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Yang J, Gao Y, Duan Q, Qiu Y, Feng S, Zhan C, Huang Y, Zhang Y, Ma G, Nie K, Wang L. Renin-angiotensin system blockers affect cognitive decline in Parkinson's disease: The PPMI dataset. Parkinsonism Relat Disord 2022; 105:90-95. [PMID: 36395543 DOI: 10.1016/j.parkreldis.2022.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the potential clinical effects of renin-angiotensin system blocker (RASB, angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs)) in patients from the Parkinson's Progress Marker Initiative (PPMI) study database. METHODS One hundred and seven untreated, newly diagnosed PD patients with hypertension, from the PPMI were included. We measured cognitive performance, biomarkers in CSF, and magnetic resonance imaging (MRI) during the five follow-up years for patients exposed or not to renal-angiotensin system blockers. Sixteen PD patients with hypertension underwent [18F]florbetaben positron emission tomography (PET) scanning. SUVRs of region of interest (ROI) were calculated and compared within different groups. RESULT Treatment with ARBs but not ACEIs improved global cognitive function evaluated by MoCA score in PD patients with hypertension compared to other hypertensive medicines up to 5 years follow up. Specifically, ARBs improved visuospatial, memory, executive abilities, processing speed attention test scores in PD. There was no significant impact of ARBs on α-syn, tau, Aβ in CSF. RASBs reduced [18F] florbetaben uptake in cortex and subcortex nuclei in the brain. CONCLUSIONS These results show potential protective effect with ARBs in cognitive impairment of parkinson's disease with hypertension.
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Affiliation(s)
- Jianhua Yang
- The Second School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China; Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China; Department of Neurology, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Yuyuan Gao
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Qingrui Duan
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Yihui Qiu
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Shujun Feng
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Cuijing Zhan
- The Second School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China; Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Yin Huang
- The Second School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China; Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Guixian Ma
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Kun Nie
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Lijuan Wang
- The Second School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China; Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Culig L, Chu X, Bohr VA. Neurogenesis in aging and age-related neurodegenerative diseases. Ageing Res Rev 2022; 78:101636. [PMID: 35490966 PMCID: PMC9168971 DOI: 10.1016/j.arr.2022.101636] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
Abstract
Adult neurogenesis, the process by which neurons are generated in certain areas of the adult brain, declines in an age-dependent manner and is one potential target for extending cognitive healthspan. Aging is a major risk factor for neurodegenerative diseases and, as lifespans are increasing, these health challenges are becoming more prevalent. An age-associated loss in neural stem cell number and/or activity could cause this decline in brain function, so interventions that reverse aging in stem cells might increase the human cognitive healthspan. In this review, we describe the involvement of adult neurogenesis in neurodegenerative diseases and address the molecular mechanistic aspects of neurogenesis that involve some of the key aggregation-prone proteins in the brain (i.e., tau, Aβ, α-synuclein, …). We summarize the research pertaining to interventions that increase neurogenesis and regulate known targets in aging research, such as mTOR and sirtuins. Lastly, we share our outlook on restoring the levels of neurogenesis to physiological levels in elderly individuals and those with neurodegeneration. We suggest that modulating neurogenesis represents a potential target for interventions that could help in the fight against neurodegeneration and cognitive decline.
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Affiliation(s)
- Luka Culig
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Xixia Chu
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Vilhelm A Bohr
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
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Höglinger G, Schulte C, Jost WH, Storch A, Woitalla D, Krüger R, Falkenburger B, Brockmann K. GBA-associated PD: chances and obstacles for targeted treatment strategies. J Neural Transm (Vienna) 2022; 129:1219-1233. [PMID: 35639160 PMCID: PMC9463270 DOI: 10.1007/s00702-022-02511-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/01/2022] [Indexed: 11/08/2022]
Abstract
Given the clear role of GBA in the pathogenesis of Parkinson’s disease (PD) and its impact on phenotypical characteristics, this review provides an overview of the current knowledge of GBA-associated PD with a special focus on clinical trajectories and the underlying pathological mechanisms. Importantly, differences and characteristics based on mutation severity are recognized, and current as well as potential future treatment options are discussed. These findings will inform future strategies for patient stratification and cohort enrichment as well as suitable outcome measures when designing clinical trials.
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Affiliation(s)
- Günter Höglinger
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Claudia Schulte
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, Center of Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | | | - Alexander Storch
- Department of Neurology, Rostock University, Gehlsheimer Str. 20, 18147, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany
| | - Rejko Krüger
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.,Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Parkinson Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Björn Falkenburger
- Department of Neurology, Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, Center of Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany. .,German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany.
