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Lee LH, Wu SC, Ho CF, Liang WL, Liu YC, Chou CJ. White matter hyperintensities in cholinergic pathways may predict poorer responsiveness to acetylcholinesterase inhibitor treatment for Alzheimer's disease. PLoS One 2023; 18:e0283790. [PMID: 37000849 PMCID: PMC10065432 DOI: 10.1371/journal.pone.0283790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Acetylcholinesterase inhibitor (AChEI) drug regimens are the mainstay treatment options for patients with Alzheimer's disease (AD). Herein, We examined the association between clinical response to AChEI and white matter hyperintensities on magnetic resonance imaging (MRI) scan at baseline. METHODS Between 2020 and 2021, we recruited 101 individuals with a clinical diagnosis of probable AD. Each participant underwent complete neuropsychological testing and 3T (Telsa) brain magnetic resonance imaging. Responsiveness to AChEI, as assessed after 12 months, was designated as less than two points of regression in Mini-Mental State Examination scores (MMSE) and stable clinical dementia rating scale. We also evaluated MRI images by examining scores on the Cholinergic Pathways Hyperintensities Scale (CHIPS), Fazekas scale, and medial temporal atrophy (MTA) scale. RESULTS In our cohort, 52 patients (51.4%) were classified as responders. We observed significantly higher CHIPS scores in the nonresponder group (21.1 ± 12.9 vs. 14.9 ± 9.2, P = 0.007). Age at baseline, education level, sex, Clinical Dementia Rating sum of boxes scores, and three neuroimaging parameters were tested in regression models. Only CHIPS scores predicted clinical response to AChEI treatment. CONCLUSION WMHs in the cholinergic pathways, not diffuse white matter lesions or hippocampal atrophy, correlated with poorer responsiveness to AChEI treatment. Therefore, further investigation into the role of the cholinergic pathway in AD is warranted.
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Affiliation(s)
- Li-Hua Lee
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Shu-Ching Wu
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Cheng-Feng Ho
- Department of Radiology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Wan-Lin Liang
- Department of Medical Research, Far Eastern Hospital, New Taipei City, Taipei, Taiwan
| | - Yi-Chien Liu
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
- Department of Education and Research, Medical school of Fu-Jen University, New Taipei City, Taipei, Taiwan
- Geriatric Behavioral Neurology Project, Tohoku University New Industry Hatchery Center (NICHe), Sendai, Japan
- * E-mail:
| | - Chia-Ju Chou
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
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Pozzi FE, Conti E, Appollonio I, Ferrarese C, Tremolizzo L. Predictors of response to acetylcholinesterase inhibitors in dementia: A systematic review. Front Neurosci 2022; 16:998224. [PMID: 36203811 PMCID: PMC9530658 DOI: 10.3389/fnins.2022.998224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background The mainstay of therapy for many neurodegenerative dementias still relies on acetylcholinesterase inhibitors (AChEI); however, there is debate on various aspects of such treatment. A huge body of literature exists on possible predictors of response, but a comprehensive review is lacking. Therefore, our aim is to perform a systematic review of the predictors of response to AChEI in neurodegenerative dementias, providing a categorization and interpretation of the results. Methods We conducted a systematic review of the literature up to December 31st, 2021, searching five different databases and registers, including studies on rivastigmine, donepezil, and galantamine, with clearly defined criteria for the diagnosis of dementia and the response to AChEI therapy. Records were identified through the string: predict * AND respon * AND (acetylcholinesterase inhibitors OR donepezil OR rivastigmine OR galantamine). The results were presented narratively. Results We identified 1,994 records in five different databases; after exclusion of duplicates, title and abstract screening, and full-text retrieval, 122 studies were finally included. Discussion The studies show high heterogeneity in duration, response definition, drug dosage, and diagnostic criteria. Response to AChEI seems associated with correlates of cholinergic deficit (hallucinations, fluctuating cognition, substantia innominate atrophy) and preserved cholinergic neurons (faster alpha on REM sleep EEG, increased anterior frontal and parietal lobe perfusion after donepezil); white matter hyperintensities in the cholinergic pathways have shown inconsistent results. The K-variant of butyrylcholinesterase may correlate with better response in late stages of disease, while the role of polymorphisms in other genes involved in the cholinergic system is controversial. Factors related to drug availability may influence response; in particular, low serum albumin (for donepezil), CYP2D6 variants associated with reduced enzymatic activity and higher drug doses are the most consistent predictors, while AChEI concentration influence on clinical outcomes is debatable. Other predictors of response include faster disease progression, lower serum cholesterol, preserved medial temporal lobes, apathy, absence of concomitant diseases, and absence of antipsychotics. Short-term response may predict subsequent cognitive response, while higher education might correlate with short-term good response (months), and long-term poor response (years). Age, gender, baseline cognitive and functional levels, and APOE relationship with treatment outcome is controversial.
