1
|
Biernacka M, Jakubowska-Winecka A, Biernacki M, Janowski K, Jańczyk W, Socha P. Internalizing and externalizing behaviors in children and adolescents with Wilson's disease in the context of quality of life. J Pediatr Gastroenterol Nutr 2024. [PMID: 38873984 DOI: 10.1002/jpn3.12281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/18/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
Patients with Wilson's disease (WD) are at increased risk of poor quality of life (QoL) and social-emotional outcomes. The above data has been well established in the adult population. What are the predictors of QoL in children and adolescents with WD are unknown. Our study examined whether subjective feelings about QoL are related to the psychosocial functioning in paediatric patients. A cross-sectional study among 50 children with WD, aged 7-18 years. Participants completed the KINDL QoL questionnaire and the Child Behavior Checklist assessing internalizing and externalizing behaviors. Internalizing and externalizing behaviors and their interaction are significant in predicting the QoL of children with WD. Internalizing behaviors are significant predictor of the QoL β = -0.328 (p < 0.05). The effect of internalizing behavior on the QoL varies with the level of externalizing behavior β = -0.344* (p < 0.05). Simple effects analysis indicates that the highest QoL for children with WD is in the group characterized by both low levels of internalizing and medium levels of externalizing behaviors, t = -3.052 (df = 46) and p < 0.01, or high levels of externalizing behaviors, t = -2.725 (df = 46) p < 0.01. The interaction between internalizing behaviors explained an additional 7.5% of the variance in scores on the QoL scale. Overall, the final regression model explained 14.9% of the scores on the QoL scale. Monitoring internalizing and externalizing behaviors will allow a better understanding of the course of treatment. In chronic disease, the QoL is an aspect that determines the doctor-patient relationship and often determines the course of the therapeutic process.
Collapse
Affiliation(s)
- Marta Biernacka
- Department of Health Psychology, Children's Memorial Health Institute, Warsaw, Poland
| | | | - Marcin Biernacki
- Department of Aviation Psychology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Kamil Janowski
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Wojciech Jańczyk
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
| |
Collapse
|
2
|
Vlasnik J, Cambron-Mellott MJ, Costantino H, Kunjappu M. Burden of Wilson Disease among patients and care partners in the United States: results from a cross-sectional survey. Curr Med Res Opin 2024; 40:863-876. [PMID: 38571385 DOI: 10.1080/03007995.2024.2337684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This study assessed the burden of Wilson Disease (WD) among patients and care partners (WD-CPs) in the US and compared it to a US general population of adults (GPs) and care partners (GP-CPs). METHODS This cross-sectional, self-reported survey included patients with WD and WD-CPs aged ≥18 years recruited through the Wilson Disease Association (WDA), while data for GPs and GP-CPs were obtained from the 2022 National Health and Wellness Survey. GPs and GP-CPs were propensity score matched (3:1) with WD patients and WD-CPs for demographics and health characteristics. Bivariate analysis evaluated differences in comorbidity burden and health-related outcomes of the WD cohorts compared to matched GP cohorts. RESULTS Thirty-seven patients with WD and 53 WD-CPs completed the survey. Most patients reported some treatment burden (73.3%), experienced sleep problems (60%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared with matched GPs, patients with WD had a significantly higher mortality risk (p < .001) and reported greater rates of chronic liver disease, cirrhosis (both, p < .001), migraines (p = .032), non-alcoholic steatohepatitis (p = .004), sleep problems (p = .009) and HCP visits (p = .002). Most WD-CPs (75.5%) reported high burden of caring (mean ZBI-12 score, 26.5) and more negative impact on esteem than GP-CPs. CONCLUSION This study highlights the burden of WD experienced by patients and WD-CPs, with patients experiencing high treatment burden, comorbidity burden and healthcare resource utilization, and WD-CPs experiencing high impact of caring, including impact on employment and self-esteem.
