1
|
Chen X, Zhang Y. A review of the neurotransmitter system associated with cognitive function of the cerebellum in Parkinson's disease. Neural Regen Res 2024; 19:324-330. [PMID: 37488885 PMCID: PMC10503617 DOI: 10.4103/1673-5374.379042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/30/2023] [Accepted: 05/08/2023] [Indexed: 07/26/2023] Open
Abstract
The dichotomized brain system is a concept that was generalized from the 'dual syndrome hypothesis' to explain the heterogeneity of cognitive impairment, in which anterior and posterior brain systems are independent but partially overlap. The dopaminergic system acts on the anterior brain and is responsible for executive function, working memory, and planning. In contrast, the cholinergic system acts on the posterior brain and is responsible for semantic fluency and visuospatial function. Evidence from dopaminergic/cholinergic imaging or functional neuroimaging has shed significant insight relating to the involvement of the cerebellum in the cognitive process of patients with Parkinson's disease. Previous research has reported evidence that the cerebellum receives both dopaminergic and cholinergic projections. However, whether these two neurotransmitter systems are associated with cognitive function has yet to be fully elucidated. Furthermore, the precise role of the cerebellum in patients with Parkinson's disease and cognitive impairment remains unclear. Therefore, in this review, we summarize the cerebellar dopaminergic and cholinergic projections and their relationships with cognition, as reported by previous studies, and investigated the role of the cerebellum in patients with Parkinson's disease and cognitive impairment, as determined by functional neuroimaging. Our findings will help us to understand the role of the cerebellum in the mechanisms underlying cognitive impairment in Parkinson's disease.
Collapse
Affiliation(s)
- Xi Chen
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| |
Collapse
|
2
|
Roy S, Kashyap NN, Anchan AS, Punja D, Jasti DB, Upadhya D. Urinary extracellular vesicle dynamics in Parkinson's disease patients with urinary dysfunction. Front Neurol 2023; 14:1250832. [PMID: 38046591 PMCID: PMC10691254 DOI: 10.3389/fneur.2023.1250832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Parkinson's disease (PD) presents with severe motor manifestations and a plethora of non-motor symptoms. Urinary dysfunctions are one of the most common non-motor symptoms of PD patients responsible for reduced quality of life. Urinary extracellular vesicles (EVs) are mostly considered to originate from the cells in the urogenital tract. In this study, we have performed urinary EV analysis in 29 PD cases with varied severity of urinary dysfunction and correlated it with the EV dynamics in 29 age-matched controls. In the studied cases, apart from urinary dysfunction, symptoms of depression, anxiety, cognitive dysfunction, sleep, and wakefulness were observed in >75% of the cases. No significant difference in urinary EV size, concentration and urinary EV protein concentration was observed between PD cases with urinary dysfunction and controls. However, a significant positive association was observed between urinary EV concentration and motor scores (p = 0.042), while no association was observed between urinary EV concentration and urinary dysfunction scores. Chronic stress induced by motor symptoms could be one of the reasons for excessive EV production in PD patients with urinary dysfunctions. Large-scale studies on the association of urinary EV dynamics with motor and non-motor symptoms may provide additional information on urinary dysfunction in PD.
Collapse
Affiliation(s)
- Santanu Roy
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Physiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Namita N. Kashyap
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abigail Sheldon Anchan
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dhiren Punja
- Department of Physiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dushyanth Babu Jasti
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dinesh Upadhya
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
3
|
Zhang X, Molsberry SA, Pavlova M, Schwarzschild MA, Ascherio A, Gao X. Probable Parasomnias and Mortality: A Prospective Study in US Men. Mayo Clin Proc 2023; 98:1449-1457. [PMID: 37793724 DOI: 10.1016/j.mayocp.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To examine the association between parasomnias, including rapid eye movement sleep behavior disorder (RBD) and sleep walking (SW), and mortality risk in a large-scale population-based cohort. METHODS This prospective cohort study was based on 25,695 participants from the Health Professionals Follow-up Study, a population-based cohort of male health professionals in the United States. Probable SW (pSW) and probable RBD (pRBD) were measured by questions adapted from the Mayo Sleep Questionnaire in 2012. All-cause mortality and cause-specific mortality were ascertained through the national registry, reports by the families, and the postal system from January 1, 2012, through June 30, 2018. RESULTS Of the studied population, 223 reported pSW and 2720 reported pRBD. During 6 years of follow-up (2012 to 2018), 4743 mortality cases were documented. The co-occurrence of both probable parasomnias was associated with higher all-cause mortality risk (Ptrend=.008), and the adjusted hazard ratio (HR) of mortality was 1.65 (95% CI, 1.20 to 2.28) compared with participants without either probable parasomnia after adjustment for major lifestyle, sleep, and metabolic risk factors, and chronic diseases. Significant associations were found for mortality attributed to neurodegenerative diseases (adjusted HR for both parasomnias vs none, 4.57; 95% CI, 2.62 to 7.97) and accidents (adjusted HR for both parasomnias vs none, 7.36; 95% CI, 2.95 to 18.4). Having pSW alone was associated with all-cause mortality, and pSW and pRBD were individually associated with mortality attributed to neurodegenerative diseases and accidents too (P<.05 for all). CONCLUSION Probable parasomnia was associated with a higher risk of all-cause mortality and mortality attributed to neurodegenerative diseases and accidents.
