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Sobierajska-Rek A, Jabłońska-Brudło J, Dąbrowska A, Wojnicz W, Meyer-Szary J, Wierzba J. Timed rolling and rising tests in Duchenne muscular dystrophy ambulant boys: a feasibility study. Minerva Pediatr (Torino) 2024; 76:208-216. [PMID: 38639735 DOI: 10.23736/s2724-5276.21.05977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Functional activities are extensively used in motor assessments of patients with Duchenne muscular dystrophy. The role of timed items has been reported as an early prognostic factor for disease progression. However, there are two functional activities that are not widely assessed in clinical practice among Duchenne muscular dystrophy patients: rolling and bed rising. This study aimed to investigate whether the 360-degree roll (roll) and supine to sit-to-edge (bed rise) measurements are feasible tools reflecting the functional status of ambulatory DMD children by establishing possible correlations between validated measures: the Vignos Scale (VS), timed rise from floor and the 6-Minute Walk Test (6MWT). METHODS A total of 32 ambulant boys with DMD were assessed using timed items, the 6MWT and VS. RESULTS The roll and bed rise are correlated with each other. The 6MWT, the floor rise and VS are correlated with the roll and with the bed rise. CONCLUSIONS Findings offer preliminary empirical evidence addressing feasibility and safety of roll and bed rise measurements. There is a potential clinical utility of these tests in assessing functional status of DMD ambulant patients.
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Affiliation(s)
- Agnieszka Sobierajska-Rek
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland -
| | - Joanna Jabłońska-Brudło
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Aneta Dąbrowska
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Wiktoria Wojnicz
- Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gdansk, Poland
| | - Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, Gdansk, Poland
| | - Jolanta Wierzba
- Department of Pediatric and Internal Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
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Arreguin AJ, Shao Z, Colognato H. Dmd mdx mice have defective oligodendrogenesis, delayed myelin compaction and persistent hypomyelination. Dis Model Mech 2024; 17:dmm050115. [PMID: 38721692 PMCID: PMC11095635 DOI: 10.1242/dmm.050115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
Duchenne muscular dystrophy (DMD) is caused by mutations in the DMD gene, resulting in the loss of dystrophin, a large cytosolic protein that links the cytoskeleton to extracellular matrix receptors in skeletal muscle. Aside from progressive muscle damage, many patients with DMD also have neurological deficits of unknown etiology. To investigate potential mechanisms for DMD neurological deficits, we assessed postnatal oligodendrogenesis and myelination in the Dmdmdx mouse model. In the ventricular-subventricular zone (V-SVZ) stem cell niche, we found that oligodendrocyte progenitor cell (OPC) production was deficient, with reduced OPC densities and proliferation, despite a normal stem cell niche organization. In the Dmdmdx corpus callosum, a large white matter tract adjacent to the V-SVZ, we also observed reduced OPC proliferation and fewer oligodendrocytes. Transmission electron microscopy further revealed significantly thinner myelin, an increased number of abnormal myelin structures and delayed myelin compaction, with hypomyelination persisting into adulthood. Our findings reveal alterations in oligodendrocyte development and myelination that support the hypothesis that changes in diffusion tensor imaging seen in patients with DMD reflect developmental changes in myelin architecture.
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Affiliation(s)
- Andrea J. Arreguin
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794, USA
- Medical Scientist Training Program (MSTP), Stony Brook University, Stony Brook, NY 11794-8651, USA
| | - Zijian Shao
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794, USA
| | - Holly Colognato
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794, USA
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3
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Gregg J, Wilson C, Curran D, Hanna D. Neurocognitive functioning among children and young people with Duchenne Muscular Dystrophy: A systematic review and meta-analysis. Clin Neuropsychol 2024:1-28. [PMID: 38509463 DOI: 10.1080/13854046.2024.2324500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
Objective: The neurocognitive aspects of DMD have received less attention than the physiological sequalae. This study conducted a systematic review and meta-analysis of available literature on the neurocognitive profile of children and young people with DMD. Method: Five databases (EMBASE, Medline, PsycInfo, Scopus and Web of Science) and the grey literature was searched on 27th January 2023. Eligible articles were available in English and reported neurocognitive outcomes. Neurocognitive domains reported in a comparable way across a minimum of three studies were included. The neurocognitive domains of Full-Scale IQ (FSIQ), Verbal IQ (VIQ), Performance IQ (PIQ) and Working memory (WMI) derived from Wechsler scales and receptive vocabulary ability derived from the Peabody Picture Verbal Test (PPVT) were included. A single mean meta-analysis was completed. Results: Relevant data was extracted and presented for 38 eligible studies; 2 of which are from grey literature. Results suggest children with DMD perform around 1SD below non-clinical norms for FSIQ, PIQ, VIQ and WMI. Unlike VIQ, scores derived from the PPVT were within the non-clinical norms. Studies were of moderate - high quality, there was significant heterogeneity and no publication bias. Conclusion: A systematic review of working memory has not previously been completed, it appears that children with DMD perform around 1SD below the mean, like FSIQ, PIQVIQ and WMI. The PPVT is a measure of receptive verbal ability and caution is recommended around the interchangeability of PPVT scores and the wider construct of verbal intelligence.
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Affiliation(s)
- Jayne Gregg
- Regional Neurosciences, Royal Victoria Hospital
| | - Colin Wilson
- Regional Acquired Brain Injury Unit, Musgrave Park Hospital, Belfast HSC Trust
| | - David Curran
- School of Psychology, Queens University Belfast/Northern HSC Trust
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4
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Maki H, Mori-Yoshimura M, Matsuda H, Hashimoto Y, Ota M, Kimura Y, Shigemoto Y, Ishihara N, Kan H, Chiba E, Arizono E, Yoshida S, Takahashi Y, Sato N. Brain Abnormalities in Becker Muscular Dystrophy: Evaluation by Voxel-Based DTI and Morphometric Analysis. AJNR Am J Neuroradiol 2023; 44:1405-1410. [PMID: 37945525 PMCID: PMC10714854 DOI: 10.3174/ajnr.a8041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND PURPOSE Although various neuropsychological problems in Becker muscular dystrophy have attracted attention, there have been few related neuroimaging studies. We investigated brain abnormalities in patients with Becker muscular dystrophy using 3D T1WI and DTI. MATERIALS AND METHODS MR images were obtained for 30 male patients and 30 age-matched healthy male controls. We classified patients into Dp140+ and Dp140- subgroups based on their predicted dystrophin Dp140 isoform expression and performed voxel-based comparisons of gray and white matter volumes and DTI metrics among the patients, patient subgroups, and controls. ROI-based DTI analyses were also performed. RESULTS Significantly decreased fractional anisotropy was observed in the left planum temporale and right superior parietal lobule compared between the Becker muscular dystrophy and control groups. In the Dp140- subgroup, decreased fractional anisotropy was observed in the left planum temporale, but no significant changes were seen in the Dp140+ subgroup. The ROI-based analysis obtained the same results. No significant differences were evident in the gray or white matter volumes or the DTI metrics other than fractional anisotropy between the groups. CONCLUSIONS A DTI metric analysis is useful to detect white-matter microstructural abnormalities in Becker muscular dystrophy that may be affected by the Dp140 isoform expression.
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Affiliation(s)
- Hiroyuki Maki
- From the Department of Radiology (H. Maki, Y.K., Y.S., E.C., E.A., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Madoka Mori-Yoshimura
- Department of Neurology (M.M.-Y., Y.T.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Matsuda
- Department of Biofunctional Imaging (H. Matsuda), Fukushima Medical University, Fukushima, Japan
| | - Yasumasa Hashimoto
- Department of Neurology (Y.H.), Kansai Medical University, Osaka, Japan
- Department of Molecular Therapy (Y.H.), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Department of Neuropsychiatry (M.O.), University of Tsukuba, Ibaraki, Japan
| | - Yukio Kimura
- From the Department of Radiology (H. Maki, Y.K., Y.S., E.C., E.A., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Shigemoto
- From the Department of Radiology (H. Maki, Y.K., Y.S., E.C., E.A., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoko Ishihara
- Medical Genome Center (N.I., S.Y.), National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hirohito Kan
- Department of Integrated Health Sciences (H.K.), Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Emiko Chiba
- From the Department of Radiology (H. Maki, Y.K., Y.S., E.C., E.A., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Elly Arizono
- From the Department of Radiology (H. Maki, Y.K., Y.S., E.C., E.A., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Sumiko Yoshida
- Medical Genome Center (N.I., S.Y.), National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatric Rehabilitation (S.Y.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology (M.M.-Y., Y.T.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- From the Department of Radiology (H. Maki, Y.K., Y.S., E.C., E.A., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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5
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Thangarajh M, McDermott MP, Guglieri M, Griggs RC. Association between neurodevelopmental impairments and motor function in Duchenne muscular dystrophy. Ann Clin Transl Neurol 2023; 10:2285-2296. [PMID: 37804000 PMCID: PMC10723228 DOI: 10.1002/acn3.51914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/13/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE We explored various prognostic factors of motor outcomes in corticosteroid-naive boys with Duchenne Muscular Dystrophy (DMD). METHODS The associations between parent-reported neurodevelopmental concerns (speech delay, speech and language difficulties (SLD), and learning difficulties), DMD mutation location, and motor outcomes (6-minute walk distance (6MWD), North Star Ambulatory Assessment (NSAA) total score, 10-meter walk/run velocity, and rise from floor velocity) were studied in 196 corticosteroid-naive boys from ages 4 to less than 8 years. RESULTS Participants with SLD walked 25.8 fewer meters in 6 minutes than those without SLD (p = 0.005) but did not demonstrate statistical differences in NSAA total score, 10-meter walk/run velocity, and rise from floor velocity. Participants with distal DMD mutations with learning difficulties walked 51.8 fewer meters in 6 minutes than those without learning difficulties (p = 0.0007). Participants with distal DMD mutations were slower on 10-meter walk/run velocity, and rise from floor velocity (p = 0.02) than those with proximal DMD mutations. Participants with distal DMD mutations, who reported speech delay or learning difficulties, were slower on rise from floor velocity (p = 0.04, p = 0.01) than those with proximal DMD mutations. The mean NSAA total score was lower in participants with learning difficulties than in those without (p = 0.004). INTERPRETATION Corticosteroid-naive boys with DMD with distal DMD mutations may perform worse on some timed function tests, and that those with learning difficulties may perform worse on the NSAA. Pending confirmatory studies, our data underscore the importance of considering co-existing neurodevelopmental symptoms on motor outcome measures.
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Affiliation(s)
- Mathula Thangarajh
- Department of NeurologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Michael P. McDermott
- University of Rochester Medical CenterSchool of Medicine and DentistryRochesterNew YorkUSA
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals National Health Service Foundation TrustNewcastleUK
| | - Robert C. Griggs
- University of Rochester Medical CenterSchool of Medicine and DentistryRochesterNew YorkUSA
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6
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Hellebrekers DMJ, Wirken JMA, Lionarons JM, van Kuijk SMJ, Klinkenberg S, Vles JSH, Hendriksen JGM. Computerized working memory training in males with Duchenne muscular dystrophy: A single case experimental design study. Neuropsychol Rehabil 2023; 33:1325-1348. [PMID: 35876193 DOI: 10.1080/09602011.2022.2096080] [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: 07/03/2020] [Accepted: 06/24/2022] [Indexed: 10/16/2022]
Abstract
Learning disabilities (LDs) and working memory problems (WM) are common brain-related comorbidities in Duchenne muscular dystrophy (DMD). Despite growing evidence on the efficacy of computerized WM training in children with LDs, research in DMD is lacking. This exploratory study assessed whether training (1) improves dystrophin-associated WM problems in DMD, (2) effects are present at post-intervention, 3 and 8 months follow-up, and (3) improves problems that arise from their LDs. A single case non-concurrent multiple baseline across patients design evaluated the target behaviour i.e. parental reports of WM problems of four DMD participants with LDs. Additionally, participants completed cognitive tests of verbal and visual WM, academics, attention, processing speed and fluid reasoning. Parents and teachers completed behavioural questionnaires. Testing and questionnaires were administered at baseline, post-intervention (T2), 3 (T3) and 8 (T4) months follow-up. Positive effects on target behaviour were found for three of four participants, but parental bias cannot be ruled out. Short and long-term, near-and far transfer effects were found for verbal and visual WM (T2:n = 2, T3&T4:n = 1), reading (T2:n = 4,T3:n = 3,T4:n = 2), arithmetic (all T:n = 1), processing speed (all T:n = 4) and fluid reasoning (T2:n = 1,T3&T4:n = 2). Behavioural questionnaires displayed minimal changes (T2:n = 1,T3&T4:n = 2). Promising WM training results are shown in DMD that merit further research.