Collapse
Affiliation(s)
- Jon Vlasnik
- Alexion Pharmaceuticals Inc, AstraZeneca Rare Disease, Boston, MA, USA
| | | | | | - Mary Kunjappu
- Alexion Pharmaceuticals Inc, AstraZeneca Rare Disease, Boston, MA, USA
| |
Collapse
|
3
|
Chen H, Wang X, Zhang J, Xie D. Effect of high-frequency repetitive transcranial magnetic stimulation on cognitive impairment in WD patients based on inverse probability weighting of propensity scores. Front Neurosci 2024; 18:1375234. [PMID: 38660222 PMCID: PMC11039870 DOI: 10.3389/fnins.2024.1375234] [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] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Hepatolenticular degeneration [Wilson disease (WD)] is an autosomal recessive metabolic disease characterized by copper metabolism disorder. Cognitive impairment is a key neuropsychiatric symptom of WD. At present, there is no effective treatment for WD-related cognitive impairment. Methods In this study, high-frequency repetitive transcranial magnetic stimulation (rTMS) was used to treat WD-related cognitive impairment, and inverse probability weighting of propensity scores was used to correct for confounding factors. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Boston Naming Test (BNT), Clock Drawing Test (CDT) and Trail Making Test (TMT) were used to evaluate overall cognition and specific cognitive domains. Results The MMSE, MoCA and CDT scores after treatment were significantly different from those before treatment (MMSE: before adjustment: OR = 1.404, 95% CI: 1.271-1.537; after adjustment: OR = 1.381, 95% CI: 1.265-1.497, p < 0.001; MoCA: before adjustment: OR = 1.306, 95% CI: 1.122-1.490; after adjustment: OR = 1.286, 95% CI: 1.104; AVLT: OR = 1.161, 95% CI: 1.074-1.248; after adjustment: OR = 1.145, 95% CI: 1.068-1.222, p < 0.05; CDT: OR = 1.524, 95% CI: 1.303-1.745; after adjustment: OR = 1.518, 95% CI: 1.294-1.742, p < 0.001). The BNT and TMT scores after adjustment were not significantly different from those before adjustment (BNT: before adjustment: OR = 1.048, 95% CI: 0.877-1.219; after adjustment: OR = 1.026, 95% CI: 0.863-1.189, p > 0.05; TMT: before adjustment: OR = 0.816, 95% CI: 1.122-1.490; after adjustment: OR = 0.791, 95% CI: 0.406-1.176, p > 0.05). Conclusion High-frequency rTMS can effectively improve cognitive impairment, especially memory and visuospatial ability, in WD patients. The incidence of side effects is low, and the safety is good.
Collapse
Affiliation(s)
- Hong Chen
- The First Clinical Mdical College of Anhui University of Chinese Medicine, Hefei, China
| | - Xie Wang
- The First Clinical Mdical College of Anhui University of Chinese Medicine, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Daojun Xie
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| |
Collapse
|
4
|
Jopowicz A, Tarnacka B. Neurological Wilson's Disease Signs-Hepatic Encephalopathy or Copper Toxicosis? Diagnostics (Basel) 2023; 13:diagnostics13050893. [PMID: 36900037 PMCID: PMC10001333 DOI: 10.3390/diagnostics13050893] [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: 01/27/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Wilson's disease (WD) is a rare autosomal recessive (AR) disorder resulting from mutations in the ATP7B gene, which is responsible for the encryption of transmembrane copper transporting ATPase. The symptomatic presentation of the disease is estimated to be about 1 in 30,000. The impairment of ATP7B function results in a copper overload in hepatocytes, which further leads to liver pathology. This copper overload also occurs in other organs, most particularly in the brain. This could then cause the occurrence of neurological and psychiatric disorders. Symptoms differ substantially and most often occur between the ages of 5 and 35 years. Early symptoms are commonly hepatic, neurological, or psychiatric. While disease presentation is most often asymptomatic, it could also range as far as to include fulminant hepatic failure, ataxia, and cognitive disorders. Various treatments are available for Wilson's disease, including chelation therapy and zinc salts, which can reverse copper overload through different mechanisms. In select cases, liver transplantation is recommended. New medications, such as tetrathiomolybdate salts, are currently being investigated in clinical trials. With prompt diagnosis and treatment, prognosis is favorable; however, diagnosing patients before the onset of severe symptoms is a significant concern. Early screening for WD could help in diagnosing patients earlier and improving treatment outcomes.
