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Groener JB, Jende JME, Kurz FT, Kender Z, Treede RD, Schuh-Hofer S, Nawroth PP, Bendszus M, Kopf S. Understanding Diabetic Neuropathy-From Subclinical Nerve Lesions to Severe Nerve Fiber Deficits: A Cross-Sectional Study in Patients With Type 2 Diabetes and Healthy Control Subjects. Diabetes 2020; 69:436-447. [PMID: 31826867 DOI: 10.2337/db19-0197] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022]
Abstract
Studies on magnetic resonance neurography (MRN) in diabetic polyneuropathy (DPN) have found proximal sciatic nerve lesions. The aim of this study was to evaluate the functional relevance of sciatic nerve lesions in DPN, with the expectation of correlations with the impairment of large-fiber function. Sixty-one patients with type 2 diabetes (48 with and 13 without DPN) and 12 control subjects were enrolled and underwent MRN, quantitative sensory testing, and electrophysiological examinations. There were differences in mechanical detection (Aβ fibers) and mechanical pain (Aδ fibers) but not in thermal pain and thermal detection clusters (C fibers) among the groups. Lesion load correlated with lower Aα-, Aβ-, and Aδ-fiber but not with C-fiber function in all participants. Patients with lower function showed a higher load of nerve lesions than patients with elevated function or no measurable deficit despite apparent DPN. Longer diabetes duration was associated with higher lesion load in patients with DPN, suggesting that nerve lesions in DPN may accumulate over time and become clinically relevant once a critical amount of nerve fascicles is affected. Moreover, MRN is an objective method for determining lower function mainly in medium and large fibers in DPN.
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Affiliation(s)
- Jan B Groener
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
- Medicover Neuroendokrinologie, Munich, Germany
| | - Johann M E Jende
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix T Kurz
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Zoltan Kender
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter P Nawroth
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
- Joint Heidelberg-ICD Translational Diabetes Program, Helmoltz-Zentrum, Munich, Germany
| | - Martin Bendszus
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
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The single intake of levodopa modulates implicit learning in drug naïve, de novo patients with idiopathic Parkinson’s disease. J Neural Transm (Vienna) 2016; 123:601-10. [DOI: 10.1007/s00702-016-1557-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/12/2016] [Indexed: 11/25/2022]
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Anderson ED, Horak FB, Lasarev MR, Nutt JG. Performance of a motor task learned on levodopa deteriorates when subsequently practiced off. Mov Disord 2013; 29:54-60. [PMID: 24132873 DOI: 10.1002/mds.25702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/29/2013] [Accepted: 09/01/2013] [Indexed: 11/10/2022] Open
Abstract
Studies in animals and in people with Parkinson's disease (PD) demonstrate complex effects of dopamine on learning motor tasks; its effect on retention of motor learning has received little attention. Recent animal studies demonstrate that practicing a task in the off state, when initially learned in the on state, leads to progressive deterioration in performance. We measured the acquisition and retention of 3 different motor tasks in the presence and absence of levodopa. Twenty individuals with Hoehn and Yahr Stage 1.5 to 3 PD practiced the tasks daily for two 4-day weeks, one half practicing on L-dopa the first week and off the second week. The other half practiced off l-dopa both weeks. The tasks were (1) alternate tapping of 2 keys, (2) moving the body toward 2 targets on a posturography device, and (3) mirror drawing of a star. For the tapping and body movement tests, those who practiced on the first week had a progressive decline in performance with practice during week 2, while subjects off during week 1 maintained or improved. In contrast, for the mirror task, subjects on L-dopa initially had much more difficulty completing the task compared to subjects who practiced off. Both groups improved with practice the first week and had flat performance the second week. These data suggest that performance of speed-accuracy tasks learned in the on state may progressively worsen if subsequently practiced in the off state. In addition, performance, but not learning, of some tasks may be impeded by L-dopa.
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Affiliation(s)
- Elise D Anderson
- Northwest Parkinson's Disease Research, Education and Clinical Center, Portland Veterans Affairs (VA), Portland, Oregon, USA; Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon, USA
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Abstract
Jealousy is a complex emotion characterized by the perception of a threat of loss of something that the person values,particularly in reference to a relationship with a loved one, which includes affective, cognitive, and behavioral components. Neural systems and cognitive processes underlying jealousy are relatively unclear, and only a few neuroimaging studies have investigated them. The current article discusses recent empirical findings on delusional jealousy, which is the most severe form of this feeling, in neurodegenerative diseases. After reviewing empirical findings on neurological and psychiatric disorders with delusional jealousy, and after considering its high prevalence in patients with Parkinson's disease under dopamine agonist treatment, we propose a core neural network and core cognitive processes at the basis of (delusional) jealousy, characterizing this symptom as possible endophenotype. In any case,empirical investigation of the neural bases of jealousy is just beginning, and further studies are strongly needed to elucidate the biological roots of this complex emotion.
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