Collapse
Affiliation(s)
- Xinyuan Zhang
- Department of Nutritional Sciences, Pennsylvania State University, University Park, MA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Samantha A Molsberry
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Social & Scientific Systems, Durham, NC
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | | | - Alberto Ascherio
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, MA; Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
| |
Collapse
|
4
|
Palacios N, Wilkinson J, Bjornevik K, Schwarzschild MA, McIver L, Ascherio A, Huttenhower C. Metagenomics of the Gut Microbiome in Parkinson's Disease: Prodromal Changes. Ann Neurol 2023; 94:486-501. [PMID: 37314861 PMCID: PMC10538421 DOI: 10.1002/ana.26719] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Prior studies on the gut microbiome in Parkinson's disease (PD) have yielded conflicting results, and few studies have focused on prodromal (premotor) PD or used shotgun metagenomic profiling to assess microbial functional potential. We conducted a nested case-control study within 2 large epidemiological cohorts to examine the role of the gut microbiome in PD. METHODS We profiled the fecal metagenomes of 420 participants in the Nurses' Health Study and the Health Professionals Follow-up Study with recent onset PD (N = 75), with features of prodromal PD (N = 101), controls with constipation (N = 113), and healthy controls (N = 131) to identify microbial taxonomic and functional features associated with PD and features suggestive of prodromal PD. Omnibus and feature-wise analyses identified bacterial species and pathways associated with prodromal and recently onset PD. RESULTS We observed depletion of several strict anaerobes associated with reduced inflammation among participants with PD or features of prodromal PD. A microbiome-based classifier had moderate accuracy (area under the curve [AUC] = 0.76 for species and 0.74 for pathways) to discriminate between recently onset PD cases and controls. These taxonomic shifts corresponded with functional shifts indicative of carbohydrate source preference. Similar, but less marked, changes were observed in participants with features of prodromal PD, in both microbial features and functions. INTERPRETATION PD and features of prodromal PD were associated with similar changes in the gut microbiome. These findings suggest that changes in the microbiome could represent novel biomarkers for the earliest phases of PD. ANN NEUROL 2023;94:486-501.
Collapse
Affiliation(s)
- Natalia Palacios
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA
- Department of Veterans Affairs, ENRM VA Hospital, Bedford, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Chan Microbiome in Public Health Center (HCMPH)
| | | | - Kjetil Bjornevik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Chan Microbiome in Public Health Center (HCMPH)
| | | | - Lauren McIver
- Harvard Chan Microbiome in Public Health Center (HCMPH)
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Alberto Ascherio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Chan Microbiome in Public Health Center (HCMPH)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Curtis Huttenhower
- Harvard Chan Microbiome in Public Health Center (HCMPH)
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
5
|
Luthra NS, Clow A, Corcos DM. The Interrelated Multifactorial Actions of Cortisol and Klotho: Potential Implications in the Pathogenesis of Parkinson's Disease. Brain Sci 2022; 12:1695. [PMID: 36552155 PMCID: PMC9775285 DOI: 10.3390/brainsci12121695] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
The pathogenesis of Parkinson's disease (PD) is complex, multilayered, and not fully understood, resulting in a lack of effective disease-modifying treatments for this prevalent neurodegenerative condition. Symptoms of PD are heterogenous, including motor impairment as well as non-motor symptoms such as depression, cognitive impairment, and circadian disruption. Aging and stress are important risk factors for PD, leading us to explore pathways that may either accelerate or protect against cellular aging and the detrimental effects of stress. Cortisol is a much-studied hormone that can disrupt mitochondrial function and increase oxidative stress and neuroinflammation, which are recognized as key underlying disease mechanisms in PD. The more recently discovered klotho protein, considered a general aging-suppressor, has a similarly wide range of actions but in the opposite direction to cortisol: promoting mitochondrial function while reducing oxidative stress and inflammation. Both hormones also converge on pathways of vitamin D metabolism and insulin resistance, also implicated to play a role in PD. Interestingly, aging, stress and PD associate with an increase in cortisol and decrease in klotho, while physical exercise and certain genetic variations lead to a decrease in cortisol response and increased klotho. Here, we review the interrelated opposite actions of cortisol and klotho in the pathogenesis of PD. Together they impact powerful and divergent mechanisms that may go on to influence PD-related symptoms. Better understanding of these hormones in PD would facilitate the design of effective interventions that can simultaneously impact the multiple systems involved in the pathogenesis of PD.