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Affiliation(s)
- Danique M J Hellebrekers
- Centre for Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jose M A Wirken
- Centre for Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
| | - Judith M Lionarons
- Centre for Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sylvia Klinkenberg
- Centre for Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Johan S H Vles
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jos G M Hendriksen
- Centre for Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Dutch Duchenne Centre, Leiden, The Netherlands
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7
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Pascual-Morena C, Cavero-Redondo I, Álvarez-Bueno C, Jiménez-López E, Saz-Lara A, Martínez-García I, Martínez-Vizcaíno V. Global prevalence of intellectual developmental disorder in dystrophinopathies: A systematic review and meta-analysis. Dev Med Child Neurol 2022; 65:734-744. [PMID: 36440509 DOI: 10.1111/dmcn.15481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/16/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
AIM To estimate the global prevalence of intellectual developmental disorder (IDD) and the IDD prevalence-genotype association in Becker muscular dystrophy (BMD) or Duchenne muscular dystrophy (DMD) according to the affected isoforms of the DMD gene: Dp427, Dp140, Dp71. METHOD Systematic searches in MEDLINE, Scopus, Web of Science, and the Cochrane Library were conducted from inception of each database to March 2022. Observational studies that determined the prevalence of IDD in the population with BMD or DMD were included. Meta-analyses of IDD prevalence and prevalence ratios of the IDD-genotype association were conducted. RESULTS Forty-nine studies were included. The prevalence of IDD in BMD was 8.0% (95% confidence interval 5.0-11.0), and in DMD it was 22.0% (18.0-27.0). Meta-analyses of IDD-genotype association showed a deleterious association between IDD and the number of isoforms affected in DMD, with a prevalence ratio = 0.43 (0.28-0.64) and 0.17 (0.09-0.34) for Dp140+ /Dp71+ versus Dp140- /Dp71+ and Dp140+ /Dp71+ versus Dp140- /Dp71- comparisons respectively. However, in BMD, there was no association for Dp140+ /Dp71+ versus Dp140- /Dp71+ . INTERPRETATION There is a high prevalence of IDD in BMD and DMD. Moreover, the number of isoforms affected is strongly and negatively associated with the prevalence of IDD in DMD.
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Affiliation(s)
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Estela Jiménez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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8
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Barboni MTS, Joachimsthaler A, Roux MJ, Nagy ZZ, Ventura DF, Rendon A, Kremers J, Vaillend C. Retinal dystrophins and the retinopathy of Duchenne muscular dystrophy. Prog Retin Eye Res 2022:101137. [DOI: 10.1016/j.preteyeres.2022.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
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9
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Language Development in Preschool Duchenne Muscular Dystrophy Boys. Brain Sci 2022; 12:brainsci12091252. [PMID: 36138988 PMCID: PMC9497138 DOI: 10.3390/brainsci12091252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND the present study aims to assess language in preschool-aged Duchenne muscular dystrophy (DMD) boys with normal cognitive quotients, and to establish whether language difficulties are related to attentional aspects or to the involvement of brain dystrophin isoforms. METHODS 20 children aged between 48 and 72 months were assessed with language and attention assessments for preschool children. Nine had a mutation upstream of exon 44, five between 44 and 51, four between 51 and 63, and two after exon 63. A control group comprising 20 age-matched boys with a speech language disorder and normal IQ were also used. RESULTS lexical and syntactic comprehension and denomination were normal in 90% of the boys with Duchenne, while the articulation and repetition of long words, and sentence repetition frequently showed abnormal results (80%). Abnormal results were also found in tests assessing selective and sustained auditory attention. Language difficulties were less frequent in patients with mutations not involving isoforms Dp140 and Dp71. The profile in Duchenne boys was different form the one observed in SLI with no cognitive impairment. CONCLUSION The results of our observational cross-sectional study suggest that early language abilities are frequently abnormal in preschool Duchenne boys and should be assessed regardless of their global neurodevelopmental quotient.
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10
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Kreko-Pierce T, Pugh JR. Altered Synaptic Transmission and Excitability of Cerebellar Nuclear Neurons in a Mouse Model of Duchenne Muscular Dystrophy. Front Cell Neurosci 2022; 16:926518. [PMID: 35865113 PMCID: PMC9294606 DOI: 10.3389/fncel.2022.926518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is generally regarded as a muscle-wasting disease. However, human patients and animal models of DMD also frequently display non-progressive cognitive deficits and high comorbidity with neurodevelopmental disorders, suggesting impaired central processing. Previous studies have identified the cerebellar circuit, and aberrant inhibitory transmission in Purkinje cells, in particular, as a potential site of dysfunction in the central nervous system (CNS). In this work, we investigate potential dysfunction in the output of the cerebellum, downstream of Purkinje cell (PC) activity. We examined synaptic transmission and firing behavior of excitatory projection neurons of the cerebellar nuclei, the primary output of the cerebellar circuit, in juvenile wild-type and mdx mice, a common mouse model of DMD. Using immunolabeling and electrophysiology, we found a reduced number of PC synaptic contacts, but no change in postsynaptic GABAA receptor expression or clustering in these cells. Furthermore, we found that the replenishment rate of synaptic vesicles in Purkinje terminals is reduced in mdx neurons, suggesting that dysfunction at these synapses may be primarily presynaptic. We also found changes in the excitability of cerebellar nuclear neurons. Specifically, we found greater spontaneous firing but reduced evoked firing from a hyperpolarized baseline in mdx neurons. Analysis of action potential waveforms revealed faster repolarization and greater after-hyperpolarization of evoked action potentials in mdx neurons, suggesting an increased voltage- or calcium- gated potassium current. We did not find evidence of dystrophin protein or messenger RNA (mRNA) expression in wild-type nuclear neurons, suggesting that the changes observed in these cells are likely due to the loss of dystrophin in presynaptic PCs. Together, these data suggest that the loss of dystrophin reduces the dynamic range of synaptic transmission and firing in cerebellar nuclear neurons, potentially disrupting the output of the cerebellar circuit to other brain regions and contributing to cognitive and neurodevelopmental deficits associated with DMD.
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Affiliation(s)
- Tabita Kreko-Pierce
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jason R. Pugh
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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11
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Rocha CT, Escolar DM. Treatment and Management of Muscular Dystrophies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Specht S, Straub V. Intellectual disability in paediatric patients with genetic muscle diseases. Neuromuscul Disord 2021; 31:988-997. [PMID: 34736636 DOI: 10.1016/j.nmd.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022]
Abstract
The differential diagnosis of genetic muscle disease has become increasingly difficult due to the rapid progress in genetic medicine in recent years. Where classifications based on the clinical picture were attributed to one gene only a few years ago, today we know that a variety of clinical presentations can result from the same mutation and, conversely, various genes are associated with a similar phenotype. A significant consideration in assessing a patient with muscle weakness is the presence or absence of intellectual disability, thus narrowing the differential diagnostic approach in any child with an as yet undiagnosed muscle disease. Intellectual disability in neuromuscular diseases is often associated with behavioural disorders and may be correlated with abnormal brain imaging. Conversely, brain involvement can sometimes be seen without intellectual disability, but may be associated with an epilepsy risk and is helpful for the differential diagnosis. This review focuses on the three most common causes of paediatric muscle diseases with intellectual disability, dystrophinopathies, myotonic dystrophy type 1 and dystroglycanopathies. It also summarises differential diagnostic considerations when assessing a child with a genetic muscle disease and intellectual disability. The recent scientific literature on this topic is reviewed, the frequency of intellectual disability assessed, and specific clinical features are described. Where available, data on disease onset, progression and serum creatine kinase levels are presented and the pattern of muscle involvement described in an algorithm. Central nervous involvement and brain imaging analysis was reviewed and included.
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Affiliation(s)
- Sabine Specht
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle, UK.
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13
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Battini R, Lenzi S, Lucibello S, Chieffo D, Moriconi F, Cristofani P, Bulgheroni S, Cumbo F, Pane M, Baranello G, Alfieri P, Astrea G, Cioni G, Vicari S, Mercuri E. Longitudinal data of neuropsychological profile in a cohort of Duchenne muscular dystrophy boys without cognitive impairment. Neuromuscul Disord 2021; 31:319-327. [PMID: 33658162 DOI: 10.1016/j.nmd.2021.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 12/18/2022]
Abstract
The aim of the study was to re-assess neuropsychological profile in a group of boys with Duchenne muscular dystrophy without intellectual disability and neuropsychiatric disorder three years apart from a previous evaluation, to establish possible changes over time. We were also interested in defining more in detail correlation between genotype and neuropsychological phenotype. Thirty-three of the previous 40 subjects (mean age at follow up: 10 years and 7 months) agreed to participate in the follow up study and to perform the new assessment. The results confirm a typical neuropsychological profile, with difficulty in the manipulation of stored information, poor abstract reasoning and planning capacity and impulsiveness, supporting the involvement of a cerebellar striatal cortical network for these children. The more detailed description of subgroups of subjects, according to the real expression of Dp140, let to reveal possible genotype-neuropsychological phenotype correlations, and a more general neuropsychological impairment emerged in boys without Dp140 expression.
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Affiliation(s)
- R Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 341/ ABC, Calambrone, Pisa 56128, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Savi10, 56126 Pisa, Italy.
