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Al-Kuraishy HM, Jabir MS, Al-Gareeb AI, Albuhadily AK. New insight on the possible role of statins in Vascular Parkinsonism: A need for presumptive therapy. Ageing Res Rev 2024; 95:102209. [PMID: 38286334 DOI: 10.1016/j.arr.2024.102209] [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: 10/22/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 01/31/2024]
Abstract
Vascular Parkinsonism (VP) is clinical term represents a progressive ischemic changes and subcortical lacunar infarct leading to Parkinsonism mainly in the lower limbs so called lower body Parkinsonism. The VP neuropathology is differed from that of PD neuropathology which rarely associated with basal ganglion lesions. Dopamine transporters are normal in VP but are highly reduced in PD, and dopaminergic agonists had no effective role on VP. The neuropathological mechanisms of VP are related to vascular injury which induces the interruption of the neural connection between basal ganglion and cerebral cortex. Hyperlipidemia and other cardiometabolic risk factors augment VP risk and the related neuropathology. Targeting of these cardiometabolic disorders by lipid-lowering statins may be effective in the management of VP. Therefore, this mini-review aims to clarify the possible role of statins in the management of VP. Statins have neuroprotective effects against different neurodegenerative diseases by anti-inflammatory, antioxidant and antithrombotic effects with enhancement of endothelial function. In conclusion, statins can prevent and treat VP by inhibiting inflammatory and oxidative stress disorders, mitigating of white matter hyperintensities and improving of neuronal signaling pathways. Additional preclinical, clinical trials and prospective studies are warranted in this regard.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Majid S Jabir
- Department of Applied Science, University of Technology, Iraq.
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Ali K Albuhadily
- Department of Clinical Pharmacology and Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
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2
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Grotewold N, Albin RL. Update: Descriptive epidemiology of Parkinson disease. Parkinsonism Relat Disord 2024; 120:106000. [PMID: 38233324 PMCID: PMC10922566 DOI: 10.1016/j.parkreldis.2024.106000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
We review the descriptive epidemiology of Parkinson disease (PD). PD is a prevalent neurologic disorder in high Socio-Demographic Index (SDI) nations with rising prevalence in low and middle SDI nations. PD became a prevalent disorder in high SDI nations during the 20th century. Population growth, population aging, and increased disease duration are major drivers of rising PD prevalence. Exposure to industrial toxicants may also be a contributor to rising PD prevalence. PD is an age-related disorder with incidence likely peaking in the 8th decade of life and prevalence in the 9th decade of life. PD is notable for significant sex difference in PD risk with greater risk in men. There may be ancestral differences in PD prevalence and risk. PD is associated with moderately increased mortality though this may be underestimated. Despite significant research, there is considerable uncertainty about basic features of PD epidemiology.
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Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
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3
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Park S, No C, Kim S, Han K, Jung JM, Kwon KY, Lee M. A multimodal screening system for elderly neurological diseases based on deep learning. Sci Rep 2023; 13:21013. [PMID: 38030653 PMCID: PMC10687257 DOI: 10.1038/s41598-023-48071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
In this paper, we propose a deep-learning-based algorithm for screening neurological diseases. We proposed various examination protocols for screening neurological diseases and collected data by video-recording persons performing these protocols. We converted video data into human landmarks that capture action information with a much smaller data dimension. We also used voice data which are also effective indicators of neurological disorders. We designed a subnetwork for each protocol to extract features from landmarks or voice and a feature aggregator that combines all the information extracted from the protocols to make a final decision. Multitask learning was applied to screen two neurological diseases. To capture meaningful information about these human landmarks and voices, we applied various pre-trained models to extract preliminary features. The spatiotemporal characteristics of landmarks are extracted using a pre-trained graph neural network, and voice features are extracted using a pre-trained time-delay neural network. These extracted high-level features are then passed onto the subnetworks and an additional feature aggregator that are simultaneously trained. We also used various data augmentation techniques to overcome the shortage of data. Using a frame-length staticizer that considers the characteristics of the data, we can capture momentary tremors without wasting information. Finally, we examine the effectiveness of different protocols and different modalities (different body parts and voice) through extensive experiments. The proposed method achieves AUC scores of 0.802 for stroke and 0.780 for Parkinson's disease, which is effective for a screening system.
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Affiliation(s)
- Sangyoung Park
- Department of Electrical and Electronic Engineering, Hanyang University ERICA, Ansan, 15588, South Korea
| | - Changho No
- Department of Electrical and Electronic Engineering, Hanyang University ERICA, Ansan, 15588, South Korea
| | - Sora Kim
- Department of Electrical and Electronic Engineering, Hanyang University ERICA, Ansan, 15588, South Korea
| | - Kyoungmin Han
- Department of Electrical and Electronic Engineering, Hanyang University ERICA, Ansan, 15588, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, 15355, South Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, 04401, South Korea
| | - Minsik Lee
- Department of Electrical and Electronic Engineering, Hanyang University ERICA, Ansan, 15588, South Korea.
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4
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Jacob MA, Cai M, Bergkamp M, Darweesh SKL, Gelissen LMY, Marques J, Norris DG, Duering M, Esselink RAJ, Tuladhar AM, de Leeuw FE. Cerebral Small Vessel Disease Progression Increases Risk of Incident Parkinsonism. Ann Neurol 2023; 93:1130-1141. [PMID: 36762437 DOI: 10.1002/ana.26615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Cerebral small vessel disease (SVD) is associated with motor impairments and parkinsonian signs cross-sectionally, however, there are little longitudinal data on whether SVD increases risk of incident parkinsonism itself. We investigated the relation between baseline SVD severity as well as SVD progression, and incident parkinsonism over a follow-up of 14 years. METHODS This study included 503 participants with SVD, and without parkinsonism at baseline, from the RUN DMC prospective cohort study. Baseline inclusion was performed in 2006 and follow-up took place in 2011, 2015, and 2020, including magnetic resonance imaging (MRI) and motor assessments. Parkinsonism was diagnosed according to the UK Brain Bank criteria, and stratified into vascular parkinsonism (VaP) and idiopathic Parkinson's disease (IPD). Linear mixed-effect models were constructed to estimate individual rate changes of MRI-characteristics. RESULTS Follow-up for incident parkinsonism was near-complete (99%). In total, 51 (10.2%) participants developed parkinsonism (33 VaP, 17 IPD, and 1 progressive supranuclear palsy). Patients with incident VaP had higher SVD burden compared with patients with IPD. Higher baseline white matter hyperintensities (hazard ratio [HR] = 1.46 per 1-SD increase, 95% confidence interval [CI] = 1.21-1.78), peak width of skeletonized mean diffusivity (HR = 1.66 per 1-SD increase, 95% CI = 1.34-2.05), and presence of lacunes (HR = 1.84, 95% CI = 0.99-3.42) were associated with increased risk of all-cause parkinsonism. Incident lacunes were associated with incident VaP (HR = 4.64, 95% CI = 1.32-16.32). INTERPRETATION Both baseline SVD severity and SVD progression are independently associated with long-term parkinsonism. Our findings indicate a causal role of SVD in parkinsonism. Future studies are needed to examine the underlying pathophysiology of this relation. ANN NEUROL 2023.