Collapse
Affiliation(s)
- Nijee S. Luthra
- Department of Neurology, University of California San Francisco, San Francisco, CA 94127, USA
| | - Angela Clow
- Department of Psychology, School of Social Sciences, University of Westminster, London W1B 2HW, UK
| | - Daniel M. Corcos
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| |
Collapse
|
6
|
Zhang X, Xu J, Liu Y, Chen S, Wu S, Gao X. Diet Quality is Associated with Prodromal Parkinson's Disease Features in Chinese Adults. Mov Disord 2022; 37:2367-2375. [PMID: 36069990 DOI: 10.1002/mds.29208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The prodromal phase of Parkinson's disease (PD) is a critical window for prevention by modifying lifestyle factors. However, there is limited knowledge on how diet quality is associated with prodromal PD symptoms in Asian populations. OBJECTIVE To examine the association between overall diet quality and prodromal PD features. METHODS A total of 71,640 Chinese participants who were free of PD were included in this cross-sectional study. Diet quality was assessed using the modified Alternative Healthy Eating Index (mAHEI) and alternate Mediterranean Diet (aMED). Five prodromal features including probable rapid eye movement sleep behavior disorder (pRBD), hyposmia, excessive daytime sleepiness, constipation, and depressive symptom were measured using validated questionnaires. Logistic regression was used to calculate the odds ratio (OR) for having a combination of prodromal PD symptoms (1 and 2+ symptoms vs. 0 symptoms), adjusting for age, sex, lifestyle factors, total energy intake, and other potential confounders. RESULTS In the multivariable-adjusted model, the OR for having 2+ versus 0 prodromal PD features was 0.64 (95% confidence interval [CI]: 0.49, 0.85) comparing the highest versus the lowest mAHEI diet quality quartiles with a significant inverse trend (P-trend = 0.003). For individual prodromal PD features, better diet quality, as assessed by the mAHEI, was associated with lower odds of having excessive daytime sleepiness and constipation (P-trend < 0.05 for both). We observed a marginally significant association between aMED and prodromal PD features (adjusted OR comparing the extreme quartiles = 0.74; 95% CI: 0.55, 0.98; P-trend = 0.09). CONCLUSION Better diet quality, as assessed by the mAHEI and the aMED, was associated with lower probability of having prodromal PD features in Chinese adults. © 2022 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Xinyuan Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jipo Xu
- Department of Cardiology, Tangjizhuang Hospital Affiliated to Kailuan General Hospital, Tangshan, China
| | - Yesong Liu
- Department of Neurology, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Institute of Nutrition, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Zhang C, Wu QQ, Hou Y, Wang Q, Zhang GJ, Zhao WB, Wang X, Wang H, Li WG. Ophthalmologic problems correlates with cognitive impairment in patients with Parkinson's disease. Front Neurosci 2022; 16:928980. [PMID: 36278010 PMCID: PMC9583907 DOI: 10.3389/fnins.2022.928980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Visual impairment is a common non-motor symptom (NMS) in patients with Parkinson's disease (PD) and its implications for cognitive impairment remain controversial. We wished to survey the prevalence of visual impairment in Chinese Parkinson's patients based on the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q), identify the pathogens that lead to visual impairment, and develop a predictive model for cognitive impairment risk in Parkinson's based on ophthalmic parameters. Methods A total of 205 patients with Parkinson's disease and 200 age-matched controls completed the VIPD-Q and underwent neuro-ophthalmologic examinations, including ocular fundus photography and optical coherence tomography. We conducted nomogram analysis and the predictive model was summarized using the multivariate logistic and LASSO regression and verified via bootstrap validation. Results One or more ophthalmologic symptoms were present in 57% of patients with Parkinson's disease, compared with 14% of the controls (χ2-test; p < 0.001). The visual impairment questionnaire showed good sensitivity and specificity (area under the curve [AUC] = 0.918, p < 0.001) and a strong correlation with MoCA scores (Pearson r = −0.4652, p < 0.001). Comparing visual impairment scores between pre- and post-deep brain stimulation groups showed that DBS improved visual function (U-test, p < 0.001). The thickness of the retinal nerve fiber layer and vessel percentage area predicted cognitive impairment in PD. Interpretation The study findings provide novel mechanistic insights into visual impairment and cognitive decline in Parkinson's disease. The results inform an effective tool for predicting cognitive deterioration in Parkinson's based on ophthalmic parameters.
Collapse
Affiliation(s)
- Chao Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Qian-qian Wu
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Ying Hou
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Qi Wang
- Department of Gerontology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guang-jian Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, China
| | - Wen-bo Zhao
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Xu Wang
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Wei-guo Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Wei-guo Li
| |
Collapse
|
8
|
Molsberry SA, Hughes KC, Schwarzschild MA, Ascherio A. Who to Enroll in Parkinson Disease Prevention Trials? The Case for Composite Prodromal Cohorts. Neurology 2022; 99:26-33. [PMID: 35970591 DOI: 10.1212/wnl.0000000000200788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Significant progress has been made in expanding our understanding of prodromal Parkinson disease (PD), particularly for recognition of early motor and nonmotor signs and symptoms. Although identification of these prodromal features may improve our understanding of the earliest stages of PD, they are individually insufficient for early disease detection and enrollment of participants in prevention trials in most cases because of low sensitivity, specificity, and positive predictive value. Composite cohorts, composed of individuals with multiple co-occurring prodromal features, are an important resource for conducting prodromal PD research and eventual prevention trials because they are more representative of the population at risk for PD, allow investigators to evaluate the efficacy of an intervention across individuals with varying prodromal feature patterns, are able to produce larger sample sizes, and capture individuals at different stages of prodromal PD. A key challenge in identifying individuals with prodromal disease for composite cohorts and prevention trial participation is that we know little about the natural history of prodromal PD. To move toward prevention trials, it is critical that we better understand common prodromal feature patterns and be able to predict the probability of progression and phenoconversion. Ongoing research in cohort studies and administrative databases is beginning to address these questions, but further longitudinal analyses in a large population-based sample are necessary to provide a convincing and definitive strategy for identifying individuals to be enrolled in a prevention trial.