Collapse
Affiliation(s)
- Anna Jopowicz
- Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
- Correspondence:
| | - Beata Tarnacka
- Department of Rehabilitation Medicine, Faculty of Medicine, Warsaw Medical University, Spartańska 1, 02-637 Warsaw, Poland
| |
Collapse
|
5
|
Schilsky ML, Roberts EA, Bronstein JM, Dhawan A, Hamilton JP, Rivard AM, Washington MK, Weiss KH, Zimbrean PC. A multidisciplinary approach to the diagnosis and management of Wilson disease: 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases. Hepatology 2022:01515467-990000000-00207. [PMID: 36151586 DOI: 10.1002/hep.32801] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Michael L Schilsky
- Medicine and Surgery , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Eve A Roberts
- Paediatrics, Medicine, Pharmacology and Toxicology , University of Toronto , Toronto , Ontario , Canada
| | - Jeff M Bronstein
- Neurology , University of California Los Angeles , Los Angeles , California , USA
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and MowatLabs , King's College Hospital , London , UK
| | - James P Hamilton
- Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Anne Marie Rivard
- Food and Nutrition Services , Yale New Haven Hospital , New Haven , Connecticut , USA
| | - Mary Kay Washington
- Pathology, Immunology and Microbiology , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | | | - Paula C Zimbrean
- Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA
| |
Collapse
|
6
|
Chakraborty AP, Mukherjee A, Sarkar S, Sinharoy U, Biswas A. Evaluation of Non-Motor Symptoms in Wilson Disease Using the Parkinson's Disease Nonmotor Symptoms Questionnaire: A Pilot Cross-Sectional Study and Critical Assessment. Ann Indian Acad Neurol 2022; 25:1062-1066. [PMID: 36911485 PMCID: PMC9996490 DOI: 10.4103/aian.aian_1040_21] [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: 12/05/2021] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background There is a dearth of studies on non-motor symptoms of Wilson's disease (WD) which is primarily because of the non-availability of a suitable scale. Objective To assess the suitability of the Parkinson's Disease non motor symptoms questionnaire (PD-NMS Quest) in the assessment of non-motor symptoms of WD patients. Methods In this case-control study, patients of WD above ≥12 years of age diagnosed by Leipzig's criteria and age and gender-matched control subjects were recruited. Critically ill patients, patients with severe hepatic impairment, or with pure hepatic WD were excluded. PD-NMS Quest was applied and relevant statistical analyses were performed. Results A total of 18 cases and 25 controls were studied. Patients had a mean age of 22.6 years and a median disease duration of 8 years. WD patients had higher frequencies of all NMS than controls. Drooling (P = 0.0037), dysphagia or choking (P = 0.0088), nocturia (P = 0.0471), anxiety/fear (P = 0.0337), feeling sad or blue (P = 0.0020) and falling (P = 0.0197) were significantly higher in WD patients than controls. Conclusions Although many NMS of WD patients are picked up effectively with PD-NMS Quest, some of them need detail assessment including cognitive, behavioral, and psychiatric symptoms, drooling and dysphagia, sleep as well as autonomic disturbances. Questions pertaining to sexual activity may be omitted from the questionnaire.
