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Saeda S, Sumi Y, Fujiwara K, Kadotani H. Blunted tachycardia and cardiac sympathetic denervation in isolated rapid eye movement sleep behavior disorder. BMC Neurol 2024; 24:317. [PMID: 39232705 PMCID: PMC11373284 DOI: 10.1186/s12883-024-03822-w] [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: 05/22/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Isolated rapid eye movement sleep behavior disorder (iRBD) serves as a prodromal phase of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Blunted tachycardia (BT) during postural changes indicates neurogenic orthostatic hypotension, a marker of autonomic dysfunction. We aimed to investigate whether BT is associated with cardiac sympathetic neurogenic denervation. Additionally, we conducted a preliminary short-term follow-up to examine the potential prognostic significance of BT regarding phenoconversion and mortality. METHODS Forty-three patients with iRBD at Shiga University of Medical Science Hospital underwent active standing tests to identify BT, defined by a specific ratio of decrease in systolic blood pressure to inadequate increase in heart rate after standing, and orthostatic hypotension. 123I-metaiodobenzylguanidine myocardial scintigraphy (123I-MIBG) and dopamine transporter single-photon emission computed tomography (DAT-SPECT) were performed. Participants were followed up for 3.4 ± 2.4 years for phenoconversion and 4.0 ± 2.3 years for mortality assessment, and the risk of events was analyzed using log-rank tests. RESULTS Among the 43 participants (mean age, 72.3 ± 7.9 years; 8 female), 17 met the BT criteria. We found no significant comorbidity-related differences in hypertension or diabetes between the BT(+) and BT(-) groups. Orthostatic hypotension was more prevalent in the BT(+) group than in the BT(-) group (47.1% vs 7.7%, p = 0.003). BT(+) patients were older with a lower early and delayed MIBG uptake; however, no significant differences were observed in DAT accumulation. Phenoconversion was observed in seven (41.2%) BT(+) and seven (26.9%) BT(-) patients. Three deaths were recorded in the BT(+) group (17.6%) and three in the BT(-) group (11.5%). No significant differences were observed in the risk of phenoconversion or mortality between the groups. CONCLUSIONS We have identified the possibility that BT reflects cardiac sympathetic neurogenic denervation in patients with iRBD. Future research is needed to elucidate the potential prognostic value of BT.
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Affiliation(s)
- Shota Saeda
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Koichi Fujiwara
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan.
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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Park DG, Kang W, Shin IJ, Chalita M, Oh HS, Hyun DW, Kim H, Chun J, An YS, Lee EJ, Yoon JH. Difference in gut microbial dysbiotic patterns between body-first and brain-first Parkinson's disease. Neurobiol Dis 2024; 201:106655. [PMID: 39218360 DOI: 10.1016/j.nbd.2024.106655] [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: 06/18/2024] [Revised: 07/31/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study aims to identify distinct microbial and functional biomarkers characteristic of body-first or brain-first subtypes of Parkinson's disease (PD). This could illuminate the unique pathogenic mechanisms within these subtypes. METHODS In this cross-sectional study, we classified 36 well-characterized PD patients into body-first, brain-first, or undetermined subtypes based on the presence of premotor REM sleep behavior disorder (RBD) and cardiac meta-iodobenzylguanidine (MIBG) uptake. We then conducted an in-depth shotgun metagenomic analysis of the gut microbiome for each subtype and compared the results with those from age- and sex-matched healthy controls. RESULTS Significant differences were found in the gut microbiome of body-first PD patients (n = 15) compared to both brain-first PD patients (n = 9) and healthy controls. The gut microbiome in body-first PD showed a distinct profile, characterized by an increased presence of Escherichia coli and Akkermansia muciniphila, and a decreased abundance of short-chain fatty acid-producing commensal bacteria. These shifts were accompanied by a higher abundance of microbial genes associated with curli protein biosynthesis and a lower abundance of genes involved in putrescine and spermidine biosynthesis. Furthermore, the combined use of premotor RBD and MIBG criteria was more strongly correlated with these microbiome differences than the use of each criterion independently. CONCLUSIONS Our findings highlight the significant role of dysbiotic and pathogenic gut microbial alterations in body-first PD, supporting the body-first versus brain-first hypothesis. These insights not only reinforce the gut microbiome's potential as a therapeutic target in PD but also suggest the possibility of developing subtype-specific treatment strategies.
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Affiliation(s)
- Don Gueu Park
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Woorim Kang
- CJ Bioscience Inc., Seoul 04527, Republic of Korea
| | - In-Ja Shin
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | | | - Hyun-Seok Oh
- CJ Bioscience Inc., Seoul 04527, Republic of Korea
| | | | - Hyun Kim
- CJ Bioscience Inc., Seoul 04527, Republic of Korea
| | - Jongsik Chun
- CJ Bioscience Inc., Seoul 04527, Republic of Korea
| | - Young-Sil An
- Department of Nuclear Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Eun Jeong Lee
- Department of Brain Science, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
| | - Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
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Sakurai K, Tokumaru AM, Yoshida M, Saito Y, Wakabayashi K, Komori T, Hasegawa M, Ikeuchi T, Hayashi Y, Shimohata T, Murayama S, Iwasaki Y, Uchihara T, Sakai M, Yabe I, Tanikawa S, Takigawa H, Adachi T, Hanajima R, Fujimura H, Hayashi K, Sugaya K, Hasegawa K, Sano T, Takao M, Yokota O, Miki T, Kobayashi M, Arai N, Ohkubo T, Yokota T, Mori K, Ito M, Ishida C, Idezuka J, Toyoshima Y, Kanazawa M, Aoki M, Hasegawa T, Watanabe H, Hashizume A, Niwa H, Yasui K, Ito K, Washimi Y, Kubota A, Toda T, Nakashima K, Aiba I. Conventional magnetic resonance imaging key features for distinguishing pathologically confirmed corticobasal degeneration from its mimics: a retrospective analysis of the J-VAC study. Neuroradiology 2024:10.1007/s00234-024-03432-w. [PMID: 39039147 DOI: 10.1007/s00234-024-03432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Due to the indistinguishable clinical features of corticobasal syndrome (CBS), the antemortem differentiation between corticobasal degeneration (CBD) and its mimics remains challenging. However, the utility of conventional magnetic resonance imaging (MRI) for the diagnosis of CBD has not been sufficiently evaluated. This study aimed to investigate the diagnostic performance of conventional MRI findings in differentiating pathologically confirmed CBD from its mimics. METHODS Semiquantitative visual rating scales were employed to assess the degree and distribution of atrophy and asymmetry on conventional T1-weighted and T2-weighted images. Additionally, subcortical white matter hyperintensity (SWMH) on fluid-attenuated inversion recovery images were visually evaluated. RESULTS In addition to 19 patients with CBD, 16 with CBD mimics (progressive supranuclear palsy (PSP): 9, Alzheimer's disease (AD): 4, dementia with Lewy bodies (DLB): 1, frontotemporal lobar degeneration with TAR DNA-binding protein of 43 kDa(FTLD-TDP): 1, and globular glial tauopathy (GGT): 1) were investigated. Compared with the CBD group, the PSP-CBS subgroup showed severe midbrain atrophy without SWMH. The non-PSP-CBS subgroup, comprising patients with AD, DLB, FTLD-TDP, and GGT, showed severe temporal atrophy with widespread asymmetry, especially in the temporal lobes. In addition to over half of the patients with CBD, two with FTLD-TDP and GGT showed SWMH, respectively. CONCLUSION This study elucidates the distinct structural changes between the CBD and its mimics based on visual rating scales. The evaluation of atrophic distribution and SWMH may serve as imaging biomarkers of conventional MRI for detecting background pathologies.
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Affiliation(s)
- Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan.
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, 173-0015, Japan
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, 187-8551, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, 036-8562, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, 183-0042, Japan
| | - Masato Hasegawa
- Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, 156-8506, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo, Niigata, 951-8585, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan
| | - Shigeo Murayama
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, 173-0015, Japan
- Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Toshiki Uchihara
- Department of General Internal Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, 904-2293, Japan
- Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, 156-8506, Japan
| | - Motoko Sakai
- Department of Neurology, NHO Suzuka National Hospital, Suzuka, Mie, 513-8501, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoshi Tanikawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan
| | - Hiroshi Takigawa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Tadashi Adachi
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Harutoshi Fujimura
- Department of Neurology, NHO Osaka Toneyama Medical Center, Toyonaka, Osaka, 560-8552, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, 183-0042, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, 183-0042, Japan
| | - Kazuko Hasegawa
- Department of Neurology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, 252-0392, Japan
| | - Terunori Sano
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, 187-8551, Japan
| | - Masaki Takao
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, 187-8551, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama, 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama, 700-8558, Japan
| | - Tomoko Miki
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama, 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama, 700-8558, Japan
| | - Michio Kobayashi
- Department of Neurology, NHO Akita National Hospital, Yurihonjo, Akita, 018-1393, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, 156-8506, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8519, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8519, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie, 512-1111, Japan
| | - Masumi Ito
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie, 512-1111, Japan
| | - Chiho Ishida
- Department of Neurology, NHO Iou National Hospital, Kanazawa, Ishikawa, 920-0192, Japan
| | - Jiro Idezuka
- Department of Neurology, Ojiya Sakura Hospital, Ojiya, Niigata, 947-0041, Japan
| | - Yasuko Toyoshima
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata, 959-2221, Japan
- Department of Pathology, Brain Research Institute, Niigata University, Chuo, Niigata, 951-8585, Japan
| | - Masato Kanazawa
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Chuo, Niigata, 951-8585, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Atsushi Hashizume
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, 466-8650, Japan
| | - Keita Ito
- Department of Neurology, Hekinan Municipal Hospital, Hekinan, Aichi, 447-8502, Japan
| | - Yukihiko Washimi
- Department of Neurology, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, 113-8655, Japan
| | - Kenji Nakashima
- Department of Neurology, NHO Matsue Medical Center, Matsue, Shimane, 690-8556, Japan
| | - Ikuko Aiba
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi, 465-8620, Japan
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Pitton Rissardo J, Fornari Caprara AL. Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review. Brain Sci 2023; 13:1471. [PMID: 37891838 PMCID: PMC10605004 DOI: 10.3390/brainsci13101471] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Cardiac sympathetic denervation, as documented on 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, is relatively sensitive and specific for distinguishing Parkinson's disease (PD) from other neurodegenerative causes of parkinsonism. The present study aims to comprehensively review the literature regarding the use of cardiac MIBG in PD. MIBG is an analog to norepinephrine. They share the same uptake, storage, and release mechanisms. An abnormal result in the cardiac MIBG uptake in individuals with parkinsonism can be an additional criterion for diagnosing PD. However, a normal result of cardiac MIBG in individuals with suspicious parkinsonian syndrome does not exclude the diagnosis of PD. The findings of cardiac MIBG studies contributed to elucidating the pathophysiology of PD. We investigated the sensitivity and specificity of cardiac MIBG scintigraphy in PD. A total of 54 studies with 3114 individuals diagnosed with PD were included. The data were described as means with a Hoehn and Yahr stage of 2.5 and early and delayed registration H/M ratios of 1.70 and 1.51, respectively. The mean cutoff for the early and delayed phases were 1.89 and 1.86. The sensitivity for the early and delayed phases was 0.81 and 0.83, respectively. The specificity for the early and delayed phases were 0.86 and 0.80, respectively.