Collapse
Affiliation(s)
- Samantha A Molsberry
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Katherine C Hughes
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
9
|
Crotty GF, Keavney JL, Alcalay RN, Marek K, Marshall GA, Rosas HD, Schwarzschild MA. Planning for Prevention of Parkinson Disease: Now Is the Time. Neurology 2022; 99:1-9. [PMID: 36219787 PMCID: PMC10519135 DOI: 10.1212/wnl.0000000000200789] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Parkinson disease (PD) is a chronic progressive neurodegenerative disease with increasing worldwide prevalence. Despite many trials of neuroprotective therapies in manifest PD, no disease-modifying therapy has been established. Over the past several decades, a series of breakthroughs have identified discrete populations at substantially increased risk of developing PD. Based on this knowledge, now is the time to design and implement PD prevention trials. This endeavor builds on experience gained from early prevention trials in Alzheimer disease and Huntington disease. This article first reviews prevention trial precedents in these other neurodegenerative diseases before focusing on the critical design elements for PD prevention trials, including whom to enroll for these trials, what therapeutics to test, and how to measure outcomes in prevention trials. Our perspective reflects progress and remaining challenges that motivated a 2021 conference, "Planning for Prevention of Parkinson: A Trial Design Symposium and Workshop."
Collapse
Affiliation(s)
- Grace F Crotty
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Jessi L Keavney
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Roy N Alcalay
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kenneth Marek
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gad A Marshall
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - H Diana Rosas
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Department of Neurology (G.F.C., M.A.S.), Massachusetts General Hospital, Boston, MA; Parkinson's Foundation Research Advocates Program (J.L.K.), Parkinson's Foundation, Miami, FL/New York, NY; Department of Neurology (R.N.A.), Columbia University Irving Medical Center, New York, NY; Institute for Neurodegenerative Disorders (K.M.), New Haven, CT; Center for Alzheimer Research and Treatment (G.A.M.) and Center for Neuroimaging of Aging and Neurodegenerative Diseases (H.D.R.), Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Hughes KC, Gao X, Baker JM, Stephen CD, Kim IY, Valeri L, Schwarzschild MA, Ascherio A. Non-Motor Features of Parkinson's Disease in Women. JOURNAL OF PARKINSONS DISEASE 2021; 11:1237-1246. [PMID: 33935102 DOI: 10.3233/jpd-202409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Non-motor symptoms are common in Parkinson's disease (PD) and some, including hyposmia, constipation, and REM sleep behavior disorder, often precede the clinical diagnosis. OBJECTIVE To assess the relation between combinations of non-motor features and presence of PD among women. METHODS A nested case-control study was conducted among women in the Nurses' Health Study. Women were eligible if they responded to screening questions for constipation and probable REM sleep behavior disorder (pRBD) on a 2012 questionnaire and were under age 85 on January 1, 2012. 87 women with confirmed PD and 14,170 women without PD agreed to participate and completed in 2015 the Brief Smell Identification Test to assess hyposmia, as well as a questionnaire to assess parkinsonism and other non-motor PD features, including depressive symptoms, excessive daytime sleepiness, impaired color vision, and body pain. RESULTS In age-adjusted logistic models, each non-motor feature was significantly associated with PD, and the odds of PD increased exponentially with the number of features. Women with constipation, pRBD, and hyposmia had an age-adjusted OR for PD of 211 (95% CI 84.2-529) compared to women with none of these features. The odds of having PD rose further with the presence of additional non-motor signs. Comparing women with at least 6 of the 7 features assessed in this study to women with one or none, the age-adjusted OR for PD was 356 (95% CI 113-1126). CONCLUSION Results suggest that these non-motor features could be useful in discriminating PD patients from controls in women, and since they often appear during the prodromal period of PD, their combinations may prove useful for identifying populations at high risk of developing PD.
Collapse
Affiliation(s)
- Katherine C Hughes
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Xiang Gao
- Department of Nutritional Health, The Pennsylvania State University, University Park, PA, USA
| | - Jessica M Baker
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Iris Y Kim
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael A Schwarzschild
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Alberto Ascherio
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Flores-Torres MH, Hughes KC, Molsberry S, Gao X, Kang JH, Schwarzschild MA, Ascherio A. Cognitive function in men with non-motor features of Parkinson's disease. BMJ Neurol Open 2021; 3:e000112. [PMID: 34250483 PMCID: PMC8217956 DOI: 10.1136/bmjno-2020-000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/25/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Subtle cognitive deficits can occur during the prodromal phase of Parkinson’s disease (PD), commonly in conjunction with hyposmia. However, little is known about the association between cognitive function and other features suggestive of prodromal PD. We evaluated the association of non-motor prodromal PD features, including hyposmia, constipation and probable REM sleep behaviour disorder (pRBD), with objective measures of cognitive function and self-reported cognitive decline. Methods The study population comprised 804 men who responded to a telephone cognitive interview in 2016–2017. Participants included 680 individuals with hyposmia, of whom 45 had confirmed PD, and 124 men without hyposmia. Among these men, we evaluated objective cognitive function and subjective cognitive decline to determine whether the presence of non-motor features of prodromal PD was associated with cognitive functioning. Analyses were adjusted for age, physical activity, body mass index, smoking status and coffee consumption. Results Individuals with non-motor features of prodromal PD had worse objective and subjective cognitive performance relative to men without non-motor features. Cognitive impairment was particularly prevalent among individuals with concurrent hyposmia, pRBD and constipation (multivariate-adjusted OR=3.80; 95% CI 1.52 to 9.47 for objective poor cognitive function; OR=8.71; 95% CI 3.18 to 23.83 for subjective cognitive decline). As expected, both objective (OR=7.91) and subjective (OR=17.42) cognitive impairment were also more common among men with confirmed PD. Conclusions Our study suggests that cognition is commonly affected in individuals with non-motor prodromal PD features, particularly when multiple of these features are present.