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Masilamoni GJ, Weinkle A, Papa SM, Smith Y. Cortical Serotonergic and Catecholaminergic Denervation in MPTP-Treated Parkinsonian Monkeys. Cereb Cortex 2021; 32:1804-1822. [PMID: 34519330 DOI: 10.1093/cercor/bhab313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 11/14/2022] Open
Abstract
Decreased cortical serotonergic and catecholaminergic innervation of the frontal cortex has been reported at early stages of Parkinson's disease (PD). However, the limited availability of animal models that exhibit these pathological features has hampered our understanding of the functional significance of these changes during the course of the disease. In the present study, we assessed longitudinal changes in cortical serotonin and catecholamine innervation in motor-symptomatic and asymptomatic monkeys chronically treated with low doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Densitometry and unbiased stereological techniques were used to quantify changes in serotonin and tyrosine hydroxylase (TH) immunoreactivity in frontal cortices of 3 control monkeys and 3 groups of MPTP-treated monkeys (motor-asymptomatic [N = 2], mild parkinsonian [N = 3], and moderate parkinsonian [N = 3]). Our findings revealed a significant decrease (P < 0.001) in serotonin innervation of motor (Areas 4 and 6), dorsolateral prefrontal (Areas 9 and 46), and limbic (Areas 24 and 25) cortical areas in motor-asymptomatic MPTP-treated monkeys. Both groups of symptomatic MPTP-treated animals displayed further serotonin denervation in these cortical regions (P < 0.0001). A significant loss of serotonin-positive dorsal raphe neurons was found in the moderate parkinsonian group. On the other hand, the intensity of cortical TH immunostaining was not significantly affected in motor asymptomatic MPTP-treated monkeys, but underwent a significant reduction in the moderate symptomatic group (P < 0.05). Our results indicate that chronic intoxication with MPTP induces early pathology in the corticopetal serotonergic system, which may contribute to early non-motor symptoms in PD.
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Affiliation(s)
- Gunasingh Jeyaraj Masilamoni
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Udall Center of Excellence for Parkinson's Disease, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Allison Weinkle
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Stella M Papa
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Yoland Smith
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Udall Center of Excellence for Parkinson's Disease, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
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Chang Z, Zou H, Xie Z, Deng B, Que R, Huang Z, Weng G, Wu Z, Pan Y, Wang Y, Li M, Xie H, Zhu S, Xiong L, Ct Mok V, Jin K, Yenari MA, Wei X, Wang Q. Cystatin C is a potential predictor of unfavorable outcomes for cerebral ischemia with intravenous tissue plasminogen activator treatment: A multicenter prospective nested case-control study. Eur J Neurol 2020; 28:1265-1274. [PMID: 33277774 DOI: 10.1111/ene.14663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/12/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to explore whether cystatin C (CysC) could be used as a potential predictor of clinical outcomes in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA). METHODS We performed an observational study including a retrospective analysis of data from 125 AIS patients with intravenous thrombolysis. General linear models were applied to compare CysC levels between groups with different outcomes; logistic regression analysis and receiver-operating characteristic curves were adopted to identify the association between CysC and the therapeutic effects. RESULTS Compared with the "good and sustained benefit" (GSB) outcome group (defined as ≥4-point reduction in National Institutes of Health Stroke Scale or a score of 0-1 at 24 h and 7 days) and the "good functional outcome" (GFO) group (modified Rankin Scale score 0-2 at 90 days), serum CysC baseline levels were increased in the non-GSB and non-GFO groups. Logistic regression analysis found that CysC was an independent negative prognostic factor for GSB (odds ratio [OR] 0.010; p = 0.005) and GFO (OR 0.011; p = 0.021) after adjustment for potential influencing factors. Receiver-operating characteristic curves showed the CysC-involved combined models provided credible efficacy for predicting post-90-day favorable clinical outcome (area under the curve 0.86; p < 0.001). CONCLUSIONS Elevated serum CysC is independently associated with unfavorable clinical outcomes after IV-tPA therapy in AIS. Our findings provide new insights into discovering potential mediators for neuropathological process or treatment in stroke.
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Affiliation(s)
- Zihan Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Haiqiang Zou
- Department of Neurology, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Zhenchao Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Rongfang Que
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Zifeng Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Guomei Weng
- Department of Neurology, 1st People Hospital of Zhaoqing, Zhaoqing, China
| | - Zhihuan Wu
- Department of Neurology, 1st People Hospital of Zhaoqing, Zhaoqing, China
| | - Ying Pan
- Department of Neurology, the 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanping Wang
- Department of Neurology, the 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou, China
| | - Huifang Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Li Xiong
- Department of Medicine and Therapeutics, Faculty of Medicine, Gerald Choa Neuroscience Centre, Prince of Wales hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent Ct Mok
- Department of Medicine and Therapeutics, Faculty of Medicine, Gerald Choa Neuroscience Centre, Prince of Wales hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kunlin Jin
- Department of Neurology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Midori A Yenari
- Department of Neurology, San Francisco & the San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Xiaobo Wei
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Brockmann K. GBA-Associated Synucleinopathies: Prime Candidates for Alpha-Synuclein Targeting Compounds. Front Cell Dev Biol 2020; 8:562522. [PMID: 33102473 PMCID: PMC7545538 DOI: 10.3389/fcell.2020.562522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022] Open
Abstract
With disease-modifying compounds targeting alpha-synuclein available in clinical trials, patient stratification according to alpha-synuclein-specific enrichment strategies is a much-needed prerequisite. Such a scenario will be exemplified for GBA, one major genetic risk factor that is specifically associated with the alpha-synucleinopathies: Parkinson's disease and dementia with Lewy bodies.