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Chun IK. Optimal Protocol and Clinical Usefulness of 123I-MIBG Cardiac Scintigraphy for Differentiation of Parkinson's Disease and Dementia with Lewy Body from Non-Parkinson's Diseases. Nucl Med Mol Imaging 2023; 57:145-154. [PMID: 37187951 PMCID: PMC10172433 DOI: 10.1007/s13139-023-00790-w] [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: 10/31/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose 123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was a useful imaging modality for the diagnosis of Parkinson's disease, but its diagnostic performances were variably reported. This retrospective study compared the diagnostic performances and investigated the optimal imaging protocol of 123I-MIBG cardiac scintigraphy at various imaging time points in patients suspected of Parkinson's disease in clinical practice. Methods In patients suspected of Parkinson's disease, clinical records, autonomic function tests, and 123I-MIBG cardiac scintigraphy were retrospectively reviewed. Semi-quantitative parameters such as heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated and compared at 15 min, 1 h, 2 h, 3 h, and 4 h post-injection (p.i.). of 123I-MIBG cardiac scintigraphy. Group A consisted of Parkinson's disease (PD), Parkinson's disease dementia (PDD), and dementia with Lewy body (DLB), and group B consisted of non-Parkinson's diseases such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), drug-induced parkinsonism (DIP), essential tremor (ET), Parkinson-plus syndrome (PPS), and unspecified secondary parkinsonism (NA). The diagnostic performances of HMR and WR were compared for differentiation of group A from group B, and their clinical usefulness and optimal imaging time points were explored. Results Seventy-eight patients were included in group A (67 PD, 7 PDD, 4 DLB), and 18 patients were included in group B (5 MSA, 3 PSP, 2 DIP, 2 ET, 1 PPS, and 1 NA). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value of HMR and WR were maximized at 4 h p.i., (82.1%, 85.7%, 82.6%, 97.0%, and 46.2%; cutoff threshold < 1.717; area under curve 0.8086) and at the time interval between 1 and 4 h p.i. (65.4%, 85.7%, 68.5%, 96.2%, and 30.8%; cutoff threshold > 24.1%; area under curve 0.8246), respectively, and PPVs of both HMR and WR persistently showed greater than 92.7% at earlier time points and shorter time intervals. Conclusion This study reassured that 4-h-delayed imaging is recommended for the best diagnostic performances in 123I-MIBG cardiac scintigraphy. Although it showed suboptimal diagnostic performances to differentiate PD, PDD, and DLB from non-Parkinson's diseases, it can be useful as an auxiliary measure for the differential diagnosis in usual clinical practice. Supplementary Information The online version contains supplementary material available at 10.1007/s13139-023-00790-w.
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Affiliation(s)
- In Kook Chun
- Department of Nuclear Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine and School of Medicine, 1 Kangwondaehak-gil, Chuncheon, Gangwon-do 24341 Republic of Korea
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Javanshiri K, Drakenberg T, Haglund M, Englund E. Sudden cardiac death in synucleinopathies. J Neuropathol Exp Neurol 2023; 82:242-249. [PMID: 36668680 PMCID: PMC9941831 DOI: 10.1093/jnen/nlad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to investigate the cause of death in subjects with α-synucleinopathies (ASs) and the confirmed presence of cardiac α-synuclein (α-syn), compared to non-AS disorders in a neuropathologically confirmed cohort. In total, 78 neuropathologically confirmed AS cases positive for cardiac α-syn were included in the study. Individuals with other neurocognitive diseases, having no α-syn in the brainstem or above, nor in cardiac nerves, served as controls (n = 53). Data regarding the cause of death, cardiac α-syn, pathological cardiac findings, and cardio- and cerebrovascular disease were assembled from autopsy reports and medical records. In the AS group, there was a significantly higher prevalence of sudden cardiac death ([SCD]; n = 40, 51.3%) compared to the control group (n = 12, 22.6%, p < 0.001). No statistically significant differences between the groups were reported regarding other cardiac conditions on autopsy or regarding cardio- and cerebrovascular disease from the medical records. The most prevalent cause of death in the AS group was SCD, which differed significantly from the control group. This suggests that α-syn deposits in cardiac nerves may cause lethal alterations in cardiac function, warranting further research.
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Affiliation(s)
- Keivan Javanshiri
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Tove Drakenberg
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mattias Haglund
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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7
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Tsujimoto M, Suzuki K, Takeda A, Saji N, Sakurai T, Washimi Y. Differentiating Dementia with Lewy Bodies from Alzheimer's Disease Using the Fall Risk Evaluation Questionnaire. Intern Med 2022; 61:1687-1692. [PMID: 34707050 PMCID: PMC9259302 DOI: 10.2169/internalmedicine.8383-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Dementia with Lewy bodies (DLB) is the second-most common form of neurodegenerative dementia after Alzheimer's disease (AD). Falls are a vital prognostic factor in patients with dementia and are a characteristic feature of DLB. This study investigated the screening potential of the fall risk evaluation for DLB and compared it with that of AD to facilitate an accurate diagnosis. Methods We enrolled patients diagnosed with DLB (n=410) and AD (n=2,683) and categorized the participants into 3 groups depending on their physical ability, age, cognitive function, and fall events. Using the Fall Risk Index-21 (FRI-21) questionnaire, we evaluated and comparatively analyzed the fall risk between DLB and AD patients in three defined groups of participants. Results The FRI-21 score was significantly higher in DLB patients than in AD patients in every group. Using this score, we were able to distinguish between DLB and AD patients in each group. Among the three groups, the group with a young age, relatively mild cognitive dysfunction, and no fall events exhibited the best specificity for DLB (0.895). Conclusions The FRI-21 is a useful tool for screening for DLB and differentiating it from AD. This questionnaire can be used at a relatively early stage of the disease in young patients with mild cognitive dysfunction and no history of falling. These preliminary results need to be validated in an interventional study to evaluate the effectiveness of rehabilitative measures and daily environmental changes carried out to prevent falls using this tool.
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Affiliation(s)
- Masashi Tsujimoto
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Japan
| | - Keisuke Suzuki
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Japan
| | - Akinori Takeda
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
| | - Yukihiko Washimi
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
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Javanshiri K, Drakenberg T, Haglund M, Englund E. Cardiac Alpha-Synuclein Is Present in Alpha-Synucleinopathies. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1125-1131. [PMID: 35275559 PMCID: PMC9198726 DOI: 10.3233/jpd-223161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Alpha-synucleinopathies (AS) are characterized by pathologic aggregations of alpha-synuclein (α-syn) in the central nervous system, and comprise dementia with Lewy bodies, Parkinson’s disease, and multiple system atrophy. Previous studies on AS have reported findings of α-syn pathology in the peripheral nervous system of multiple organs, including the heart. Objective: The aim of this study was to further investigate and confirm the presence of cardiac α-syn in AS compared to other major neurocognitive disorders in a neuropathologically confirmed cohort. Methods: All deceased patients with performed autopsy and with neuropathologically confirmed AS at the Clinical Department of Pathology in Lund 2010–May 2021 were evaluated for inclusion. Cases with insufficiently sampled cardiac tissue or only limited neuropathological investigation were excluded. An age-matched group of individuals with other neurodegenerative diseases, having no α-syn in the CNS, served as controls. In total, 68 AS and 32 control cases were included in the study. Immunohistochemistry for detection of cardiac α-syn aggregates was performed. Results: The AS group had a significantly higher prevalence of cardiac α-syn pathology (p≤0.001) than the control group, 82% and 0%, respectively. Conclusion: This study confirms the association between AS and the presence of cardiac α-syn in a neuropathologically confirmed cohort. This motivates further research on potential pathophysiological effects on cardiac function in AS patients.