Collapse
Affiliation(s)
- Mario H Flores-Torres
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Mexico.,Departmet of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine C Hughes
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Molsberry
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University Huck Institutes of the Life Sciences, University Park, Pennsylvania, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael A Schwarzschild
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alberto Ascherio
- Departmet of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Zhang X, Molsberry SA, Pavlova M, Schwarzschild MA, Ascherio A, Gao X. Association of Sleepwalking and REM Sleep Behavior Disorder With Parkinson Disease in Men. JAMA Netw Open 2021; 4:e215713. [PMID: 33847749 PMCID: PMC8044732 DOI: 10.1001/jamanetworkopen.2021.5713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Previous studies conducted among patients with Parkinson disease (PD) reported that parasomnias other than rapid eye movement (REM) sleep behavior disorder (RBD), particularly sleepwalking (SW), are associated with PD severity. However, it remains unclear whether the presence of SW is associated with altered odds of having PD in a population-based study. OBJECTIVE To evaluate whether probable SW, either alone or co-occurring with probable RBD, is associated with higher odds of PD in men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 25 694 men from the Health Professionals Follow-up Study, a population-based cohort of male health professionals in the US with information on probable SW and probable RBD. Data collection took place between January 2012 and June 2018, and data analysis took place from July 2020 to October 2020. EXPOSURES Probable SW and probable RBD were measured by questions adapted from the Mayo Sleep Questionnaire in 2012. MAIN OUTCOMES AND MEASURES PD, confirmed after review of medical records by a movement disorder specialist. RESULTS Of the 25 694 studied men (mean [SD] age, 75.6 [7.4] years), 223 (0.9%) had probable SW, 2720 (10.6%) had probable RBD, and 257 (1.0%) had PD. After adjusting for potential confounders (eg, age, smoking, caffeine intake, chronic disease status, and other sleep disorders), compared with individuals without probable SW and probable RBD, participants with probable SW, probable RBD, and both probable SW and probable RBD had higher odds of PD, (probable SW: odds ratio [OR], 4.80; 95% CI, 1.61-14.26; probable RBD: OR, 6.36; 95% CI, 4.83-8.37; both probable SW and probable RBD: OR, 8.44; 95% CI, 3.90-18.27). CONCLUSIONS AND RELEVANCE In this cross-sectional study of a male population, probable sleep parasomnias, including both SW and RBD, were associated with higher odds of having PD. PD-related neurodegeneration may impair arousal regulation during sleep.
Collapse
Affiliation(s)
- Xinyuan Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
| | - Samantha A. Molsberry
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Milena Pavlova
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Alberto Ascherio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
| |
Collapse
|
13
|
Iijima M, Okuma Y, Suzuki K, Yoshii F, Nogawa S, Osada T, Hirata K, Kitagawa K, Hattori N. Associations between probable REM sleep behavior disorder, olfactory disturbance, and clinical symptoms in Parkinson's disease: A multicenter cross-sectional study. PLoS One 2021; 16:e0247443. [PMID: 33606814 PMCID: PMC7894886 DOI: 10.1371/journal.pone.0247443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rapid eye movement sleep behavior disorder (RBD) and olfactory dysfunction are useful for early diagnosis of Parkinson's disease (PD). RBD and severe olfactory dysfunction are also regarded as risk factors for cognitive impairment in PD. This study aimed to assess the associations between RBD, olfactory function, and clinical symptoms in patients with PD. METHODS The participants were 404 patients with non-demented PD. Probable RBD (pRBD) was determined using the Japanese version of the RBD screening questionnaire (RBDSQ-J) and the RBD Single-Question Screen (RBD1Q). Olfactory function was evaluated using the odor identification test for Japanese. Clinical symptoms were evaluated using the Movement Disorder Society Revision of the Unified PD Rating Scale (MDS-UPDRS) parts I-IV. RESULTS In total, 134 (33.2%) patients indicated a history of pRBD as determined by the RBD1Q and 136 (33.7%) by the RBDSQ-J based on a cutoff value of 6 points. Moreover, 101 patients were diagnosed as pRBD by both questionnaires, 35 by the RBDSQ-J only, and 33 by the RBD1Q only. The MDS-UPDRS parts I-III scores were significantly higher and disease duration significantly longer in the pRBD group. pRBD was significantly associated with male gender and the MDS-UPDRS part I score. The olfactory identification function was significantly reduced in the pRBD group. CONCLUSIONS About 33% of the patients with PD had pRBD based on the questionnaires, and both motor and non-motor functions were significantly decreased in these patients. These results suggest that more extensive degeneration occurred in patients with non-demented PD with RBD.