Collapse
Affiliation(s)
- Arka P. Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Adreesh Mukherjee
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Sumanta Sarkar
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Uma Sinharoy
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| |
Collapse
|
7
|
Rangarajan SK, Sugadev SJX, Philip S. Bedside cognitive assessments in Wilson's disease: Comparing cases and matched controls. J Neurosci Rural Pract 2022; 13:795-799. [PMID: 36743749 PMCID: PMC9893945 DOI: 10.25259/jnrp-2021-11-25-r2-(2189)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives Wilson's disease (WD) is an autosomal recessively inherited disorder with a reported prevalence of 33-68/100,000 in Asian countries not including India. There is a paucity of research in India on prevalence, pattern, and profile of neuropsychological deficits among these patients. The objectives of the study were to profile neuropsychological differences between patients with WD and age- and education-matched healthy controls. Material and Methods A hospital-based, cross-sectional, and comparative study using strategic combination of neuropsychological tests. Persons with neurological WD receiving IP care over a 3-month period were compared with matched controls. The inclusion criteria were diagnoses of Chu Stage 1 and Chu Stage 2 neurological WD, age 15-45 years, illness of minimum 6 months, and diagnosis confirmed by low serum ceruloplasmin. Exclusion criteria were evidence or clinical suspicion of intellectual disability and past or current psychiatric illness. Results Median age of patients - 17.5, median age of controls - 18. R software was used to analyze the results. For all cases and controls, time taken to administer the set of tests was always <30 min. Non-parametric tests were chosen considering the data distribution. Statistically significant differences with P < 0.05 are noted in domains of processing speed, frontal executive function, focused attention, verbal, and visual memory in descending order. Conclusion A strategic compilation of easily performed bedside neuropsychological tests demonstrated differences between the two groups. This combination can be rapidly administered in the clinical setting and hence improve change tracking. This may aid in early identification and hence, earlier initiation of therapy with a possibility of improved clinical outcomes.
Collapse
Affiliation(s)
- Subhashini K Rangarajan
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sebastian J. X. Sugadev
- Department of Psychiatry, Government Sivagangai Medical College, Sivagangai, Tamil Nadu, India
| | - Sharap Philip
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India
| |
Collapse
|
8
|
Degenerative dementias: a question of syndrome or disease? NEUROLOGÍA (ENGLISH EDITION) 2022; 37:480-491. [DOI: 10.1016/j.nrleng.2019.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/07/2019] [Indexed: 11/20/2022] Open
|
9
|
Robles Bayón A. Degenerative dementias: A question of syndrome or disease? Neurologia 2022; 37:480-491. [PMID: 31331676 DOI: 10.1016/j.nrl.2019.03.016] [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: 01/04/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neurologists refer to numerous "syndromes,‿ consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative "diseases,‿ on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage. DEVELOPMENT We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic. CONCLUSIONS Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new "diseases‿ should be defined and adapted to current knowledge and practice.
Collapse
Affiliation(s)
- A Robles Bayón
- Unidad de Neurología Cognitiva, Hospital HM Rosaleda, Santiago de Compostela, La Coruña, España.
| |
Collapse
|
10
|
Abstract
Metal homeostasis in the central nervous system (CNS) is a crucial component of healthy brain function, because metals serve as enzymatic cofactors and are key components of intra- and inter-neuronal signaling. Metal dysregulation wreaks havoc on neural networks via induction and proliferation of pathological pathways that cause oxidative stress, synaptic impairment, and ultimately, cognitive deficits. Thus, exploration of metal biology in relation to neurodegenerative pathology is essential in pursuing novel therapies for Alzheimer's Disease and other neurodegenerative disorders. This review covers mechanisms of action of aluminum, iron, copper, and zinc ions with respect to the progressive, toxic accumulation of extracellular β-amyloid plaques and intracellular hyperphosphorylated neurofibrillary tau tangles that characterizes Alzheimer's Disease, with the goal of evaluating the therapeutic potential of metal ion interference in neurodegenerative disease prevention and treatment. As neuroscientific interest in the role of metals in neurodegeneration escalates-in large part due to emerging evidence substantiating the interplay between metal imbalances and neuropathology-it becomes clear that the use of metal chelating agents may be a viable method for ameliorating Alzheimer's Disease pathology, as its etiology remains obscure. We conclude that, although metal therapies can potentially deter neurodegenerative processes, the most promising treatments will remain elusive until further understanding of neurodegenerative etiology is achieved. New research directions may best be guided by animal models of neurodegeneration, which reveal specific insights into biological mechanisms underlying dementia.