| | - S Lenzi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 341/ ABC, Calambrone, Pisa 56128, Italy
| | - S Lucibello
- Pediatric Neurology Unit, Catholic University and Nemo Center, Policlinico Universitario Gemelli Largo Agostino Gemelli, 8. Rome, Italy
| | - D Chieffo
- Pediatric Neurology Unit, Catholic University and Nemo Center, Policlinico Universitario Gemelli Largo Agostino Gemelli, 8. Rome, Italy
| | - F Moriconi
- Pediatric Neurology Unit, Catholic University and Nemo Center, Policlinico Universitario Gemelli Largo Agostino Gemelli, 8. Rome, Italy
| | - P Cristofani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 341/ ABC, Calambrone, Pisa 56128, Italy
| | - S Bulgheroni
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
| | - F Cumbo
- Child and Adolescent Neuropsychiatry Unit, Department of Neurological and Psychiatric Science, IRCCS Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio, 4. Rome 00165, Italy
| | - M Pane
- Pediatric Neurology Unit, Catholic University and Nemo Center, Policlinico Universitario Gemelli Largo Agostino Gemelli, 8. Rome, Italy
| | - G Baranello
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy
| | - P Alfieri
- Child and Adolescent Neuropsychiatry Unit, Department of Neurological and Psychiatric Science, IRCCS Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio, 4. Rome 00165, Italy
| | - G Astrea
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 341/ ABC, Calambrone, Pisa 56128, Italy
| | - G Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 341/ ABC, Calambrone, Pisa 56128, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Savi10, 56126 Pisa, Italy
| | - S Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neurological and Psychiatric Science, IRCCS Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio, 4. Rome 00165, Italy; Department of Life Sciences and Public Health, Catholic University, Largo Agostino Gemelli, 8, Rome, Italy
| | - E Mercuri
- Pediatric Neurology Unit, Catholic University and Nemo Center, Policlinico Universitario Gemelli Largo Agostino Gemelli, 8. Rome, Italy
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Hendriksen JGM, Thangarajh M, Kan HE, Muntoni F. 249th ENMC International Workshop: The role of brain dystrophin in muscular dystrophy: Implications for clinical care and translational research, Hoofddorp, The Netherlands, November 29th-December 1st 2019. Neuromuscul Disord 2020; 30:782-794. [PMID: 32912717 DOI: 10.1016/j.nmd.2020.08.357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Jos G M Hendriksen
- Kempenhaeghe Center For Neurological Learning Disabilities, Heeze, the Netherlands; Duchenne Center, the Netherlands
| | - Mathula Thangarajh
- Department of Neurology, Virginia Commonwealth University, Richmond, USA
| | - Hermien E Kan
- Duchenne Center, the Netherlands; C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre, University College London, Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Thangarajh M, Elfring GL, Trifillis P. Longitudinal Evaluation of Working Memory in Duchenne Muscular Dystrophy. J Clin Med 2020; 9:jcm9092940. [PMID: 32933029 PMCID: PMC7563441 DOI: 10.3390/jcm9092940] [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: 05/26/2020] [Revised: 07/16/2020] [Accepted: 09/02/2020] [Indexed: 01/16/2023] Open
Abstract
Objective: The developmental maturation of forward and backward digit spans—indices of working memory—in boys with nonsense (nm) Duchenne muscular dystrophy (DMD) (nmDMD) was assessed using prospective, longitudinal data. Methods: Fifty-five boys of the 57 subjects with genetically confirmed nmDMD—who were from the placebo arm of a 48-week-long phase 2b clinical trial—were evaluated. Forward and backward digit spans were obtained every 12 weeks for a total of five assessments in all study subjects. Changes in forward and backward digit spans were evaluated based on age, corticosteroid treatment, and DMD mutation location. Results: Boys with nmDMD had lower mean scores on normalized forward digit span. Normalized forward digit spans were comparable between subjects stratified by age and between corticosteroid-naïve and corticosteroid-treated subjects. When stratified by DMD mutation location, normalized forward digit spans were lower in nmDMD subjects with mutations downstream of DMD exon 30, exon 45, and exon 63, both at baseline evaluation and at follow-up evaluation at 48 weeks. On average, normalized backward digit span scores were stable over 48 weeks in these subjects. Developmental growth modeling showed that subjects with nmDMD mutations upstream of DMD exon 30, upstream of DMD exon 45, and upstream of DMD exon 63 appeared to make better gains in working memory than subjects with mutations downstream of DMD exon 30, downstream of DMD exon 45, and downstream of DMD exon 63. Conclusion: Performance in working memory shows deficits in nmDMD and differed based on nmDMD location. Maturation in cognition was seen over a 48-week period. The developmental trajectory of working memory in this cohort was influenced by DMD mutation location.
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Affiliation(s)
- Mathula Thangarajh
- Department of Neurology, Virginia Commonwealth University, 1101 East Marshall Street, P.O. Box 980599, Richmond, VA 23298, USA
- Correspondence: ; Tel.: +1-804-628-0396
| | - Gary L. Elfring
- PTC Therapeutics Inc., South Plainfield, NJ 07080, USA; (G.L.E.); (P.T.)
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16
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Demirci H, Durmus H, Toksoy G, Uslu A, Parman Y, Hanagasi H. Cognition of the mothers of patients with Duchenne muscular dystrophy. Muscle Nerve 2020; 62:710-716. [PMID: 32893363 DOI: 10.1002/mus.27057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/22/2022]
Abstract
Duchenne muscular dystrophy (DMD) has been found to be associated with cognitive impairment. However, few studies have addressed cognitive impairment among mothers of children with DMD. In the present study, the neuropsychological profiles of both carrier mothers (C-Ms) and noncarrier mothers (NC-Ms) were examined, and the findings were compared with healthy control mothers (HC-Ms). There were 90 participants, consisting of 31 C-Ms, 24 NC-Ms, and 35 HC-Ms, each of whom completed a neuropsychological test battery. C-Ms had poorer cognition performance in attention, working memory, immediate verbal memory, visuospatial skills, and executive functions than NC-Ms, and HC-Ms. This study provides evidence that there may be cognitive impairment in mothers of patients with DMD. The cognitive impairment of C-Ms has similarities to that seen in children with DMD.
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Affiliation(s)
- Hasan Demirci
- Department of Psychiatry, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hacer Durmus
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atilla Uslu
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yesim Parman
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Interleukin-6: A neuro-active cytokine contributing to cognitive impairment in Duchenne muscular dystrophy? Cytokine 2020; 133:155134. [DOI: 10.1016/j.cyto.2020.155134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
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Tyagi R, Aggarwal P, Mohanty M, Dutt V, Anand A. Computational cognitive modeling and validation of Dp140 induced alteration of working memory in Duchenne Muscular Dystrophy. Sci Rep 2020; 10:11989. [PMID: 32686699 PMCID: PMC7371893 DOI: 10.1038/s41598-020-68381-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/10/2020] [Indexed: 12/26/2022] Open
Abstract
Duchenne Muscular Dystrophy has emerged as a model to assess cognitive domains. The DMD gene variant location and its association with variable degrees of cognitive impairment necessitate identification of a common denominator. Computer architectures provide a framework to delineate the mechanisms involved in the cognitive functioning of the human brain. Copy number variations in the 79 exons of DMD gene were screened in 84 DMD subjects by Multiplex Ligation-dependent Probe Amplification (MLPA). DMD subjects were categorized based on the presence or absence of DP140 isoform. The cognitive and neuropsychological assessments were carried out as per inclusion criteria using standard scales. Instance-based learning theory (IBLT) based on the partial matching process was developed to mimic Stroop Color and Word Task (SCWT) performance on Adaptive Control of Thought-Rational (ACT-R) cognitive architecture based on IBLT. Genotype-phenotype correlation was conducted based on the mutation location in DMD gene. Assessment of specific cognitive domains in DP140 - ve group corresponded to the involvement of multiple brain lobes including temporal (verbal and visual learning and memory), parietal (visuo-conceptual and visuo-constructive abilities) and frontal (sustained and focused attention, verbal fluency, cognitive control). Working memory axis was found to be the central domain through tasks including RAVLT trial 1, recency effect, digit span backward, working memory index, arithmetic subtests in the Dp140 - ve group. IBLT validated the non-reliance of DMD subjects on recency indicating affected working memory domain. Modeling strategy revealed altered working memory processes in DMD cases with affected Dp140 isoform. DMD brain was observed to rely on primacy than the recency suggesting alterations in working memory capacity. Modeling revealed lowered activation of DMD brain with Dp140 - ve in order to retrieve the instances.
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Affiliation(s)
- Rahul Tyagi
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Palvi Aggarwal
- Indian Institute of Technology, Mandi, Himachal Pradesh, India
| | - Manju Mohanty
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dutt
- Indian Institute of Technology, Mandi, Himachal Pradesh, India
| | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Preethish-Kumar V, Shah A, Kumar M, Ingalhalikar M, Polavarapu K, Afsar M, Rajeswaran J, Vengalil S, Nashi S, Thomas PT, Sadasivan A, Warrier M, Nalini A, Saini J. In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI. AJNR Am J Neuroradiol 2020; 41:1271-1278. [PMID: 32616576 DOI: 10.3174/ajnr.a6604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Duchenne muscular dystrophy is an X-linked disorder characterized by progressive muscle weakness and prominent nonmotor manifestations, such as a low intelligence quotient and neuropsychiatric disturbance. We investigated WM integrity in patients with Duchenne muscular dystrophy using DTI. MATERIALS AND METHODS Fractional anisotropy and mean, axial, and radial diffusivity (DTI measures) were used to assess WM microstructural integrity along with neuropsychological evaluation in patients with Duchenne muscular dystrophy (n = 60) and controls (n = 40). Exon deletions in the DMD gene were confirmed using multiplex ligation-dependent probe amplification. Patients were classified into proximal (DMD Dp140+) and distal (DMD Dp140-) subgroups based on the location of the exon deletion and expression of short dystrophin Dp140 isoform. WM integrity was examined using whole-brain Tract-Based Spatial Statistics and atlas-based analysis of DTI data. The Pearson correlation was performed to investigate the possible relationship between neuropsychological scores and DTI metrics. RESULTS The mean ages of Duchenne muscular dystrophy and control participants were 8.0 ± 1.2 years and 8.2 ± 1.4 years, respectively. The mean age at disease onset was 4.1 ± 1.8 years, and mean illness duration was 40.8 ± 25.2 months. Significant differences in neuropsychological scores were observed between the proximal and distal gene-deletion subgroups, with more severe impairment in the distal-deletion subgroup (P < .05). Localized fractional anisotropy changes were seen in the corpus callosum, parietal WM, and fornices in the patient subgroup with Dp140+, while widespread changes were noted in the Dp140- subgroup. The Dp140+ subgroup showed increased axial diffusivity in multiple WM regions relative to the Dp140- subgroup. No significant correlation was observed between clinical and neuropsychological scores and diffusion metrics. CONCLUSIONS Widespread WM differences are evident in patients with Duchenne muscular dystrophy relative to healthy controls. Distal mutations in particular are associated with extensive WM abnormalities and poor neuropsychological profiles.
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Affiliation(s)
| | - A Shah
- Symbiosis Centre for Medical Image Analysis (A.Shah, M.I.), Symbiosis International University, Mulshi Pune, Maharashtra, India
| | - M Kumar
- Neuroimaging and Interventional Radiology (M.K., J.S.)
| | - M Ingalhalikar
- Symbiosis Centre for Medical Image Analysis (A.Shah, M.I.), Symbiosis International University, Mulshi Pune, Maharashtra, India
| | - K Polavarapu
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - M Afsar
- Neuropsychology (M.A., J.R.)
| | | | - S Vengalil
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - S Nashi
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - P T Thomas
- Psychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Sadasivan
- Psychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M Warrier
- Psychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Nalini
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - J Saini
- Neuroimaging and Interventional Radiology (M.K., J.S.)
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20
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Peristeri E, Aloizou AM, Keramida P, Tsouris Z, Siokas V, Mentis AFA, Dardiotis E. Cognitive Deficits in Myopathies. Int J Mol Sci 2020; 21:ijms21113795. [PMID: 32471196 PMCID: PMC7312055 DOI: 10.3390/ijms21113795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023] Open
Abstract
Myopathies represent a wide spectrum of heterogeneous diseases mainly characterized by the abnormal structure or functioning of skeletal muscle. The current paper provides a comprehensive overview of cognitive deficits observed in various myopathies by consulting the main libraries (Pubmed, Scopus and Google Scholar). This review focuses on the causal classification of myopathies and concomitant cognitive deficits. In most studies, cognitive deficits have been found after clinical observations while lesions were also present in brain imaging. Most studies refer to hereditary myopathies, mainly Duchenne muscular dystrophy (DMD), and myotonic dystrophies (MDs); therefore, most of the overview will focus on these subtypes of myopathies. Most recent bibliographical sources have been preferred.
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Affiliation(s)
- Eleni Peristeri
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece; (E.P.); (A.-M.A.); (P.K.); (Z.T.); (V.S.)
| | - Athina-Maria Aloizou
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece; (E.P.); (A.-M.A.); (P.K.); (Z.T.); (V.S.)
| | - Paraskevi Keramida
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece; (E.P.); (A.-M.A.); (P.K.); (Z.T.); (V.S.)
| | - Zisis Tsouris
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece; (E.P.); (A.-M.A.); (P.K.); (Z.T.); (V.S.)
| | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece; (E.P.); (A.-M.A.); (P.K.); (Z.T.); (V.S.)
| | - Alexios-Fotios A. Mentis
- Public Health Laboratories, Hellenic Pasteur Institute, PC 11521 Athens, Greece;
- Department of Microbiology, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, PC 41110 Larissa, Greece; (E.P.); (A.-M.A.); (P.K.); (Z.T.); (V.S.)
