined additions of APOE status, DAT imaging, and CSF biomarkers. We did univariate and multivariate linear analyses with MoCA change scores between baseline and 2 years, and with MoCA scores at 2 years as dependent variables, using backwards linear regression analysis. Additionally, we constructed a prediction model for diagnosis of cognitive impairment using logistic regression analysis. FINDINGS 390 patients with Parkinson's disease recruited between July 1, 2010, and May 31, 2013, and for whom data on MoCA scores at baseline and 2 years were available. In multivariate analyses, baseline age, University of Pennsylvania Smell Inventory Test (UPSIT) scores, CSF amyloid - (Aβ42) to t-tau ratio, and APOE status were associated with change in MoCA scores over time. Baseline age, MoCA and UPSIT scores, and CSF Aβ42 to t-tau ratio were associated with MoCA score at 2 years (using a backwards p-removal threshold of 0·1). Accuracy of prediction of cognitive impairment using age alone (area under the curve 0·68, 95% CI 0·60-0·76) significantly improved by addition of clinical scores (UPSIT, Rapid Eye Movement Sleep Behaviour Disorder Screening Questionnaire [RBDSQ], Geriatric Depression Scale, and Movement Disorder Society Unified Parkinson's Disease Rating Scale motor scores; 0·76, 0·68-0·83), CSF variables (0·74, 0·68-0·81), or DAT imaging results (0·76, 0·68-0·83). In combination, the five variables showing the most significant associations with cognitive impairment (age, UPSIT, RBDSQ, CSF Aβ42, and caudate uptake on DAT imaging) allowed prediction of cognitive impairment at 2 years (0·80, 0·74-0·87; p=0·0003 compared to age alone). INTERPRETATION In newly diagnosed Parkinson's disease, the occurrence of cognitive impairment at 2 year follow-up can be predicted with good accuracy using a model combining information on age, non-motor assessments, DAT imaging, and CSF biomarkers. FUNDING None.
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Affiliation(s)
- Anette Schrag
- Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, London, UK.
| | - Uzma Faisal Siddiqui
- Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, London, UK
| | - Zacharias Anastasiou
- Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, London, UK
| | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
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Abstract
The broad importance of dementia is undisputed, with Alzheimer's disease justifiably getting the most attention. However, dementia with Lewy bodies and Parkinson's disease dementia, now called Lewy body dementias, are the second most common type of degenerative dementia in patients older than 65 years. Despite this, Lewy body dementias receive little attention and patients are often misdiagnosed, leading to less than ideal management. Over the past 10 years, considerable effort has gone into improving diagnostic accuracy by refining diagnostic criteria and using imaging and other biomarkers. Dementia with Lewy bodies and Parkinson's disease dementia share the same pathophysiology, and effective treatments will depend not only on successful treatment of symptoms but also on targeting the pathological mechanisms of disease, ideally before symptoms and clinical signs develop. We summarise the most pertinent progress from the past 10 years, outlining some of the challenges for the future, which will require refinement of diagnosis and clarification of the pathogenesis, leading to disease-modifying treatments.
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Affiliation(s)
- Zuzana Walker
- Division of Psychiatry, University College London, London, UK; North Essex Partnership University NHS Foundation Trust, Epping, UK.
| | - Katherine L Possin
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Bradley F Boeve
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Division of Movement Disorders, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dag Aarsland
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway; Department of Neurobiology, Care Sciences and Society, Division of Alzheimer's Disease Research Centre, Karolinska Institute, Stockholm, Sweden
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Zeighami Y, Ulla M, Iturria-Medina Y, Dadar M, Zhang Y, Larcher KMH, Fonov V, Evans AC, Collins DL, Dagher A. Network structure of brain atrophy in de novo Parkinson's disease. eLife 2015; 4:e08440. [PMID: 26344547 PMCID: PMC4596689 DOI: 10.7554/elife.08440] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/05/2015] [Indexed: 01/01/2023] Open
Abstract
We mapped the distribution of atrophy in Parkinson's disease (PD) using magnetic resonance imaging (MRI) and clinical data from 232 PD patients and 117 controls from the Parkinson's Progression Markers Initiative. Deformation-based morphometry and independent component analysis identified PD-specific atrophy in the midbrain, basal ganglia, basal forebrain, medial temporal lobe, and discrete cortical regions. The degree of atrophy reflected clinical measures of disease severity. The spatial pattern of atrophy demonstrated overlap with intrinsic networks present in healthy brain, as derived from functional MRI. Moreover, the degree of atrophy in each brain region reflected its functional and anatomical proximity to a presumed disease epicenter in the substantia nigra, compatible with a trans-neuronal spread of the disease. These results support a network-spread mechanism in PD. Finally, the atrophy pattern in PD was also seen in healthy aging, where it also correlated with the loss of striatal dopaminergic innervation.