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Affiliation(s)
- Mina A Jacob
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mayra Bergkamp
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liza M Y Gelissen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Marques
- Center for Cognitive Neuroimaging, Cognition and Behaviour, Nijmegen, The Netherlands
| | - David G Norris
- Center for Cognitive Neuroimaging, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marco Duering
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Rianne A J Esselink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Still A, Hale L, Jayakaran P. The inter-relationship between various non-motor symptoms and with habitual physical activity in Parkinsonism: a scoping review protocol. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2133885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Amanda Still
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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6
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Narasimhan M, Schwartz R, Halliday G. Parkinsonism and cerebrovascular disease. J Neurol Sci 2021; 433:120011. [PMID: 34686356 DOI: 10.1016/j.jns.2021.120011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
The relationship between cerebrovascular disease and parkinsonism is commonly seen in everyday clinical practice but remains ill-defined and under-recognised with little guidance for the practising neurologist. We attempt to define this association and to illustrate key clinical, radiological and pathological features of the syndrome of Vascular Parkinsonism (VaP). VaP is a major cause of morbidity in the elderly associated with falls, hip fractures and cognitive impairment. Although acute parkinsonism is reported in the context of an acute cerebrovascular event, the vast majority of VaP presents as an insidious syndrome usually in the context of vascular risk factors and radiological evidence of small vessel disease. There may be an anatomic impact on basal ganglia neuronal networks, however the effect of small vessel disease (SVD) on these pathways is not clear. There are now established reporting standards for radiological features of SVD on MRI. White matter hyperintensities and lacunes have been thought to be the representative radiological features of SVD but other features such as the perivascular space are gaining more importance, especially in context of the glymphatic system. It is important to consider VaP in the differential diagnosis of Parkinson disease (PD) and in these situations, neuroimaging may offer diagnostic benefit especially in those patients with atypical presentations or refractoriness to levodopa. Proactive management of vascular risk factors, monitoring of bone density and an exercise program may offer easily attainable therapeutic targets in PD and VaP. Levodopa therapy should be considered in patients with VaP, however the dose and effect may be different from use in PD. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Manisha Narasimhan
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
| | - Raymond Schwartz
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Glenda Halliday
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
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7
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Cerami C, Dodich A, Iannaccone S, Magnani G, Marcone A, Guglielmo P, Vanoli G, Cappa SF, Perani D. Individual Brain Metabolic Signatures in Corticobasal Syndrome. J Alzheimers Dis 2021; 76:517-528. [PMID: 32538847 DOI: 10.3233/jad-200153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Corticobasal syndrome (CBS) is the usual clinical presentation of patients with corticobasal degeneration pathology. Nevertheless, there are CBS individuals with postmortem neuropathology typical of Alzheimer's disease (AD). OBJECTIVE In this study, we aim to detect FDG-PET metabolic signatures at the single-subject level in a CBS sample, also evaluated with cerebrospinal fluid (CSF) markers for AD pathology. METHODS 21 patients (68.9±6.4 years; MMSE score = 21.7±6.3) fulfilling current criteria for CBS were enrolled. All underwent a clinical-neuropsychological assessment and an instrumental evaluation for biomarkers of neurodegeneration, amyloid and tau pathology (i.e., FDG-PET imaging and CSF Aβ42 and tau levels) at close intervals. CBS subjects were classified according to the presence or absence of CSF markers of AD pathology (i.e., low Aβ42 and high phosphorylated tau levels). Optimized voxel-based SPM procedures provided FDG-PET metabolic patterns at the single-subject and group levels. RESULTS Eight CBS had an AD-like CSF profile (CBS-AD), while thirteen were negative (CBS-noAD). The two subgroups did not differ in demographic characteristics or global cognitive impairment. FDG-PET SPM t-maps identified different metabolic signatures. Namely, all CBS-AD patients showed the typical AD-like hypometabolic pattern involving posterior cingulate cortex, precuneus and temporo-parietal cortex, whereas CBS-noAD cases showed bilateral hypometabolism in fronto-insular cortex and basal ganglia that is typical of the frontotemporal lobar degeneration spectrum. DISCUSSION These results strongly suggest the inclusion of FDG-PET imaging in the diagnostic algorithm of individuals with CBS clinical phenotype in order to early identify functional metabolic signatures due to different neuropathological substrates, thus improving the diagnostic accuracy.
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Affiliation(s)
- Chiara Cerami
- Dipartimento di Scienze Umane e della Vita, Scuola Universitaria di Studi Superiori IUSS Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Dodich
- CeRiN, Centre for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | | | | | | | | | | | - Stefano F Cappa
- Dipartimento di Scienze Umane e della Vita, Scuola Universitaria di Studi Superiori IUSS Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Daniela Perani
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy.,Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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8
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Nasri A, Ben Djebara M, Sghaier I, Mrabet S, Zidi S, Gargouri A, Kacem I, Gouider R. Atypical parkinsonian syndromes in a North African tertiary referral center. Brain Behav 2021; 11:e01924. [PMID: 33179436 PMCID: PMC7821582 DOI: 10.1002/brb3.1924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/06/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Data on epidemiology of atypical parkinsonian syndromes (APS) in North African countries are limited. Our objective was to study the epidemiological features of APS in a Tunisian population. METHODS We conducted a 17-year retrospective cross-sectional descriptive study in the Department of Neurology at Razi University Hospital. We included all patients responding to consensus diagnosis criteria of APS. We recorded demographic and clinical data. Group differences were assessed with a post hoc ANOVA with a Bonferroni error correction. RESULTS We included 464 APS patients. Hospital prevalence of APS among all parkinsonism cases was 20.6%. Mean annual increase of incidence defined as newly diagnosed APS cases per year reached 38.8%/year. APS were divided into 4 etiological subgroups: dementia with Lewy bodies (DLB; 56.7%); progressive supranuclear palsy(PSP; 16.2%); multiple system atrophy (MSA; 14.6%); and finally corticobasal syndrome (CBS; 12.5%). Sex-ratio was 1.2. This male predominance was found in all subgroups except MSA (p = .013). Mean age at onset was 68.5 years, most belated in DLB (69.7 years; p < .001). Young-onset parkinsonism (<40 years) was found only in MSA subgroup (p = .031). Parkinsonism was of late onset (>70 years) in 50.7% of patients and was significantly associated with DLB subgroup (p = .013). Inaugural parkinsonism was associated with CBS and MSA (p = .0497), and gait disorders at disease onset were associated with PSP and MSA (p = .0062). Cognitive and mood disorders were more marked in DLB and most preserved in MSA. Consanguinity was more marked in CBS (p = .037), and family history of dementia and psychiatric diseases was more common in DLB. Thirty-seven families with similar cases of APS were identified. CONCLUSIONS This is the largest African epidemiological study on APS. In our population, APS were frequent and dominated by DLB. The age of onset of parkinsonism was the most decisive feature for differential diagnosis.
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Affiliation(s)
- Amina Nasri
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Mouna Ben Djebara
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Ikram Sghaier
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
| | - Saloua Mrabet
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Sabrina Zidi
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
| | - Amina Gargouri
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Imen Kacem
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Riadh Gouider
- Neurology Department, LR18SP03, Clinical Investigation Center (CIC) "Neurosciences and Mental Health"Razi University HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
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9
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Li WS, Chan LL, Chao YX, Tan EK. Parkinson's disease following COVID-19: causal link or chance occurrence? J Transl Med 2020; 18:493. [PMID: 33375935 PMCID: PMC7770740 DOI: 10.1186/s12967-020-02670-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Wei-Shan Li
- National Neuroscience Institute, Duke NUS Medical School, Outram road, Singapore, 169608, Singapore
| | - Ling-Ling Chan
- National Neuroscience Institute, Duke NUS Medical School, Outram road, Singapore, 169608, Singapore
| | - Yin-Xia Chao
- National Neuroscience Institute, Duke NUS Medical School, Outram road, Singapore, 169608, Singapore
| | - Eng-King Tan
- National Neuroscience Institute, Duke NUS Medical School, Outram road, Singapore, 169608, Singapore.