Collapse
Affiliation(s)
- Nikita Das
- Division of Neurotoxicology HFT-132, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - James Raymick
- Division of Neurotoxicology HFT-132, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Sumit Sarkar
- Division of Neurotoxicology HFT-132, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA.
| |
Collapse
|
11
|
Clinical significance of self-descriptive apathy assessment in patients with neurological form of Wilson's disease. Neurol Sci 2021; 43:1385-1394. [PMID: 34125323 PMCID: PMC8789726 DOI: 10.1007/s10072-021-05366-0] [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: 02/15/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
Background and aim Apathy is one of the neuropsychiatric symptoms of Wilson’s disease (WD) which typically affects the brain’s fronto-basal circuits. Lack of agreed diagnostic criteria and common use of self-description assessment tools lead to underestimation of this clinical phenomenon. The aim of this study was to investigate whether subjective and informant-based clinical features of apathy in patients with WD enable clinicians to make a valid diagnosis. Methods Multiple aspects of goal-oriented behavior were assessed in 30 patients with the neurological form of WD and 30 age-matched healthy participants using two questionnaires, the Lille Apathy Rating Scale (LARS) and the Dysexecutive Questionnaire (DEX). Both included a self-descriptive and a caregiver/proxy version. Cognitive functioning was estimated with the use of Addenbrooke’s Cognitive Examination-Revised. Results Patients obtained significantly worse scores on all clinical scales when more objective measures were considered. Features of apathy and executive dysfunction were revealed in patients’ caregiver versions of LARS and DEX, which may indicate poor self-awareness of patients with WD. Roughly 30% of participants were likely to present with clinically meaningful symptoms, independent of cognitive dysfunction. Conclusions Methods relying on self-description appear inferior to informant-based scales when diagnosing apathy. More objective criteria and measurement tools are needed to better understand this clinical syndrome.
Collapse
|
12
|
Abstract
Wilson's disease patients with neurological symptoms have motor symptoms and cognitive deficits, including frontal executive, visuospatial processing, and memory impairments. Although the brain structural abnormalities associated with Wilson's disease have been documented, it remains largely unknown how Wilson's disease affects large-scale functional brain networks. In this study, we investigated functional brain networks in Wilson's disease. Particularly, we analyzed resting state functional magnetic resonance images of 30 Wilson's disease patients and 26 healthy controls. First, functional brain networks for each participant were extracted using an independent component analysis method. Then, a computationally efficient pattern classification method was developed to identify discriminative brain functional networks associated with Wilson's disease. Experimental results indicated that Wilson's disease patients, compared with healthy controls, had altered large-scale functional brain networks, including the dorsal anterior cingulate cortex and basal ganglia network, the middle frontal gyrus, the dorsal striatum, the inferior parietal lobule, the precuneus, the temporal pole, and the posterior lobe of cerebellum. Classification models built upon these networks distinguished between neurological WD patients and HCs with accuracy up to 86.9% (specificity: 86.7%, sensitivity: 89.7%). The classification scores were correlated with the United Wilson's Disease Rating Scale measures and durations of disease of the patients. These results suggest that Wilson's disease patients have multiple aberrant brain functional networks, and classification scores derived from these networks are associated with severity of clinical symptoms.