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Affiliation(s)
| | - Elisa Conti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Department, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Milan, Italy
| | - Carlo Ferrarese
- Neurology Department, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Milan, Italy
| | - Lucio Tremolizzo
- Neurology Department, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Milan, Italy
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Bentham C, De Marco M, Venneri A. Cerebrovascular Pathology and Responsiveness to Treatment in Alzheimer's Disease: A Systematic Review. Curr Alzheimer Res 2021; 18:103-124. [PMID: 33855943 DOI: 10.2174/1567205018666210414121227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 02/12/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Responsiveness to treatment with cholinesterase inhibitors (ChEIs) is difficult to predict in Alzheimer's disease (AD). In the current review, vascular burden is considered as a potential moderator of treatment responsiveness. Cerebrovascular burden co-occurs in at least 30% of AD brains, although it is debated if vascular pathology plays a causal or synergistic role in AD pathogenesis. Vascular burden, therefore, could potentially limit response to treatment due to limited brain reserve or foster treatment efficacy as those with vascular pathology may represent a subgroup with comparable clinical expression but less progressed AD neurodegeneration. METHODS A systematic search of Web of Science, Pubmed, Scopus and EthoS identified 32 papers which met the criteria for inclusion. Association of treatment response and vascular burden across five broad markers are discussed: cerebral hypoperfusion, intima-media thickness, white matter changes, cerebral microbleeds and co-existing diagnosis of cerebrovascular disease. RESULTS Analysis of frontal regional cerebral blood flow and intima-media thickness may have predictive ability to distinguish those with AD who may respond optimally to short-term treatment with ChEIs. The impact of white matter changes is less consistent; the majority of studies demonstrates no association with treatment response and those that do implicate changes in executive functioning. There is preliminary evidence that deep cerebral microbleeds limit treatment response in subcortical cognitive domains, but this finding requires replication. The use of diagnosis of co-occurring cerebrovascular disease yields no robust variability in response to ChEIs in AD. CONCLUSION There is limited evidence that markers of cerebral hypoperfusion, intima-media thickness and cerebral microbleeds moderate response to ChEIs. Findings for other markers of vascular burden are less consistent and do not support any moderating effect.
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Affiliation(s)
- Charlotte Bentham
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by the accumulation of amyloid β in the form of extracellular plaques and by intracellular neurofibrillary tangles, with eventual neurodegeneration and dementia. There is currently no disease-modifying treatment though several symptomatic medications exist with modest benefit on cognition. Acetylcholinesterase inhibitors have a consistent benefit across all stages of dementia; their benefit in mild cognitive impairment and prodromal AD is unproven. Memantine has a smaller benefit on cognition overall which is limited to the moderate to severe stages, and the combination of a cholinesterase inhibitor and memantine may have additional efficacy. Evidence for the efficacy of vitamin E supplementation and medical foods is weak but might be considered in the context of cost, availability, and safety in individual patients. Apparently promising disease-modifying interventions, mostly addressing the amyloid cascade hypothesis of AD, have recently failed to demonstrate efficacy so novel approaches must be considered.