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Affiliation(s)
- Keivan Javanshiri
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
| | - Tove Drakenberg
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
| | - Mattias Haglund
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
| | - Elisabet Englund
- Department of Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
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Horsager J, Knudsen K, Sommerauer M. Clinical and imaging evidence of brain-first and body-first Parkinson's disease. Neurobiol Dis 2022; 164:105626. [PMID: 35031485 DOI: 10.1016/j.nbd.2022.105626] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Braak's hypothesis has been extremely influential over the last two decades. However, neuropathological and clinical evidence suggest that the model does not conform to all patients with Parkinson's disease (PD). To resolve this controversy, a new model was recently proposed; in brain-first PD, the initial α-synuclein pathology arise inside the central nervous system, likely rostral to the substantia nigra pars compacta, and spread via interconnected structures - eventually affecting the autonomic nervous system; in body-first PD, the initial pathological α-synuclein originates in the enteric nervous system with subsequent caudo-rostral propagation to the autonomic and central nervous system. By using REM-sleep behavior disorder (RBD) as a clinical identifier to distinguish between body-first PD (RBD-positive at motor symptom onset) and brain-first PD (RBD-negative at motor symptom onset), we explored the literature to evaluate clinical and imaging differences between these proposed subtypes. Body-first PD patients display: 1) a larger burden of autonomic symptoms - in particular orthostatic hypotension and constipation, 2) more frequent pathological α-synuclein in peripheral tissues, 3) more brainstem and autonomic nervous system involvement in imaging studies, 4) more symmetric striatal dopaminergic loss and motor symptoms, and 5) slightly more olfactory dysfunction. In contrast, only minor cortical metabolic alterations emerge before motor symptoms in body-first. Brain-first PD is characterized by the opposite clinical and imaging patterns. Patients with pathological LRRK2 genetic variants mostly resemble a brain-first PD profile whereas patients with GBA variants typically conform to a body-first profile. SNCA-variant carriers are equally distributed between both subtypes. Overall, the literature indicates that body-first and brain-first PD might be two distinguishable entities on some clinical and imaging markers.
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Affiliation(s)
- Jacob Horsager
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sommerauer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
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10
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Park DG, Kang J, An YS, Chang J, Yoon JH. Association of plasma α-synuclein with cardiac 123I-MIBG scintigraphy in early Parkinson’s disease. Neurosci Lett 2022; 770:136399. [DOI: 10.1016/j.neulet.2021.136399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 01/28/2023]
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11
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You S, Won KS, Kim KT, Lee HW, Cho YW. Cardiac Autonomic Dysfunction Is Associated with Severity of REM Sleep without Atonia in Isolated REM Sleep Behavior Disorder. J Clin Med 2021; 10:5414. [PMID: 34830696 PMCID: PMC8621819 DOI: 10.3390/jcm10225414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023] Open
Abstract
123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was performed to assess cardiac autonomic dysfunction and demonstrate its correlation with clinical and polysomnographic characteristics in patients with isolated rapid eye movement (REM) sleep behavior disorder. All subjects including 39 patients with isolated REM sleep behavior disorder and 17 healthy controls underwent MIBG cardiac scintigraphy for cardiac autonomic dysfunction assessment. The isolated REM sleep behavior disorder was confirmed by in-lab overnight polysomnography. A receiver operating curve was constructed to determine the cut-off value of the early and delayed heart-to-mediastinum ratio in patients with isolated REM sleep behavior disorder. Based on each cut-off value, a comparison analysis of REM sleep without atonia was performed by dividing isolated REM sleep behavior disorder patients into two groups. MIBG uptake below the cut-off value was associated with higher REM sleep without atonia. The lower heart-to-mediastinum ratio had significantly higher REM sleep without atonia (%), both with cut-off values of early (11.0 ± 5.6 vs. 29.3 ± 23.2%, p = 0.018) and delayed heart-to-mediastinum ratio (9.1 ± 4.3 vs. 30.0 ± 22.9%, p = 0.011). These findings indicate that reduced MIBG uptake is associated with higher REM sleep without atonia in isolated REM sleep behavior disorder.
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Affiliation(s)
- Sooyeoun You
- Department of Neurology, Keimyung University School of Medicine, Daegu 42601, Korea; (S.Y.); (K.T.K.)
| | - Kyoung Sook Won
- Department of Nuclear Medicine, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu 42601, Korea; (S.Y.); (K.T.K.)
| | - Hyang Woon Lee
- Departments of Neurology, Medical Science, Computational Medicine, System Health Science & Engineering, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul 07985, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu 42601, Korea; (S.Y.); (K.T.K.)
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12
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Roberts G, Lloyd JJ, Jefferson E, Kane JPM, Durcan R, Lawley S, Petrides GS, Howe K, Haq I, O'Brien JT, Thomas AJ. Uniformity of cardiac 123I-MIBG uptake on SPECT images in older adults with normal cognition and patients with dementia. J Nucl Cardiol 2021; 28:2151-2163. [PMID: 31820410 PMCID: PMC8648658 DOI: 10.1007/s12350-019-01977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Some studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls. We aimed to evaluate regional cardiac MIBG uptake patterns in healthy older adults and patients with dementia. METHODS 31 older adults with normal cognition, 15 Alzheimer's disease (AD), and 17 Dementia with Lewy bodies (DLB) patients were recruited. 5 individuals had previous myocardial infarction. Participants with sufficient cardiac uptake for regional SPECT analysis (29/31 controls, 15/15 AD, 5/17 DLB) had relative uptake pattern recorded. Controls were assessed for risk of future cardiovascular events using QRISK2, a validated online tool. RESULTS In controls uptake was reduced in the inferior wall (85%), apex (23%), septum (15%), and lateral wall (8%). AD and DLB showed similar patterns to controls. Lung or liver interference was present in 61% of cases. Myocardial infarction cases showed regional reductions in uptake, but normal/borderline planar uptake. In controls, there was no relationship between cardiovascular risk score and uptake pattern. CONCLUSIONS Significant variability of regional cardiac 123I-MIBG uptake is common in cases with normal planar cardiac uptake. Heterogeneity of regional uptake appears non-specific and unlikely to aid in the diagnosis of Lewy body disease.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK.
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Jim J Lloyd
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Elizabeth Jefferson
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Rory Durcan
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - Sarah Lawley
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - George S Petrides
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Kim Howe
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Iftikhar Haq
- Cardiology Department, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
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Choudhary G, Bhambhvani P. Myocardial Sympathetic Innervation Imaging with MIBG in Dementia with Lewy Bodies. J Nucl Cardiol 2021; 28:2164-2166. [PMID: 32002846 DOI: 10.1007/s12350-020-02042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Gagandeep Choudhary
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, JT 779, Birmingham, AL, 35249, USA
| | - Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, JT 779, Birmingham, AL, 35249, USA.
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14
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Roberts G, Lloyd JJ, Kane JPM, Durcan R, Lawley S, Howe K, Petrides GS, O'Brien JT, Thomas AJ. Cardiac 123I-MIBG normal uptake values are population-specific: Results from a cohort of controls over 60 years of age. J Nucl Cardiol 2021; 28:1692-1701. [PMID: 31529384 DOI: 10.1007/s12350-019-01887-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Cardiac 123I-MIBG image interpretation is affected by population differences and technical factors. We recruited older adults without cognitive decline and compared their cardiac MIBG uptake with results from the literature. METHODS Phantom calibration confirmed that cardiac uptake results from Japan could be applied to our center. We recruited 31 controls, 17 individuals with dementia with Lewy bodies (DLB) and 15 with Alzheimer's disease (AD). Images were acquired 20 minutes and four hours after injection using Siemens cameras with medium-energy low-penetration (MELP) collimators. Local normal heart-to-mediastinum (HMR) ratios were compared to Japanese results. RESULTS Siemens gamma cameras with MELP collimators should give HMRs very close to the calibrated values used in Japan. However, our cut-offs with controls were lower at 2.07 for early and 1.86 for delayed images. Applying our lower cut-off to the dementia patients may increase the specificity of cardiac MIBG imaging for DLB diagnosis in a UK population without reducing sensitivity. CONCLUSIONS Our local HMR cut-off values are lower than in Japan, higher than in a large US study but similar to those found in another UK center. UK centers using other cameras and collimators may need to use different cut-offs to apply our results.
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Affiliation(s)
- G Roberts
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK.
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - J J Lloyd
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - J P M Kane
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - R Durcan
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - S Lawley
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - K Howe
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - G S Petrides
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - J T O'Brien
- Department of Psychiatry, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - A J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
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15
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Milán-Tomás Á, Fernández-Matarrubia M, Rodríguez-Oroz MC. Lewy Body Dementias: A Coin with Two Sides? Behav Sci (Basel) 2021; 11:94. [PMID: 34206456 PMCID: PMC8301188 DOI: 10.3390/bs11070094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Lewy body dementias (LBDs) consist of dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which are clinically similar syndromes that share neuropathological findings with widespread cortical Lewy body deposition, often with a variable degree of concomitant Alzheimer pathology. The objective of this article is to provide an overview of the neuropathological and clinical features, current diagnostic criteria, biomarkers, and management of LBD. Literature research was performed using the PubMed database, and the most pertinent articles were read and are discussed in this paper. The diagnostic criteria for DLB have recently been updated, with the addition of indicative and supportive biomarker information. The time interval of dementia onset relative to parkinsonism remains the major distinction between DLB and PDD, underpinning controversy about whether they are the same illness in a different spectrum of the disease or two separate neurodegenerative disorders. The treatment for LBD is only symptomatic, but the expected progression and prognosis differ between the two entities. Diagnosis in prodromal stages should be of the utmost importance, because implementing early treatment might change the course of the illness if disease-modifying therapies are developed in the future. Thus, the identification of novel biomarkers constitutes an area of active research, with a special focus on α-synuclein markers.