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10
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Lee YH, Lee S, Chung SJ, Yoo HS, Jung JH, Baik K, Ye BS, Sohn YH, Yun M, Lee PH. The pattern of FP-CIT PET in pure white matter hyperintensities-related vascular parkinsonism. Parkinsonism Relat Disord 2020; 82:1-6. [PMID: 33220520 DOI: 10.1016/j.parkreldis.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether vascular parkinsonism (VaP) patients with visually normal dopamine transporter (DAT) scans have presynaptic dopaminergic depletion. METHODS We enrolled 23 VaP patients who had parkinsonism, relevant diffuse subcortical white matter hyperintensities (WMH), and visually normal DAT scans, 23 Parkinson's disease (PD) patients, and 31 control subjects. By quantitatively analyzing 18F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane (18F-FP-CIT) positron emission tomography, we compared the pattern of striatal DAT availability among groups. The discriminatory power of striatal DAT availability to differentiate VaP patients from control subjects or PD patients was assessed using receiver operating characteristics (ROC) analyses. Additionally, correlation analysis was performed to determine whether WMH severity or Unified Parkinson Disease Rating Scale Part III (UPDRS-III) score is related to presynaptic dopaminergic depletion in VaP. RESULTS VaP patients exhibited decreased DAT availability in all striatal subregions, including posterior putamen, compared to control subjects. VaP patients and control subjects had similar patterns of anteroposterior and ventrodorsal DAT gradients in caudate and putamen level, but VaP patients exhibited significantly different patterns at putamen level, relative to PD patients. The severity of periventricular WMH was significantly correlated with all substriatal DAT availability in VaP, but not with UPDRS-III scores. The ROC analysis showed that DAT availability in caudate and posterior putamen had a fair discriminatory power when differentiating VaP patients from control subjects. CONCLUSIONS This study demonstrates that VaP patients with WMH exhibited diffusely decreased DAT availability without any specific regional gradients of DAT patterns distinct from either control subjects or PD patients.
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Affiliation(s)
- Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Sangwon Lee
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea.
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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11
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Zhao P, Zhang B, Gao S, Li X. Clinical features, MRI, and 18F-FDG-PET in differential diagnosis of Parkinson disease from multiple system atrophy. Brain Behav 2020; 10:e01827. [PMID: 32940411 PMCID: PMC7667335 DOI: 10.1002/brb3.1827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/21/2020] [Accepted: 07/22/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to differentiate the variations in the clinical characteristics, MRI irregularity, and glucose metabolism on 18 F-FDG-PET for the differential diagnosis of Parkinson's Disease (PD), MSA with predominant Parkinsonism (MSA-P), and MSA with predominant cerebellar features (MSA-C). METHODS Thirty PD patients, 22 MSA-P patients, and 28 MSA-C patients received an MRI and 20 PD patients, 11 MSA-P patients, and 13 MSA-C patients received 18 F-FDG-PET. RESULTS Firstly, we found that the clinical data presented a tremor at rest, bradykinesia, and postural instability that was predominated in PD (100%), MSA-P (86.4%), and MSA-C (53.6%) patients, respectively. Then, we used MRI analyses and found that putamina atrophy and hyperintensive rim (T2 WI) were characteristic features in MSA-P and cerebellar atrophy, the "hot cross bun" sign and signal rise in the middle cerebellar peduncle were more obvious in MSA-C. To further explore the distinctions among the 3 diseases, we also used 18F-FDG-PET technology for our examination and found a decrease in glucose metabolism in the parietal area for Parkinson's Disease (PD), in the bilateral putamen for MSA-P, and in the bilateral cerebellum for MSA-C. CONCLUSION This study identified the distinctive features of the clinic symptoms, MRI irregularity, and glucose metabolism on 18 F-FDG-PET, which provided a new basis for the differential diagnosis of Parkinson's Disease (PD), MSA with predominant Parkinsonism (MSA-P), and MSA with predominant cerebellar features (MSA-C).
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Affiliation(s)
- Ping Zhao
- Department of NeurologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Benshu Zhang
- Department of NeurologyGeneral Hospital of Tianjin Medical UniversityTianjinChina
| | - Shuo Gao
- Department of Nuclear MedicineGeneral Hospital of Tianjin Medical UniversityTianjinChina
| | - Xin Li
- Department of NeurologySecond Hospital of Tianjin Medical UniversityTianjinChina
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12
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Peterson BJ, Rocca WA, Bower JH, Savica R, Mielke MM. Identifying incident Parkinson's disease using administrative diagnostic codes: a validation study. Clin Park Relat Disord 2020; 3:100061. [PMID: 34164614 PMCID: PMC8218579 DOI: 10.1016/j.prdoa.2020.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Administrative databases that capture diagnostic codes are increasingly being used worldwide for research because they can save time and reduce costs. However, assessing validity is necessary before defining diseases using only diagnostic codes in research applications. OBJECTIVE Our objective was to assess the validity of using diagnostic codes to identify incident Parkinson's disease (PD) cases in Olmsted County, Minnesota using an established standard for comparison (1976-2005). METHODS Cases were identified solely using computer programs applied to administrative diagnostic code indexes from the Rochester Epidemiology Project (REP). Two codes >30 days apart or one code on the death certificate constituted PD. The standard was a clinical diagnosis by movement disorders specialists based on medical record review. Validity was assessed using positive predictive value (PPV) and sensitivity. Numbers of incident cases and incidence rates were compared between the two ascertainment methods by sex. RESULTS The codes only method over-counted the number of incident PD cases by 73% (804 versus 464), and this over-counting generally increased with calendar year. Sensitivity was 80% (95% CI [76%, 84%]) and PPV was 46% (95% CI [34%, 50%]). Disease status misclassification accounted for two-thirds of falsely identified cases, where individuals were found to not have PD (43%) or even parkinsonism (23%) after medical record review. The codes only method also over-estimated the incidence rate time trend for men and women by approximately two-fold. CONCLUSION In our context, using administrative diagnostic codes only to identify incident PD cases is not recommended unless more accurate algorithms are developed.
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Affiliation(s)
- Brett J. Peterson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Walter A. Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - James H. Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M. Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Geut H, Hepp DH, Foncke E, Berendse HW, Rozemuller JM, Huitinga I, van de Berg WDJ. Neuropathological correlates of parkinsonian disorders in a large Dutch autopsy series. Acta Neuropathol Commun 2020; 8:39. [PMID: 32216828 PMCID: PMC7098103 DOI: 10.1186/s40478-020-00914-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023] Open
Abstract
The clinical diagnosis in patients with parkinsonian disorders can be challenging, and a definite diagnosis requires neuropathological confirmation. The aim of this study was to examine whether a clinical diagnosis of Parkinson’s disease (PD) and atypical parkinsonian disorders predict the presence of Lewy pathology (LP) and concomitant neuropathological lesions. We included 293 donors with a history of parkinsonism without dementia at disease onset, collected by the Netherlands Brain Bank (NBB) from 1989 to 2015. We retrospectively categorized donors according the International Parkinson and Movement Disorder Society clinical diagnostic criteria for PD (MDS-PD criteria) as ‘not PD’, ‘probable PD’ or ‘established PD’. We compared the final clinical diagnosis to presence of neuropathological lesions as defined by BrainNet Europe and National Institute on Aging – Alzheimer's Association guidelines. LP was present in 150 out of 176 donors (85%) with a clinical diagnosis of PD, in 8 out of 101 donors (8%) with atypical parkinsonian disorders and in 4 out of 16 donors (25%) without a definite clinical diagnosis. Independent from age at death, stages of amyloid-β, but not neurofibrillary tau or neuritic plaques, were higher in donors with LP compared to other types of pathology (p = 0.009). The MDS-PD criteria at a certainty level of ‘probable PD’ predicted presence of LP with a diagnostic accuracy of 89.3%. Among donors with LP, ‘established PD’ donors showed similar Braak α-synuclein stages and stages of amyloid-β, neurofibrillary tau and neuritic plaques compared to ‘not PD’ or ‘probable PD’ donors. In conclusion, both a clinical diagnosis of PD as well as MDS-PD criteria accurately predicted presence of LP in NBB donors. LP was associated with more widespread amyloid-β pathology, suggesting a link between amyloid-β accumulation and LP formation.
