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Jellinger KA. The enigma of depression in corticobasal degeneration, a frequent but poorly understood co-morbidity. J Neural Transm (Vienna) 2024; 131:195-202. [PMID: 38216704 DOI: 10.1007/s00702-023-02731-5] [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: 11/03/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024]
Abstract
Depression is one of the most frequent neuropsychiatric symptoms in corticobasal degeneration (CBD), a rare, sporadic, and late-onset progressive neurodegenerative disorder of unknown etiology. It is clinically characterized by a levodopa-poorly responsible akinetic-rigid syndrome, apraxia, limb dystonia, cognitive, mood, behavioral, and language disorders. This 4-repeat (4R) tauopathy is morphologically featured by asymmetric frontoparietal atrophy, neuronal loss, and gliosis in cortex and subcortex including substantia nigra, ballooned/achromatic neurons with filamentous 4R tau aggregates in cortex and striatum, widespread thread-like structures, pathognomonic "astroglial plaques", "tufted astrocytes", and numerous "coiled bodies" (in astrocytes and oligodendroglia) in cerebral white matter. CBD is non-specific, as pathologically proven cases include several clinical phenotypes. Pubmed and Google Scholar were systematically analyzed until October 2023, with focus on the prevalence, clinical manifestation, neuroimaging data, and treatment options of depression in CBD. Its prevalence is about 30-40% which is more frequent than in most other atypical parkinsonian syndromes. Depression usually does not correlate with motor and other clinical parameters, suggesting different pathophysiological mechanisms. Asymmetric atrophy and hypometabolism of frontoparietal cortical areas are associated with disruption of fronto-subcortical circuits, nigrostriatal dopaminergic, and cholinergic deficiency. Since no specific neuroimaging, neuropathological, or biomarker studies of depression in CBD are available, its pathobiological mechanisms and pathogenesis are poorly understood. Antidepressive therapy may be useful, but is often poorly tolerated. Depression in CBD, like in other parkinsonian syndromes, may be related to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate treatment to improve the quality of life in this fatal disease.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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2
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Jellinger KA. Pathomechanisms of cognitive and behavioral impairment in corticobasal degeneration. J Neural Transm (Vienna) 2023; 130:1509-1522. [PMID: 37659990 DOI: 10.1007/s00702-023-02691-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Corticobasal degeneration (CBD) is a rare, sporadic, late-onset progressive neurodegenerative disorder of unknown etiology, clinically characterized by an akinetic-rigid syndrome, behavior and personality disorders, language problems (aphasias), apraxia, executive and cognitive abnormalities and limb dystonia. The syndrome is not specific, as clinical features of pathologically proven CBD include several phenotypes. This 4-repeat (4R) tauopathy is morphologically featured by often asymmetric frontoparietal atrophy, ballooned/achromatic neurons containing filamentous 4R-tau aggregates in cortex and striatum, thread-like processes that are more widespread than in progressive supranuclear palsy (PSP), pathognomonic "astroglial plaques", and numerous inclusions in both astrocytes and oligodendroglia ("coiled bodies") in the white matter. Cognitive deficits in CBD are frequent initial presentations before onset of motor symptoms, depending on the phenotypic variant. They predominantly include executive and visuospatial dysfunction, sleep disorders and language deficits with usually preserved memory domains. Neuroimaging studies showed heterogenous locations of brain atrophy, particularly contralateral to the dominant symptoms, with disruption of striatal connections to prefrontal cortex and basal ganglia circuitry. Asymmetric hypometabolism, mainly involving frontal and parietal regions, is associated with brain cholinergic deficits, and dopaminergic nigrostriatal degeneration. Widespread alteration of cortical and subcortical structures causing heterogenous changes in various brain functional networks support the concept that CBD, similar to PSP, is a brain network disruption disorder. Putative pathogenic factors are hyperphosphorylated tau-pathology, neuroinflammation and oxidative injury, but the basic mechanisms of cognitive impairment in CBD, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for early diagnosis and adequate treatment of this fatal disorder.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Ananthavarathan P, Patel B, Peeros S, Obrocki R, Malek N. Neurological update: non-motor symptoms in atypical parkinsonian syndromes. J Neurol 2023; 270:4558-4578. [PMID: 37316556 PMCID: PMC10421812 DOI: 10.1007/s00415-023-11807-x] [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: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Among people with Parkinson's disease (PD), non-motor symptoms (NMS) are a well-recognised cause of significant morbidity and poor quality of life. Yet, it is only more recently that NMS have been recognised to affect the lives of patients with atypical parkinsonian syndromes in a similar fashion. The aim of this article is to highlight and compare the relative prevalence of NMS among patients with atypical parkinsonian syndromes in the published literature, which largely remain underreported and unaddressed in routine clinical practice. All NMS that