Collapse
|
13
|
Hanuška J, Dušek P, Rusz J, Ulmanová O, Burgetová A, Růžička E. Eye movement abnormalities are associated with brainstem atrophy in Wilson disease. Neurol Sci 2020; 41:1097-1103. [DOI: 10.1007/s10072-019-04225-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/22/2019] [Indexed: 12/26/2022]
|
14
|
Role of endoplasmic reticulum stress and protein misfolding in disorders of the liver and pancreas. Adv Med Sci 2019; 64:315-323. [PMID: 30978662 DOI: 10.1016/j.advms.2019.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 03/21/2019] [Indexed: 12/24/2022]
Abstract
The endoplasmic reticulum (ER) is the site of synthesis and folding of membrane and secretory proteins. The fraction of protein passing through the ER represents a large proportion of the total protein in the cell. Protein folding, glycosylation, sorting and transport are essential tasks of the ER and a compromised ER folding network has been recognized to be a key component in the disease pathogenicity of common neurodegenerative, metabolic and malignant diseases. On the other hand, the ER protein folding machinery also holds significant potential for therapeutic interventions. Many causes can lead to ER stress. A disturbed calcium homeostasis, the generation of reactive oxygen species (ROS) and a persistent overload of misfolded proteins within the ER can drive the course of adisease. In this review the role of ER-stress in diseases of the liver and pancreas will be examined using pancreatitis and Wilson´s disease as examples. Potential therapeutic targets in ER-stress pathways will also be discussed.
Collapse
|
15
|
Litwin T, Dusek P, Szafrański T, Dzieżyc K, Członkowska A, Rybakowski JK. Psychiatric manifestations in Wilson's disease: possibilities and difficulties for treatment. Ther Adv Psychopharmacol 2018; 8:199-211. [PMID: 29977520 PMCID: PMC6022881 DOI: 10.1177/2045125318759461] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/02/2018] [Indexed: 12/14/2022] Open
Abstract
Wilson's disease (WD) is an inherited metabolic disorder related to disturbances of copper metabolism, and predominantly presents with liver and neuropsychiatric symptoms. In most cases it can be successfully treated with anti-copper agents, and both liver function and neuropsychiatric symptoms typically improve. Treatment guidelines for WD include recommendations for anti-copper treatment as well as for the treatment of liver failure symptoms. Recently, recommendations for treatment of the neurological symptoms of WD have also been proposed. Although most WD patients present with psychiatric symptoms at some stage of the disease, currently there are no guidelines for the treatment of the psychiatric manifestations. Treatment of the psychiatric symptoms of WD is often guided by general psychiatric experience, which typically glosses over the specificity of WD, and can result in severe neurological and/or hepatic complications. Here we review and discuss the possible treatments available for the mood disturbances, psychosis, behavioral and cognitive disorders that can occur in WD, as well as their efficacy.
Collapse
Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Polandc
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- Department of Radiology, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | | | - Karolina Dzieżyc
- Second Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Janusz K. Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
16
|
Nonmotor Manifestations of Wilson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1443-1459. [DOI: 10.1016/bs.irn.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
17
|
Zimbrean P, Seniów J. Cognitive and psychiatric symptoms in Wilson disease. HANDBOOK OF CLINICAL NEUROLOGY 2017; 142:121-140. [DOI: 10.1016/b978-0-444-63625-6.00011-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
18
|
Frota NAF, Barbosa ER, Porto CS, Lucato LT, Ono CR, Buchpiguel CA, Machado AAC, Caramelli P. Which factors are associated with global cognitive impairment in Wilson's disease? Dement Neuropsychol 2016; 10:320-326. [PMID: 29213476 PMCID: PMC5619272 DOI: 10.1590/s1980-5764-2016dn1004011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Patients with Wilson's disease (WD) present cognitive impairment, especially
in executive functions. Which other factors might be associated with global
cognitive decline in these patients remains unclear. Objective To assess which factors are associated with worse performance on a global
cognitive test in patients with WD. Methods Twenty patients with WD underwent cognitive assessment with the following
tests: the Mini-Mental State Examination (MMSE), Dementia Rating Scale
(DRS), verbal fluency test, brief cognitive battery, clock drawing test,
Frontal Assessment Battery, Stroop test, Wisconsin card sorting test, Hopper
test, cubes (WAIS) and the Pfeffer questionnaire. MRI changes were
quantified. Patients with poor performance on the DRS were compared to
patients with normal performance. Results Nine patients had a poor performance on the DRS. This group had lower
educational level (9.11±3.58× 12.82±3.06) and a greater
number of changes on MRI (9.44±2.74× 6.27±2.45). The
presence of hyperintensity in the globus pallidus on MRI was more frequent
in this group (66.6% vs 9.0%), with OR=5.38 (95% CI 0.85-33.86). Conclusion Global cognitive impairment was prevalent in this sample of patients with WD
and was associated with low educational level, number of changes on MRI and
MRI hyperintensity in the globus pallidus.