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Affiliation(s)
- Yashar Zeighami
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Miguel Ulla
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
- Service de Neurologie A, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yasser Iturria-Medina
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Mahsa Dadar
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Yu Zhang
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | | | - Vladimir Fonov
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Alan C Evans
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Alain Dagher
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
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16
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Brain activity during walking: A systematic review. Neurosci Biobehav Rev 2015; 57:310-27. [PMID: 26306029 DOI: 10.1016/j.neubiorev.2015.08.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/27/2015] [Accepted: 08/02/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND This systematic review provides an overview of the literature deducing information about brain activation during (1) imagined walking using MRI/fMRI or (2) during real walking using measurement systems as fNIRS, EEG and PET. METHODS Three independent reviewers undertook an electronic database research browsing six databases. The search request consisted of three search fields. The first field comprised common methods to evaluate brain activity. The second search field comprised synonyms for brain responses to movements. The third search field comprised synonyms for walking. RESULTS 48 of an initial yield of 1832 papers were reviewed. We found differences in cortical activity regarding young vs. old individuals, physically fit vs. physically unfit cohorts, healthy people vs. patients with neurological diseases, and between simple and complex walking tasks. CONCLUSIONS We summarize that the dimension of brain activity in different brain areas during walking is highly sensitive to task complexity, age and pathologies supporting previous assumptions underpinning the significance of cortical control. Many compensation mechanisms reflect the brain's plasticity which ensures stable walking.
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Caproni S, Muti M, Di Renzo A, Principi M, Caputo N, Calabresi P, Tambasco N. Subclinical visuospatial impairment in Parkinson's disease: the role of Basal Ganglia and limbic system. Front Neurol 2014; 5:152. [PMID: 25157239 PMCID: PMC4128219 DOI: 10.3389/fneur.2014.00152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Visual perception deficits are a recurrent manifestation in Parkinson's disease (PD). Recently, structural abnormalities of fronto-parietal areas and subcortical regions, implicated in visual stimuli analysis, have been observed in PD patients with cognitive decline and visual hallucinations. The aim of the present study was to investigate the salient aspects of visual perception in cognitively unimpaired PD patients. METHODS Eleven right-handed non-demented right-sided onset PD patients without visuospatial impairment or hallucinations and 11 healthy controls were studied with functional magnetic resonance imaging while performing a specific visuoperceptual/visuospatial paradigm that allowed to highlight the specific process underlying visuospatial judgment. RESULTS Significant changes in both cortical areas and subcortical regions involved in visual stimuli processing were observed. In particular, PD patients showed a reduced activation for the right insula, left putamen, bilateral caudate, and right hippocampus, as well as an over-activation of the right dorso-lateral prefrontal and of the posterior parietal cortices, particularly in the right hemisphere. CONCLUSIONS We found that both loss of efficiency and compensatory mechanisms occur in PD patients, providing further insight into the pathophysiological role of the functional alterations of basal ganglia and limbic structures in the impairment of visuoperceptual and visuospatial functions observed in PD.