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Affiliation(s)
- Elizabeth Joe
- Alzheimer Disease Research Center, Department of Neurology, Keck School of Medicine at USC, 1520 San Pablo Street Suite 3000, Los Angeles, CA 90033, USA
| | - John M Ringman
- Alzheimer Disease Research Center, Department of Neurology, Keck School of Medicine at USC, 1520 San Pablo Street Suite 3000, Los Angeles, CA 90033, USA
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Wu MN, Kao YH, Chou PS, Lin TC, Kao LL, Yang YH. Location of white matter changes and response to donepezil in patients with Alzheimer's disease: A retrospective and observational study. Geriatr Gerontol Int 2017; 18:123-129. [DOI: 10.1111/ggi.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/16/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Meng-Ni Wu
- Department of Neurology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Master's Program in Neurology, Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yi-Hui Kao
- Department of Neurology; National Taiwan University Hospital Yun-Lin Branch; Yun-Lin Taiwan
| | - Ping-Song Chou
- Department of Neurology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Master's Program in Neurology, Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Tzu-Chao Lin
- Department of Neurology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Lin-Li Kao
- Department of Neurology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Yuan-Han Yang
- Department of Neurology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Master's Program in Neurology, Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
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Park KW, Kim EJ, Han HJ, Shim YS, Kwon JC, Ku BD, Park KH, Yi HA, Kim KK, Yang DW, Lee HW, Kang H, Kwon OD, Kim S, Lee JH, Chung EJ, Park SW, Park MY, Yoon B, Kim BC, Seo SW, Choi SH. Efficacy and tolerability of rivastigmine patch therapy in patients with mild-to-moderate Alzheimer's dementia associated with minimal and moderate ischemic white matter hyperintensities: A multicenter prospective open-label clinical trial. PLoS One 2017; 12:e0182123. [PMID: 28786987 PMCID: PMC5546604 DOI: 10.1371/journal.pone.0182123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/12/2017] [Indexed: 12/04/2022] Open
Abstract
Background and objective Studies investigating the impact of white matter hyperintensities (WMHs) on the response of acetylcholinesterase inhibitors in patients with Alzheimer’s disease (AD) have presented inconsistent results. We aimed to compare the effects of the rivastigmine patch between patients with AD with minimal WMHs and those with moderate WMHs. Methods Three hundred patients with mild to moderate AD were enrolled in this multicenter prospective open-label study and divided into two groups. Group 1 comprised patients with AD with minimal WMHs and group 2 comprised those with moderate WMHs. The patients were treated with a rivastigmine patch for 24 weeks. Efficacy measures were obtained at baseline and after 24 weeks. The primary endpoint was the change in the AD Assessment Scale-Cognitive subscale (ADAS-Cog) from the baseline to the end of the study. Results Of the 300 patients, there were 206 patients in group 1 and 94 patients in group 2. The intention-to-treat group comprised 198 patients (group 1, n = 136; group 2, n = 46) during the 24-week study period. Demographic factors did not differ between group 1 and group 2. There were no significant differences in change in ADAS-cog between group 1 (-0.62±5.70) and group 2 (-0.23±5.98) after the 24-week rivastigmine patch therapy (p = 0.378). The patients in group 1 had a 0.63-point improvement from baseline on the Frontal Assessment Battery, while group 2 had a 0.16-point decline compared to baseline at the end of the study (p = 0.037). The rates of adverse events (AEs) (42.6 vs. 40.3%) and discontinuation due to AEs (10.3% vs. 4.3%) did not differ between the groups. Conclusions Although the efficacy and tolerability of rivastigmine patch therapy were not associated with WMH severity in patients with AD, some improvement in frontal function was observed in those with minimal WMHs. Trial registration ClinicalTrials.gov NCT01380288
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Affiliation(s)
- Kyung Won Park
- Department of Neurology, Cognitive Disorders and Dementia Center, Dong-A University College of Medicine and Institute of Convergence Bio-Health, Busan, South Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital and Biomedical Research Institute, Pusan National University School of Medicine, Busan, South Korea
| | - Hyun Jeong Han
- Department of Neurology, Seonam University College of Medicine, Myongji Hospital, Goyang, South Korea
| | - Yong S. Shim
- Department of Neurology, Holy Family Hospital, The Catholic University of Korea, School of Medicine, Bucheon, South Korea
| | - Jae C. Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, South Korea
| | - Bon D. Ku
- Department of Neurology, Catholic Kwandong University College of Medicine, Gangneung, South Korea
| | - Kee Hyung Park
- Department of Neurology, Gachon University Gil Hospital, Incheon, South Korea
| | - Hyon-Ah Yi
- Department of Neurology, Keimyung University College of Medicine, Daegu, South Korea
| | - Kwang K. Kim
- Department of Neurology, Dongguk University College of Medicine, Seoul, South Korea
| | - Dong Won Yang
- Department of Neurology, The Catholic University of Korea, School of Medicine, Seoul, South Korea
| | - Ho-Won Lee
- Department of Neurology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Heeyoung Kang
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Oh Dae Kwon
- Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae-Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Eun Joo Chung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sang-Won Park
- Department of Neurology, Daegu Fatima Hospital, Daegu, South Korea
| | - Mee Young Park