are recognised to occur in PD are also found to commonly occur in atypical parkinsonian syndromes. In particular, excessive daytime sleepiness is more prevalent among atypical parkinsonian syndromes (94.3%) compared to PD (33.9%) or normal controls (10.5%) (p < 0.001). Urinary dysfunction (not limited to urinary incontinence) is not only found to occur in MSA (79.7%) and PD (79.9%), but has also been reported in nearly half of the patients with PSP (49.3%), DLB (42%) and CBD (53.8%) (p < 0.001). Apathy is significantly more common among the atypical parkinsonian syndromes [PSP (56%), MSA (48%), DLB (44%), CBD (43%)] compared to PD (35%) (p = 0.029). Early recognition and addressing of NMS among atypical parkinsonian syndromes may help improve the holistic patient care provided and may encompass a range of conservative and pharmacotherapeutic treatments to address these symptoms.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Department of Neuroinflammation, Institute of Neurology, University College London, 1st Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
| | - B Patel
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - S Peeros
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - R Obrocki
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - N Malek
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
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Pathomechanisms of depression in progressive supranuclear palsy. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02621-w. [PMID: 36933007 DOI: 10.1007/s00702-023-02621-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Depression is one of the most frequent neuropsychiatric symptoms in progressive supranuclear palsy (PSP), a four-repeat tauopathy and most common atypical parkinsonian disorder, but its pathophysiology and pathogenesis are poorly understood. Pubmed/Medline was systematically analyzed until January 2023, with focus on the prevalence, major clinical features, neuroimaging findings and treatment options of depression in PSP. The average prevalence of depression in PSP is around 50%; it does usually not correlate with most other clinical parameters. Depression is associated with multi-regional patterns of morphometric gray matter variations, e.g., reduced thickness of temporo-parieto-occipital cortices, and altered functional orbitofrontal and medial frontal circuits with disturbances of mood-related brain networks. Unfortunately, no specific neuropathological data about depression in PSP are available. Antidepressive and electroconvulsive therapies are effective in improving symptoms; the efficacy of transcranial stimulation needs further confirmation. Depression in PSP is a common symptom, related to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for adequate treatment to improve the quality of life in this fatal disease.
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Flavell J, Nestor PJ. A Systematic Review of Apathy and Depression in Progressive Supranuclear Palsy. J Geriatr Psychiatry Neurol 2022; 35:280-292. [PMID: 33567955 DOI: 10.1177/0891988721993545] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression and apathy can be significant problems in progressive supranuclear palsy (PSP). Using PRISMA guidelines, this systematic review examined prevalence estimates for depression and apathy in PSP, and, how different methods of definition may influence results. 29 studies meeting inclusion/exclusion criteria were identified: 12 on depression, 9 on apathy, and 8 on both. Studies were stratified according to whether a diagnostic criteria, rating scale or screening question methodology was employed. The weighted mean prevalence was 59.7% for depression (sample size = 473) and 58.3% for apathy (sample size = 858). Results for depression using diagnostic criteria or rating scales were similar whereas screening questions were associated with considerable inconsistency. Depression prevalence appeared to be influenced by apathy but not somatic symptoms. Most apathy studies relied only on a screening question method. Depression and apathy are common in PSP but there is a need for consensus on how they are defined (both tools and cut-off scores). In particular, more studies probing apathy in greater detail than a simple screening question are required.
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Affiliation(s)
- Joshua Flavell
- Cairns & Hinterland Mental Health and Alcohol Tobacco & Other Drugs Service, Cairns, Australia
| | - Peter J Nestor
- Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia.,171919Queensland Brain Institute, University of Queensland, Brisbane, Australia
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Sönmez Güngör E, Durmaz O, Halilbeyoğlu B, Domaç SF. An atypical case of corticobasal syndrome with psychotic depression and delusional jealousy. Neurocase 2021; 27:425-429. [PMID: 34587867 DOI: 10.1080/13554794.2021.1984539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Corticobasal syndrome (CBS) is one of the Parkinson-plus disorders. While initially defined as a movement disorder rather than cognition, it is now known that CBS is related to various psychiatric symptoms. We describe a patient clinically diagnosed with CBS whose initial presentation was psychiatric and rather atypical. His clinical picture included psychotic depression and delusional jealousy. Misdiagnosing these syndromes may delay the initiation of the treatment and worsen the patients' condition, as well as increase the burden of the caretakers. Finally, COVID-19-related changes in the organization of health services complicated the diagnosis and follow-up processes of this patient.