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Affiliation(s)
- Stefano Caproni
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia , Italy
| | - Marco Muti
- Servizio di Fisica Sanitaria, Azienda Ospedaliera di Terni , Italy
| | - Antonio Di Renzo
- Servizio di Fisica Sanitaria, Azienda Ospedaliera di Terni , Italy
| | - Massimo Principi
- Servizio di Neuroradiologia, Azienda Ospedaliera di Terni , Italy
| | - Nevia Caputo
- Servizio di Neuroradiologia, Azienda Ospedaliera di Terni , Italy
| | - Paolo Calabresi
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia , Italy ; I.R.C.C.S. - Fondazione S. Lucia - Roma , Italy
| | - Nicola Tambasco
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia , Italy
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Mak E, Zhou J, Tan LCS, Au WL, Sitoh YY, Kandiah N. Cognitive deficits in mild Parkinson's disease are associated with distinct areas of grey matter atrophy. J Neurol Neurosurg Psychiatry 2014; 85:576-80. [PMID: 24133286 DOI: 10.1136/jnnp-2013-305805] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES The neuroanatomical substrates underlying cognitive impairment in Parkinson's disease (PD) remain poorly understood. To address this gap, we compared the grey matter atrophy patterns in PD patients with mild cognitive impairment (PD-MCI) with PD patients having no cognitive impairment (PD-NCI), and examined relationships between atrophic regions and cognitive performance in specific domains. METHODS 90 non-demented PD patients (64.95±7.54 years, Hoehn and Yahr=1.88±0.39) were classified using formal diagnostic criteria as PD-MCI (n=23) or PD-NCI (n=67). Grey matter volume differences were examined using voxel-based morphometry on structural MRI, and multivariate linear regressions were employed to assess the relationships between cognitive performance in specific domains and atrophic regions. RESULTS Patients with PD-MCI had lower global cognition scores compared with PD-NCI (Mini Mental State Examination: 26.9 vs. 28.4, p=0.011; Montreal Cognitive Assessment: 24.5 vs. 27.0, p<0.001). The PD-MCI group demonstrated significantly poorer performance on executive function, attention, memory and language abilities. Patients with PD-MCI had reductions in grey matter volumes in the left insular, left superior frontal and left middle temporal areas compared to PD-NCI. Multiple regressions controlling for age, education and cardiovascular risk factors revealed significant positive correlations between left insular atrophy and executive-attention dysfunction. CONCLUSIONS Domain specific cognitive impairment in mild PD is associated with distinct areas of grey matter atrophy. These regions of atrophy are demonstrable early in the disease course and may serve as a biomarker for dementia in PD.
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Affiliation(s)
- Elijah Mak
- Department of Neurology, National Neuroscience Institute, Singapore
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19
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Abstract
Neurodegenerative disorders leading to dementia are common diseases that affect many older and some young adults. Neuroimaging methods are important tools for assessing and monitoring pathological brain changes associated with progressive neurodegenerative conditions. In this review, the authors describe key findings from neuroimaging studies (magnetic resonance imaging and radionucleotide imaging) in neurodegenerative disorders, including Alzheimer's disease (AD) and prodromal stages, familial and atypical AD syndromes, frontotemporal dementia, amyotrophic lateral sclerosis with and without dementia, Parkinson's disease with and without dementia, dementia with Lewy bodies, Huntington's disease, multiple sclerosis, HIV-associated neurocognitive disorder, and prion protein associated diseases (i.e., Creutzfeldt-Jakob disease). The authors focus on neuroimaging findings of in vivo pathology in these disorders, as well as the potential for neuroimaging to provide useful information for differential diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Shannon L. Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J. Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
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Huryn DM, Resnick LO, Wipf P. Contributions of academic laboratories to the discovery and development of chemical biology tools. J Med Chem 2013; 56:7161-76. [PMID: 23672690 DOI: 10.1021/jm400132d] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The academic setting provides an environment that may foster success in the discovery of certain types of small molecule tools while proving less suitable in others. For example, small molecule probes for poorly understood systems, those that exploit a specific resident expertise, and those whose commercial return is not apparent are ideally suited to be pursued in a university setting. In this review, we highlight five projects that emanated from academic research groups and generated valuable tool compounds that have been used to interrogate biological phenomena: reactive oxygen species (ROS) sensors, GPR30 agonists and antagonists, selective CB2 agonists, Hsp70 modulators, and β-amyloid PET imaging agents. By taking advantage of the unique expertise resident in university settings and the ability to pursue novel projects that may have great scientific value but with limited or no immediate commercial value, probes from academic research groups continue to provide useful tools and generate a long-term resource for biomedical researchers.
