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Fukasawa N, Maeda M, Sugiyama Y, Fukuda T, Shimoda M. Distribution of proteinase K-resistant anti-α-synuclein immunoreactive axons in the cardiac plexus is unbiased to the left ventricular anterior wall. Pathol Int 2024; 74:1-12. [PMID: 38038140 DOI: 10.1111/pin.13389] [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: 09/06/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
Lewy body disease (LBD) is characterized by the appearance of Lewy neurites and Lewy bodies, which are predominantly composed of α-synuclein. Notably, the cardiac plexus (CP) is one of the main targets of LBD research. Although previous studies have reported obvious differences in the frequency of Lewy body pathology (LBP) in the CP, none of them have confirmed whether LBP preferably appears in any part of the CP. Thus, we aimed to clarify the emergence and/or propagation of LBP in the CP. In this study, 263 consecutive autopsy cases of patients aged ≥50 years were included, with one region per case selected from three myocardial perfusion areas (MPAs) and subjected to proteinase K and then immunohistochemically stained with anti-α-synuclein antibodies to assess LBP. We stained all three MPAs in 17 cases with low-density LBP and observed the actual distribution of LBP. LBP were identified in the CP in 20.2% (53/263) of patients. Moreover, we found that LBP may appear in only one region of MPAs, mainly in the young-old group (35.3% (6/17) of patients). These findings suggest that it is possible to underestimate LBP in the CP, especially in the young-old group, by restricting the search to only one of the three MPAs.
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Affiliation(s)
- Nei Fukasawa
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Miku Maeda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
- Medical Center for Memory & Cognitive Disorders, Sasebo Chuo Hospital, Nagasaki, Japan
| | - Masayuki Shimoda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
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Hase Y, Polvikoski TM, Firbank MJ, Craggs LJL, Hawthorne E, Platten C, Stevenson W, Deramecourt V, Ballard C, Kenny RA, Perry RH, Ince P, Carare RO, Allan LM, Horsburgh K, Kalaria RN. Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction. Brain Pathol 2019; 30:191-202. [PMID: 31357238 DOI: 10.1111/bpa.12769] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/21/2019] [Indexed: 12/16/2022] Open
Abstract
We performed a clinicopathological study to assess the burden of small vessel disease (SVD) type of pathological changes in elderly demented subjects, who had clinical evidence of autonomic dysfunction, either carotid sinus hypersensitivity or orthostatic hypotension or both or had exhibited unexpected repeated falls. Clinical and neuropathological diagnoses in 112 demented subjects comprised dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Alzheimer's disease (AD), Mixed dementia (mostly AD-DLB) and vascular dementia (VaD). Of these, 12 DLB subjects had no recorded unexpected falls in life and therefore no evidence of concomitant autonomic dysfunction. A further 17 subjects were assessed as aging controls without significant pathology or signs of autonomic dysfunction. We quantified brain vascular pathological changes and determined severities of neurodegenerative lesions including α-synuclein pathology. We found moderate-severe vascular changes and high-vascular pathology scores (P < 0.01) in all neurodegenerative dementias and as expected in VaD compared to similar age controls. Arteriolosclerosis, perivascular spacing and microinfarcts were frequent in the basal ganglia and frontal white matter (WM) across all dementias, whereas small infarcts (<5 mm) were restricted to VaD. In a sub-set of demented subjects, we found that vascular pathology scores were correlated with WM hyperintensity volumes determined by MRI in life (P < 0.02). Sclerotic index values were increased by ~50% in both the WM and neocortex in all dementias compared to similar age controls. We found no evidence for increased α-synuclein deposition in subjects with autonomic dysfunction. Our findings suggest greater SVD pathological changes occur in the elderly diagnosed with neurodegenerative dementias including DLB and who develop autonomic dysfunction. SVD changes may not necessarily manifest in clinically overt symptoms but they likely confound motor or cognitive dysfunction. We propose dysautonomia promotes chronic cerebral hypoperfusion to impact upon aging-related neurodegenerative disorders and characterize their end-stage clinical syndromes.