- Correspondence: ; Tel.:+ 30-241-350-1137
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Doorenweerd N. Combining genetics, neuropsychology and neuroimaging to improve understanding of brain involvement in Duchenne muscular dystrophy - a narrative review. Neuromuscul Disord 2020; 30:437-442. [PMID: 32522501 DOI: 10.1016/j.nmd.2020.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Abstract
Duchenne muscular dystrophy is a multifactorial disease including a cognitive phenotype. It is caused by mutations in the X-chromosomal DMD gene from which dystrophin is synthesized. Multiple isoforms of dystrophin have been identified. The full length dystrophin isoform Dp427m is expressed predominantly in muscle. Other isoforms include: Dp427c, Dp427p, Dp260, Dp140, Dp116, Dp71 and Dp40. The majority of these isoforms are expressed in brain and several hypotheses exist on their role in subtypes of neurons and astrocytes. However, their function in relation to cognition remains unclear. Unlike progressive muscle wasting, cognitive involvement is not seen in all DMD patients and the severity varies greatly. To achieve a better understanding of brain involvement in DMD, a multidisciplinary approach is required. Here, we review the latest findings on dystrophin isoform expression in the brain; specific DMD-associated learning and behavioural difficulties; and imaging and spectroscopy findings relating to brain structure, networks, perfusion and metabolism. The main challenge lies in determining links between these different findings. If we can determine which factors play a role in the differentiation between severe and minor cognitive problems in DMD in the near future, we can both provide better advise for the patients and also develop targeted therapeutic interventions.
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Affiliation(s)
- Nathalie Doorenweerd
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, C-03-Q, P.O. Box 9600, 2300 RC Leiden, The Netherlands; John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom.
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22
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Caudal D, François V, Lafoux A, Ledevin M, Anegon I, Le Guiner C, Larcher T, Huchet C. Characterization of brain dystrophins absence and impact in dystrophin-deficient Dmdmdx rat model. PLoS One 2020; 15:e0230083. [PMID: 32160266 PMCID: PMC7065776 DOI: 10.1371/journal.pone.0230083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022] Open
Abstract
Duchenne Muscular Dystrophy (DMD) is a severe muscle-wasting disease caused by mutations in the DMD gene encoding dystrophin, expressed mainly in muscles but also in other tissues like retina and brain. Non-progressing cognitive dysfunction occurs in 20 to 50% of DMD patients. Furthermore, loss of expression of the Dp427 dystrophin isoform in the brain of mdx mice, the most used animal model of DMD, leads to behavioral deficits thought to be linked to insufficiencies in synaptogenesis and channel clustering at synapses. Mdx mice where the locomotor phenotype is mild also display a high and maladaptive response to stress. Recently, we generated Dmdmdx rats carrying an out-of frame mutation in exon 23 of the DMD gene and exhibiting a skeletal and cardiac muscle phenotype similar to DMD patients. In order to evaluate the impact of dystrophin loss on behavior, we explored locomotion parameters as well as anhedonia, anxiety and response to stress, in Dmdmdx rats aged from 1.5 to 7 months, in comparison to wild-type (WT) littermates. Pattern of dystrophin expression in the brain of WT and Dmdmdx rats was characterized by western-blot analyses and immunohistochemistry. We showed that dystrophin-deficient Dmdmdx rats displayed motor deficits in the beam test, without association with depressive or anxiety-like phenotype. However, Dmdmdx rats exhibited a strong response to restraint-induced stress, with a large increase in freezings frequency and duration, suggesting an alteration in a functional circuit including the amygdala. In brain, large dystrophin isoform Dp427 was not expressed in mutant animals. Dmdmdx rat is therefore a good animal model for preclinical evaluations of new treatments for DMD but care must be taken with their responses to mild stress.
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Affiliation(s)
- Dorian Caudal
- Therassay Platform, CAPACITES, Université de Nantes, Nantes, France
- * E-mail:
| | - Virginie François
- Nantes Gene Therapy Laboratory, Université de Nantes, INSERM UMR 1089, Nantes, France
| | - Aude Lafoux
- Therassay Platform, CAPACITES, Université de Nantes, Nantes, France
| | | | | | - Caroline Le Guiner
- Nantes Gene Therapy Laboratory, Université de Nantes, INSERM UMR 1089, Nantes, France
| | | | - Corinne Huchet
- Therassay Platform, CAPACITES, Université de Nantes, Nantes, France
- Nantes Gene Therapy Laboratory, Université de Nantes, INSERM UMR 1089, Nantes, France
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Hellebrekers DMJ, Doorenweerd N, Sweere DJJ, van Kuijk SMJ, Aartsma-Rus AM, Klinkenberg S, Vles JSH, Hendriksen JGM. Longitudinal follow-up of verbal span and processing speed in Duchenne muscular dystrophy. Eur J Paediatr Neurol 2020; 25:120-126. [PMID: 31964551 DOI: 10.1016/j.ejpn.2020.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
Neurocognitive deficits are frequently described in Duchenne muscular dystrophy (DMD), but it is unknown how these progress over time. Our aim was to longitudinally assess verbal span capacity and information processing speed in DMD and to explore a genotype-phenotype relation. Verbal span and processing speed scores were available of 28 males with DMD on two time-points, with a mean time interval of 28.34 months (SD = 16.09). The cohort contained of six patients missing only dystrophin isoform Dp427, sixteen missing Dp427 and Dp140, and six were undeterminable. A lower verbal span capacity was found at the first and second assessment, whereas processing speed was normal at both time-points. Post-hoc analyses suggested lower scores on verbal span and processing speed for patients missing Dp427 and Dp140. In DMD, a developmental stagnation in verbal span capacity, irrespective of normal processing speed, is detected through longitudinal follow-up. This appears more pronounced in patients missing Dp427 and Dp140.
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Affiliation(s)
- Danique M J Hellebrekers
- Kempenhaeghe, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Nathalie Doorenweerd
- Department of Radiology, Leiden University Medical Centre, the Netherlands; John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Dirk J J Sweere
- Kempenhaeghe, Centre for Neurological Learning Disabilities, Heeze, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessments, Maastricht University Medical Centre, the Netherlands
| | | | - Sylvia Klinkenberg
- Kempenhaeghe, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre, the Netherlands
| | - Johan S H Vles
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jos G M Hendriksen
- Kempenhaeghe, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands.
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Naidoo M, Anthony K. Dystrophin Dp71 and the Neuropathophysiology of Duchenne Muscular Dystrophy. Mol Neurobiol 2020; 57:1748-1767. [PMID: 31836945 PMCID: PMC7060961 DOI: 10.1007/s12035-019-01845-w] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022]
Abstract
Duchenne muscular dystrophy (DMD) is caused by frameshift mutations in the DMD gene that prevent the body-wide translation of its protein product, dystrophin. Besides a severe muscle phenotype, cognitive impairment and neuropsychiatric symptoms are prevalent. Dystrophin protein 71 (Dp71) is the major DMD gene product expressed in the brain and mutations affecting its expression are associated with the DMD neuropsychiatric syndrome. As with dystrophin in muscle, Dp71 localises to dystrophin-associated protein complexes in the brain. However, unlike in skeletal muscle; in the brain, Dp71 is alternatively spliced to produce many isoforms with differential subcellular localisations and diverse cellular functions. These include neuronal differentiation, adhesion, cell division and excitatory synapse organisation as well as nuclear functions such as nuclear scaffolding and DNA repair. In this review, we first describe brain involvement in DMD and the abnormalities observed in the DMD brain. We then review the gene expression, RNA processing and functions of Dp71. We review genotype-phenotype correlations and discuss emerging cellular/tissue evidence for the involvement of Dp71 in the neuropathophysiology of DMD. The literature suggests changes observed in the DMD brain are neurodevelopmental in origin and that their risk and severity is associated with a cumulative loss of distal DMD gene products such as Dp71. The high risk of neuropsychiatric syndromes in Duchenne patients warrants early intervention to achieve the best possible quality of life. Unravelling the function and pathophysiological significance of dystrophin in the brain has become a high research priority to inform the development of brain-targeting treatments for Duchenne.
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Affiliation(s)
- Michael Naidoo
- Centre for Physical Activity and Life Sciences, Faculty of Arts, Science and Technology, University of Northampton, University Drive, Northampton, Northamptonshire, NN1 5PH, UK
| | - Karen Anthony
- Centre for Physical Activity and Life Sciences, Faculty of Arts, Science and Technology, University of Northampton, University Drive, Northampton, Northamptonshire, NN1 5PH, UK.
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Thangarajh M, Kaat AJ, Bibat G, Mansour J, Summerton K, Gioia A, Berger C, Hardy KK, Wagner KR. The NIH Toolbox for cognitive surveillance in Duchenne muscular dystrophy. Ann Clin Transl Neurol 2019; 6:1696-1706. [PMID: 31472009 PMCID: PMC6764624 DOI: 10.1002/acn3.50867] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a prospective, cross-sectional cognitive assessment in subjects with Duchenne Muscular Dystrophy (DMD) and their biological mothers. METHODS Thirty subjects with out-of-frame mutations in the dystrophin (DMD) gene, and 25 biological mothers were evaluated using the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB). A parent completed the Behavior Rating Inventory of Executive Functioning (BRIEF), a standardized rating scale of executive functioning, for their child. Mothers completed self-reports of BRIEF and Neuro Quality-of-Life (NeuroQoL) Cognitive Function. RESULTS Overall, the subjects with DMD scored approximately one standard deviation (SD) below age-corrected norms on the NIHTB-CB Total Cognition score. They scored 1.5 SD below age-corrected norms in Fluid Cognition, which evaluates the cognitive domains of executive function, working memory, episodic memory, attention, and processing speed. Their performance was consistent with age expectations (i.e., within 1 SD below age-corrected norms) in Crystalized Cognition, which evaluates vocabulary and reading. Subjects with DMD had higher T-scores in several domains of BRIEF, demonstrating greater difficulty in executive functioning. The biological mothers had overall average or above average T-scores on NIHTB-CB. Mothers who were carriers of DMD mutation performed lower overall compared to mothers who were not carriers of DMD mutation (Cohen's d = -1.1). Carrier mothers performed lower than average (1.5 SD) in Executive Function, measured by Flanker Inhibitory Control and Attention. Biological mothers scored within expected score ranges for adults in BRIEF and NeuroQoL. INTERPRETATION The NIHTB-CB, combined with standardized self-reported measures, can be a sensitive screening tool for cognitive surveillance in DMD.