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Alster P, Madetko N, Koziorowski D, Friedman A. Progressive Supranuclear Palsy-Parkinsonism Predominant (PSP-P)-A Clinical Challenge at the Boundaries of PSP and Parkinson's Disease (PD). Front Neurol 2020; 11:180. [PMID: 32218768 PMCID: PMC7078665 DOI: 10.3389/fneur.2020.00180] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Progressive Supranuclear Palsy (PSP) and Parkinson's Disease (PD), especially in their early stages, show overlapping clinical manifestations. The criteria for the diagnosis of PSP, released in 2017, indicate four basic features of the disease—postural instability (P), akinesia (A), oculomotor dysfunction (O) and cognitive and lingual disorders (C), which clarify the interpretation of the disease. There is growing interest in the second most common variant of PSP—parkinsonism predominant PSP-P. It is observed in up to 35% of cases. The diagnosis of PSP-P requires the presence of akinetic-rigid predominantly axial and levodopa resistant parkinsonism (A2) or parkinsonism with tremor and/or asymmetric and/or levodopa responsive (A3). The development of supplementary methods of examination added new insights to observations related to PSP-P. Among the methods recently analyzed are freezing of swallowing and speech breathing assessment, transcranial sonography, and various methods using magnetic resonance imaging, such as pons/midbrain area ratio and magnetic resonance parkinsonism index (MRPI), fractional anisotropy or mean diffusivity. The proper examination of overlapping parkinsonian syndromes, regardless of the development of the method of examination, remains an incompletely explored issue. The aim of this review is to elucidate which factors may be interpreted as influential in the differential diagnosis of PSP-P, PSP-RS and postural instability and gait difficulty (PIGD) subtype of Parkinson's disease (PD).
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Madetko
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
| | | | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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van Eimeren T, Antonini A, Berg D, Bohnen N, Ceravolo R, Drzezga A, Höglinger GU, Higuchi M, Lehericy S, Lewis S, Monchi O, Nestor P, Ondrus M, Pavese N, Peralta MC, Piccini P, Pineda-Pardo JÁ, Rektorová I, Rodríguez-Oroz M, Rominger A, Seppi K, Stoessl AJ, Tessitore A, Thobois S, Kaasinen V, Wenning G, Siebner HR, Strafella AP, Rowe JB. Neuroimaging biomarkers for clinical trials in atypical parkinsonian disorders: Proposal for a Neuroimaging Biomarker Utility System. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:301-309. [PMID: 30984816 PMCID: PMC6446052 DOI: 10.1016/j.dadm.2019.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Therapeutic strategies targeting protein aggregations are ready for clinical trials in atypical parkinsonian disorders. Therefore, there is an urgent need for neuroimaging biomarkers to help with the early detection of neurodegenerative processes, the early differentiation of the underlying pathology, and the objective assessment of disease progression. However, there currently is not yet a consensus in the field on how to describe utility of biomarkers for clinical trials in atypical parkinsonian disorders. METHODS To promote standardized use of neuroimaging biomarkers for clinical trials, we aimed to develop a conceptual framework to characterize in more detail the kind of neuroimaging biomarkers needed in atypical parkinsonian disorders, identify the current challenges in ascribing utility of these biomarkers, and propose criteria for a system that may guide future studies. RESULTS As a consensus outcome, we describe the main challenges in ascribing utility of neuroimaging biomarkers in atypical parkinsonian disorders, and we propose a conceptual framework that includes a graded system for the description of utility of a specific neuroimaging measure. We included separate categories for the ability to accurately identify an intention-to-treat patient population early in the disease (Early), to accurately detect a specific underlying pathology (Specific), and the ability to monitor disease progression (Progression). DISCUSSION We suggest that the advancement of standardized neuroimaging in the field of atypical parkinsonian disorders will be furthered by a well-defined reference frame for the utility of biomarkers. The proposed utility system allows a detailed and graded description of the respective strengths of neuroimaging biomarkers in the currently most relevant areas of application in clinical trials.
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Affiliation(s)
- Thilo van Eimeren
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Berg
- Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - Nico Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, and VAMC, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- VAMC, Ann Arbor, MI, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alexander Drzezga
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Forschungszentrum Jülich, INM-2, Jülich, Germany
| | - Günter U. Höglinger
- German Centre for Neurodegenerative Diseases (DZNE), and Technical University Munich, Department of Neurology, Munich, Germany
| | - Makoto Higuchi
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Stephane Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, ICM Team “Movement Investigations and Therapeutics”, Sorbonne Universités, Inserm U1127, CNRS UMR, Paris, France
| | - Simon Lewis
- Brain & Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
- Mater Hospital, South Brisbane, QLD, Australia
| | - Matej Ondrus
- AXON Neuroscience CRM Services SE, Bratislava, Slovak Republic
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - María Cecilia Peralta
- Center for Medical Education and Clinical Research, Section of Neurology, Buenos Aires, Argentina
| | - Paola Piccini
- Department of Medicine, Imperial College London, London, United Kingdom
| | - José Ángel Pineda-Pardo
- hmCINAC, University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Irena Rektorová
- First Department of Neurology – Faculty of Medicine and CEITEC MU, Masaryk University, Brno, Czech Republic
| | | | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Alessandro Tessitore
- Department of Medical, Surgery, Neurological, Metabolic and Aging Sciences, University of Campania, “L. Vanvitelli”, Caserta CE, Italy
| | - Stephane Thobois
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Medecine Lyon Sud Charles Merieux, Lyon, France
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C, Lyon, France
- CNRS, Institut des Sciences Cognitives, Bron, France
| | - Valtteri Kaasinen
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Gregor Wenning
- Division of Clinical Neurology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hartwig R. Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN, Toronto, Ontario, Canada
- Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Abstract
PURPOSE OF REVIEW Being a disease with heterogeneous presentations and unclear consensus on its diagnostic criteria, it is difficult to differentiate vascular parkinsonism (VaP) from other neurodegenerative parkinsonism variants. Ongoing research on structural and functional neuroimaging targeting dopaminergic pathway provides us more insight into the pathophysiology of VaP to improve diagnostic accuracy. The aim of this article is to review how the emerging imaging modalities help the diagnostic process and treatment decision in VaP. RECENT FINDINGS Dopamine transporter imaging is a promising tool in differentiating presynaptic parkinsonism and VaP. It also predicts the levodopa responders in VaP. Advanced MRI techniques including volumetry, diffusion tensor imaging and sequences visualising substantia nigra are under development, and they are complementary to each other in detecting structural and functional changes in VaP, which is crucial to ensure the quality of future therapeutic trials for VaP. Dopamine transporter imaging is recommended to patients with suspected VaP. Multimodal MRI in VaP would be an important area to be investigated in the near future.
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Affiliation(s)
- Karen K Y Ma
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Lin
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- BrainNow Research Institute, Guangdong Province, Shenzhen, China
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- BrainNow Research Institute, Guangdong Province, Shenzhen, China.