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Affiliation(s)
- Kathrin Brockmann
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Disease (DZNE), Bonn, Germany
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Prell T, Witte OW, Grosskreutz J. Biomarkers for Dementia, Fatigue, and Depression in Parkinson's Disease. Front Neurol 2019; 10:195. [PMID: 30906277 PMCID: PMC6418014 DOI: 10.3389/fneur.2019.00195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/15/2019] [Indexed: 12/26/2022] Open
Abstract
Parkinson's disease is a common multisystem neurodegenerative disorder characterized by typical motor and non-motor symptoms. There is an urgent need for biomarkers for assessment of disease severity, complications and prognosis. In addition, biomarkers reporting the underlying pathophysiology assist in understanding the disease and developing neuroprotective therapies. Ultimately, biomarkers could be used to develop a more efficient personalized approach for clinical trials and treatment strategies. With the goal to improve quality of life in Parkinson's disease it is essential to understand and objectively monitor non-motor symptoms. This narrative review provides an overview of recent developments of biomarkers (biofluid samples and imaging) for three common neuropsychological syndromes in Parkinson's disease: dementia, fatigue, and depression.
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Affiliation(s)
- Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Julian Grosskreutz
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
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Kotagal V, Spino C, Bohnen NI, Koeppe RA, Albin RL. Serotonin, β-amyloid, and cognition in Parkinson disease. Ann Neurol 2018; 83:994-1002. [PMID: 29665066 PMCID: PMC6021203 DOI: 10.1002/ana.25236] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/15/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Serotoninergic neurotransmission may modulate β-amyloid peptide (Aβ) metabolism through upregulation of α-secretase. Early Parkinson disease (PD) shows variable serotoninergic denervation, which may impact Aβ deposition. METHODS We conducted 3 analyses to explore associations between serotoninergic neurotransmission and cerebral Aβ burden in PD. The first was a cross-sectional imaging study of PD subjects (n = 23) using the serotoninergic transporter positron emission tomography (PET) ligand [11 C]3-amino-4-(2-dimethylaminomethyl-phenylsulfaryl)-benzonitrile (DASB) and amyloid PET Pittsburgh compound B ([11 C]PiB). The second was a baseline study of Parkinson's Progression Markers Initiative (PPMI) subjects exploring the influence of serotoninergic medications on cerebrospinal fluid (CSF) Aβ-42 levels (n = 389), controlling for age, sex, Geriatric Depression Scale, disease duration, and education. Third, we fit an interval censored proportional hazard model with longitudinal PPMI data (n = 367) to test whether serotoninergic medication use associates with reduced risk of PD cognitive decline, defined as time to reach a Montreal Cognitive Assessment score ≤ 20, adjusting for baseline caudate dopamine transporter [123 I]ioflupane single photon emission computed tomography and CSF Aβ-42 levels. RESULTS Serotoninergic DASB distribution volume ratio (DVR) inversely associated with PiB DVR in the cerebral cortex (Pearson r = -0.478, p = 0.021) but not the striatum (r = -0.264, p = 0.224). In the baseline PPMI analysis, serotoninergic medication use for ≥6 months associated with a lower level of CSF Aβ-42 (t = -2.20, p = 0.029). In the longitudinal PPMI model, baseline serotoninergic medication use associated with a reduced risk of cognitive decline (t = -2.03, p = 0.043) after controlling for covariates. INTERPRETATION Cortical Aβ burden in PD associates inversely with serotoninergic innervation. Serotoninergic medications may alter Aβ metabolism and reduce the risk of PD cognitive decline. Ann Neurol 2018;83:994-1002.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Health System (VAAAHS), Ann Arbor, Michigan
| | - Cathie Spino
- University of Michigan Morris K. Udall Center of Excellence for Parkinson’s Disease Research, Ann Arbor, MI
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Health System (VAAAHS), Ann Arbor, Michigan
- University of Michigan Morris K. Udall Center of Excellence for Parkinson’s Disease Research, Ann Arbor, MI
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI
| | - Robert A. Koeppe
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Health System (VAAAHS), Ann Arbor, Michigan
- University of Michigan Morris K. Udall Center of Excellence for Parkinson’s Disease Research, Ann Arbor, MI
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