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Affiliation(s)
- Donna M Huryn
- Department of Pharmaceutical Sciences, University of Pittsburgh Chemical Diversity Center (UP-CDC) , 3501 Terrace Street, Pittsburgh, Pennsylvania 15261, United States
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Jellinger KA. Neurobiology of cognitive impairment in Parkinson’s disease. Expert Rev Neurother 2012; 12:1451-1466. [DOI: 10.1586/ern.12.131] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Goker-Alpan O, Masdeu JC, Kohn PD, Ianni A, Lopez G, Groden C, Chapman MC, Cropp B, Eisenberg DP, Maniwang ED, Davis J, Wiggs E, Sidransky E, Berman KF. The neurobiology of glucocerebrosidase-associated parkinsonism: a positron emission tomography study of dopamine synthesis and regional cerebral blood flow. ACTA ACUST UNITED AC 2012; 135:2440-8. [PMID: 22843412 DOI: 10.1093/brain/aws174] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mutations in GBA, the gene encoding glucocerebrosidase, the enzyme deficient in Gaucher disease, are common risk factors for Parkinson disease, as patients with Parkinson disease are over five times more likely to carry GBA mutations than healthy controls. Patients with GBA mutations generally have an earlier onset of Parkinson disease and more cognitive impairment than those without GBA mutations. We investigated whether GBA mutations alter the neurobiology of Parkinson disease, studying brain dopamine synthesis and resting regional cerebral blood flow in 107 subjects (38 women, 69 men). We measured dopamine synthesis with (18)F-fluorodopa positron emission tomography, and resting regional cerebral blood flow with H(2)(15)O positron emission tomography in the wakeful, resting state in four study groups: (i) patients with Parkinson disease and Gaucher disease (n = 7, average age = 56.6 ± 9.2 years); (ii) patients with Parkinson disease without GBA mutations (n = 11, 62.1 ± 7.1 years); (iii) patients with Gaucher disease without parkinsonism, but with a family history of Parkinson disease (n = 14, 52.6 ± 12.4 years); and (iv) healthy GBA-mutation carriers with a family history of Parkinson disease (n = 7, 50.1 ± 18 years). We compared each study group with a matched control group. Data were analysed with region of interest and voxel-based methods. Disease duration and Parkinson disease functional and staging scores were similar in the two groups with parkinsonism, as was striatal dopamine synthesis: both had greatest loss in the caudal striatum (putamen Ki loss: 44 and 42%, respectively), with less reduction in the caudate (20 and 18% loss). However, the group with both Parkinson and Gaucher diseases showed decreased resting regional cerebral blood flow in the lateral parieto-occipital association cortex and precuneus bilaterally. Furthermore, two subjects with Gaucher disease without parkinsonian manifestations showed diminished striatal dopamine. In conclusion, the pattern of dopamine loss in patients with both Parkinson and Gaucher disease was similar to sporadic Parkinson disease, indicating comparable damage in midbrain neurons. However, H(2)(15)O positron emission tomography studies indicated that these subjects have decreased resting activity in a pattern characteristic of diffuse Lewy body disease. These findings provide insight into the pathophysiology of GBA-associated parkinsonism.
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Affiliation(s)
- Ozlem Goker-Alpan
- Section on Molecular Neurogenetics, Medical Genetics Branch, NHGRI Intramural Research Program, National Institutes of Health,Bethesda, MD 20892, USA
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Mild cognitive impairment in Parkinson disease: heterogenous mechanisms. J Neural Transm (Vienna) 2012; 120:157-67. [DOI: 10.1007/s00702-012-0771-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
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Rana AQ, Yousuf MS, Naz S, Qa'aty N. Prevalence and relation of dementia to various factors in Parkinson's disease. Psychiatry Clin Neurosci 2012; 66:64-8. [PMID: 22250611 DOI: 10.1111/j.1440-1819.2011.02291.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Parkinson's disease is a chronic neurodegenerative disorder characterized by bradykinesia, rigidity, and resting tremor. Dementia, among its non-motor symptoms, is a debilitating complication affecting intellectual functioning. The aim of the present study was to determine the prevalence of dementia in Parkinson's disease and its relation to age, gender and stage of the disease. METHODS A retrospective chart analysis was performed on Parkinson's disease patients seen in a community-based Parkinson's disease and movement disorder clinic between 2005 and 2010. RESULTS A total of 310 patients were included in this survey, among whom 61 patients (19.7%) with Parkinson's disease met the criteria for dementia. Age was found to be a significant factor in developing dementia, with 90% of patients with dementia aged ≥70. Gender, however, was not correlated with dementia in Parkinson's disease. On analysis of stage at which dementia developed, progression of the disease was positively correlated with prevalence of dementia. CONCLUSIONS As age increases, the chances of developing dementia increase. Dementia, contrarily, is not selective between genders. The likelihood of developing dementia increases as the stage of disease advances. Further research is required in order to understand underlying mechanisms of dementia in Parkinson's disease.
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Affiliation(s)
- Abdul Qayyum Rana
- Parkinson's Clinic of Eastern Toronto and Movement Disorders Center, Toronto, Canada.