Collapse
Affiliation(s)
- Mutsumi Iijima
- Department of Neurology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Yasuyuki Okuma
- Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Fumihito Yoshii
- Department of Neurology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Kanagawa, Japan
| | - Shigeru Nogawa
- Department of Neurology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takashi Osada
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Saitama, Japan
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Molsberry S, Bjornevik K, Hughes KC, Healy B, Schwarzschild M, Ascherio A. Diet pattern and prodromal features of Parkinson disease. Neurology 2020; 95:e2095-e2108. [PMID: 32817391 DOI: 10.1212/wnl.0000000000010523] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the relationship between diet pattern and prodromal Parkinson disease (PD) features. METHODS These analyses include 47,679 participants from the Nurses' Health Study and the Health Professionals Follow-up Study. Since 1986, both cohorts have collected dietary information every 4 years and calculated scores for adherence to different diet patterns, including the alternate Mediterranean diet (aMED) and the Alternative Healthy Eating Index (AHEI). In 2012, participants responded to questions regarding constipation and probable REM sleep behavior disorder. For a subset of 17,400 respondents to the 2012 questionnaire, 5 additional prodromal features of PD were assessed in 2014 to 2015. We used multinomial logistic regression to estimate the association between baseline (1986) diet pattern score quintiles and number of prodromal features (0, 1, 2, or ≥3) in 2012 to 2015. Additional analyses investigated the association between long-term adherence to these dietary patterns over 20 years and prodromal features suggestive of PD. RESULTS In a comparison of extreme aMED diet quintiles, the odds ratio for ≥3 vs 0 features was 0.82 (95% confidence interval [CI] 0.68-1.00, false discovery rate [FDR]-adjusted p trend = 0.03) at baseline and 0.67 (95% CI 0.54-0.83, FDR-p trend < 0.001) for long-term diet; results were equally strong for the association with AHEI scores. Higher adherence to these diets was inversely associated with individual features, including constipation, excessive daytime sleepiness, and depression. CONCLUSIONS The inverse association between these diet patterns and prodromal PD features is consistent with previous findings and suggests that adherence to a healthy diet may reduce the occurrence of nonmotor symptoms that often precede PD diagnosis.
Collapse
Affiliation(s)
- Samantha Molsberry
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Kjetil Bjornevik
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Katherine C Hughes
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brian Healy
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael Schwarzschild
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Population Health Sciences Program (S.M.), Harvard University, Cambridge; Departments of Nutrition (K.B., K.C.H., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (B.H.), Brigham and Women's Hospital; Department of Neurology (M.S.), Massachusetts General Hospital; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
Jankovic J, Tan EK. Parkinson's disease: etiopathogenesis and treatment. J Neurol Neurosurg Psychiatry 2020; 91:795-808. [PMID: 32576618 DOI: 10.1136/jnnp-2019-322338] [Citation(s) in RCA: 464] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
The concept of 'idiopathic' Parkinson's disease (PD) as a single entity has been challenged with the identification of several clinical subtypes, pathogenic genes and putative causative environmental agents. In addition to classic motor symptoms, non-motor manifestations (such as rapid eye movement sleep disorder, anosmia, constipation and depression) appear at prodromic/premotor stage and evolve, along with cognitive impairment and dysautonomia, as the disease progresses, often dominating the advanced stages of the disease. The key molecular pathogenic mechanisms include α-synuclein misfolding and aggregation, mitochondrial dysfunction, impairment of protein clearance (associated with deficient ubiquitin-proteasome and autophagy-lysosomal systems), neuroinflammation and oxidative stress. The involvement of dopaminergic as well as noradrenergic, glutamatergic, serotonergic and adenosine pathways provide insights into the rich and variable clinical phenomenology associated with PD and the possibility of alternative therapeutic approaches beyond traditional dopamine replacement therapies.One of the biggest challenges in the development of potential neuroprotective therapies has been the lack of reliable and sensitive biomarkers of progression. Immunotherapies such as the use of vaccination or monoclonal antibodies directed against aggregated, toxic α-synuclein.as well as anti-aggregation or protein clearance strategies are currently investigated in clinical trials. The application of glucagon-like peptide one receptor agonists, specific PD gene target agents (such as GBA or LRRK2 modifiers) and other potential disease modifying drugs provide cautious optimism that more effective therapies are on the horizon. Emerging therapies, such as new symptomatic drugs, innovative drug delivery systems and novel surgical interventions give hope to patients with PD about their future outcomes and prognosis.