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Dodich A, Cerami C, Inguscio E, Iannaccone S, Magnani G, Marcone A, Guglielmo P, Vanoli G, Cappa SF, Perani D. The clinico-metabolic correlates of language impairment in corticobasal syndrome and progressive supranuclear palsy. NEUROIMAGE-CLINICAL 2019; 24:102009. [PMID: 31795064 PMCID: PMC6978212 DOI: 10.1016/j.nicl.2019.102009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/06/2019] [Accepted: 09/17/2019] [Indexed: 01/14/2023]
Abstract
CBS and PSP patients show heterogeneous language profiles. Patients with nfvPPA profile show the typical nfvPPA hypometabolic pattern. Parietal hypometabolism characterizes CBS cases with undefined language deficits. Frontal hypometabolism characterizes PSP cases with undefined language deficits. Patients without language deficit show a predominant right hemisphere involvement.
Purpose To assess the clinical-metabolic correlates of language impairment in a large sample of patients clinically diagnosed as corticobasal syndrome (CBS) and progressive supranuclear palsy syndrome (PSPs). Methods We included 70 patients fulfilling current criteria for CBS (n = 33) or PSPs (n = 37). All subjects underwent clinical-neuropsychological and FDG-PET assessments at the time of diagnosis. The whole patient's cohort was grouped into three subgroups according to the language characteristics, i.e., (a) nfv-PPA; (b) subtle language impairments, LANG-; (c) no language deficits, NOL-. FDG-PET data were analysed using an optimized voxel-based SPM method at the single-subject and group levels in order to evaluate specific hypometabolic patterns and regional dysfunctional FDG-PET commonalities in subgroups. Results 21 patients had a nfvPPA diagnosis (i.e., nfv-PPA/CBS = 12 and nfv-PPA/PSPs = 9), while 20 patients had a subtle language impairment LANG- (i.e., CBS = 12 and PSPs = 8), not fulfilling the criteria for a nfv-PPA diagnosis. The remaining sample (i.e., 9/33 CBS and 20/37 PSPs patients) did not show any language deficit. FDG-PET results in individuals with a nfv-PPA diagnosis were consistent with the typical nfv-PPA pattern of hypometabolism (i.e., left fronto-insular and superior medial frontal cortex involvement), both in CBS and PSPs. The LANG-CBS and LANG-PSPs subjects had different FDG-PET hypometabolic patterns involving, respectively, parietal and frontal regions. As expected, NOL-CBS and NOL-PSPs showed a predominant right hemisphere involvement, with selective functional metabolic signatures typical of the two syndromes. Conclusions Language impairments, fulfilling the nfv-PPA criteria, are associated with both CBS and PSPs clinical presentations early in the disease course. Subtle language deficits may be present in an additional proportion of patients not fulfilling the nfv-PPA criteria. The topography of brain hypometabolism is a major dysfunctional signature of language deficits in CBS and PSPs clinical phenotypes.
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Affiliation(s)
- Alessandra Dodich
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
| | - Chiara Cerami
- Neurorehabilitation Unit and Cognitive Neuroscience Laboratory, Istituti Clinici Scientifici Maugeri IRCCS di Pavia, Pavia, Italy
| | | | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | - Stefano F Cappa
- Istituto Universitario di Studi Superiori, Pavia, Italy; IRCCS Ospedale Mondino, Pavia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy; Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.
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Jellinger KA. Neuropathology and pathogenesis of extrapyramidal movement disorders: a critical update-I. Hypokinetic-rigid movement disorders. J Neural Transm (Vienna) 2019; 126:933-995. [PMID: 31214855 DOI: 10.1007/s00702-019-02028-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
Extrapyramidal movement disorders include hypokinetic rigid and hyperkinetic or mixed forms, most of them originating from dysfunction of the basal ganglia (BG) and their information circuits. The functional anatomy of the BG, the cortico-BG-thalamocortical, and BG-cerebellar circuit connections are briefly reviewed. Pathophysiologic classification of extrapyramidal movement disorder mechanisms distinguish (1) parkinsonian syndromes, (2) chorea and related syndromes, (3) dystonias, (4) myoclonic syndromes, (5) ballism, (6) tics, and (7) tremor syndromes. Recent genetic and molecular-biologic classifications distinguish (1) synucleinopathies (Parkinson's disease, dementia with Lewy bodies, Parkinson's disease-dementia, and multiple system atrophy); (2) tauopathies (progressive supranuclear palsy, corticobasal degeneration, FTLD-17; Guamian Parkinson-dementia; Pick's disease, and others); (3) polyglutamine disorders (Huntington's disease and related disorders); (4) pantothenate kinase-associated neurodegeneration; (5) Wilson's disease; and (6) other hereditary neurodegenerations without hitherto detected genetic or specific markers. The diversity of phenotypes is related to the deposition of pathologic proteins in distinct cell populations, causing neurodegeneration due to genetic and environmental factors, but there is frequent overlap between various disorders. Their etiopathogenesis is still poorly understood, but is suggested to result from an interaction between genetic and environmental factors. Multiple etiologies and noxious factors (protein mishandling, mitochondrial dysfunction, oxidative stress, excitotoxicity, energy failure, and chronic neuroinflammation) are more likely than a single factor. Current clinical consensus criteria have increased the diagnostic accuracy of most neurodegenerative movement disorders, but for their definite diagnosis, histopathological confirmation is required. We present a timely overview of the neuropathology and pathogenesis of the major extrapyramidal movement disorders in two parts, the first one dedicated to hypokinetic-rigid forms and the second to hyperkinetic disorders.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Parkinsonism Caused by Viral Encephalitis Affecting the Bilateral Substantia Nigra. Clin Neuroradiol 2019; 29:571-573. [DOI: 10.1007/s00062-019-00769-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
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Abstract
Progressive supranuclear palsy, corticobasal degeneration and multiple system atrophy account for approximately 10% of neurodegenerative parkinsonism. Considerable clinical overlap exists between these disorders that extends to features considered characteristic of each disease. Clinical diagnostic criteria have attempted to increase the accuracy of clinical diagnosis as accurate diagnosis is necessary to inform prognosis and to facilitate the recognition of disease-modifying treatments. Currently no such treatment exists. Nevertheless, many clinical trials aiming to change the natural history of these diseases are ongoing. The spread and accumulation of abnormal proteins are among the pathophysiological mechanisms targeted. For the time being, however, only symptomatic treatment is available. Levodopa is used to treat parkinsonism, but patients usually show a poor or transient response. Amantadine is also used in practice for the same indication. Botulinum toxin can alleviate focal dystonic manifestations. Addressing non-motor manifestations is limited by the potential of available drugs to impact on other aspects of the disease. Most of the new symptomatic formulations under study are focused on orthostatic hypotension in multiple system atrophy. Exercise, occupational, physical, and speech therapy and psychotherapy should always accompany pharmacological approaches.
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Rooney JPK, Brayne C, Tobin K, Logroscino G, Glymour MM, Hardiman O. Benefits, pitfalls, and future design of population-based registers in neurodegenerative disease. Neurology 2017; 88:2321-2329. [PMID: 28515268 DOI: 10.1212/wnl.0000000000004038] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/24/2017] [Indexed: 12/13/2022] Open
Abstract
Population-based disease registers identify and characterize all cases of disease, including those that might otherwise be neglected. Prospective population-based registers in neurodegeneration are necessary to provide comprehensive data on the whole phenotypic spectrum and can guide planning of health services. With the exception of the rare disease amyotrophic lateral sclerosis, few complete population-based registers exist for neurodegenerative conditions. Incomplete ascertainment, limitations and uncertainty in diagnostic categorization, and failure to recognize sources of bias reduce the accuracy and usefulness of many registers. Common biases include population stratification, the use of prevalent rather than incident cases in earlier years, changes in disease understanding and diagnostic criteria, and changing demographics over time. Future registers are at risk of funding shortfalls and changes to privacy legislation. Notwithstanding, as heterogeneities of clinical phenotype and disease pathogenesis are increasingly recognized in the neurodegenerations, well-designed longitudinal population-based disease registers will be an essential requirement to complete clinical understanding of neurodegenerative diseases.