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Affiliation(s)
- Ángela Milán-Tomás
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
| | - Marta Fernández-Matarrubia
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Cruz Rodríguez-Oroz
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIMA, Center of Applied Medical Research, Universidad de Navarra, Neurosciences Program, 31008 Pamplona, Spain
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16
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Katsi V, Papakonstantinou I, Solomou E, Antonopoulos AS, Vlachopoulos C, Tsioufis K. Management of Hypertension and Blood Pressure Dysregulation in Patients with Parkinson's Disease-a Systematic Review. Curr Hypertens Rep 2021; 23:26. [PMID: 33961147 DOI: 10.1007/s11906-021-01146-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The aim of this review article was to summarize the cardiovascular and blood pressure profile regarding Parkinson disease patients and to provide an update on the recent advancements in the field of the diagnosis and management of blood pressure abnormalities in these patients. Our goal was to guide physicians to avoid pitfalls in current practice while treating patients with Parkinson disease and blood pressure abnormalities. For this purpose, we searched bibliographic databases (PubMed, Google Scholar) for all publications published on blood pressure effects in Parkinson disease until May 2020. Furthermore, we highlight some thoughts and potential perspectives for the next possible steps in the field. RECENT FINDINGS Blood pressure dysregulation in patients with Parkinson's disease has several implications in clinical practice and presents an ongoing concern. Compared with chronic essential hypertension, the syndrome of combined neurogenic orthostatic hypotension and supine hypertension in Parkinson's disease has received little attention. If left untreated, hypertension may lead to cardiovascular disease whereas hypotension may lead to fall-related complications, with tremendous impact on the quality of life of affected individuals. The effect of blood Epressure control and the risk of death from cardiovascular disease in Parkinson disease are largely unexplored. Blood pressure abnormalities in Parkinson disease present bidirectional relationship and the rationale for treating and controlling hypertension in persons with Parkinson disease and concurrent neurogenic orthostatic hypotension and/or supine hypertension is compelling. Further research is warranted in order to clarify the mechanisms, clinical implications, and potential reversibility of compromised cardiovascular function, in persons with Parkinson disease.
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Affiliation(s)
- Vasiliki Katsi
- Cardiology Department, Hippokration General Hospital, Athens, Greece. .,Internal Medicine, Evangelismos Hospital, Athens, Greece.
| | - Ilias Papakonstantinou
- Cardiology Department, Hippokration General Hospital, Athens, Greece.,Internal Medicine, Evangelismos Hospital, Athens, Greece
| | - Eirini Solomou
- Cardiology Department, Hippokration General Hospital, Athens, Greece.,Internal Medicine, Evangelismos Hospital, Athens, Greece
| | - Alexios S Antonopoulos
- Cardiology Department, Hippokration General Hospital, Athens, Greece.,Internal Medicine, Evangelismos Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- Cardiology Department, Hippokration General Hospital, Athens, Greece.,Internal Medicine, Evangelismos Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- Cardiology Department, Hippokration General Hospital, Athens, Greece.,Internal Medicine, Evangelismos Hospital, Athens, Greece
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17
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Gastrointestinal Dysfunction in Parkinson's Disease. J Clin Med 2021; 10:jcm10030493. [PMID: 33572547 PMCID: PMC7866791 DOI: 10.3390/jcm10030493] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease. Patients show deposits of pathological, aggregated α-synuclein not only in the brain but throughout almost the entire length of the digestive tract. This gives rise to non-motor symptoms particularly within the gastrointestinal tract and patients experience a wide range of frequent and burdensome symptoms such as dysphagia, bloating, and constipation. Recent evidence suggests that progressive accumulation of gastrointestinal pathology is underway several years before a clinical diagnosis of PD. Notably, constipation has been shown to increase the risk of developing PD and in contrast, truncal vagotomy seems to decrease the risk of PD. Animal models have demonstrated gut-to-brain spreading of pathological α-synuclein and it is currently being intensely studied whether PD begins in the gut of some patients. Gastrointestinal symptoms in PD have been investigated by the use of several different questionnaires. However, there is limited correspondence between subjective gastrointestinal symptoms and objective dysfunction along the gastrointestinal tract, and often the magnitude of dysfunction is underestimated by the use of questionnaires. Therefore, objective measures are important tools to clarify the degree of dysfunction in future studies of PD. Here, we summarize the types and prevalence of subjective gastrointestinal symptoms and objective dysfunction in PD. The potential importance of the gastrointestinal tract in the etiopathogenesis of PD is briefly discussed.
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18
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Kang J, Kim JW, Heo H, Lee J, Park KY, Yoon JH, Chang J. Identification of BAG2 and Cathepsin D as Plasma Biomarkers for Parkinson's Disease. Clin Transl Sci 2020; 14:606-616. [PMID: 33202088 PMCID: PMC7993325 DOI: 10.1111/cts.12920] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/10/2020] [Indexed: 12/30/2022] Open
Abstract
The current diagnosis of Parkinson’s disease (PD) mostly relies on clinical rating scales related to motor dysfunction. Given that clinical symptoms of PD appear after significant neuronal cell death in the brain, it is required to identify accessible, objective, and quantifiable biomarkers for early diagnosis of PD. In this study, a total of 20 patients with idiopathic PD and 20 age‐matched patients with essential tremor according to the UK Brain Bank Criteria were consecutively enrolled to identify peripheral blood biomarkers for PD. Clinical data were obtained by clinical survey and assessment. Using albumin‐depleted and immunoglobulin G‐depleted plasma samples, we performed immunoblot analysis of seven autophagy‐related proteins and compared the levels of proteins to those of the control group. We also analyzed the correlation between the levels of candidate proteins and clinical characteristics. Finally, we validated our biomarker models using receiver operating characteristic curve analysis. We found that the levels of BCL2‐associated athanogene 2 (BAG2) and cathepsin D were significantly decreased in plasma of patients with PD (P = 0.009 and P = 0.0077, respectively). The level of BAG2 in patients with PD was significantly correlated with Cross‐Culture Smell Identification Test score, which indicates olfactory dysfunction. We found that our biomarker model distinguishes PD with 87.5% diagnostic accuracy (area under the curve (AUC) = 0.875, P < 0.0001). Our result suggests BAG2 and cathepsin D as candidates for early‐diagnosis plasma biomarkers for PD. We provide the possibility of plasma biomarkers related to the autophagy pathway, by which decreased levels of BAG2 and cathepsin D might lead to dysfunction of autophagy.
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Affiliation(s)
- Juhee Kang
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jae Whan Kim
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Hansol Heo
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jihyun Lee
- Department of Brain Science, Ajou University School of Medicine, Suwon, Korea
| | - Kwan Yong Park
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jaerak Chang
- Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea.,Department of Brain Science, Ajou University School of Medicine, Suwon, Korea
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19
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Difference in cardiovascular response during orthostatic stress in Parkinson's disease and multiple system atrophy. J Neural Transm (Vienna) 2020; 127:1377-1386. [PMID: 32783093 DOI: 10.1007/s00702-020-02241-8] [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: 05/22/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
Although orthostatic hypotension is more prominent in multiple system atrophy (MSA) than in Parkinson's disease (PD), there is no study comparing the degree of decrease in total peripheral resistance and cardiac response during orthostatic stress between both diseases. In this study, we examined whether there is a difference in cardiovascular response between MSA and PD. We examined the results of the head-up tilt test in 68 patients with MSA, 28 patients with cardiac non-denervated PD, and 70 patients with cardiac denervated PD whose total peripheral resistance after 60° tilting was lower than the value at 0°. Differences in cardiac output and blood pressure changes were compared against the decrease in total peripheral resistance. There was no difference in the degree of decrease in total peripheral resistance among the three groups. However, the slope of the regression line revealed that the increase in cardiac output against the change in total peripheral resistance was significantly lower in the MSA group than in the cardiac non-denervated and denervated PD groups, and that the decrease in systolic blood pressure against the change in total peripheral resistance was significantly greater in the MSA group than in the cardiac non-denervated and denervated PD groups. In MSA, the cardiac response during orthostatic stress is lower than that in PD, possibly underlying the fact that orthostatic hypotension is more prominent in MSA than in PD.
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20
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Sakamoto F, Shiraishi S, Ogasawara K, Tsuda N, Nakagawa M, Tomiguchi S, Yamashita Y. A diagnostic strategy for Lewy body disease using DAT-SPECT, MIBG and Combined index. Ann Nucl Med 2020; 34:415-423. [PMID: 32301068 DOI: 10.1007/s12149-020-01464-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/24/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE The functional imaging methods widely used for the diagnosis of Lewy body disease (LBD) are 123I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropan (FP-CIT) with dopamine transporter single photon emission computed tomography (DAT-SPECT) and 123I-iodobenzylguanidine (MIBG) myocardial scintigraphy. The aim of this study was to determine whether DAT-SPECT or 123I-MIBG myocardial scintigraphy should be examined first and to evaluate whether the combined use of DAT-SPECT and MIBG myocardial scintigraphy is superior to using either modality alone for diagnosing suspected LBD. METHODS In this retrospective study, a total of 117 patients suspected of having LBD underwent DAT-SPECT imaging followed by MIBG myocardial scintigraphy. The delayed heart-to-mediastinum (H/M) ratio of MIBG scintigraphy, and the specific binding ratio (SBR) of DAT-SPECT imaging, and Combined index (defined as SBR mean × H/M in the delayed phase) were used as semi-quantitative measures. The diagnostic ability was evaluated using these indexes. RESULTS The sensitivity, specificity, and accuracy of diagnosing Lewy body disease were 59.6%, 71.4%, and 67.5% by SBR mean of DAT-SPECT, 85.1%, 91.4%, and 88.9% by delayed H/M ratio of MIBG myocardial scintigraphy, 76.6%, 74.3%, and 75.2% by Combined index, respectively. CONCLUSION In the diagnosis of LBD, DAT-SPECT, MIBG myocardial scintigraphy, and Combined index may be reliable indices. In particular, MIBG myocardial scintigraphy was the specific modality for LBD diagnosis. Understanding the effectiveness and limits of DAT-SPECT and MIBG myocardial scintigraphy and using both properly will lead to a more accurate diagnosis and better treatment.