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Affiliation(s)
- Mathula Thangarajh
- Department of NeurologyChildren’s National Health SystemDistrict of ColumbiaWashington
| | - Aaron J. Kaat
- Department of Medical Social SciencesNorthwestern UniversityChicagoIllinois
| | - Genila Bibat
- Center for Genetic Muscle DisordersKennedy Krieger Institute, Johns Hopkins School of MedicineBaltimoreMaryland
| | - Jennifer Mansour
- Center for Genetic Muscle DisordersKennedy Krieger Institute, Johns Hopkins School of MedicineBaltimoreMaryland
| | - Katherine Summerton
- Center for Genetic Muscle DisordersKennedy Krieger Institute, Johns Hopkins School of MedicineBaltimoreMaryland
| | - Anthony Gioia
- Departments of Psychiatry & Behavioral Science and PediatricsGeorge Washington University School of MedicineDistrict of ColumbiaWashington
| | - Carly Berger
- Departments of Psychiatry & Behavioral Science and PediatricsGeorge Washington University School of MedicineDistrict of ColumbiaWashington
| | - Kristina K. Hardy
- Departments of Psychiatry & Behavioral Science and PediatricsGeorge Washington University School of MedicineDistrict of ColumbiaWashington
| | - Kathryn R. Wagner
- Center for Genetic Muscle DisordersKennedy Krieger Institute, Johns Hopkins School of MedicineBaltimoreMaryland
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Comim CM, Ventura L, Freiberger V, Dias P, Bragagnolo D, Dutra ML, Amaral RA, Camargo-Fagundes ALS, Reis PA, Castro-Faria-Neto HC, Vainzof M, Rosa MI. Neurocognitive Impairment in mdx Mice. Mol Neurobiol 2019; 56:7608-7616. [PMID: 31077034 DOI: 10.1007/s12035-019-1573-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 03/20/2019] [Indexed: 12/16/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a neuromuscular disorder that affects muscles and also the brain, resulting in memory and behavioral problems. In the pathogenesis of DMD, inflammation is an important factor during the degenerative process. However, the involvement of the brain is still unclear. Therefore, the objective of this study is to evaluate the cognitive involvement, BDNF levels, cytokine levels through the levels of TNF-α and IL-1β, the myeloperoxidase (MPO) activity, and the expression of proteins postsynaptic density (PSD)-95 and synaptophysin in the brain of mdx mice. To this aim, we used adult mdx mice. It was observed that mdx mice presented deficits on the habituation, aversive, and object recognition memory. These animals also had a depression-like behavior and an anxiety-like behavior, a decrease of BDNF levels, an increase in the levels of TNF-α and IL-1β, an increase of MPO activity, and an overexpression of synaptophysin and PSD-95 in brain tissue. In conclusion, these data show that mdx mice possibly present a neuroinflammatory component and the involvement of synaptic proteins associated to memory storage and restoring process impairment as well as a depressive- and anxiety-like behavior.
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Affiliation(s)
- Clarissa M Comim
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil.
| | - Letícia Ventura
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil
| | - Viviane Freiberger
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil
| | - Paula Dias
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil
| | - Daiane Bragagnolo
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil
| | - Matheus L Dutra
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil
| | - Ricardo A Amaral
- Research Group on Neurodevelopment of Childhood and Adolescence, Laboratory of Experimental Neuroscience, Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, SC, Brazil
| | - Ana Lucia S Camargo-Fagundes
- Laboratory of Epidemiology, Postgraduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, 88806-000, Brazil
| | - Patrícia A Reis
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz/IOC/FIOCRUZ-Manguinhos, Rio de Janeiro, Brazil
| | - Hugo C Castro-Faria-Neto
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz/IOC/FIOCRUZ-Manguinhos, Rio de Janeiro, Brazil
| | - Mariz Vainzof
- Human Genome Research Center, Biosciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Maria I Rosa
- Laboratory of Epidemiology, Postgraduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, 88806-000, Brazil
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Moon HY, Javadi S, Stremlau M, Yoon KJ, Becker B, Kang SU, Zhao X, van Praag H. Conditioned media from AICAR-treated skeletal muscle cells increases neuronal differentiation of adult neural progenitor cells. Neuropharmacology 2018; 145:123-130. [PMID: 30391731 DOI: 10.1016/j.neuropharm.2018.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
Abstract
Exercise has profound benefits for brain function in animals and humans. In rodents, voluntary wheel running increases the production of new neurons and upregulates neurotrophin levels in the hippocampus, as well as improving synaptic plasticity, memory function and mood. The underlying cellular mechanisms, however, remain unresolved. Recent research indicates that peripheral organs such as skeletal muscle, liver and adipose tissue secrete factors during physical activity that may influence neuronal function. Here we used an in vitro cell assay and proteomic analysis to investigate the effects of proteins secreted from skeletal muscle cells on adult hippocampal neural progenitor cell (aNPC) differentiation. We also sought to identify the relevant molecules driving these effects. Specifically, we treated rat L6 skeletal muscle cells with the AMP-kinase (AMPK) agonist 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranoside (AICAR) or vehicle (distilled water). We then collected the conditioned media (CM) and fractionated it using high-performance liquid chromatography (HPLC). Treatment of aNPCs with a specific fraction of the AICAR-CM upregulated expression of doublecortin (DCX) and Tuj1, markers of immature neurons. Proteomic analysis of this fraction identified proteins known to be involved in energy metabolism, cell migration, adhesion and neurogenesis. Culturing differentiating aNPCs in the presence of one of the factors, glycolytic enzyme glucose-6-phosphate isomerase (GPI), or AICAR-CM, increased the proportion of neuronal (Tuj1+) and astrocytic, glial fibrillary acidic protein (GFAP+) cells. Our study provides further evidence that proteins secreted from skeletal muscle cells may serve as a critical communication link to the brain through factors that enhance neural differentiation.
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Affiliation(s)
- Hyo Youl Moon
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA; Institute of Sport Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Sahar Javadi
- Waisman Center and Department of Neuroscience, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Matthew Stremlau
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Kyeong Jin Yoon
- Institute of Sport Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Benjamin Becker
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Sung-Ung Kang
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xinyu Zhao
- Waisman Center and Department of Neuroscience, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Henriette van Praag
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA; Department of Biomedical Science, Charles E. Schmidt College of Medicine, and Brain Institute, Florida Atlantic University, Jupiter, FL, 33458, USA.
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Thangarajh M, Spurney CF, Gordish-Dressman H, Clemens PR, Hoffman EP, McDonald CM, Henricson EK. Neurodevelopmental Needs in Young Boys with Duchenne Muscular Dystrophy (DMD): Observations from the Cooperative International Neuromuscular Research Group (CINRG) DMD Natural History Study (DNHS). PLOS CURRENTS 2018; 10. [PMID: 30443431 PMCID: PMC6209412 DOI: 10.1371/currents.md.4cdeb6970e54034db2bc3dfa54b4d987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Duchenne muscular dystrophy (DMD) is the most common X-linked neuromuscular condition manifested by progressive skeletal muscle weakness, cardiopulmonary involvement and cognitive deficits. Neurodevelopmental symptoms and signs are under-appreciated in this population despite the recognition that cognition has a major impact on quality-of-life. We describe the neurodevelopmental needs in a large cohort of young boys with DMD from the DMD Natural History Study (DNHS). We explore the association between neurodevelopmental needs and DMD mutation location, and with glucocorticoid use. Methods: We prospectively evaluated 204 participants between ages 4 to less than 9 years of age with DMD as part of a large, longitudinal, international DNHS. We obtained parent- or primary care-giver report of neurodevelopmental needs as part of their study visit. We assessed the relationship between parent/care-giver neurodevelopmental needs and DMD mutation location, and glucocorticoid use. RESULTS The neurodevelopmental needs that were most commonly reported included speech delay (33%), mild developmental delay (24%), significant behavioral problems (16.5%), language impairment (14.5%), learning disability (14.5%), attention-deficit hyperactivity disorder (5%) and autism spectrum disorder (3%). Neurodevelopmental needs were more commonly reported by care-givers in those with DMD mutations downstream of exon 51. There was no relationship between care-giver reported neurodevelopmental needs and glucocorticoid use. CONCLUSION Neurodevelopmental needs are highly prevalent in young boys with DMD. Care-givers report higher neurodevelopmental needs when subjects have DMD mutations downstream of exon 51. Early interventions aimed at cognitive health are critical to improve the quality-of-life of individuals with DMD. TRIAL REGISTRATION ClinicalTrials.gov NCT00468832.
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Affiliation(s)
- Mathula Thangarajh
- Department of Neurology, Children's National Health System, Washington, D.C
| | | | | | - Paula R Clemens
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric P Hoffman
- Pharmaceutical Sciences, State University of Binghamton, NY, USA
| | - Craig M McDonald
- Department of Physical Medicine & Rehabilitation, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Erik K Henricson
- Department of Physical Medicine & Rehabilitation, University of California, Davis School of Medicine, Sacramento, CA, USA
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Abstract
OBJECTIVES To examine academic performance in dystrophinopathy as a function of dystrophin gene mutation position as well as intellectual function, executive skills, socioeconomic status (SES), behavior, and physical ability. METHODS In a cross-sectional study, boys with dystrophinopathy (ages 5-17; n=50) completed tests of academics (Woodcock-Johnson-III: spelling, reading, calculation and total scores), executive functioning (selective attention/inhibitory control, set shifting, working memory, and processing speed), single word comprehension and nonverbal reasoning. Motor skills were assessed and parents provided demographic information and child behavioral assessments. Dystrophin gene mutation positions were dichotomized into groups (upstream versus downstream of exon 43, location of isoforms previously linked to intellectual impairment). Genetic mutation groups were compared on measures of academic achievement, and multiple regression analyses examined unique and joint contributions of executive skills, intelligence quotient (IQ), SES, motor abilities, behavior, and mutation positions to academic outcomes. RESULTS Academic performance was slightly, yet significantly, lower than IQ and varied as a function of dystrophin gene position, wherein boys possessing the downstream mutation exhibited greater impairment than boys with the upstream mutation. Digit span forward (indexing verbal span), but no other measure of executive function, contributed significant variance to total academic achievement, spelling and calculation. CONCLUSIONS Weak academic performance is associated with dystrophinopathy and is more common in downstream mutations. A specific deficit in verbal span may underlie inefficiencies observed in children with dystrophinopathy and may drive deficits impacting academic abilities. (JINS, 2018, 24, 928-938).
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Colvin MK, Poysky J, Kinnett K, Damiani M, Gibbons M, Hoskin J, Moreland S, Trout CJ, Weidner N. Psychosocial Management of the Patient With Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S99-S109. [PMID: 30275254 DOI: 10.1542/peds.2018-0333l] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
In this article, we outline a comprehensive plan for the psychosocial management of patients with Duchenne muscular dystrophy (DMD) across the life span. In 2010, the Centers for Disease Control and Prevention sponsored the development of multidisciplinary management guidance for DMD, and in 2018, that guidance was updated. In the intervening years, a new emphasis was placed on studying and addressing the psychosocial issues that affect patients with DMD, driven in part by improved patient survival. Once viewed as ancillary to managing the significant medical needs of patients with DMD, it is now standard practice to integrate psychosocial management into the multidisciplinary management of the disease. It is also increasingly recognized that neurodevelopmental disorders in DMD occur at a higher rate than what was previously understood and that these disorders warrant early and intensive intervention. In this article, we expand on the content found in the 2018 DMD Care Considerations.
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Affiliation(s)
- Mary K Colvin
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts;
| | | | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | - Mario Damiani
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | | | - Janet Hoskin
- University of East London, London, United Kingdom
| | | | | | - Norbert Weidner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
The immune response to acute muscle damage is important for normal repair. However, in chronic diseases such as many muscular dystrophies, the immune response can amplify pathology and play a major role in determining disease severity. Muscular dystrophies are inheritable diseases that vary tremendously in severity, but share the progressive loss of muscle mass and function that can be debilitating and lethal. Mutations in diverse genes cause muscular dystrophy, including genes that encode proteins that maintain membrane strength, participate in membrane repair, or are components of the extracellular matrix or the nuclear envelope. In this article, we explore the hypothesis that an important feature of many muscular dystrophies is an immune response adapted to acute, infrequent muscle damage that is misapplied in the context of chronic injury. We discuss the involvement of the immune system in the most common muscular dystrophy, Duchenne muscular dystrophy, and show that the immune system influences muscle death and fibrosis as disease progresses. We then present information on immune cell function in other muscular dystrophies and show that for many muscular dystrophies, release of cytosolic proteins into the extracellular space may provide an initial signal, leading to an immune response that is typically dominated by macrophages, neutrophils, helper T-lymphocytes, and cytotoxic T-lymphocytes. Although those features are similar in many muscular dystrophies, each muscular dystrophy shows distinguishing features in the magnitude and type of inflammatory response. These differences indicate that there are disease-specific immunomodulatory molecules that determine response to muscle cell damage caused by diverse genetic mutations. © 2018 American Physiological Society. Compr Physiol 8:1313-1356, 2018.