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Affiliation(s)
- James P K Rooney
- From the Academic Unit of Neurology (J.P.K.R., K.T., O.H.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Public Health and Primary Care (C.B.), School of Clinical Medicine, University of Cambridge, UK; Department of Basic Medical Sciences, Neuroscience and Sense Organs (G.L.), University of Bari "Aldo Moro," Bari; Unit of Neurodegenerative Diseases (G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro," Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Department of Epidemiology and Biostatistics (M.M.G.), University of California, San Francisco; and Department of Neurology (O.H.), Beaumont Hospital, Dublin, Ireland.
| | - Carol Brayne
- From the Academic Unit of Neurology (J.P.K.R., K.T., O.H.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Public Health and Primary Care (C.B.), School of Clinical Medicine, University of Cambridge, UK; Department of Basic Medical Sciences, Neuroscience and Sense Organs (G.L.), University of Bari "Aldo Moro," Bari; Unit of Neurodegenerative Diseases (G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro," Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Department of Epidemiology and Biostatistics (M.M.G.), University of California, San Francisco; and Department of Neurology (O.H.), Beaumont Hospital, Dublin, Ireland
| | - Katy Tobin
- From the Academic Unit of Neurology (J.P.K.R., K.T., O.H.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Public Health and Primary Care (C.B.), School of Clinical Medicine, University of Cambridge, UK; Department of Basic Medical Sciences, Neuroscience and Sense Organs (G.L.), University of Bari "Aldo Moro," Bari; Unit of Neurodegenerative Diseases (G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro," Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Department of Epidemiology and Biostatistics (M.M.G.), University of California, San Francisco; and Department of Neurology (O.H.), Beaumont Hospital, Dublin, Ireland
| | - Giancarlo Logroscino
- From the Academic Unit of Neurology (J.P.K.R., K.T., O.H.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Public Health and Primary Care (C.B.), School of Clinical Medicine, University of Cambridge, UK; Department of Basic Medical Sciences, Neuroscience and Sense Organs (G.L.), University of Bari "Aldo Moro," Bari; Unit of Neurodegenerative Diseases (G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro," Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Department of Epidemiology and Biostatistics (M.M.G.), University of California, San Francisco; and Department of Neurology (O.H.), Beaumont Hospital, Dublin, Ireland
| | - M Maria Glymour
- From the Academic Unit of Neurology (J.P.K.R., K.T., O.H.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Public Health and Primary Care (C.B.), School of Clinical Medicine, University of Cambridge, UK; Department of Basic Medical Sciences, Neuroscience and Sense Organs (G.L.), University of Bari "Aldo Moro," Bari; Unit of Neurodegenerative Diseases (G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro," Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Department of Epidemiology and Biostatistics (M.M.G.), University of California, San Francisco; and Department of Neurology (O.H.), Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- From the Academic Unit of Neurology (J.P.K.R., K.T., O.H.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Public Health and Primary Care (C.B.), School of Clinical Medicine, University of Cambridge, UK; Department of Basic Medical Sciences, Neuroscience and Sense Organs (G.L.), University of Bari "Aldo Moro," Bari; Unit of Neurodegenerative Diseases (G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro," Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Department of Epidemiology and Biostatistics (M.M.G.), University of California, San Francisco; and Department of Neurology (O.H.), Beaumont Hospital, Dublin, Ireland
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Huin V, Deramecourt V, Caparros-Lefebvre D, Maurage CA, Duyckaerts C, Kovari E, Pasquier F, Buée-Scherrer V, Labreuche J, Behal H, Buée L, Dhaenens CM, Sablonnière B. TheMAPTgene is differentially methylated in the progressive supranuclear palsy brain. Mov Disord 2016; 31:1883-1890. [DOI: 10.1002/mds.26820] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 01/03/2023] Open
Affiliation(s)
- Vincent Huin
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
| | - Vincent Deramecourt
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
| | | | - Claude-Alain Maurage
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
| | - Charles Duyckaerts
- Laboratoire de Neuropathologie Escourolle, AP-HP, Hôpital de la Pitié Salpêtrière; Paris France
| | - Eniko Kovari
- Department of Mental Health and Psychiatry; University Hospitals and University of Geneva; Geneva Switzerland
| | - Florence Pasquier
- Univ. Lille, Inserm, CHU Lille, U1171 - CNR-MAJ, DISTALZ; Lille France
| | - Valérie Buée-Scherrer
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Département de Statistiques; Lille France
| | - Hélène Behal
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, Département de Statistiques; Lille France
| | - Luc Buée
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
| | - Claire-Marie Dhaenens
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
| | - Bernard Sablonnière
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer; Lille France
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Beghdadli B, Ghomari O, Hamimed M, Azza A, Edjekouane I, Ider M, Baraka F, Abdi L, Taleb A, Benabadji S, Kandouci B. Maladie de Parkinson et facteurs de risque professionnels et environnementaux : enquête cas-témoins dans l’ouest algérien. ARCH MAL PROF ENVIRO 2016. [DOI: 10.1016/j.admp.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rizzo G, Copetti M, Arcuti S, Martino D, Fontana A, Logroscino G. Accuracy of clinical diagnosis of Parkinson disease: A systematic review and meta-analysis. Neurology 2016; 86:566-76. [PMID: 26764028 DOI: 10.1212/wnl.0000000000002350] [Citation(s) in RCA: 426] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/16/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of clinical diagnosis of Parkinson disease (PD) reported in the last 25 years by a systematic review and meta-analysis. METHODS We searched for articles published between 1988 and August 2014. Studies were included if reporting diagnostic parameters regarding clinical diagnosis of PD or crude data. The selected studies were subclassified based on different study setting, type of test diagnosis, and gold standard. Bayesian meta-analyses of available data were performed. RESULTS We selected 20 studies, including 11 using pathologic examination as gold standard. Considering only these 11 studies, the pooled diagnostic accuracy was 80.6% (95% credible interval [CrI] 75.2%-85.3%). Accuracy was 73.8% (95% CrI 67.8%-79.6%) for clinical diagnosis performed mainly by nonexperts. Accuracy of clinical diagnosis performed by movement disorders experts rose from 79.6% (95% CrI 46%-95.1%) of initial assessment to 83.9% (95% CrI 69.7%-92.6%) of refined diagnosis after follow-up. Using UK Parkinson's Disease Society Brain Bank Research Center criteria, the pooled diagnostic accuracy was 82.7% (95% CrI 62.6%-93%). CONCLUSION The overall validity of clinical diagnosis of PD is not satisfying. The accuracy did not significantly improve in the last 25 years, particularly in the early stages of disease, where response to dopaminergic treatment is less defined and hallmarks of alternative diagnoses such as atypical parkinsonism may not have emerged. Misclassification rate should be considered to calculate the sample size both in observational studies and randomized controlled trials. Imaging and biomarkers are urgently needed to improve the accuracy of clinical diagnosis in vivo.
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Affiliation(s)
- Giovanni Rizzo
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Massimiliano Copetti
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Simona Arcuti
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Davide Martino
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Andrea Fontana
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Giancarlo Logroscino
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy.