Collapse
Affiliation(s)
| | - Egberto Reis Barbosa
- Department of Neurology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Claudia Sellitto Porto
- PhD. Department of Neurology, University of São Paulo School of Medicine, São Paulo, SP Brazil
| | - Leandro Tavares Lucato
- MD, PhD. Department of Radiology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Carla Rachel Ono
- MD, PhD. Department of Radiology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | | | | | - Paulo Caramelli
- MD, PhD. Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, MG, Brazil
| |
Collapse
|
19
|
Han Y, Zhang F, Tian Y, Hu P, Li B, Wang K. Selective impairment of attentional networks of alerting in Wilson's disease. PLoS One 2014; 9:e100454. [PMID: 24949936 PMCID: PMC4065050 DOI: 10.1371/journal.pone.0100454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022] Open
Abstract
Wilson's disease (WD) is typically affected by attention, which is one of the cognitive domains. The Attention Network Test (ANT) was developed to measure the functioning of the following three individual attentional networks: orienting, alerting, and executive control. The ANT has been used in a variety of neuropsychiatric conditions; however, it has not been used in WD. The aim of this study was to investigate the attentional function of WD patients, and 35 patients with early and moderate neurological WD, as well as 35 gender-, age-, and education-matched healthy controls performed the ANT. Remarkable differences between the patients and healthy controls were observed in the alerting network (p = 0.007) in contrast the differences in the orienting (p = 0.729) and executive control (p = 0.888) networks of visual attention. The mean reaction time in the ANT was significantly longer in the WD patients than in the controls (p<0.001, 0.001). In the WD patients, there was an effect specifically on the alerting domain of the attention network, whereas the orienting and executive control domains were not affected.
Collapse
Affiliation(s)
- Yongsheng Han
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, Anhui Province, PR China
| | - Fangfang Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Bo Li
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, Anhui Province, PR China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| |
Collapse
|
20
|
Wenisch E, De Tassigny A, Trocello JM, Beretti J, Girardot-Tinant N, Woimant F. Cognitive profile in Wilson's disease: a case series of 31 patients. Rev Neurol (Paris) 2013; 169:944-9. [PMID: 24120329 DOI: 10.1016/j.neurol.2013.06.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/29/2013] [Accepted: 06/04/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wilson's disease (WD) is a rare autosomal recessive disorder of copper metabolism. If untreated, WD, which is initially a liver disease, can turn into a multi-systemic disease with neurological involvement. Very few studies have described cognitive impairment in WD. The aim of this study is to report the cognitive profile of 31 treated WD patients. METHODS Patients were classed into two groups using the Unified Wilson Disease Rating Scale (UWDRS): WD patients without neurological signs (WD-N(-)) (n=13), and WD patients with neurological signs (WD-N(+)) (n=18). The patients participated in a neuropsychological assessment evaluating memory, executive function and visuo-spatial abilities. RESULTS Both groups performed well for verbal intelligence and episodic memory skills. However, the majority of these patients exhibited altered performance for at least one cognitive test, particularly in the executive domain. The WD-N(+) group performed less well than the WD-N(-) group on cognitive tests involving rapid motor function, abstract thinking, working memory and top-down inhibitory control. CONCLUSIONS Cognitive impairment in treated WD patients essentially affects executive function involving fronto-striatal circuits. Verbal intelligence and episodic memory abilities seem to be remarkably preserved. Neuropsychological assessment is a valuable tool to evaluate the presence and the consequences of these cognitive impairments in WD patients with or without neurological signs in the course of this chronic disease.