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Jellinger KA. Neuropathology of sporadic Parkinson's disease: evaluation and changes of concepts. Mov Disord 2011; 27:8-30. [PMID: 22081500 DOI: 10.1002/mds.23795] [Citation(s) in RCA: 311] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 12/30/2022] Open
Abstract
Parkinson's disease (PD), one of the most frequent neurodegenerative disorders, is no longer considered a complex motor disorder characterized by extrapyramidal symptoms, but a progressive multisystem or-more correctly-multiorgan disease with variegated neurological and nonmotor deficiencies. It is morphologically featured not only by the degeneration of the dopaminergic nigrostriatal system, responsible for the core motor deficits, but by multifocal involvement of the central, peripheral and autonomic nervous system and other organs associated with widespread occurrence of Lewy bodies and dystrophic Lewy neurites. This results from deposition of abnormal α-synuclein (αSyn), the major protein marker of PD, and other synucleinopathies. Recent research has improved both the clinical and neuropathological diagnostic criteria of PD; it has further provided insights into the development and staging of αSyn and Lewy pathologies and has been useful in understanding the pathogenesis of PD. However, many challenges remain, for example, the role of Lewy bodies and the neurobiology of axons in the course of neurodegeneration, the relation between αSyn, Lewy pathology, and clinical deficits, as well as the interaction between αSyn and other pathologic proteins. Although genetic and experimental models have contributed to exploring the causes, pathomechanisms, and treatment options of PD, there is still a lack of an optimal animal model, and the etiology of this devastating disease is far from being elucidated.
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Heterogenous mechanisms of mild cognitive impairment in Parkinson’s disease. J Neural Transm (Vienna) 2011; 119:381-2. [PMID: 21960008 DOI: 10.1007/s00702-011-0716-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/13/2011] [Indexed: 10/17/2022]
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Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011; 2011:617927. [PMID: 21876810 PMCID: PMC3163144 DOI: 10.4061/2011/617927] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022] Open
Abstract
Age-related white matter changes (WMC) are considered manifestation of arteriolosclerotic small vessel disease and are related to age and vascular risk factors. Most recent studies have shown that WMC are associated with a host of poor outcomes, including cognitive impairment, dementia, urinary incontinence, gait disturbances, depression, and increased risk of stroke and death. Although the clinical relevance of WMC has been extensively studied, to date, only very few clinical trials have evaluated potential symptomatic or preventive treatments for WMC. In this paper, we reviewed the current understanding in the pathophysiology, epidemiology, clinical importance, chemical biomarkers, and treatments of age-related WMC.
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Affiliation(s)
- Yun Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shatin 999077, Hong Kong
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Clinicopathological correlates of behavioral and psychological symptoms of dementia. Acta Neuropathol 2011; 122:117-35. [PMID: 21455688 DOI: 10.1007/s00401-011-0821-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/18/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
Behavioral and psychological symptoms are commonly observed in a majority of demented patients at some time during the course of their illness. Many of these psychiatric manifestations, especially those related to mood, may be early expressions of dementia and/or mild cognitive impairment. The literature suggests that behavioral and psychological symptoms of dementia (BPSD) are an integral part of the disease process. The dissociation, in many cases, between BPSD and the rather linear decline in cognitive functions suggests that independent pathophysiological mechanisms give rise to these symptoms. A review of the neuroimaging and neuropathology literature indicates that BPSD are the expression of regional rather than diffuse brain pathology. Psychotic symptoms in demented patients usually demonstrate preferential involvement of the frontal lobe and/or limbic regions. Visual hallucinations differentiate themselves from other psychotic symptoms by their tendency to involve the occipital lobes. There is a significant association between apathy and structural changes of the anterior cingulate gyrus. White matter hyperintensities occur in a significant number of depressed patients; otherwise, there is lack of association between depression and either specific brain changes or affected regions. Strictly neuropathological explanations are likely to be insufficient to explain BPSD. Environmental changes, neurochemical abnormalities, past psychiatric history (including premorbid personality), social history (e.g., intellectual achievement and life-long learning), family history, and genetic susceptibility are factors, among others, that influence BPSD.
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Jellinger KA. Mild cognitive impairment in Parkinson’s disease: a critical update. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.10.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Aarsland D, Bronnick K, Williams-Gray C et al.: Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology 75, 1062–1069 (2010). A clinical analysis of 1346 patients with Parkinson’s disease (PD) from eight different cohorts, using standardized criteria and cognitive tests, revealed an incidence of mild cognitive impairment (MCI) in 25.8%. It affected various cognitive domains, most frequently memory (13.3%), visuospatial (11%) and attention-executive abilities (10.1%). MCI was classified as nonamnestic and amnestic single domain (11.2 and 8.9%, respectively), and amnestic and nonamnestic multiple domain (4.8 and 1.3%, respectively). The author comments on this clinical study of a well-characterized multicenter cohort showing that PD-MCI was associated with older age at disease onset, male gender, depression, more severe motor symptoms and advanced disease stage. The potential mechanisms underlying MCI in PD patients are compared with non-PD patients, and recent data on heterogeneous neuropathology in both PD-MCI and non-PD-MCI are discussed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, A-1070 Vienna, Austria
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