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Elbaz A, Carcaillon L, Kab S, Moisan F. Epidemiology of Parkinson's disease. Rev Neurol (Paris) 2016; 172:14-26. [DOI: 10.1016/j.neurol.2015.09.012] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 12/25/2022]
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van der Holst HM, van Uden IWM, Tuladhar AM, de Laat KF, van Norden AGW, Norris DG, van Dijk EJ, Esselink RAJ, Platel B, de Leeuw FE. Cerebral small vessel disease and incident parkinsonism: The RUN DMC study. Neurology 2015; 85:1569-77. [PMID: 26446068 DOI: 10.1212/wnl.0000000000002082] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/12/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate the relation between baseline cerebral small vessel disease (SVD) and the risk of incident parkinsonism using different MRI and diffusion tensor imaging (DTI) measures. METHODS In the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, a prospective cohort study, 503 elderly participants with SVD and without parkinsonism were included in 2006. During follow-up (2011-2012), parkinsonism was diagnosed according to UK Brain Bank criteria. Cox regression analysis was used to investigate the association between baseline imaging measures and incident all-cause parkinsonism and vascular parkinsonism (VP). Tract-based spatial statistics analysis was used to identify differences in baseline DTI measures of white matter (WM) tracts between participants with VP and without parkinsonism. RESULTS Follow-up was available from 501 participants (mean age 65.6 years; mean follow-up duration 5.2 years). Parkinsonism developed in 20 participants; 15 were diagnosed with VP. The 5-year risk of (any) parkinsonism was increased for those with a high white matter hyperintensity (WMH) volume (hazard ratio [HR] 1.8 per SD increase, 95% confidence interval [CI] 1.3-2.4) and a high number of lacunes (HR 1.4 per number increase, 95% CI 1.1-1.8) at baseline. For VP, this risk was also increased by the presence of microbleeds (HR 5.7, 95% CI 1.9-16.8) and a low gray matter volume (HR 0.4 per SD increase, 95% CI 0.2-0.8). Lower fractional anisotropy values in bifrontal WM tracts involved in movement control were observed in participants with VP compared to participants without parkinsonism. CONCLUSIONS SVD at baseline, especially a high WMH volume and a high number of lacunes, is associated with incident parkinsonism. Our findings favor a role of SVD in the etiology of parkinsonism.
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Affiliation(s)
- Helena M van der Holst
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inge W M van Uden
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karlijn F de Laat
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anouk G W van Norden
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - David G Norris
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ewoud J van Dijk
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne A J Esselink
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bram Platel
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.
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Abstract
Atypical parkinsonism comprises typically progressive supranuclear palsy, corticobasal degeneration, and mutilple system atrophy, which are distinct pathologic entities; despite ongoing research, their cause and pathophysiology are still unknown, and there are no biomarkers or effective treatments available. The expanding phenotypic spectrum of these disorders as well as the expanding pathologic spectrum of their classic phenotypes makes the early differential diagnosis challenging for the clinician. Here, clinical features and investigations that may help to diagnose these conditions and the existing limited treatment options are discussed.
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Affiliation(s)
- Maria Stamelou
- Second Department of Neurology, Attiko Hospital, University of Athens, Rimini 1, Athens 12462, Greece; Department of Neurology, Philipps Universität, Baldingerstrasse, Marburg 35039, Germany; Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Vale TC, Caramelli P, Cardoso F. Clinicoradiological comparison between vascular parkinsonism and Parkinson's disease. J Neurol Neurosurg Psychiatry 2015; 86:547-53. [PMID: 25006209 DOI: 10.1136/jnnp-2014-307867] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/19/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the clinical and radiological features of vascular parkinsonism (VP) and Parkinson's disease (PD). METHODS Cross-sectional study where 15 patients with VP (8 (53.3%) men; aged 75.7 ± 10.4 years) and 30 patients with PD (17 (56.7%) men; aged 67.3 ± 7.5 years) underwent motor and cognitive evaluation and brain MRI. RESULTS Patients with VP were, on average, 8.4 years older (p = 0.004); all had arterial hypertension. They presented with a sudden onset of parkinsonism (80%) and a rapidly progressive clinical course (53.3%). Predominant lower body parkinsonism (p<0.001), postural instability (p=0.003) with freezing of gait (p<0.001) and falls (p<0.001), urinary incontinence (p < 0.001) and pyramidal signs (p<0.001) were more common in patients with VP. Movement Disorders Society's Unified PD Rating Scale (MDS-UPDRS) scores were higher in patients with VP (p=0.005 in 'OFF' state and p<0.001 in 'ON' state). They had greater cognitive impairment and 12 (80%) fulfilled diagnostic criteria for probable vascular dementia. Most patients with VP had brain MRI changes: multiple lacunar infarcts (66.7%) or extensive white matter disease (26.7%). CONCLUSIONS VP can be clinically distinguished from PD based on sudden onset of parkinsonism at an older age, characterised by lower body predominance, urinary incontinence, pyramidal signs, postural instability with freezing of gait and falls, and dementia.
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Affiliation(s)
- Thiago Cardoso Vale
- Department of Neurology Service and Internal Medicine, Faculty of Medicine, University Hospital, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Paulo Caramelli
- Cognitive and Behavioral Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Francisco Cardoso
- Movement Disorders Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Wang V, Chao TH, Hsieh CC, Lin CC, Kao CH. Cancer risks among the users of ergot-derived dopamine agonists for Parkinson's disease, a nationwide population-based survey. Parkinsonism Relat Disord 2015; 21:18-22. [DOI: 10.1016/j.parkreldis.2014.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/09/2014] [Accepted: 10/12/2014] [Indexed: 11/26/2022]
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Vranová HP, Hényková E, Kaiserová M, Menšíková K, Vaštík M, Mareš J, Hluštík P, Zapletalová J, Strnad M, Stejskal D, Kaňovský P. Tau protein, beta-amyloid1–42 and clusterin CSF levels in the differential diagnosis of Parkinsonian syndrome with dementia. J Neurol Sci 2014; 343:120-4. [DOI: 10.1016/j.jns.2014.05.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
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Joutsa J, Gardberg M, Röyttä M, Kaasinen V. Diagnostic accuracy of parkinsonism syndromes by general neurologists. Parkinsonism Relat Disord 2014; 20:840-4. [PMID: 24816002 DOI: 10.1016/j.parkreldis.2014.04.019] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/18/2014] [Accepted: 04/15/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Movement disorder specialists can achieve a high level of accuracy when clinically diagnosing parkinsonism syndromes. However, data about the diagnostic accuracy among general neurologists is limited. OBJECTIVES This study investigated the recent diagnostic accuracy of parkinsonism syndromes by general neurologists. METHODS A retrospective examination of 1362 post-mortem cases diagnosed in the years 2000-2012 by neuropathologists was performed. Out of these cases, we identified 111 patients who received a clinical parkinsonism diagnosis during life and 122 patients who received a neuropathological diagnosis of a parkinsonism syndrome post-mortem including 11 incidental cases. RESULTS Fifty-eight (75.3%) of the 77 patients who had received clinical Parkinson's disease (PD) diagnoses were confirmed after the neuropathological examination. The sensitivity of the clinical diagnosis for idiopathic Parkinson's disease (PD) was 89.2% and the specificity was 57.8%. The corresponding numbers for progressive supranuclear palsy (PSP) were 52.9% and 100%, and for multiple system atrophy (MSA) were 64.3% and 99.0%, respectively. CONCLUSIONS Parkinson's disease is heavily overdiagnosed by general neurologists, whereas parkinsonism plus syndromes are underdiagnosed. Despite improvements in the diagnostic methods during recent decades and the development of diagnostic clinical criteria for parkinsonian syndromes, the diagnostic accuracy of Parkinson's disease remains relatively low, and 1/4 of diagnoses are incorrect.