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Affiliation(s)
- James G. Tidball
- Molecular, Cellular & Integrative Physiology Program, University of California, Los Angeles, California, USA
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA
| | - Steven S. Welc
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California, USA
| | - Michelle Wehling-Henricks
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California, USA
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Thangarajh M, Elfring GL, Trifillis P, McIntosh J, Peltz SW. The relationship between deficit in digit span and genotype in nonsense mutation Duchenne muscular dystrophy. Neurology 2018; 91:e1215-e1219. [PMID: 30135256 DOI: 10.1212/wnl.0000000000006245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/28/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between deficit in digit span and genotype in nonsense mutation (nm) Duchenne muscular dystrophy (DMD) (nmDMD). METHODS We investigated the relationship between normalized digit-span forward (d-sf) and digit-span backward (d-sb) scores to the location of nmDMD mutations in 169 participants ≥5 to ≤20 years who participated in a phase 2b clinical trial. Because alternative promoters are found upstream of DMD exons 30, 45, and 63, we correlated d-sf and d-sb to the specific nmDMD mutation location. RESULTS Participants with nm downstream of exon 30, downstream of exon 45, and downstream of exon 63 had significantly lower normalized d-sf scores (p < 0.0001). Participants with nm downstream of exon 45 in addition had significantly lower normalized d-sb score (p < 0.04). There was no significant difference in the normalized d-sb score in participants with mutations upstream or downstream of DMD exon 30 or upstream or downstream of DMD exon 63. CONCLUSION Our data provide evidence that specific cognitive deficits correlate to genotype in individuals with nmDMD, highlighting the critical role of brain-specific dystrophin isoforms in the neurobiological manifestations of this disease. CLINICALTRIALSGOV IDENTIFIER NCT02090959.
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Affiliation(s)
- Mathula Thangarajh
- From the Children's National Health System (M.T.), Washington, DC; and PTC Therapeutics Inc. (G.L.E., P.T., J.M., S.W.P.), South Plainfield, NJ.
| | - Gary L Elfring
- From the Children's National Health System (M.T.), Washington, DC; and PTC Therapeutics Inc. (G.L.E., P.T., J.M., S.W.P.), South Plainfield, NJ
| | - Panayiota Trifillis
- From the Children's National Health System (M.T.), Washington, DC; and PTC Therapeutics Inc. (G.L.E., P.T., J.M., S.W.P.), South Plainfield, NJ
| | - Joseph McIntosh
- From the Children's National Health System (M.T.), Washington, DC; and PTC Therapeutics Inc. (G.L.E., P.T., J.M., S.W.P.), South Plainfield, NJ
| | - Stuart W Peltz
- From the Children's National Health System (M.T.), Washington, DC; and PTC Therapeutics Inc. (G.L.E., P.T., J.M., S.W.P.), South Plainfield, NJ
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Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Colvin MK, Cripe L, Herron AR, Kennedy A, Kinnett K, Naprawa J, Noritz G, Poysky J, Street N, Trout CJ, Weber DR, Ward LM. Diagnosis and management of Duchenne muscular dystrophy, part 3: primary care, emergency management, psychosocial care, and transitions of care across the lifespan. Lancet Neurol 2018; 17:445-455. [PMID: 29398641 PMCID: PMC5902408 DOI: 10.1016/s1474-4422(18)30026-7] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 11/22/2017] [Accepted: 01/12/2018] [Indexed: 11/17/2022]
Abstract
Improvements in the function, quality of life, and longevity of patients with Duchenne muscular dystrophy (DMD) have been achieved through a multidisciplinary approach to management across a range of health-care specialties. In part 3 of this update of the DMD care considerations, we focus on primary care, emergency management, psychosocial care, and transitions of care across the lifespan. Many primary care and emergency medicine clinicians are inexperienced at managing the complications of DMD. We provide a guide to the acute and chronic medical conditions that these first-line providers are likely to encounter. With prolonged survival, individuals with DMD face a unique set of challenges related to psychosocial issues and transitions of care. We discuss assessments and interventions that are designed to improve mental health and independence, functionality, and quality of life in critical domains of living, including health care, education, employment, interpersonal relationships, and intimacy.
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Affiliation(s)
- David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Katharine Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | - Susan D Apkon
- Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Mary K Colvin
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Linda Cripe
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Adrienne R Herron
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Annie Kennedy
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - James Naprawa
- Emergency Department, University of California San Francisco Benioff Children's Hospital, Oakland, CA, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | | | - Natalie Street
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina J Trout
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - David R Weber
- Division of Endocrinology and Diabetes, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
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Hendriksen RGF, Vles JSH, Aalbers MW, Chin RFM, Hendriksen JGM. Brain-related comorbidities in boys and men with Duchenne Muscular Dystrophy: A descriptive study. Eur J Paediatr Neurol 2018; 22:488-497. [PMID: 29306518 DOI: 10.1016/j.ejpn.2017.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/20/2017] [Accepted: 12/09/2017] [Indexed: 11/15/2022]
Abstract
AIM Duchenne Muscular Dystrophy (DMD) is more than a muscle disease since there is a higher prevalence of neuropsychological comorbidities. Similarly, the prevalence of epilepsy is increased. Given the nowadays-increasing interest in brain-related comorbidities in DMD, this study aimed to evaluate the relationship between DMD, epilepsy, and associated neurodevelopmental disorders in an international sample of DMD patients. METHOD Using a questionnaire-based study we investigated the occurrence of self/by-proxy reported brain-related comorbidities in a group of 228 DMD patients. We evaluated the presence of epilepsy and other brain-related comorbidities, but also the specific mutation in the dystrophin gene. With respect to epilepsy, all individually reported epilepsy cases as based on the questionnaire results including information provided on epilepsy treatment, EEG abnormalities, and a description of how a typical seizure would look like, were independently and blindly re-assessed by two external paediatric neurologists (Cohen's kappa of 0.85). RESULTS Based on the latter, 18 (7.9%) DMD patients were considered to have epilepsy. In patients with both DMD and epilepsy, certain other brain-related comorbidities (i.e. attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety disorders and sleep disorders) were significantly more prevalent. CONCLUSION This study is supportive of a high occurrence of epilepsy and other brain-related comorbidities in DMD. Furthermore this study shows for the first time that the frequency of some of these disorders appear to be further increased when epilepsy is present next to DMD. As this study is limited by the self/by proxy setup and the lack of response rates, future studies should elucidate the true incidence of the (triangular) cooccurrence between epilepsy, neurodevelopmental deficits, and DMD.
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Affiliation(s)
- Ruben G F Hendriksen
- Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health & Neuroscience (MHeNS), Maastricht University, Universiteitssingel 40, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Marlien W Aalbers
- Department of Neurosurgery, Groningen University Medical Centre, Hanzeplein 1, P.O. Box 30001, 9713 GZ Groningen, The Netherlands.
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, The University of Edinburgh, Sylvan Road 20, EH9 1UW Edinburgh, United Kingdom; Department of Paediatric Neuroscience, Royal Hospital for Sick Children, Sciennes Road 9, EH9 1LF Edinburgh, United Kingdom.
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Kempenhaeghe Epilepsy Centre, Centre for Neurological Learning Disabilities, Sterkselseweg 65, 5591 VE Heeze, The Netherlands.
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35
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Abstract
Accumulating research in rodents and humans indicates that exercise benefits brain function and may prevent or delay onset of neurodegenerative conditions. In particular, exercise modifies the structure and function of the hippocampus, a brain area important for learning and memory. This review addresses the central and peripheral mechanisms underlying the beneficial effects of exercise on the hippocampus. We focus on running-induced changes in adult hippocampal neurogenesis, neural circuitry, neurotrophins, synaptic plasticity, neurotransmitters, and vasculature. The role of peripheral factors in hippocampal plasticity is also highlighted. We discuss recent evidence that systemic factors released from peripheral organs such as muscle (myokines), liver (hepatokines), and adipose tissue (adipokines) during exercise contribute to hippocampal neurotrophin and neurogenesis levels, and memory function. A comprehensive understanding of the body-brain axis is needed to elucidate how exercise improves hippocampal plasticity and cognition.
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Affiliation(s)
- C'iana Cooper
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Biomedical Research Center, Baltimore, Maryland 21224
| | - Hyo Youl Moon
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Biomedical Research Center, Baltimore, Maryland 21224
- Institute of Sport Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Henriette van Praag
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Biomedical Research Center, Baltimore, Maryland 21224
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36
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Battini R, Chieffo D, Bulgheroni S, Piccini G, Pecini C, Lucibello S, Lenzi S, Moriconi F, Pane M, Astrea G, Baranello G, Alfieri P, Vicari S, Riva D, Cioni G, Mercuri E. Cognitive profile in Duchenne muscular dystrophy boys without intellectual disability: The role of executive functions. Neuromuscul Disord 2017; 28:122-128. [PMID: 29305139 DOI: 10.1016/j.nmd.2017.11.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/19/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022]
Abstract
The aim of our prospective observational study was to assess profiles of cognitive function and a possible impairment of executive functions in a cohort of boys with Duchenne muscular dystrophy without intellectual and behavior disability. Forty Duchenne boys (range of age: 6 years to 11 years and 6 months) were assessed by Wechsler Intelligence scale and battery of tests including tasks assessing working memory and executive functions (inhibition and switching, problem solving and planning). In our cohort some aspects of cognitive function were often impaired. These included multitasking, problem solving, inhibition and working memory necessary to plan and direct goal oriented behavior. Our results support the suggestion that aspects of cognitive function could be impaired even in boys without intellectual disability and support the hypothesis that executive functions may play an important role in specific aspects of cognitive impairment in Duchenne muscular dystrophy.
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Affiliation(s)
- R Battini
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - D Chieffo
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - S Bulgheroni
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - G Piccini
- Unit of Child Neuropsichiatry, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - C Pecini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - S Lucibello
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - S Lenzi
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - F Moriconi
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - M Pane
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy
| | - G Astrea
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy
| | - G Baranello
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - P Alfieri
- Unit of Child Neuropsichiatry, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - S Vicari
- Unit of Child Neuropsichiatry, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - D Riva
- Developmental Neurology Division, IRCCS Fondazione Istituto Neurologico C. Besta, Milan, Italy
| | - G Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone (Pisa), Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, and Nemo Center, UCSC Rome, Italy.
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Remmelink E, Aartsma-Rus A, Smit AB, Verhage M, Loos M, van Putten M. Cognitive flexibility deficits in a mouse model for the absence of full-length dystrophin. GENES BRAIN AND BEHAVIOR 2017; 15:558-67. [PMID: 27220066 DOI: 10.1111/gbb.12301] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a progressive muscle-wasting disorder, caused by mutations in the DMD gene and the resulting lack of dystrophin. The DMD gene has seven promoters, giving rise to multiple full-length and shorter isoforms. Besides the expression of dystrophin in muscles, the majority of dystrophin isoforms is expressed in brain and dystrophinopathy can lead to cognitive deficits, including intellectual impairments and deficits in executive function. In contrast to the muscle pathology, the impact of the lack of dystrophin on the brain is not very well studied. Here, we study the behavioral consequences of a lack of full-length dystrophin isoforms in mdx mice, particularly with regard to domains of executive functions and anxiety. We observed a deficit in cognitive flexibility in mdx mice in the absence of motor dysfunction or general learning impairments using two independent behavioral tests. In addition, increased anxiety was observed, but its expression depended on the context. Overall, these results suggest that the absence of full-length dystrophin in mice has specific behavioral effects that compare well to deficits observed in DMD patients.