Collapse
Affiliation(s)
- E Wenisch
- French national reference centre for Wilson's disease, neurology department, Lariboisière hospital, 2, rue Ambroise-Paré, 75010 Paris cedex 10, France.
| | | | | | | | | | | |
Collapse
|
21
|
Frota NAF, Barbosa ER, Porto CS, Lucato LT, Ono CR, Buchpiguel CA, Caramelli P. Cognitive impairment and magnetic resonance imaging correlations in Wilson's disease. Acta Neurol Scand 2013; 127:391-8. [PMID: 23215772 DOI: 10.1111/ane.12037] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the cognitive performance of a group of patients with Wilson's disease (WD) and to correlate the cognitive findings with changes in magnetic resonance imaging (MRI). METHODS All patients with WD consecutively attended in a Movement Disorders Clinic between September 2006 and October 2007 were invited to participate in the study, together with a group of matched healthy controls. Patients and controls were submitted to comprehensive neuropsychological assessment. MRI was performed in all patients, and abnormalities (high-intensity signal, low-intensity signal and atrophy) were semi-quantitatively rated. Performance of patients and controls in each cognitive test was compared, and correlations between cognitive scores and MRI changes were investigated within the patients' group. RESULTS Twenty patients with WD (11 men) and 20 controls (nine men) were evaluated. Mean age in the WD and control groups was 30.05 ± 7.25 and 32.15 ± 5.37 years, respectively. Mean schooling years were 11.15 ± 3.73 among WD cases and 10.08 ± 2.62 among controls. Patients with WD performed significantly worse than controls in the Mini-Mental State Examination, Dementia Rating Scale, phonemic verbal fluency (FAS), verb generation, digit span forward, Stroop test, Frontal Assessment Battery and in the Brief Cognitive Screening Battery. A significant correlation emerged between global cognitive impairment and MRI scale (r = 0.535), being higher for high-intensity signal plus atrophy (r = 0.718). CONCLUSION Patients with WD presented cognitive impairment, especially in executive functions, with good correlation between cognitive abnormalities and MRI changes.
Collapse
Affiliation(s)
| | - E. R. Barbosa
- Department of Neurology; University of São Paulo School of Medicine; São Paulo; São Paulo; Brazil
| | - C. S. Porto
- Department of Neurology; University of São Paulo School of Medicine; São Paulo; São Paulo; Brazil
| | - L. T. Lucato
- Department of Radiology; University of São Paulo School of Medicine; São Paulo,; Brazil
| | - C. R. Ono
- Department of Radiology; University of São Paulo School of Medicine; São Paulo,; Brazil
| | - C. A. Buchpiguel
- Department of Radiology; University of São Paulo School of Medicine; São Paulo,; Brazil
| | - P. Caramelli
- Department of Internal Medicine; Faculty of Medicine; Federal University of Minas Gerais; Belo Horizonte; Minas Gerais; Brazil
| |
Collapse
|
22
|
Is cognitive function linked to serum free copper levels? A cohort study in a normal population. Clin Neurophysiol 2010; 121:502-7. [PMID: 20097602 DOI: 10.1016/j.clinph.2009.11.090] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 10/20/2009] [Accepted: 11/10/2009] [Indexed: 11/22/2022]
|