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Affiliation(s)
- Fumi Sakamoto
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto, Kumamoto, 8608550, Japan. .,Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto, Kumamoto, 8608550, Japan
| | - Koji Ogasawara
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto, Kumamoto, 8608550, Japan
| | - Noriko Tsuda
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto, Kumamoto, 8608550, Japan
| | - Masataka Nakagawa
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto, Kumamoto, 8608550, Japan
| | - Seiji Tomiguchi
- Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto, Kumamoto, 8608550, Japan
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Roberts G, Lloyd JJ, Petrides GS, O'Brien JT, Thomas AJ. Cardiac 123I-MIBG planar heart to mediastinum ratios depend on patient size; phantom studies suggest SPECT-CT could improve quantification. Biomed Phys Eng Express 2019; 6:015011. [PMID: 33438599 DOI: 10.1088/2057-1976/ab5c09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Planar 123I-MIBG (meta-iodobenzylguanidine) cardiac imaging is listed as an indicative biomarker in the 2017 international consensus criteria for the diagnosis of dementia with Lewy bodies. There has been very little research into the relationship between apparent cardiac uptake and patient size, or in the possible advantage of attenuation and scatter corrected SPECT-CT compared to planar imaging. We aimed to evaluate this in both a chest phantom and in older adults with normal cognition. MATERIALS AND METHODS An anthropomorphic chest phantom was filled with 123I solution using activities typical of healthy subjects. The phantom was scanned on a Siemens Intevo gamma camera with MELP collimators using both planar and SPECT-CT techniques. Further scans were acquired with a PMMA chest plate added, then water filled plastic breasts. The SPECT-CT images were reconstructed using a resolution recovery OSEM method with and without attenuation and scatter correction (ACSC) applied. Twenty-nine adults over 60 years of age (mean 75.2 ± 8.3 years) underwent planar cardiac MIBG imaging, followed by SPECT-CT. SPECT images were reconstructed as above. Heart-to-mediastinum ratios (HMRs) were calculated for planar and SPECT images. RESULTS Phantom planar HMR decreased by 20% with the PMMA chest plate added; 39% with plate and breasts. ACSC SPECT cardiac counts showed less dependence on phantom size than SPECT without ACSC (3% versus 37%). The body mass indices (BMI) of the older adults ranged from 22 to 38. There was a significant linear relationship between planar HMR and BMI (R2 = 0.44, p<0.01), but not for ACSC SPECT. However, there was no significant difference between the slopes for planar and ACSC SPECT (p = 0.11). CONCLUSION Planar cardiac 123I-MIBG HMR results are correlated with BMI. Phantom results suggest that ACSC SPECT can correct for patient size. A large patient population or clinical database would be required to demonstrate a clinical effect.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle Upon Tyne. NE4 6BE, United Kingdom. Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle Upon Tyne. NE1 4LP, United Kingdom
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Striatal dopamine activity and myocardial 123I-metaiodobenzylguanidine uptake in early Parkinson's disease. Parkinsonism Relat Disord 2019; 63:156-161. [DOI: 10.1016/j.parkreldis.2019.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 12/12/2022]
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Initial Versus Follow-up Sequential Myocardial 123I-MIBG Scintigraphy to Discriminate Parkinson Disease From Atypical Parkinsonian Syndromes. Clin Nucl Med 2019; 44:282-288. [PMID: 30589669 DOI: 10.1097/rlu.0000000000002424] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Previous single-center or meta-analysis studies analyzed myocardial I-metaiodobenzylguanidine (I-MIBG) scintigraphy in a single image session and demonstrated low sensitivity and high specificity for discriminating Parkinson disease (PD) from atypical Parkinsonian syndromes (APS). This study aimed to assess diagnostic ability of myocardial I-MIBG scintigraphy at 2 phases to discriminate PD from APS. PATIENTS AND METHODS This hospital-based prospective study enrolled 162 PD and 26 APS patients who underwent 2 sequential I-MIBG scintigraphy evaluations. Patients were stratified into normal and decreased I-MIBG groups according to early and delayed heart-to-mediastinum (H/M) ratios. Patients with PD and normal I-MIBG uptake (initial delayed H/M ratio, ≥1.78) were considered scans without evidence of cardiac norepinephrine deficit (SWEND). Early and delayed H/M ratios on the initial and 2-year follow-up scintigraphs were studied. The diagnostic sensitivity and specificity were calculated from these confusion matrices and were analyzed according to receiver-operating characteristic curve analysis. A repeated-measures general linear model was used to investigate differences among groups over time in H/M ratio changes and washout rates. RESULTS Follow-up I-MIBG scintigraphy analysis had a higher diagnostic sensitivity (89.5%) than the initial imaging (72.2%). The improved sensitivity was associated with a steeper decrease in H/M ratio in the SWEND group than in the APS group. CONCLUSIONS Follow-up I-MIBG scintigraphy can identify cardiac sympathetic denervation and its progression in patients with PD and may be effective in discriminating PD from APS. A later decrease in myocardial I-MIBG uptake in the group with SWEND meets the Braak staging threshold hypothesis for synucleinopathy.
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Rafanelli M, Walsh K, Hamdan MH, Buyan-Dent L. Autonomic dysfunction: Diagnosis and management. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:123-137. [PMID: 31753129 DOI: 10.1016/b978-0-12-804766-8.00008-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The autonomic nervous system is designed to maintain physiologic homeostasis. Its widespread connections make it vulnerable to disruption by many disease processes including primary etiologies such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, and pure autonomic failure and secondary etiologies such as diabetes mellitus, amyloidosis, and immune-mediated illnesses. The result is numerous symptoms involving the cardiovascular, gastrointestinal, and urogenital systems. Patients with autonomic dysfunction (AUD) often have peripheral and/or cardiac denervation leading to impairment of the baroreflex, which is known to play a major role in determining hemodynamic outcome during orthostatic stress and low cardiac output states. Heart rate and plasma norepinephrine responses to orthostatic stress are helpful in diagnosing impairment of the baroreflex in patients with orthostatic hypotension (OH) and suspected AUD. Similarly, cardiac sympathetic denervation diagnosed with MIBG scintigraphy or 18F-DA PET scanning has also been shown to be helpful in distinguishing preganglionic from postganglionic involvement and in diagnosing early stages of neurodegenerative diseases. In this chapter, we review the causes of AUD, the pathophysiology and resulting cardiovascular manifestations with emphasis on the diagnosis and treatment of OH.
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Affiliation(s)
- Martina Rafanelli
- Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | - Kathleen Walsh
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Mohamed H Hamdan
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Laura Buyan-Dent
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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Cova I, Priori A. Diagnostic biomarkers for Parkinson's disease at a glance: where are we? J Neural Transm (Vienna) 2018; 125:1417-1432. [PMID: 30145631 PMCID: PMC6132920 DOI: 10.1007/s00702-018-1910-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder whose aetiology remains unclear: degeneration involves several neurotransmission systems, resulting in a heterogeneous disease characterized by motor and non-motor symptoms. PD causes progressive disability that responds only to symptomatic therapies. Future advances include neuroprotective strategies for use in at-risk populations before the clinical onset of disease, hence the continuing need to identify reliable biomarkers that can facilitate the clinical diagnosis of PD. In this evaluative review, we summarize information on potential diagnostic biomarkers for use in the clinical and preclinical stages of PD.
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Affiliation(s)
- Ilaria Cova
- Neurology Unit, L. Sacco University Hospital, Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy.
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Abstract
PURPOSE OF REVIEW Patients with Parkinson's disease (PD) often display gastrointestinal and genitourinary autonomic symptoms years or even decades prior to diagnosis. These symptoms are thought to be caused in part by pathological α-synuclein inclusions in the peripheral autonomic and enteric nervous systems. It has been proposed that the initial α-synuclein aggregation may in some PD patients originate in peripheral nerve terminals and then spread centripetally to the spinal cord and brainstem. In vivo imaging methods can directly quantify the degeneration of the autonomic nervous system as well as the functional consequences such as perturbed motility. Here, we review the methodological principles of these imaging techniques and the major findings in patients with PD and atypical parkinsonism. RECENT FINDINGS Loss of sympathetic and parasympathetic nerve terminals in PD can be visualized using radiotracer imaging, including 123I-MIBG scintigraphy, and 18F-dopamine and 11C-donepezil PET. Recently, ultrasonographical studies disclosed reduced diameter of the vagal nerves in PD patients. Radiological and radioisotope techniques have demonstrated dysmotility and prolonged transit time throughout all subdivisions of the gastrointestinal tract in PD. The prevalence of objective dysfunction as measured with these imaging methods is often considerably higher compared to the prevalence of subjective symptoms experienced by the patients. Degeneration of the autonomic nervous system may play a key role in the pathogenesis of PD. In vivo imaging techniques provide powerful and noninvasive tools to quantify the degree and extent of this degeneration and its functional consequences.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark.
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Capouch SD, Farlow MR, Brosch JR. A Review of Dementia with Lewy Bodies' Impact, Diagnostic Criteria and Treatment. Neurol Ther 2018; 7:249-263. [PMID: 29987534 PMCID: PMC6283803 DOI: 10.1007/s40120-018-0104-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 12/16/2022] Open
Abstract
Dementia with Lewy bodies is one of the most common causes of dementia. It is not as common as Alzheimer's disease; the general public's awareness of the disease is poor in comparison. Its effects on caregivers and patients alike are not well known to the general population. There are currently no FDA-approved medications specifically for the treatment of DLB. Many of the medications that are approved for Alzheimer's disease are widely used in the treatment of DLB with varying degrees of success. Treatment of DLB is life long and requires a dedicated team of physicians and caregivers to minimize the degree of morbidity and mortality experienced by the patients suffering from the disease as it progresses.
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Affiliation(s)
- Samuel D Capouch
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St #4700, Indianapolis, IN, 46202, USA
| | - Martin R Farlow
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St #4700, Indianapolis, IN, 46202, USA
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St #4700, Indianapolis, IN, 46202, USA.