- Department of Neurology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, South Korea
| | - Byeong C. Kim
- Department of Neurology, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
- * E-mail:
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Ho BL, Kao YH, Chou MC, Yang YH. Cerebral White Matter Changes on Therapeutic Response to Rivastigmine in Alzheimer’s Disease. J Alzheimers Dis 2016; 54:351-7. [DOI: 10.3233/jad-160364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bo-Lin Ho
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hui Kao
- Department of Neurology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Mei-Chuan Chou
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of and Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kimura N, Nakama H, Nakamura K, Aso Y, Kumamoto T. Relationship between White Matter Lesions and Progression of Cognitive Decline in Alzheimer's Disease. Dement Geriatr Cogn Dis Extra 2013; 3:96-101. [PMID: 23637702 PMCID: PMC3638977 DOI: 10.1159/000350317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study examined the relationship between baseline white matter lesions (WMLs) and the progression of cognitive decline in patients with late-onset Alzheimer's disease (AD). METHODS Fifty-six patients with AD were included in the study (23 men, 33 women; mean age, 77.8 years). All subjects were treated with acetylcholinesterase inhibitors and followed up for approximately 1 year. The Mini-Mental State Examination (MMSE) score was assessed at least twice to evaluate the progressive cognitive impairment. All subjects underwent brain MRI at baseline and were divided into WMLs(-), mild WMLs(+), and moderate WMLs(+) groups based on WML severity. Changes in MMSE scores between baseline and follow-up were analyzed using the Wilcoxon signed-rank test. RESULTS MMSE scores at baseline did not differ significantly among the three groups (p = 0.1658), whereas MMSE scores at the follow-up evaluation were significantly lower in the moderate WMLs(+) group than in the WMLs(-) group (p = 0.0257). The mean MMSE scores remained above baseline values during the approximately 1-year follow-up in the WMLs(-) group, whereas they were decreased in the mild and moderate WMLs(+) groups. Moreover, the frequency of improvement in patients from the WMLs(-) group tended to be higher than that in patients from the WMLs(+) groups. CONCLUSION Baseline WMLs may be associated with the heterogeneous progression of cognitive decline in patients with AD.
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Affiliation(s)
- Noriyuki Kimura
- Department of Neurology and Neuromuscular Disorders, Oita University, Faculty of Medicine, Oita, Japan
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Amyloid deposition after cerebral hypoperfusion: Evidenced on [18F]AV-45 positron emission tomography. J Neurol Sci 2012; 319:124-9. [DOI: 10.1016/j.jns.2012.04.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 03/21/2012] [Accepted: 04/13/2012] [Indexed: 11/24/2022]
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Stopa EG, Butala P, Salloway S, Johanson CE, Gonzalez L, Tavares R, Hovanesian V, Hulette CM, Vitek MP, Cohen RA. Cerebral Cortical Arteriolar Angiopathy, Vascular Beta-Amyloid, Smooth Muscle Actin, Braak Stage, and
APOE
Genotype. Stroke 2008; 39:814-21. [DOI: 10.1161/strokeaha.107.493429] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Edward G. Stopa
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Parag Butala
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Stephen Salloway
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Conrad E. Johanson
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Liliana Gonzalez
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Rosemarie Tavares
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Virginia Hovanesian
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Christine M. Hulette
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Michael P. Vitek
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
| | - Ronald A. Cohen
- From the Departments of Pathology (E.G.S., P.B., R.T., V.H.), Psychiatry and Human Behavior (S.S., R.A.C.), and Clinical Neurosciences (E.G.S., S.S., C.E.J.), Warren Alpert Medical School of Brown University, Providence, RI; the Department of Computer Science and Statistics (L.G.), University of Rhode Island, Kingston, RI; and Departments of Medicine (Neurology Division) and Pathology (Neuropathology Division) (C.M.H., M.P.V.), Bryan Alzheimer Disease Research Center, Duke University School of
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Hayashi M, Adachi Y, Mori M, Nakano T, Nakashima K. Clinical and genetic epidemiological study of 16q22.1-linked autosomal dominant cerebellar ataxia in western Japan. Acta Neurol Scand 2007; 116:123-7. [PMID: 17661799 DOI: 10.1111/j.1600-0404.2007.00815.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Autosomal dominant cerebellar ataxia (ADCA) is a heterogeneous neurodegenerative disorder. A single nucleotide substitution in the puratrophin-1 gene is associated with 16q22.1-linked ADCA showing pure cerebellar ataxia. We screened patients with spinocerebellar degeneration (SCD) to investigate the frequency and clinical features of 16q22.1-linked ADCA. MATERIALS AND METHODS We examined 91 SCD patients from a 1998 community-based prevalence study of Tottori Prefecture in western Japan. We also analyzed samples from 176 patients with SCD collected from a 1996 to 2006 laboratory-based study. RESULTS In the community-based study, the prevalence of spinocerebellar ataxia 6 (SCA6) and 16q22.1-linked ADCA was 2.4 and 1.12 per 100,000 individuals, respectively. In the laboratory-based study, the frequency of SCA6 and 16q22.1-linked ADCA was 28% and 17%, respectively. We found two cases of 16q22.1-linked ADCA among 26 SCD patients with no family history. CONCLUSION In this area in Japan, 16q22.1-linked ADCA was the second most common type of hereditary SCD.