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Affiliation(s)
- E Remmelink
- Sylics (Synaptologics B.V.), The Netherlands.,Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University, The Netherlands.,Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, The Netherlands
| | - A Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A B Smit
- Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University, The Netherlands
| | - M Verhage
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, The Netherlands
| | - M Loos
- Sylics (Synaptologics B.V.), The Netherlands
| | - M van Putten
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
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38
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Fabbro F, Marini A, Felisari G, Comi GP, D'Angelo MG, Turconi AC, Bresolin N. Language Disturbances in a Group of Participants Suffering from Duchenne Muscular Dystrophy: A Pilot Study. Percept Mot Skills 2016; 104:663-76. [PMID: 17566456 DOI: 10.2466/pms.104.2.663-676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Results from several studies suggest that the process of language acquisition may be altered in patients suffering from Duchenne Muscular Dystrophy. In this study, a group of 8 male participants with Duchenne Muscular Dystrophy ( M age = 16 yr., SD = 4.7) underwent an extensive neuropsychological and language assessment. They also performed a discourse production task. Results showed mild mental retardation associated with a specific deficit in Verbal rather than Performance IQ. At the linguistic assessment, 7 of 8 participants showed moderate to severe difficulties on oral language processing with particularly impaired morphosyntactic competence.
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Affiliation(s)
- F Fabbro
- Istituto Scientifico E. Medea IRCCS, Università degli Studi di Udine, Italy.
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39
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Filippini M, Guerra A, Negosanti A, Santi S, Sarajlija J, Musti MA, Gobbi G, Lassonde M, Pini A. Mismatch Negativity Recording in Children With Duchenne Muscular Dystrophy: A Preliminary Study Integrating Neurophysiological and Neuropsychological Results. J Child Neurol 2016; 31:1468-1474. [PMID: 27422795 DOI: 10.1177/0883073816656404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/26/2016] [Indexed: 11/15/2022]
Abstract
Many studies on Duchenne muscular dystrophy children support the hypothesis of a specific neuropsychological phenotype affecting mostly phonological skills. This prospective study aimed to shed light on the role of phonological abilities. Fourteen Duchenne muscular dystrophy children and 7 healthy children underwent mismatch negativity. Moreover, verbal intelligence, visuospatial attention, immediate verbal memory, working memory, grammar, vocabulary, visuomotor skills, reading, text comprehension, writing, and arithmetic were tested in Duchenne muscular dystrophy children. No significant difference between control and Duchenne muscular dystrophy children was found neither for mismatch negativity amplitude (P = .191 and .116, respectively) nor for latency (P = .135). Eight (57.14%) patients showed an impairment of immediate verbal memory and of visuomotor skills, 7 (63.64%) patients had a deficit in writing and arithmetic skills, even with a mean normal intelligence quotient. Taken together, the results put in evidence a heterogeneous neuropsychological profile not explainable on the basis of a phonological deficit.
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Affiliation(s)
- Melissa Filippini
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Angelo Guerra
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Sara Santi
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Jasenka Sarajlija
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Giuseppe Gobbi
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Maryse Lassonde
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Antonella Pini
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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40
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Abstract
The dystrophin gene involved in Duchenne and Becker muscular dystrophy is expressed in three main tissues resulting in clinical manifestations: skeletal muscle, heart and central nervous system. The 6 different existing dystrophins in the brain may play a role in the maturation and plasticity of neuronal synapses in particular by their functions in clustering and stabilization of different receptors at the post synaptic membrane. The possibility of an intellectual deficiency in Duchenne muscular dystrophy is known from the original description by Duchenne himself. Current data are in line with a constant cognitive impairment with a Gaussian curve shifted intellectual quotient (IQ) at -1 standard deviation from the standard population with an average IQ around 80. Clinical manifestations suggestive of a central nervous system involvement can affect all dystrophinopathies, including isolated central presentations without myopathic sign. The phenotypic spectrum appears broader and more subtle than non specific intellectual deficiency. The isolated or shared involvement of specific cognitive functions is possible (memory functions, executive functions, attention) with or without intellectual deficiency. Autism spectrum disorders are also among the encountered events. In clinical practice, it seems worth to ask for a measurement of serum creatine kinase (CK) in these different situations, keeping in mind that pure forms of central dystrophinopathies with a normal CK level have been recently reported.
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Affiliation(s)
- J-M Cuisset
- Service de Neuropédiatrie, Centre de Référence des Maladies Neuromusculaires, CHRU, 59307 Lille cedex, France
| | - F Rivier
- CHRU de Montpellier, Neuropédiatrie & Centre de Référence des Maladies Neuromusculaires, Montpellier, France; U1046 INSERM, UMR9214 CNRS, Université de Montpellier, France.
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41
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Astrea G, Battini R, Lenzi S, Frosini S, Bonetti S, Moretti E, Perazza S, Santorelli FM, Pecini C. Learning disabilities in neuromuscular disorders: a springboard for adult life. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2016; 35:90-95. [PMID: 28344438 PMCID: PMC5343745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the presence of cognitive deficits in Duchenne muscular dystrophy or myotonic dystrophy DM1 is well established in view of brain-specific expression of affected muscle proteins, in other neuromuscular disorders, such as congenital myopathies and limb-girdle muscular dystrophies, cognitive profiles are poorly defined. Also, there are limited characterization of the cognitive profile of children with congenital muscular dystrophies, notwithstanding the presence of cerebral abnormality in some forms, and in spinal muscular atrophies, with the exception of distal spinal muscular atrophy (such as the DYN1CH1- associated form). Starting from the Duchenne muscular dystrophy, which may be considered a kind of paradigm for the co-occurrence of learning disabilities in the contest of a progressive muscular involvement, the findings of neuropsychological (or cognitive) dysfunctions in several forms of neuromuscular diseases will be examined and reviewed.
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Affiliation(s)
- Guja Astrea
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa;,Address for correspondence: Guja Astrea, IRCCS Stella Maris, via dei giacinti 2, 56128 Calambrone (PI). E-mail:
| | - Roberta Battini
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
| | - Sara Lenzi
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
| | - Silvia Frosini
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
| | - Silvia Bonetti
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
| | - Elena Moretti
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
| | - Silvia Perazza
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
| | | | - Chiara Pecini
- Departmet of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa
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Digit Span Performance in Children with Dystrophinopathy: A Verbal Span or Working Memory Contribution? J Int Neuropsychol Soc 2016; 22:777-84. [PMID: 27268852 DOI: 10.1017/s1355617716000461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES In a large cohort of boys with dystrophinopathies and their unaffected siblings, we examined whether consistently observed performance on digit span is due primarily to a verbal span or executive deficit. We additionally assessed whether digit span performance contributed to the observed variability in reading performance noted in this population. METHODS Performance of 170 boys with dystrophinopathy was compared to 95 unaffected sibling controls on measures of verbal function, reading, and digit span. Maximum digit span forward (DSF) and backward (DSB) lengths were converted to Z-scores using normative data. Independent sample t tests, analysis of variance, and hierarchical multiple regression were run (α=0.05). RESULTS Probands performed worse than controls on digit span, even after accounting for differences in general verbal function (p<.0001). Differences were significant for both DSF (p<.005) and DSB (p<.0001) span length, and an interaction effect yielded significantly worse DSB compared with DSF (p=.01). Reading performance was also lower in probands (p<.0001). The contribution of general level of verbal function, and forward and backward span lengths, did not vary between groups. CONCLUSIONS In boys with dystrophinopathy, decreased performance on digit span appears to be due to both decreased span forward (measuring verbal span only) and backward (measuring verbal span and working memory). The extent to which sibling controls exhibited better performance compared to the probands was significantly greater for backward span when compared with forward span. Thus, immediate verbal memory and executive control are differentially compromised among boys with dystrophinopathy, and both of these abilities independently contribute to reading performance. (JINS, 2016, 22, 777-784).
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43
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Rae MG, O'Malley D. Cognitive dysfunction in Duchenne muscular dystrophy: a possible role for neuromodulatory immune molecules. J Neurophysiol 2016; 116:1304-15. [PMID: 27385793 DOI: 10.1152/jn.00248.2016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X chromosome-linked disease characterized by progressive physical disability, immobility, and premature death in affected boys. Underlying the devastating symptoms of DMD is the loss of dystrophin, a structural protein that connects the extracellular matrix to the cell cytoskeleton and provides protection against contraction-induced damage in muscle cells, leading to chronic peripheral inflammation. However, dystrophin is also expressed in neurons within specific brain regions, including the hippocampus, a structure associated with learning and memory formation. Linked to this, a subset of boys with DMD exhibit nonprogressing cognitive dysfunction, with deficits in verbal, short-term, and working memory. Furthermore, in the genetically comparable dystrophin-deficient mdx mouse model of DMD, some, but not all, types of learning and memory are deficient, and specific deficits in synaptogenesis and channel clustering at synapses has been noted. Little consideration has been devoted to the cognitive deficits associated with DMD compared with the research conducted into the peripheral effects of dystrophin deficiency. Therefore, this review focuses on what is known about the role of full-length dystrophin (Dp427) in hippocampal neurons. The importance of dystrophin in learning and memory is assessed, and the potential importance that inflammatory mediators, which are chronically elevated in dystrophinopathies, may have on hippocampal function is also evaluated.
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Affiliation(s)
- Mark G Rae
- Department of Physiology, University College Cork, Cork, Ireland; and
| | - Dervla O'Malley
- Department of Physiology, University College Cork, Cork, Ireland; and APC Microbiome Institute, University College Cork, Cork, Ireland
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44
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Fu Y, Dong Y, Zhang C, Sun Y, Zhang S, Mu X, Wang H, Xu W, Wu S. Diffusion tensor imaging study in Duchenne muscular dystrophy. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:109. [PMID: 27127762 DOI: 10.21037/atm.2016.03.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a progressive muscle disorder associated with an intellectual deficit which is non-progressive. The aim of this study was to investigate brain microstructural changes in DMD and to explore the relationship between such changes and cognitive impairment. METHODS All participants (12 DMD patients, 14 age-matched healthy boys), intelligence quotients (IQs) [both full (FIQ) and verbal (VIQ)] were evaluated using the Wechsler intelligence scale for children China revised (WISC-CR) edition, and brain gray matter (GM) and white matter (WM) changes were mapped using diffusion tensor imaging (DTI) with fractional anisotropy (FA). The differences between groups were analyzed using the t-test and the association of cognition with neuroimaging parameters was evaluated using Pearson's correlation coefficient. RESULTS Compared to the normal controls, the DMD group had lower FIQ (82.0±15.39 vs. 120.21±16.06) and significantly lower splenium of corpus callosum (CC) FA values (P<0.05). Splenium of CC FA was positively correlated with VIQ (r=0.588, P=0.044). CONCLUSIONS There were microstructural changes of splenium of CC in DMD patients, which was associated with cognitive impairment.
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Affiliation(s)
- Ya Fu
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Yuru Dong
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Chao Zhang
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Yu Sun
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Shu Zhang
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Xuetao Mu
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Hong Wang
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Weihai Xu
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
| | - Shiwen Wu
- 1 Department of Neurology, 2 Department of MRI, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China ; 3 Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing 100005, China
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45
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Banihani R, Smile S, Yoon G, Dupuis A, Mosleh M, Snider A, McAdam L. Cognitive and Neurobehavioral Profile in Boys With Duchenne Muscular Dystrophy. J Child Neurol 2015; 30:1472-82. [PMID: 25660133 DOI: 10.1177/0883073815570154] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/04/2015] [Indexed: 01/18/2023]
Abstract
Duchenne muscular dystrophy is a progressive neuromuscular condition that has a high rate of cognitive and learning disabilities as well as neurobehavioral disorders, some of which have been associated with disruption of dystrophin isoforms. Retrospective cohort of 59 boys investigated the cognitive and neurobehavioral profile of boys with Duchenne muscular dystrophy. Full-scale IQ of < 70 was seen in 27%; learning disability in 44%, intellectual disability in 19%; attention-deficit/hyperactivity disorder in 32%; autism spectrum disorders in 15%; and anxiety in 27%. Mutations affecting Dp260 isoform and 5'untranslated region of Dp140 were observed in 60% with learning disability, 50% intellectual disability, 77% with autism spectrum disorders, and 94% with anxiety. No statistically significant correlation was noted between comorbidities and dystrophin isoforms; however, there is a trend of cumulative loss of dystrophin isoforms with declining full-scale IQ. Enhanced psychology testing to include both cognitive and neurobehavioral disorders is recommended for all individuals with Duchenne muscular dystrophy.