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Matsusue E, Fujihara Y, Tanaka K, Aozasa Y, Shimoda M, Nakayasu H, Nakamura K, Ogawa T. The Utility of the Combined Use of 123I-FP-CIT and 123I-MIBG Myocardial Scintigraphy in Differentiating Parkinson's Disease from Other Parkinsonian Syndromes. Yonago Acta Med 2018; 61:117-127. [PMID: 29946218 PMCID: PMC6015794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/11/2018] [Indexed: 09/27/2023]
Abstract
BACKGROUND 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguish Parkinson's disease (PD) from parkinsonian syndromes other than PD (non-PD), including atypical parkinsonian disorder (APD) and non-PD other than APD (nPD-nAPD). The purpose of this study was to determine whether combining DAT-SPECT and MIBG myocardial scintigraphy using multiparametric scoring system (MSS) could improve diagnostic test accuracy in discriminating PD from APD or discriminating PD from nPD-nAPD. METHODS A total of 52 patients, including 36 PD, eight APD and eight nPD-nAPD, underwent both MIBG myocardial scintigraphy and DAT-SPECT, were evaluated. The heart-to-mediastinum (H/M) ratios (early and delayed), washout-rate (WR), the average (Ave) and asymmetry index (AI) of specific binding ratio (SBR) were calculated. Cutoff values were determined, using ROC analysis, for discriminating PD from APD and for discriminating PD from nPD-nAPD, on five parameters. All cases were scored as either 1 (PD) or 0 (nPD-nAPD or APD) for each parameter according to its threshold in each discrimination. These individual scores were summed for each case, yielding a combined score to obtain a cutoff value for the MSS in each discrimination. RESULTS For discriminating PD from nPD-nAPD, the highest accuracy was 80% at a cutoff value of 19% for the WR and a cut off value of 2 improved diagnostic accuracy to 84% for MSS. For discriminating PD from APD, the highest accuracy was 86% at a cutoff value of 2.8 for the H/M ratio (late) and a cut off value of 2 showed diagnostic accuracy of 86% for MSS. CONCLUSION A MSS has comparable or better accuracy compared to each parameter of MIBG myocardial scintigraphy and DAT-SPECT in distinguishing PD from nPD-nAPD or distinguishing PD from APD.
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Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yoshio Fujihara
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kenichiro Tanaka
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yuki Aozasa
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Manabu Shimoda
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hiroyuki Nakayasu
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Toshihide Ogawa
- ‡Division of Radiology, Department of Pathophysiological Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Langston JW, Wiley JC, Tagliati M. Optimizing Parkinson's disease diagnosis: the role of a dual nuclear imaging algorithm. NPJ PARKINSONS DISEASE 2018; 4:5. [PMID: 29507872 PMCID: PMC5824845 DOI: 10.1038/s41531-018-0041-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/08/2018] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
Abstract
The diagnosis of Parkinson's disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine 123I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining 123I-ioflupane SPECT and the noradrenergic receptor ligand 123I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral 123I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.
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Affiliation(s)
| | - Jesse C Wiley
- 2Department of Comparative Medicine, University of Washington, 1959 NE Pacific Ave Seattle, Seattle, WA USA
| | - Michele Tagliati
- Department of Neurology, Cedar-Sinai Medical Center, 127 S San Vicente Blvd, AHSP 6600, Los Angeles, CA 90272 USA
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Nisitani S, Miyoshi H, Katsuoka Y. Extensive Delayed Brain Atrophy after Resuscitation in a Patient with Multiple System Atrophy. Front Neurol 2018; 8:754. [PMID: 29379469 PMCID: PMC5775520 DOI: 10.3389/fneur.2017.00754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/28/2017] [Indexed: 11/13/2022] Open
Abstract
Brain magnetic resonance imaging (MRI) of multiple system atrophy (MSA) shows atrophy in the cerebrum, cerebellum, and brainstem. It is also characterized by specific patterns such as hyperintense lateral putaminal rim. MRI of hypoxic encephalopathy shows atrophy mainly in the gray matter, and laminar necrosis in the cerebral cortex is often observed. Here, we report an MSA patient damaged by hypoxic insult and resuscitated after 18-min cardiac arrest. The brain of the patient developed severe atrophy within a period of 10 months. Furthermore, brain atrophy was observed in the white and gray matter, which preserved the brain atrophy pattern in MSA. We assume that alpha-synuclein oligomerization is involved in the neural cell death and brain atrophy. It might have caused further neural cell death in the brain damaged by hypoxia. Alpha-synuclein, which is involved in the pathogenesis of MSA, is suggested to be a prion. Misfolded alpha-synuclein may propagate through cell-to-cell transmission and cause wide pathological change, visible as atrophied MR imaging.
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Does sympathetic dysfunction occur before denervation in pure autonomic failure? Clin Sci (Lond) 2018; 132:1-16. [PMID: 29162745 DOI: 10.1042/cs20170240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 11/03/2017] [Accepted: 11/17/2017] [Indexed: 01/08/2023]
Abstract
Pure autonomic failure (PAF) is a rare sporadic disorder characterized by autonomic failure in the absence of a movement disorder or dementia and is associated with very low plasma norepinephrine (NE) levels-suggesting widespread sympathetic denervation, however due to its rarity the pathology remains poorly elucidated. We sought to correlate clinical and neurochemical findings with sympathetic nerve protein abundances, accessed by way of a forearm vein biopsy, in patients with PAF and in healthy controls and patients with multiple systems atrophy (MSA) in whom sympathetic nerves are considered intact. The abundance of sympathetic nerve proteins, extracted from forearm vein biopsy specimens, in 11 patients with PAF, 8 patients with MSA and 9 age-matched healthy control participants was performed following a clinical evaluation and detailed evaluation of sympathetic nervous system function, which included head-up tilt (HUT) testing with measurement of plasma catecholamines and muscle sympathetic nerve activity (MSNA) in addition to haemodynamic assessment to confirm the clinical phenotype. PAF participants were found to have normal abundance of the NE transporter (NET) protein, together with very low levels of tyrosine hydroxylase (TH) (P<0.0001) and reduced vesicular monoamine transporter 2 (VMAT2) (P<0.05) protein expression compared with control and MSA participants. These findings were associated with a significantly higher ratio of plasma 3,4-dihydroxyphenylglycol (DHPG):NE in PAF participants when compared with controls (P<0.05). The finding of normal NET abundance in PAF suggests intact sympathetic nerves but with reduced NE synthesis. The finding of elevated plasma ratio of DHPG:NE and reduced VMAT2 in PAF indicates a shift towards intraneuronal NE metabolism over sequestration in sympathetic nerves and suggests that sympathetic dysfunction may occur ahead of denervation.
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Matsusue E, Fujihara Y, Tanaka K, Aozasa Y, Shimoda M, Nakayasu H, Nakamura K, Ogawa T. The Utility of the Combined Use of 123I-FP-CIT and 123I-MIBG Myocardial Scintigraphy in Differentiating Parkinson’s Disease from Other Parkinsonian Syndromes. Yonago Acta Med 2018. [DOI: 10.33160/yam.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Eiji Matsusue
- *Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yoshio Fujihara
- *Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kenichiro Tanaka
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yuki Aozasa
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Manabu Shimoda
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hiroyuki Nakayasu
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kazuhiko Nakamura
- *Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Toshihide Ogawa
- ‡Division of Radiology, Department of Pathophysiological Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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The utility of the combination of a SPECT study with [123I]-FP-CIT of dopamine transporters and [123I]-MIBG myocardial scintigraphy in differentiating Parkinson disease from other degenerative parkinsonian syndromes. Nucl Med Commun 2017; 38:487-492. [PMID: 28410288 PMCID: PMC5433627 DOI: 10.1097/mnm.0000000000000674] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Molecular imaging of nigrostriatal dopamine transporters (DAT) and sympathetic cardiac innervation with single-photon emission computed tomography (SPECT) are useful tools for differentiating idiopathic Parkinson disease (PD) from other degenerative parkinsonian syndromes (non-PD). Nevertheless, these modalities are often insufficient for achieving a definite diagnosis. The aims of this study were to evaluate the diagnostic accuracy of the combination of these tools. Materials and methods The SPECT radiotracers [123I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)-nortropane (FP-CIT) and meta-[123I]-iodobenzylguanidine (MIBG) were used to research presynaptic dopaminergic projections (DAT SPECT) and myocardial adrenergic innervation (MIBG scintigraphy), respectively. PD patients (n=15; age: 61.5±13.6 years) and non-PD patients (n=19; age: 62.6±14.2 years) who underwent both tests were enrolled in this study. Receiver-operating characteristic analyses were used to set the cutoff values of the specific binding ratio in DAT SPECT and the heart to mediastinum ratio in delayed scan in MIBG scintigraphy for differentiating PD from non-PD. We calculated the sensitivity, specificity, and test accuracy of the individual methods and also the combination of these two modalities. Results When DAT SPECT and MIBG scintigraphy were used individually, they showed mild accuracy in differentiating PD from non-PD (DAT, 67.6%; MIBG, 67.6%). The combination of the two approaches using cutoff values of less than 3.24 for the specific binding ratio and less than 2.745 for the delayed heart to mediastinum ratio enabled more accurate differentiation between PD and non-PD. The accuracy of these indices in distinguishing PD from non-PD was 79.4%. Conclusion These results suggested that the combination of DAT SPECT and MIBG scintigraphy may improve the diagnostic accuracy in differentiating PD from non-PD.