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Affiliation(s)
- Juho Joutsa
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Neurology, Satakunta Central Hospital, Pori, Finland.
| | - Maria Gardberg
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Matias Röyttä
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Valtteri Kaasinen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland
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Shulman JM, Yu L, Buchman AS, Evans DA, Schneider JA, Bennett DA, De Jager PL. Association of Parkinson disease risk loci with mild parkinsonian signs in older persons. JAMA Neurol 2014; 71:429-35. [PMID: 24514572 PMCID: PMC4039209 DOI: 10.1001/jamaneurol.2013.6222] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Parkinsonian motor signs are common in the aging population and are associated with adverse health outcomes. Compared with Parkinson disease (PD), potential genetic risk factors for mild parkinsonian signs have been largely unexplored. OBJECTIVE To determine whether PD susceptibility loci are associated with parkinsonism or substantia nigra pathology in a large community-based cohort of older persons. DESIGN, SETTING, AND PARTICIPANTS Eighteen candidate single-nucleotide polymorphisms from PD genome-wide association studies were evaluated in a joint clinicopathologic cohort. Participants included 1698 individuals and a nested autopsy collection of 821 brains from the Religious Orders Study and the Rush Memory and Aging Project, 2 prospective community-based studies. MAIN OUTCOMES AND MEASURES The primary outcomes were a quantitative measure of global parkinsonism or component measures of bradykinesia, rigidity, tremor, and gait impairment that were based on the motor Unified Parkinson's Disease Rating Scale. In secondary analyses, we examined associations with additional quantitative motor traits and postmortem indices, including substantia nigra Lewy bodies and neuronal loss. RESULTS Parkinson disease risk alleles in the MAPT (rs2942168; P = .0006) and CCDC62 (rs12817488; P = .004) loci were associated with global parkinsonism, and these associations remained after exclusion of patients with a PD diagnosis. Based on motor Unified Parkinson's Disease Rating Scale subscores, MAPT (P = .0002) and CCDC62 (P = .003) were predominantly associated with bradykinesia, and we further discovered associations between SREBF1 (rs11868035; P = .005) and gait impairment, SNCA (rs356220; P = .04) and rigidity, and GAK (rs1564282; P = .03) and tremor. In the autopsy cohort, only NMD3 (rs34016896; P = .03) was related to nigral neuronal loss, and no associations were detected with Lewy bodies. CONCLUSIONS AND RELEVANCE In addition to the established link to PD susceptibility, our results support a broader role for several loci in the development of parkinsonian motor signs and nigral pathology in older persons.
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Affiliation(s)
- Joshua M Shulman
- Department of Neurology, Baylor College of Medicine, Houston, Texas2Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Philip L De Jager
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts7Harvard Medical School, Boston, Massachusetts8Program in Medical and Population Genetics, Broad Institute, Cam
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Dai D, Wang Y, Wang L, Li J, Ma Q, Tao J, Zhou X, Zhou H, Jiang Y, Pan G, Xu L, Ru P, Lin D, Pan J, Xu L, Ye M, Duan S. Polymorphisms of DRD2 and DRD3 genes and Parkinson's disease: A meta-analysis. Biomed Rep 2014; 2:275-281. [PMID: 24649110 DOI: 10.3892/br.2014.220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/17/2013] [Indexed: 12/31/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder that affects ~2% of the population aged ≥65 years. The degeneration of dopamine neurons in the substantia nigra contributes to the pathogenesis of PD. Dopamine receptor D2 (DRD2) and dopamine receptor D3 (DRD3) are two key subtypes of dopamine receptors. The aim of our study was to evaluate the association between the polymorphisms of DRD2 and DRD3 genes and PD. Meta-analyses were conducted from 16 studies (46 stages) among 4,279 cases and 5,661 controls between PD and 9 polymorphisms (DRD2: rs1800497, rs1079597, rs6278, rs6279, rs273482, rs1799732 and rs1076563; DRD3: rs6280 and rs2134655). A significant association was observed between DRD3 rs2134655 polymorphism and PD [P=0.01, odds ratio (OR)=1.17, 95% confidence interval (CI): 1.03-1.32] and a borderline association was observed between DRD2 rs1800497 polymorphism and PD in Europeans (P=0.05, OR=1.13, 95% CI: 1.00-1.27). Findings of the current meta-analysis suggested that DRD3 rs2134655 polymorphism was associated with a 17% increased risk of PD and that DRD2 rs1800497 polymorphism had a potential to increase the risk of PD by 13% in Europeans. Future large-scale studies are required to confirm the ethnic difference of DRD2 rs1800497 polymorphism and to determine whether there were significant associations of PD with other polymorphisms in DRD2 and DRD3 genes.
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Affiliation(s)
- Dongjun Dai
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China ; Department of Neurology, Affiliated Hospital, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Yunliang Wang
- Department of Neurology, 148 Central Hospital of PLA, Zibo, Shandong 255300, P.R. China
| | - Lingyan Wang
- Bank of Blood Products, Ningbo No. 2 Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Jinfeng Li
- Department of Neurology, 148 Central Hospital of PLA, Zibo, Shandong 255300, P.R. China
| | - Qingqing Ma
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Jianmin Tao
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Xingyu Zhou
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Hanlin Zhou
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Yi Jiang
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Guanghui Pan
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Limin Xu
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Ping Ru
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Danfeng Lin
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Jun Pan
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Leiting Xu
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Meng Ye
- Department of Neurology, Affiliated Hospital, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Shiwei Duan
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
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Dai D, Wang Y, Wang L, Li J, Zhou H, Ma Q, Zhou X, Pan J, Pan G, Chen C, Xu L, Ru P, Wang H, Zhu S, Lv Y, Xu L, Ye M, Duan S. Association of four GSTs gene polymorphisms with Parkinson disease: A meta-analysis. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/abb.2014.52014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vale TC, Caramelli P, Cardoso F. Vascular parkinsonism: a case series of 17 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:757-62. [DOI: 10.1590/0004-282x20130117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 06/17/2013] [Indexed: 11/22/2022]
Abstract
Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.
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Affiliation(s)
| | - Paulo Caramelli
- Federal University of Minas Gerais; Federal University of Minas Gerais, Brazil
| | - Francisco Cardoso
- Federal University of Minas Gerais; Federal University of Minas Gerais, Brazil
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Rocha H, Cerejo A, Garrett MC, Massano J. Reversible parkinsonism due to a large intracranial tumour. BMJ Case Rep 2012; 2012:bcr-2012-007823. [PMID: 23266782 DOI: 10.1136/bcr-2012-007823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 77-year-old woman presented with progressively worsening apathy, depression, urinary incontinence and slowness of movement for the past 1 year. Asymmetric akinetic-rigid parkinsonism and mild left-sided hyper-reflexia were seen on examination. No ocular movement impairment, cerebellar or sensory signs were noticed. Routine laboratory testing was normal. Brain imaging revealed a large frontal tumour which was subsequently excised and pathologically confirmed as a meningioma. Marked clinical improvement was documented 3 months after surgery, and persistent clinical and imaging remission have been confirmed annually for the following 3 years. There have been some reports of parkinsonism associated with intracranial tumours. Although this is probably an uncommon situation, it is potentially treatable, and symptoms might even remit completely following successful management. Parkinson's disease is a common cause of parkinsonism, but alternative aetiologies should be suspected whenever atypical findings are demonstrated by clinical history or examination.
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Affiliation(s)
- Helena Rocha
- Department of Neurology, Centro Hospitalar de São João, Oporto, Portugal
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