Collapse
Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Eng King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| |
Collapse
|
16
|
Baldin E, Zenesini C, Bauleo S, Montanari F, Santi S, Spampinato M, Cortelli P, D’Alessandro R, Ascherio A. Low Cost Screening for Features of Prodromal Parkinson’s Disease in General Medical Practice in Italy. JOURNAL OF PARKINSONS DISEASE 2020; 10:711-715. [DOI: 10.3233/jpd-191868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elisa Baldin
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Salvatore Bauleo
- Primary Care Department, Casalecchio di Reno district, ASL Bologna, Bologna, Italy
| | - Federico Montanari
- Primary Care Department, Casalecchio di Reno district, ASL Bologna, Bologna, Italy
| | - Sandra Santi
- Primary Care Department, Casalecchio di Reno district, ASL Bologna, Bologna, Italy
| | - Maurizio Spampinato
- Primary Care Department, Casalecchio di Reno district, ASL Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, Unit of Neurology, Bellaria Hospital University of Bologna, Bologna, Italy
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Roberto D’Alessandro
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alberto Ascherio
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Hughes KC, Gao X, Molsberry S, Valeri L, Schwarzschild MA, Ascherio A. Physical activity and prodromal features of Parkinson disease. Neurology 2019; 93:e2157-e2169. [PMID: 31719136 DOI: 10.1212/wnl.0000000000008567] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/13/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between physical activity and prodromal features of Parkinson disease that often precede the clinical diagnosis. METHODS Included are participants in 2 well-established cohorts: the Nurses' Health Study and the Health Professionals Follow-up Study. Physical activity was assessed using validated questionnaires at baseline (1986) and every 2 years until 2008. Prodromal features (e.g., constipation, hyposmia, and probable REM sleep behavior disorder [pRBD]) were assessed in 2012-2014. RESULTS The multivariable-adjusted odds ratio (OR) for having ≥3 prodromal features vs none comparing the highest to the lowest quintile were 0.65 (95% confidence interval [CI] 0.53-0.79; p trend = 0.0006) for baseline physical activity and 0.52 (95% CI 0.35-0.76; p trend = 0.009) for cumulative average physical activity. Considering each feature independently, baseline physical activity was associated with lower odds of constipation (OR 0.78, 95% CI 0.73-0.83; p trend < 0.0001), excessive daytime sleepiness (OR 0.72, 95% CI 0.60-0.86; p trend = 0.002), depressive symptoms (OR 0.82, 95% CI 0.69-0.97; p trend = 0.13), and bodily pain (OR 0.81, 95% CI 0.68-0.96; p trend = 0.03). Similar or stronger associations were observed for cumulative average physical activity, which, in addition, was associated with pRBD (OR 0.85, 95% CI 0.77-0.95; p trend = 0.02). In contrast, neither hyposmia nor impaired color vision was associated with physical activity. Early life physical activity was associated with constipation and, in men only, with the co-occurrence of ≥3 features. CONCLUSIONS The reduced prevalence of prodromal features associated with Parkinson disease in older individuals who were more physically active in midlife and beyond is consistent with the hypothesis that high levels of physical activity may reduce risk of Parkinson disease.
Collapse
Affiliation(s)
- Katherine C Hughes
- From the Department of Nutrition (K.C.H., A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutritional Health (X.G.), The Pennsylvania State University, University Park; Population Health Sciences Program (S.M.), Harvard University, Cambridge, MA; Department of Biostatistics (L.V.), Columbia University Mailman School of Public Health, New York, NY; MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital, Boston; Department of Epidemiology (A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Xiang Gao
- From the Department of Nutrition (K.C.H., A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutritional Health (X.G.), The Pennsylvania State University, University Park; Population Health Sciences Program (S.M.), Harvard University, Cambridge, MA; Department of Biostatistics (L.V.), Columbia University Mailman School of Public Health, New York, NY; MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital, Boston; Department of Epidemiology (A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Samantha Molsberry
- From the Department of Nutrition (K.C.H., A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutritional Health (X.G.), The Pennsylvania State University, University Park; Population Health Sciences Program (S.M.), Harvard University, Cambridge, MA; Department of Biostatistics (L.V.), Columbia University Mailman School of Public Health, New York, NY; MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital, Boston; Department of Epidemiology (A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Linda Valeri
- From the Department of Nutrition (K.C.H., A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutritional Health (X.G.), The Pennsylvania State University, University Park; Population Health Sciences Program (S.M.), Harvard University, Cambridge, MA; Department of Biostatistics (L.V.), Columbia University Mailman School of Public Health, New York, NY; MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital, Boston; Department of Epidemiology (A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Department of Nutrition (K.C.H., A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutritional Health (X.G.), The Pennsylvania State University, University Park; Population Health Sciences Program (S.M.), Harvard University, Cambridge, MA; Department of Biostatistics (L.V.), Columbia University Mailman School of Public Health, New York, NY; MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital, Boston; Department of Epidemiology (A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Department of Nutrition (K.C.H., A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutritional Health (X.G.), The Pennsylvania State University, University Park; Population Health Sciences Program (S.M.), Harvard University, Cambridge, MA; Department of Biostatistics (L.V.), Columbia University Mailman School of Public Health, New York, NY; MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital, Boston; Department of Epidemiology (A.A.), Harvard T. H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
18
|
Moro A, Moscovich M, Farah M, Camargo CHF, Teive HAG, Munhoz RP. Nonmotor symptoms in spinocerebellar ataxias (SCAs). CEREBELLUM & ATAXIAS 2019; 6:12. [PMID: 31485334 PMCID: PMC6712685 DOI: 10.1186/s40673-019-0106-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
Nonmotor symptoms (NMS) have been increasingly recognized in a number of neurodegenerative diseases with a burden of disability that parallels or even surpasses that induced by motor symptoms. As NMS have often been poorly recognized and inadequately treated, much of the most recent developments in the investigation of these disorders has focused on the recognition and quantification of NMS, which will form the basis of improved clinical care for these complex cases. NMS have been only sparsely investigated in a limited number of spinocerebellar ataxias (SCAs), particularly SCA3, and have not been systematically reviewed for other forms of SCAs. The aim of the present study was to review the available literature on the presence of NMS among different types of SCAs.