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Inoue Y, Abe Y, Kikuchi K, Matsunaga K, Masuda R, Nishiyama K. Correction of collimator-dependent differences in the heart-to-mediastinum ratio in 123I-metaiodobenzylguanidine cardiac sympathetic imaging: Determination of conversion equations using point-source imaging. J Nucl Cardiol 2017; 24:1725-1736. [PMID: 27251143 PMCID: PMC5629249 DOI: 10.1007/s12350-016-0546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 05/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Septal penetration causes collimator-dependent differences in the heart-to-mediastinum (H/M) ratio in 123I-metaiodobenzylguanidine (MIBG) cardiac imaging. We investigated generally applicable methods to correct such differences. METHODS AND RESULTS Four hours after 123I-MIBG injection, 40 patients underwent anterior chest imaging successively with medium-energy (ME) and various non-ME collimators. The H/M ratios obtained with the non-ME collimators before and after 123I-dual-window penetration correction were compared with the ME-derived standard values to determine patient-based conversion equations for empiric and combined corrections, respectively. A 123I point source was imaged with various collimators, and the central ratio, the ratio of count in a small central region of interest to count in a large one, was calculated. The method of predicting the conversion equations from the central ratios was determined. Correction using the patient-based conversion equations removed systematic underestimation of the H/M ratios obtained with the non-ME collimators, and combined correction depressed residual random errors to some degree. Point-source-based equations yielded results comparable to the patient-based equations. CONCLUSIONS Empiric and combined corrections effectively reduce collimator-dependent differences in the H/M ratio. The conversion equations can be predicted from simple point-source imaging, which would allow to apply these corrections to data obtained with various collimators.
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Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Yutaka Abe
- Department of Radiology, Kitasato University Hospital, Sagamihara, Japan
| | - Kei Kikuchi
- Department of Radiology, Kitasato University Hospital, Sagamihara, Japan
| | - Keiji Matsunaga
- Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ray Masuda
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazutoshi Nishiyama
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
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Cardiac sympathetic denervation and dementia in de novo Parkinson's disease: A 7-year follow-up study. J Neurol Sci 2017; 381:291-295. [DOI: 10.1016/j.jns.2017.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/25/2017] [Accepted: 09/07/2017] [Indexed: 02/06/2023]
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Schreglmann SR, Bhatia KP, Stamelou M. Advances in the Clinical Differential Diagnosis of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:79-127. [PMID: 28554422 DOI: 10.1016/bs.irn.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The differential diagnosis of Parkinson's disease has widened considerably in recent years. This chapter aims to summarize the current knowledge on the clinical differential diagnoses of sporadic Parkinson's disease. As the number of monogenic familial Parkinson's disease variants and risk factors is growing, so is the number of appreciated etiologies of atypical parkinsonian and other pallidopyramidal syndromes. This work aims at summarizing the current knowledge on both motor and nonmotor neurological signs and symptoms that aid the clinical diagnosis of Parkinson's disease and its differential diagnoses.
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Affiliation(s)
| | | | - Maria Stamelou
- University of Athens Medical School, Hospital Attikon, Athens, Greece; HYGEIA Hospital, Athens, Greece; Philipps University, Marburg, Germany.
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Borghammer P, Knudsen K, Fedorova TD, Brooks DJ. Imaging Parkinson's disease below the neck. NPJ Parkinsons Dis 2017; 3:15. [PMID: 28649615 PMCID: PMC5460119 DOI: 10.1038/s41531-017-0017-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/21/2016] [Accepted: 03/21/2017] [Indexed: 01/18/2023] Open
Abstract
Parkinson's disease is a systemic disorder with widespread and early α-synuclein pathology in the autonomic and enteric nervous systems, which is present throughout the gastrointestinal canal prior to diagnosis. Gastrointestinal and genitourinary autonomic symptoms often predate clinical diagnosis by several years. It has been hypothesized that progressive α-synuclein aggregation is initiated in hyperbranched, non-myelinated neuron terminals, and may subsequently spread via retrograde axonal transport. This would explain why autonomic nerves are so prone to formation of α-synuclein pathology. However, the hypothesis remains unproven and in vivo imaging methods of peripheral organs may be essential to study this important research field. The loss of sympathetic and parasympathetic nerve terminal function in Parkinson's disease has been demonstrated using radiotracers such as 123I-meta-iodobenzylguanidin, 18F-dopamine, and 11C-donepezil. Other radiotracer and radiological imaging methods have shown highly prevalent dysfunction of pharyngeal and esophageal motility, gastric emptying, colonic transit time, and anorectal function. Here, we summarize the methodology and main findings of radio-isotope and radiological modalities for imaging peripheral pathology in Parkinson's disease.
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Affiliation(s)
- Per Borghammer
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tatyana D. Fedorova
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David J. Brooks
- Department of Nuclear Medicine & PET Centre, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Division of Neuroscience, Department of Medicine, Imperial College London, London, UK
- Division of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Sakamoto F, Shiraishi S, Tsuda N, Hashimoto M, Tomiguchi S, Ikeda M, Yamashita Y. Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features? Br J Radiol 2016; 90:20160156. [PMID: 27897064 DOI: 10.1259/bjr.20160156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Since the clinical symptoms of different types of dementia frequently overlap, especially in the earlier stages at onset, it is difficult to distinguish dementia with Lewy bodies (DLB) from other neurodegenerative dementias based on their clinical manifestations alone. Nuclear medicine imaging has been reported as a high-value index for the objective evaluation and diagnosis of DLB. The aim of this study was to evaluate whether nuclear medicine imaging findings may yield core features to be added to the diagnosis of DLB. METHODS We enrolled 332 patients with suspected DLB. All were evaluated by both 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy and 123I-labelled N-isopropyl-p-iodoamphetamine (123I-IMP). brain perfusion single-photon emission CT. The final clinical diagnosis indicated probable DLB in 92 patients (40 males, 52 females; mean age ± standard deviation, 77.4 ± 6.4 years; range, 56-89 years); 240 patients (98 males, 142 females; mean age, 75.5 ± 9.0 years; range, 70-87 years) were recorded as being without DLB. The accepted core features used for clinical evaluations were fluctuating cognition, visual hallucinations and Parkinsonism. The nuclear medicine evaluation indices were the severity score of cerebral blood flow on 123I-IMP scintigraphs of the posterior cingulate and praecuneus and a reduction in the blood flow in the occipital lobe. For 123I-MIBG evaluation, we recorded the early and delayed heart-to-mediastinum (H/M) ratios and the washout rate. RESULTS Univariate and multivariate analyses of fluctuating cognition, visual hallucinations, Parkinsonism and early H/M ratio in patients with probable and without DLB revealed significant differences. Parameters based on 123I-IMP studies did not show any significant differences by multivariate analysis. The area under the curve for the early H/M ratio was 0.918; for fluctuating cognition, visual hallucinations and Parkinsonism, it was 0.693, 0.760 and 0.611, respectively, by receiver-operating characteristic analysis. The early H/M ratio of <2.0 on 123I-MIBG scintigraphs was of the highest diagnostic accuracy. The sensitivity, specificity and accuracy for the diagnosis of probable DLB were 82.4%, 96.3% and 92.5%, respectively. CONCLUSION The early H/M ratio obtained by 123I-MIBG myocardial scintigraphy can serve as a reliable diagnostic index for the core clinical features of DLB. It can be used for the early diagnosis and treatment of DLB. Advances in knowledge: 123I-MIBG myocardial scintigraphy performed at the initial clinical examination can facilitate the early identification or exclusion of DLB and the early H/M ratio may be a diagnostic biomarker for DLB.