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Affiliation(s)
- Yoshiki Hase
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tuomo M Polvikoski
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael J Firbank
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucinda J L Craggs
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emily Hawthorne
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Platten
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - William Stevenson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vincent Deramecourt
- Histology and Pathology Department, Lille University Hospital, University Lille Nord de France, Lille, France
| | - Clive Ballard
- School of Medicine, University of Exeter, Exeter, United Kingdom
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Robert H Perry
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Ince
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Roxana O Carare
- Clinical and Experimental Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Louise M Allan
- School of Medicine, University of Exeter, Exeter, United Kingdom
| | - Karen Horsburgh
- Centre for Neuroregeneration, University of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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Fukasawa N, Fukuda T, Nagaoka M, Harada T, Takahashi H, Ikegami M. Aggregation and phosphorylation of α-synuclein with proteinase K resistance in focal α-synucleinopathy predominantly localized to the cardiac sympathetic nervous system. Neuropathol Appl Neurobiol 2019. [PMID: 28637099 DOI: 10.1111/nan.12422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N Fukasawa
- Department of Clinical Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - T Fukuda
- Division of Neuropathology, Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - M Nagaoka
- Department of Head and Neck Surgery, Shizuoka Kenritsu Shizuoka Gan Center, Shizuoka, Japan
| | - T Harada
- Department of Clinical Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - H Takahashi
- Department of Clinical Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - M Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
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Tan MP, Murray A, Hawkins T, Chadwick TJ, Kerr SRJ, Parry SW. Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity. PLoS One 2015; 10:e0126241. [PMID: 26057525 PMCID: PMC4461270 DOI: 10.1371/journal.pone.0126241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/18/2015] [Indexed: 01/08/2023] Open
Abstract
Background Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity. Methods Consecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited. Asymptomatic carotid sinus hypersensitivity and non-carotid sinus hypersensitivity control participants recruited from a community-dwelling cohort. Cardiac sympathetic innervation was determined using Iodine-123-metaiodobenzylguanidine (123-I-MIBG) scanning. Heart to mediastinal uptake ratio (H:M) were determined for early and late uptake on planar scintigraphy at 20 minutes and 3 hours following intravenous injection of 123-I-MIBG. Results Forty-two subjects: carotid sinus syndrome (n = 21), asymptomatic carotid sinus hypersensitivity (n = 12) and no carotid sinus hypersensitivity (n = 9) were included. Compared to the non- carotid sinus hypersensitivity control group, the carotid sinus syndrome group had significantly higher early H:M (estimated mean difference, B = 0.40; 95% confidence interval, CI = 0.13 to 0.67, p = 0.005) and late H:M (B = 0.32; 95%CI = 0.03 to 0.62, p = 0.032). There was, however, no significant difference in early H:M (p = 0.326) or late H:M (p = 0.351) between the asymptomatic carotid sinus hypersensitivity group and non- carotid sinus hypersensitivity controls. Conclusions Cardiac sympathetic neuronal activity is increased relative to age-matched controls in individuals with carotid sinus syndrome but not those with asymptomatic carotid sinus hypersensitivity. Blood pressure and heart rate measurements alone may therefore represent an over simplification in the assessment for carotid sinus syndrome and the relative increase in cardiac sympathetic innervation provides additional clues to understanding the mechanisms behind the symptomatic presentation of carotid sinus hypersensitivity.
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Affiliation(s)
- Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alan Murray
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Terry Hawkins
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Thomas J. Chadwick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simon R. J. Kerr
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Steve W. Parry
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Frith J, Watson S, Maggs PHBB, Newton JL. Cognitive symptoms are common in immune thrombocytopenia and associate with autonomic symptom burden. Eur J Haematol 2011; 88:224-8. [DOI: 10.1111/j.1600-0609.2011.01730.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tan MP, Kenny RAM, Chadwick TJ, Kerr SRJ, Parry SW. Carotid sinus hypersensitivity: disease state or clinical sign of ageing? Insights from a controlled study of autonomic function in symptomatic and asymptomatic subjects. Europace 2010; 12:1630-6. [DOI: 10.1093/europace/euq317] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Costigan A, Elliott C, McDonald C, Newton JL. Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management. QJM 2010; 103:589-95. [PMID: 20534655 DOI: 10.1093/qjmed/hcq094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To establish the relationship between the functional impairment experienced by Chronic fatigue syndrome (CFS) patients and the symptoms frequently experienced by those with CFS; specifically cognitive impairment, fatigue and orthostatic symptoms. DESIGN Cross sectional questionnaire survey. SETTING Specialist CFS Clinical Service. SUBJECTS Ninety-nine Fukuda diagnosed CFS and 64-matched controls. MAIN OUTCOME MEASURES Symptom and functional assessment tools completed and returned by post included; PROMIS HAQ (Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire), CFQ (Cognitive Failures Questionnaire), FIS (Fatigue Impact Scale) and OGS (Orthostatic Grading Scale) assessment tools. RESULTS CFS patients experience greater functional impairment than controls [mean (95% CI) PROMIS HAQ scores CFS 36 (31-42) vs. controls 6 (2-10); P < 0.0001], especially in the functional domains of activities and reach. Poorer functional ability impairment is significantly associated with greater cognitive impairment (P = 0.0002, r = 0.4), fatigue (P < 0.0001, r = 0.5) and orthostatic symptoms (P < 0.0001, r = 0.6). However, only orthostatic symptoms (OGS) independently associated with functional impairment (beta = 0.4, P = 0.01). CONCLUSION Treatment of orthostatic symptoms in CFS has the potential to improve functional capacity and so improve quality of life.