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Affiliation(s)
- Rudaina Banihani
- Department of Paediatrics, Division of Developmental Paediatrics, University of Toronto, Toronto, ON, Canada Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon Smile
- Department of Paediatrics, Division of Developmental Paediatrics, University of Toronto, Toronto, ON, Canada Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Grace Yoon
- Departments of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, ON, Canada Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Annie Dupuis
- Biostatistics, Design and Analysis Division, Child Health Evaluative Sciences Research Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada Dalla Lana School of Public Health, Department of Biostatistics, University of Toronto, Toronto, ON, Canada
| | - Maureen Mosleh
- Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Andrea Snider
- Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Laura McAdam
- Department of Paediatrics, Division of Developmental Paediatrics, University of Toronto, Toronto, ON, Canada Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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46
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Chieffo D, Brogna C, Berardinelli A, D'Angelo G, Mallardi M, D'Amico A, Alfieri P, Mercuri E, Pane M. Early Neurodevelopmental Findings Predict School Age Cognitive Abilities in Duchenne Muscular Dystrophy: A Longitudinal Study. PLoS One 2015; 10:e0133214. [PMID: 26275215 PMCID: PMC4537199 DOI: 10.1371/journal.pone.0133214] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/23/2015] [Indexed: 12/28/2022] Open
Abstract
Objective Neurodevelopmental and cognitive difficulties are known to occur frequently in boys with Duchenne muscular dystrophy but so far none of the published studies have reported both early neurodevelopmental assessments and cognitive tests in the same cohort. The aim of the present longitudinal study was to establish the correlation between early neurodevelopmental assessments performed in preschool boys and the cognitive scales performed at school age or later. Methods We performed cognitive tests at school age (mean age 5.7 year ±1.7 SD) (69 months+19 SD) in a cohort of Duchenne boys, previously assessed using the Griffiths scales before the age of 4 years (mean age when the Griffiths scales were performed 30 months ±8.9 SD). Results The range of total Developmental quotients on the Griffiths ranged between 56 and 116 (mean 89 ± 15.6 SD). The total Intelligence Quotients on the Wechsler scales ranged between 35 and 119 (mean 87 ± 17.2 SD). There was a significant correlation between the findings on the two scales. P = <0.0001. When we subdivided the cohort according to site of mutations, there was a difference between boys with mutations upstream exon 44 and those with mutations in exon 44–45 affecting Dp140 on both Developmental and Intelligence Quotient (p 0.01 and p 0,003 respectively). Conclusions Our results confirm that Duchenne boys tend to slightly underperform on both neurodevelopmental and cognitive assessments. Early neurodevelopmental findings correlated with the cognitive results obtained at school age with a clear concordance between subscales exploring similar domains on the two scales.
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Affiliation(s)
- Daniela Chieffo
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Claudia Brogna
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | | | | | - Maria Mallardi
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Adele D'Amico
- Department of Neurosciences, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Alfieri
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience Bambino Gesù Children's Hospital, Rome, Italy
| | - Eugenio Mercuri
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
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Nichols B, Takeda S, Yokota T. Nonmechanical Roles of Dystrophin and Associated Proteins in Exercise, Neuromuscular Junctions, and Brains. Brain Sci 2015; 5:275-98. [PMID: 26230713 PMCID: PMC4588140 DOI: 10.3390/brainsci5030275] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023] Open
Abstract
Dystrophin-glycoprotein complex (DGC) is an important structural unit in skeletal muscle that connects the cytoskeleton (f-actin) of a muscle fiber to the extracellular matrix (ECM). Several muscular dystrophies, such as Duchenne muscular dystrophy, Becker muscular dystrophy, congenital muscular dystrophies (dystroglycanopathies), and limb-girdle muscular dystrophies (sarcoglycanopathies), are caused by mutations in the different DGC components. Although many early studies indicated DGC plays a crucial mechanical role in maintaining the structural integrity of skeletal muscle, recent studies identified novel roles of DGC. Beyond a mechanical role, these DGC members play important signaling roles and act as a scaffold for various signaling pathways. For example, neuronal nitric oxide synthase (nNOS), which is localized at the muscle membrane by DGC members (dystrophin and syntrophins), plays an important role in the regulation of the blood flow during exercise. DGC also plays important roles at the neuromuscular junction (NMJ) and in the brain. In this review, we will focus on recently identified roles of DGC particularly in exercise and the brain.
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Affiliation(s)
- Bailey Nichols
- Department of Medical Genetics, University of Alberta Faculty of Medicine and Dentistry.
| | - Shin'ichi Takeda
- Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-higashi, Kodaira, Tokyo 187-8502, Japan.
| | - Toshifumi Yokota
- Department of Medical Genetics, University of Alberta Faculty of Medicine and Dentistry.
- Muscular Dystrophy Canada Research Chair, 8812-112 St, Edmonton, AB T6G 2H7, Canada.
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Chaussenot R, Edeline JM, Le Bec B, El Massioui N, Laroche S, Vaillend C. Cognitive dysfunction in the dystrophin-deficient mouse model of Duchenne muscular dystrophy: A reappraisal from sensory to executive processes. Neurobiol Learn Mem 2015; 124:111-22. [PMID: 26190833 DOI: 10.1016/j.nlm.2015.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023]
Abstract
Duchenne muscular dystrophy (DMD) is associated with language disabilities and deficits in learning and memory, leading to intellectual disability in a patient subpopulation. Recent studies suggest the presence of broader deficits affecting information processing, short-term memory and executive functions. While the absence of the full-length dystrophin (Dp427) is a common feature in all patients, variable mutation profiles may additionally alter distinct dystrophin-gene products encoded by separate promoters. However, the nature of the cognitive dysfunctions specifically associated with the loss of distinct brain dystrophins is unclear. Here we show that the loss of the full-length brain dystrophin in mdx mice does not modify the perception and sensorimotor gating of auditory inputs, as assessed using auditory brainstem recordings and prepulse inhibition of startle reflex. In contrast, both acquisition and long-term retention of cued and trace fear memories were impaired in mdx mice, suggesting alteration in a functional circuit including the amygdala. Spatial learning in the water maze revealed reduced path efficiency, suggesting qualitative alteration in mdx mice learning strategy. However, spatial working memory performance and cognitive flexibility challenged in various behavioral paradigms in water and radial-arm mazes were unimpaired. The full-length brain dystrophin therefore appears to play a role during acquisition of associative learning as well as in general processes involved in memory consolidation, but no overt involvement in working memory and/or executive functions could be demonstrated in spatial learning tasks.
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Affiliation(s)
- Rémi Chaussenot
- Paris-Saclay Neuroscience Institute, UMR 9197, CNRS, F-91405 Orsay, France; Univ. Paris-Sud, UMR 9197, F-91405 Orsay, France; Université Paris-Saclay, France
| | - Jean-Marc Edeline
- Paris-Saclay Neuroscience Institute, UMR 9197, CNRS, F-91405 Orsay, France; Univ. Paris-Sud, UMR 9197, F-91405 Orsay, France; Université Paris-Saclay, France
| | - Benoit Le Bec
- Paris-Saclay Neuroscience Institute, UMR 9197, CNRS, F-91405 Orsay, France; Univ. Paris-Sud, UMR 9197, F-91405 Orsay, France; Université Paris-Saclay, France
| | - Nicole El Massioui
- Paris-Saclay Neuroscience Institute, UMR 9197, CNRS, F-91405 Orsay, France; Univ. Paris-Sud, UMR 9197, F-91405 Orsay, France; Université Paris-Saclay, France
| | - Serge Laroche
- Paris-Saclay Neuroscience Institute, UMR 9197, CNRS, F-91405 Orsay, France; Univ. Paris-Sud, UMR 9197, F-91405 Orsay, France; Université Paris-Saclay, France
| | - Cyrille Vaillend
- Paris-Saclay Neuroscience Institute, UMR 9197, CNRS, F-91405 Orsay, France; Univ. Paris-Sud, UMR 9197, F-91405 Orsay, France; Université Paris-Saclay, France.
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Schara U, Busse M, Timmann D, Gerwig M. Cerebellar-dependent associative learning is preserved in Duchenne muscular dystrophy: a study using delay eyeblink conditioning. PLoS One 2015; 10:e0126528. [PMID: 25973604 PMCID: PMC4431835 DOI: 10.1371/journal.pone.0126528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/03/2015] [Indexed: 02/03/2023] Open
Abstract
Objective Besides progressive muscle weakness cognitive deficits have been reported in patients with Duchenne muscular dystrophy (DMD). Cerebellar dysfunction has been proposed to explain cognitive deficits at least in part. In animal models of DMD disturbed Purkinje cell function has been shown following loss of dystrophin. Furthermore there is increasing evidence that the lateral cerebellum contributes to cognitive processing. In the present study cerebellar-dependent delay eyeblink conditioning, a form of associative learning, was used to assess cerebellar function in DMD children. Methods Delay eyeblink conditioning was examined in eight genetically defined male patients with DMD and in ten age-matched control subjects. Acquisition, timing and extinction of conditioned eyeblink responses (CR) were assessed during a single conditioning session. Results Both groups showed a significant increase of CRs during the course of learning (block effect p < 0.001). CR acquisition was not impaired in DMD patients (mean total CR incidence 37.4 ± 17.6%) as compared to control subjects (36.2 ± 17.3%; group effect p = 0.89; group by block effect p = 0.38; ANOVA with repeated measures). In addition, CR timing and extinction was not different from controls. Conclusions Delay eyeblink conditioning was preserved in the present DMD patients. Because eyeblink conditioning depends on the integrity of the intermediate cerebellum, this older part of the cerebellum may be relatively preserved in DMD. The present findings agree with animal model data showing that the newer, lateral cerebellum is primarily affected in DMD.
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Affiliation(s)
- Ulrike Schara
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics,University of Duisburg-Essen, Essen, Germany
| | - Melanie Busse
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics,University of Duisburg-Essen, Essen, Germany
| | - Dagmar Timmann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Marcus Gerwig
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- * E-mail:
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50
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Piccini G, Gazzellini S, D'Amico A, Pane M, Castelli E, Vicari S, Alfieri P. Developmental lag of visuospatial attention in Duchenne muscular dystrophy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:55-61. [PMID: 25462465 DOI: 10.1016/j.ridd.2014.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Abstract
Children with Duchenne muscular dystrophy (DMD) present a specific deficit of voluntary attention but to date there has been no clear characterization of their attentional skills. The present study investigated the hypothesis that DMD patients present deficits of both voluntary and automatic visuospatial attention systems and that their performance could be equivalent to that of younger healthy males. Twenty males (mean age 10 years) with diagnosis of DMD, 20 age-matched healthy males (10 years 3 months) and 20 healthy younger males (7 years 6 months) were required to perform two visuospatial attention tasks: voluntary and automatic. In the voluntary task, the performance of the DMD group was significantly worse than that of the age-matched group, and equal to that of the younger controls. In the automatic attention task also, the performance of the DMD patients was less efficient than that of the age-matched controls and equal to that of the younger children. This study supports the previous report of voluntary attention deficit in DMD and extends the evidence to include also an automatic attention system deficit. The development level of attention in DMD patients is below that expected for their age and corresponds to a delay of about three years.
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Affiliation(s)
- Giorgia Piccini
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Simone Gazzellini
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Adele D'Amico
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Enrico Castelli
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Stefano Vicari
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Alfieri
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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