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Affiliation(s)
- Fumi Sakamoto
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriko Tsuda
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- 2 Department of Neuropsychiatry, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Tomiguchi
- 3 Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- 2 Department of Neuropsychiatry, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Kim JS, Park HE, Park IS, Oh YS, Ryu DW, Song IU, Jung YA, Yoo IR, Choi HS, Lee PH, Lee KS. Normal ‘heart’ in Parkinson's disease: is this a distinct clinical phenotype? Eur J Neurol 2016; 24:349-356. [DOI: 10.1111/ene.13206] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- J.-S. Kim
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - H.-E. Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - I.-S. Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Y.-S. Oh
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - D.-W. Ryu
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - I.-U. Song
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Y.-A. Jung
- Department of Nuclear Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - I. R. Yoo
- Department of Nuclear Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - H.-S. Choi
- Department of Radiology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - P. H. Lee
- Department of Neurology; Yonsei University School of Medicine; Seoul Korea
| | - K.-S. Lee
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
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Tiraboschi P, Corso A, Guerra UP, Nobili F, Piccardo A, Calcagni ML, Volterrani D, Cecchin D, Tettamanti M, Antelmi L, Vidale S, Sacco L, Merello M, Stefanini S, Micheli A, Vai P, Capitanio S, Gabanelli SV, Riva R, Pinto P, Biffi AM, Muscio C. 123
I‐2β‐carbomethoxy‐3β‐(4‐iodophenyl)‐
N
‐(3‐fluoropropyl) nortropane single photon emission computed tomography and
123
I‐metaiodobenzylguanidine myocardial scintigraphy in differentiating dementia with lewy bodies from other dementias: A comparative study. Ann Neurol 2016; 80:368-78. [DOI: 10.1002/ana.24717] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Pietro Tiraboschi
- Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation “Carlo Besta” Neurological InstituteMilan Italy
| | - Angelo Corso
- Department of Nuclear MedicineSant'Anna HospitalComo Italy
| | - Ugo Paolo Guerra
- Department of Nuclear MedicinePoliambulanza FoundationBrescia Italy
| | - Flavio Nobili
- Department of NeuroscienceUniversity of GenoaGenoa Italy
| | - Arnoldo Piccardo
- Nuclear Medicine Unit, Department of Diagnostic ImagingE. O. Galliera HospitalGenoa Italy
| | | | | | - Diego Cecchin
- Department of MedicineUniversity of PaduaPadua Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Institute of Hospitalization and Scientific Care Mario Negri Institute of Pharmacological ResearchMilan Italy
| | - Luigi Antelmi
- Health Department, Institute of Hospitalization and Scientific Care Foundation Carlo Besta Neurological InstituteMilan Italy
| | - Simone Vidale
- Department of Neurology and Stroke UnitSant'Anna HospitalComo Italy
| | - Leonardo Sacco
- Department of Neurology and Stroke UnitSant'Anna HospitalComo Italy
- Neurocenter of Southern SwitzerlandLugano Switzerland
| | - Maria Merello
- European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of GazzanigaBergamo Italy
| | - Stefano Stefanini
- European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of GazzanigaBergamo Italy
| | - Anna Micheli
- Neurology Unit, San Francesco ClinicBergamo Italy
| | - Paola Vai
- Department of Nuclear MedicinePapa Giovanni XXIII HospitalBergamo Italy
| | - Selene Capitanio
- Department of Nuclear MedicinePapa Giovanni XXIII HospitalBergamo Italy
| | | | - Riccardo Riva
- Department of NeurologyPapa Giovanni XXIII HospitalBergamo Italy
| | - Patrizia Pinto
- Department of NeurologyPapa Giovanni XXIII HospitalBergamo Italy
| | - Ave Maria Biffi
- Department of PsychologyPapa Giovanni XXIII HospitalBergamo Italy
| | - Cristina Muscio
- Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation “Carlo Besta” Neurological InstituteMilan Italy
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Borghammer P, Knudsen K, Brooks DJ. Imaging Systemic Dysfunction in Parkinson’s Disease. Curr Neurol Neurosci Rep 2016; 16:51. [DOI: 10.1007/s11910-016-0655-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Odagiri H, Baba T, Nishio Y, Iizuka O, Matsuda M, Inoue K, Kikuchi A, Hasegawa T, Aoki M, Takeda A, Taki Y, Mori E. On the Utility of MIBG SPECT/CT in Evaluating Cardiac Sympathetic Dysfunction in Lewy Body Diseases. PLoS One 2016; 11:e0152746. [PMID: 27055151 PMCID: PMC4824520 DOI: 10.1371/journal.pone.0152746] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/01/2016] [Indexed: 12/30/2022] Open
Abstract
Background Abnormal cardiac uptake of 123I-metaiodobenzylguanidine (123I-MIBG) is a diagnostic marker of Lewy body diseases (LBDs), e.g., Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). Planar imaging is generally used to assess cardiac sympathetic dysfunction in 123I-MIBG scintigraphy; however, its clinical utility requires further improvement. We hypothesized that the co-registration of single-photon emission tomography (SPECT) and computed tomography (CT) images would improve the diagnostic accuracy of 123I-MIBG cardiac scintigraphy for LBDs. This study sought to evaluate the effects of SPECT/CT imaging on 123I-MIBG cardiac scintigraphy for diagnosing LBDs. Methods We retrospectively investigated data of 54 patients (consecutive 18 patients in each PD, DLB, and idiopathic normal pressure hydrocephalus [iNPH] groups) who underwent 123I-MIBG cardiac scintigraphy (planar and SPECT/CT) because of suspected LBDs at the Tohoku University hospital from June 2012 to June 2015. We compared the diagnostic accuracies of the conventional planar 123I-MIBG method and SPECT/CT methods (manual and semi-automatic). Results In the conventional planar analysis, 123I-MIBG uptake decreased only in the DLB group compared with the iNPH group. In contrast, the SPECT/CT analysis revealed significantly lower 123I-MIBG uptake in both the PD and DLB groups compared with the iNPH group. Furthermore, a receiver operating characteristic analysis revealed that both the manual and semi-automatic SPECT/CT methods were superior to the conventional planar method in differentiating the 3 disorders. Conclusions SPECT/CT 123I-MIBG cardiac scintigraphy can detect mild cardiac sympathetic dysfunction in LDBs. Our results suggest that the SPECT/CT technique improves diagnostic accuracy for LBDs.
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Affiliation(s)
- Hayato Odagiri
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Toru Baba
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
| | - Yoshiyuki Nishio
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Osamu Iizuka
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Minoru Matsuda
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Inoue
- Department of Radiology and Nuclear Medicine, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
| | - Akio Kikuchi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Yasuyuki Taki
- Department of Radiology and Nuclear Medicine, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kim JS, Park HE, Oh YS, Lee SH, Park JW, Son BC, Lee KS. Orthostatic hypotension and cardiac sympathetic denervation in Parkinson disease patients with REM sleep behavioral disorder. J Neurol Sci 2016; 362:59-63. [DOI: 10.1016/j.jns.2016.01.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/05/2015] [Accepted: 01/12/2016] [Indexed: 10/25/2022]
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Nobili F, Arnaldi D, Morbelli S. Is dopamine transporter invariably impaired at the time of diagnosis in dementia with Lewy bodies? Eur J Nucl Med Mol Imaging 2016; 43:1056-9. [PMID: 26857568 DOI: 10.1007/s00259-016-3323-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Largo Daneo, 3, 16132, Genoa, Italy.
| | - Dario Arnaldi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Largo Daneo, 3, 16132, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Science (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
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van der Zande JJ, Booij J, Scheltens P, Raijmakers PGHM, Lemstra AW. [(123)]FP-CIT SPECT scans initially rated as normal became abnormal over time in patients with probable dementia with Lewy bodies. Eur J Nucl Med Mol Imaging 2016; 43:1060-6. [PMID: 26830298 PMCID: PMC4844648 DOI: 10.1007/s00259-016-3312-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/05/2016] [Indexed: 11/25/2022]
Abstract
Purpose Decreased striatal dopamine transporter (DAT) binding on SPECT imaging is a strong biomarker for the diagnosis of dementia with Lewy bodies (DLB). There is still a lot of uncertainty about patients meeting the clinical criteria for probable DLB who have a normal DAT SPECT scan (DLB/S−). The aim of this study was to describe the clinical and imaging follow-up in these patients, and compare them to DLB patients with abnormal baseline scans (DLB/S+). Methods DLB patients who underwent DAT imaging ([123I]FP-CIT SPECT) were selected from the Amsterdam Dementia Cohort. All [123I]FP-CIT SPECT scans were evaluated independently by two nuclear medicine physicians and in patients with normal scans follow-up imaging was obtained. We matched DLB/S-− patients for age and disease duration to DLB/S+ patients and compared their clinical characteristics. Results Of 67 [123I]FP-CIT SPECT scans, 7 (10.4 %) were rated as normal. In five DLB/S− patients, a second [123I]FP-CIT SPECT was performed (after on average 1.5 years) and these scans were all abnormal. No significant differences in clinical characteristics were found at baseline. DLB/S− patients could be expected to have a better MMSE score after 1 year. Conclusion This study was the first to investigate DLB patients with the initial [123I]FP-CIT SPECT scan rated as normal and subsequent scans during disease progression rated as abnormal. We hypothesize that DLB/S− scans could represent a relatively rare DLB subtype with possibly a different severity or spread of alpha-synuclein pathology (“neocortical predominant subtype”). In clinical practice, if an alternative diagnosis is not imminent in a DLB/S− patient, repeating [123I]FP-CIT SPECT should be considered.
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Affiliation(s)
- J J van der Zande
- VU Medical Center Alzheimer Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
| | - J Booij
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - P Scheltens
- VU Medical Center Alzheimer Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - P G H M Raijmakers
- Department of Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - A W Lemstra
- VU Medical Center Alzheimer Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
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Kim JS, Oh YS, Park HE, Lee SH, Park JW, Song IU, An JY, Park HJ, Son BC, Lee KS. Cardiovascular autonomic dysfunctions in elderly patients with essential tremor: comparison with healthy controls. Neurol Sci 2016; 37:711-6. [PMID: 26728270 DOI: 10.1007/s10072-015-2465-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022]
Abstract
Questionnaire-based analyses show that patients with essential tremor (ET) may have several autonomic dysfunctions, especially in the cardiovascular and genitourinary domains; yet the laboratory correlates of autonomic dysfunction in ET are unknown and have not been studied. Herein, we explored whether sympathetic and parasympathetic functions differed between control subjects and patients with ET. Seventy-five elderly patients with ET were enrolled in this study, along with 25 age-matched controls. Orthostatic vital signs, ambulatory 24-h blood pressure monitoring and 24-h Holter monitoring values were recorded and metaiodobenzylguanidine (MIBG) uptake was assessed using the heart-to-mediastinum ratio (H/M ratio). The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different between the ET patients and the controls, although ET patients had more episodes of orthostatic intolerance. The ET group also had similar heart rate variations as the control group for all the time-domains. The mean H/M ratios for the ET group were not statistically different from that of the control group. This result proves that the autonomic control of the cardiovascular system is normal in ET.
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Affiliation(s)
- Joong-Seok Kim
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Hyung-Eun Park
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Si-Hoon Lee
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Jeong-Wook Park
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - In-Uk Song
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Jae-Young An
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Hun-Jun Park
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Chul Son
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
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123I-MIBG myocardial scintigraphy and neurocirculatory abnormalities in patients with dementia with Lewy bodies and Alzheimer's disease. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Orthostatic hypotension (OH) leads to a significant number of hospitalizations each year, and is associated with significant morbidity and mortality among affected individuals. Given the increased risk for cardiovascular events and falls, it is important to identify the underlying etiology of OH and to choose appropriate therapeutic agents. OH can be non-neurogenic or neurogenic (arising from a central or peripheral lesion). The initial evaluation includes orthostatic vital signs, complete history and a physical examination. Patients should also be evaluated for concomitant symptoms of post-prandial hypotension and supine hypertension. Non-pharmacologic interventions are the first step for treatment of OH. The appropriate selection of medications can also help with symptomatic relief. This review highlights the pathophysiology, clinical features, diagnostic work-up and treatment of patients with neurogenic OH.
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Affiliation(s)
- Pearl K Jones
- a 1 Department of Neurology, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Brett H Shaw
- b 2 Department of Cardiac Science, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Satish R Raj
- b 2 Department of Cardiac Science, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.,c 3 Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee, USA
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