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Affiliation(s)
- M Hayashi
- Department of Neurology, Faculty of Medicine, Institute of Neurological Sciences, Tottori University, Yonago, Japan.
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Abstract
Consistent with the worldwide demographic trend of population aging, dementia is expected to become a burgeoning public health problem in Asian populations. Thus, there is a pressing need for reliable and valid methods of dementia diagnosis and staging that are applicable in heterogeneous Asian populations. The Clinical Dementia Rating (CDR) is an informant-based global assessment scale with established reliability and validity that has been widely utilized as a severity-ranking scale in many studies of Asian populations. From a diagnostic standpoint, the CDR is congruent with the Diagnostic and Statistical Manual of Mental Disorders approach of dementia diagnosis. It exhibits excellent discriminatory ability in the very mild stages of dementia, a useful property that is germane to the surging interest in mild cognitive impairment and related concepts. Limitations of the CDR include its length of administration, reliance on clinical judgment and collateral source information, and relative insensitivity as a measure of change in interventional studies. Since the exercise of clinical judgment is inherent in scoring, CDR raters should be mindful of the influence of cultural factors on premorbid lifestyle, informant reliability and performance in certain CDR test items (especially those pertaining to the categories of judgment and problem solving, community, and home and hobbies). Thus, in future studies that involve the nascent use of the CDR in Asian populations, it is recommended that any transcultural adaptation of CDR items be described in detail and appropriate validation studies be carried out before adopting the CDR as a yardstick measure of assessment. The potential of adapted versions of the CDR in chronic care settings and advanced cases should be explored. An integrative approach, combining brief informant interview in conjunction with brief objective cognitive testing, could be a viable strategy for dementia screening in the clinical and research setting that warrants further evaluation in Asian populations.
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Affiliation(s)
- Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Fukui T, Hieda S, Bocti C. Do lesions involving the cortical cholinergic pathways help or hinder efficacy of donepezil in patients with Alzheimer's disease? Dement Geriatr Cogn Disord 2007; 22:421-31. [PMID: 16974095 DOI: 10.1159/000095801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2006] [Indexed: 11/19/2022] Open
Abstract
AIMS To investigate the influences of vascular lesions detected by MRI, lesions involving the cortical cholinergic pathways and hippocampal thickness on therapeutic responsiveness to donepezil in patients with Alzheimer's disease (AD). METHODS The study cohort contained 67 patients with probable AD. We used the revised Hasegawa Dementia Rating (HDS-R) and the Clock Drawing Test (CDT) to evaluate drug efficacy for 24 months. The Cholinergic Pathways Hyperintensities Scale (CHIPS), a newly developed visual scale, was used to semiquantify lesions on the cholinergic pathways. RESULTS Over the 24-month period, the results of the CDT showed more apparent and constant association with white matter hyperintensities (WMH) and lesions on the cholinergic pathways than the HDS-R. WMH may enhance, while lesions on the cholinergic pathways may attenuate sensitivity to donepezil treatment when judged by the CDT. No apparent association between the thicknesses of hippocampi with baseline cognition or therapeutic responsiveness to donepezil was found. CONCLUSION Donepezil may be more efficacious when further executive dysfunction caused by WMH is added to AD dementia and less so when cholinergic reserves are further impinged upon by lesions involving the cortical cholinergic pathways.
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Affiliation(s)
- Toshiya Fukui
- Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan.
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