Collapse
Affiliation(s)
- Adriana Moro
- 1Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, 50 Teixeira Soares Street, Batel, Curitiba, PR CEP 80240-440 Brazil.,Department of Medicine, Pequeno Príncipe College, Curitiba, PR Brazil
| | - Mariana Moscovich
- 3Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Marina Farah
- 4Neurology Service, Hospital Universitário Cajurú, Catholic University of Paraná, Curitiba, PR Brazil
| | - Carlos Henrique F Camargo
- 5Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR Brazil
| | - Hélio A G Teive
- 1Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, 50 Teixeira Soares Street, Batel, Curitiba, PR CEP 80240-440 Brazil.,5Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR Brazil
| | - Renato P Munhoz
- 6Department of Medicine, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, ON Canada
| |
Collapse
|
19
|
Wang JY, Fan QY, He JH, Zhu SG, Huang CP, Zhang X, Zhu JH. SLC6A4 Repeat and Single-Nucleotide Polymorphisms Are Associated With Depression and Rest Tremor in Parkinson's Disease: An Exploratory Study. Front Neurol 2019; 10:333. [PMID: 31024427 PMCID: PMC6465511 DOI: 10.3389/fneur.2019.00333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/19/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: Level of serotonin is mainly regulated by the serotonin reuptake transporter encoded by SLC6A4. The promoter region of SLC6A4 bears a repeat polymorphism 5-HTTLPR and a single nucleotide polymorphism rs25531. We have previously studied the association between these two variants and sporadic PD. The objective of the current study was to determine whether the SLC6A4 polymorphisms were associated with key motor and non-motor symptoms of PD. Methods: A total of 370 PD patients of Han Chinese were included. Associations between the SLC6A4 polymorphisms and PD symptoms including depression, intellectual impairment, tremor and rigidity were analyzed. Results: 5-HTTLPR was associated with depression in PD patients and presence of the LL genotype was protective against the depression risk. The rs25531 was associated with rest tremor in PD and the A allele serves as a recessive risk allele. No associations were found in the two polymorphisms with respect to intellectual impairment and rigidity in the cohort. Conclusion: The current study reveals two PD symptoms associated with SLC6A4 polymorphisms, and provides new insight into how serotonergic system genetically participates in the symptomatic progression of PD. Further study is warranted in additional populations.
Collapse
Affiliation(s)
- Jian-Yong Wang
- Department of Neurology, The First People's Hospital of Jiande, Hangzhou, China.,Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Department of Preventive Medicine, School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Qian-Ya Fan
- Department of Neurology, The First People's Hospital of Jiande, Hangzhou, China
| | - Jia-Hui He
- Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shi-Guo Zhu
- Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chen-Ping Huang
- Department of Preventive Medicine, School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Xiong Zhang
- Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jian-Hong Zhu
- Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Department of Preventive Medicine, School of Public Health, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
20
|
Xiang YQ, Xu Q, Sun QY, Wang ZQ, Tian Y, Fang LJ, Yang Y, Tan JQ, Yan XX, Tang BS, Guo JF. Clinical Features and Correlates of Excessive Daytime Sleepiness in Parkinson's Disease. Front Neurol 2019; 10:121. [PMID: 30837940 PMCID: PMC6389626 DOI: 10.3389/fneur.2019.00121] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/29/2019] [Indexed: 12/28/2022] Open
Abstract
Objective: To explore the clinical features and correlates of excessive daytime sleepiness (EDS) in a Chinese population of Parkinson's disease (PD) patients. Methods: Patients with clinically established or clinically probable PD were recruited. Clinical and demographic data were collected, and participants were evaluated using standardized assessment protocols. Patients were divided into PD with EDS and PD without EDS groups based on the Epworth sleepiness scale (ESS) scores, with a cutoff score of 10. Clinical manifestations were compared between patients with and without EDS, and correlates of EDS were also studied. In addition, the relationship between EDS and poor nighttime sleep quality was analyzed. Results: A total of 1,221 PD patients were recruited in our study. The mean ESS (min, max) score was 7.6 ± 6.1 (0, 24), and 34.1% of the patients had ESS scores ≥10. No difference was seen in lifestyle (except for alcohol consumption), environmental factors, BMI, levodopa equivalent dose (LED), initial presentation of motor symptoms, motor subtype, and wearing off between patients with and without EDS. The PD with EDS group had a higher proportion of male patients and a higher average patient age. Moreover, the PD with EDS group showed older age at PD onset, lower educational level, and longer disease duration. Patients with EDS had higher scores on the Hoehn-Yahr scale and the Unified Parkinson's Disease Rating Scale (UPDRS) parts I, II, and III score, more severe non-motor symptoms, and poorer quality of sleep and life. Logistic regression analyses demonstrated that EDS was associated with male sex, age, cognitive impairment, PD-related sleep problems, rapid eye movement sleep behavior disorder (RBD), and worse quality of life (QoL). Conclusion: EDS is a general clinical manifestation in PD, and there were significant differences in clinical features between patients with and without EDS. Moreover, our study proved that many factors were associated with EDS, including male sex, age, cognitive impairment, PD-related sleep problems, RBD, and worse QoL. Understanding the clinical characteristics of EDS in PD patients may help identify EDS early, improve QoL, and reduce the occurrence of accidents.
Collapse
Affiliation(s)
- Ya-Qin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qi-Ying Sun
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Qin Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Liang-Juan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jie-Qiong Tan
- Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Xin-Xiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bei-Sha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Medical Genetics, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,Collaborative Innovation Center for Brain Science, Shanghai, China.,Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China.,Collaborative Innovation Center for Genetics and Development, Shanghai, China
| | - Ji-Feng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Medical Genetics, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| |
Collapse
|
21
|
The association between restless legs syndrome and premotor symptoms of Parkinson's disease. J Neurol Sci 2018; 394:41-44. [DOI: 10.1016/j.jns.2018.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/17/2018] [Accepted: 08/28/2018] [Indexed: 12/20/2022]
|