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Affiliation(s)
- A Costigan
- NIHR Biomedical Research Centre in Ageing-Cardiovascular Theme, Newcastle University, Newcastle, UK
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Hollingsworth KG, Jones DEJ, Taylor R, Frith J, Blamire AM, Newton JL. Impaired cerebral autoregulation in primary biliary cirrhosis: implications for the pathogenesis of cognitive decline. Liver Int 2010; 30:878-85. [PMID: 20492494 DOI: 10.1111/j.1478-3231.2010.02259.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Cognitive impairment is recognised in the early stages of primary biliary cirrhosis (PBC). AIMS To determine the mechanisms that underlie the cognitive dysfunction that can occur in early-stage PBC, with a particular focus on the role of autonomic dysfunction and altered cerebral autoregulation. PATIENTS Early-stage PBC patients, and age- and sex-matched controls. INTERVENTIONS AND MAIN OUTCOME MEASURES Brain magnetic resonance imaging to determine the relationship between structural brain abnormalities (T(2)) and cerebral vasculature responsiveness assessed using the Valsalva manoeuvre. Dynamic assessment of cerebral vascular flow using transcranial Doppler was also performed in PBC subjects to derive the pulsatility index (a marker of cerebral resistance) and the autoregulatory slope index [ASI; ratio between the cerebral blood flow velocity and blood pressure (BP)]. RESULTS Cerebral resistance was increased (P=0.04), and cerebral autoregulation in response to the Valsalva was significantly impaired in the PBC group with markedly lower mean ASI values compared with the controls (7.8+/-7.0 vs -8.5+/-8.4; P=0.002). All controls had normal cerebral autoregulation compared with only 20% of the PBC group. Indicators of sympathetic failure (BP change between Valsalva phases III-IV and low-frequency heart rate variability) correlated with increasing globus pallidus (GP) T(2) values (P<0.05), beyond the effect of age. CONCLUSION This study demonstrates the presence of increased cerebral vascular resistance and abnormal cerebral autoregulation in PBC patients, and identifies a potentially important association between the degree of abnormality in structural changes in the GP. These findings suggest that organic brain injury in PBC is directly related to autonomic dysfunction.
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alpha-Synuclein pathology in the spinal cord autonomic nuclei associates with alpha-synuclein pathology in the brain: a population-based Vantaa 85+ study. Acta Neuropathol 2010; 119:715-22. [PMID: 20037761 DOI: 10.1007/s00401-009-0629-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 12/16/2009] [Accepted: 12/16/2009] [Indexed: 10/20/2022]
Abstract
In most subjects with Parkinson's disease and dementia with Lewy bodies, alpha-synuclein (alphaS) immunoreactive pathology is found not only in the brain but also in the autonomic nuclei of the spinal cord. However, neither has the temporal course of alphaS pathology in the spinal cord in relation to the brain progression been established, nor has the extent of alphaS pathology in the spinal cord been analyzed in population-based studies. Using immunohistochemistry, the frequency and distribution of alphaS pathology were assessed semiquantitatively in the brains and spinal cord nuclei of 304 subjects who were aged at least 85 in the population-based Vantaa 85+ study. alphaS pathology was common in the spinal cord; 102 (34%) subjects had classic alphaS pathology in the thoracic and/or sacral autonomic nuclei. Moreover, 134 (44%) subjects showed grain- or dot-like immunoreactivity in neuropil (mini-aggregates) without classic Lewy neurites or Lewy bodies (LBs). The latter type of alphaS accumulation is associated with age, but also the classic alphaS pathology was found more often in the oldest compared to the youngest age group. The severity of alphaS pathology in the spinal cord autonomic nuclei is significantly associated with the extent and severity of alphaS pathology in the brain. Of the subjects, 60% with moderate to severe thoracic alphaS pathology and up to 89% with moderate to severe sacral alphaS pathology had diffuse neocortical type of LB pathology in the brain. alphaS pathology exclusively in the spinal cord was rare. Our study indicates that in general alphaS pathology in the spinal cord autonomic nuclei is associated with similar pathology in the brain.
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Finucane C, Boyle G, Fan CW, Hade D, Byrne L, Kenny RA. Mayer wave activity in vasodepressor carotid sinus hypersensitivity. Europace 2010; 12:247-53. [DOI: 10.1093/europace/eup385] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Miller VM, Kenny RA, Oakley AE, Hall R, Kalaria RN, Allan LM. Dorsal Motor Nucleus of Vagus protein aggregates in Lewy Body Disease with autonomic dysfunction. Brain Res 2009; 1286:165-73. [DOI: 10.1016/j.brainres.2009.05.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 05/20/2009] [Accepted: 05/24/2009] [Indexed: 11/28/2022]
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Park WH, Kim SY, Park HG, Song DG, Kim TG, Min BY, Park JI. Carotid Sinus Syncope in an Elderly Patient With Unexplained Syncope. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.10.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Won Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Soo Yeun Kim
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Hyun Gyung Park
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Dae-Geun Song
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Tae Gyoon Kim
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Bo Young Min
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
| | - Joong-Il Park
- Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Center, Seoul Veterans Hospital, Seoul, Korea
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