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Affiliation(s)
- Ekin Sönmez Güngör
- Department of Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Onur Durmaz
- Department of Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Berk Halilbeyoğlu
- Department of Neurology, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Saime Füsun Domaç
- Department of Neurology, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
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Shdo SM, Ranasinghe KG, Sturm VE, Possin KL, Bettcher BM, Stephens ML, Foley JM, You SCC, Rosen HJ, Miller BL, Kramer JH, Rankin KP. Depressive Symptom Profiles Predict Specific Neurodegenerative Disease Syndromes in Early Stages. Front Neurol 2020; 11:446. [PMID: 32547476 PMCID: PMC7273507 DOI: 10.3389/fneur.2020.00446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 04/27/2020] [Indexed: 12/05/2022] Open
Abstract
Background: During early stages, patients with neurodegenerative diseases (NDG) often present with depressive symptoms. However, because depression is a heterogeneous disorder, more precise delineation of the specific depressive symptom profiles that arise early in distinct NDG syndromes is necessary to enhance patient diagnosis and care. Methods and Findings: Five-hundred and sixty four participants self-reported their depressive symptoms using the Geriatric Depression Scale (GDS), including 111 healthy older control subjects (NC) and 453 patients diagnosed with one of six NDGs who were at the mild stage of disease (CDR® Dementia Staging Instrument ≤ 1) [186 Alzheimer's disease (AD), 76 behavioral variant frontotemporal dementia (bvFTD), 52 semantic variant primary progressive aphasia (svPPA), 46 non-fluent variant PPA (nfvPPA), 49 progressive supranuclear palsy syndrome (PSPS), 44 corticobasal syndrome (CBS)]. The GDS was divided into subscales based on a previously published factor analysis, representing five symptoms (dysphoria, hopelessness, withdrawal, worry, and cognitive concerns). Mixed models were created to examine differences in depression subscale by group, and logistic regression analyses were performed to determine if patterns of depressive symptoms could predict a patient's NDG syndrome. PSPS patients presented with a hopeless, dysphoric, and withdrawn pattern, while patients with CBS presented with a similar but less severe pattern. Worry was a key symptom in the profile of patients with svPPA, while ADs only had abnormally elevated cognitive concerns. Depressive profile accurately predicted NDG diagnosis at a rate of between 70 and 84% accuracy. Conclusions: These results suggest that attention to specific depressive symptom profile can improve diagnostic sensitivity and can be used to provide more individualized patient care.
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Affiliation(s)
- Suzanne M. Shdo
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Kamalini G. Ranasinghe
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Virginia E. Sturm
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine L. Possin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Brianne M. Bettcher
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of Colorado School of Medicine, Denver, CO, United States
| | - Melanie L. Stephens
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica M. Foley
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Shou-Chin Christine You
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Howard J. Rosen
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L. Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Joel H. Kramer
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P. Rankin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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Parthimos TP, Karavasilis E, Rankin KP, Seimenis I, Leftherioti K, Papanicolaou AC, Miller B, Papageorgiou SG, Papatriantafyllou JD. The Neural Correlates of Impaired Self-Monitoring Among Individuals With Neurodegenerative Dementias. J Neuropsychiatry Clin Neurosci 2020; 31:201-209. [PMID: 30605361 DOI: 10.1176/appi.neuropsych.17120349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Self-monitoring is a crucial component of human empathy and necessary for the formation and repair of social relations. Several studies have brought to light possible neuronal substrates associated with self-monitoring, but the information that they have provided is inconclusive. The authors, therefore, studied a large group of patients with dementia to assess what brain structures are necessary for the self-monitoring function.Methods: Seventy-seven patients with dementia of various types were screened using voxel-based morphometry to assess possible volume reduction in the brain structures of patients with self-monitoring problems, and the decrease of socioemotional expressiveness and modification of self-presentation was estimated using the Revised Self-Monitoring Scale. Regression analysis was employed to investigate the correlation between gray matter loss and deficient self-monitoring.Results: The socioemotional expressiveness scores were associated with decreased gray matter volume in the right olfactory cortex, inferior frontal gyrus, superior temporal pole, parahippocampal gyrus, insula, and medial temporal gyrus bilaterally. Self-presentation scores were associated with bilateral gray matter volume reduction in the olfactory cortex, insula, rectus gyrus and inferior frontal gyrus, right superior temporal pole, and parahippocampal gyrus, as well as the left medial temporal gyrus and anterior superior frontal gyrus.Conclusions: These results suggest that patients with dementia present decreased ability of self-monitoring, probably due to impaired insula and orbitofrontal cortex and their disconnection from structures of the salience network.
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Affiliation(s)
- Theodore P Parthimos
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Efstratios Karavasilis
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Katherine P Rankin
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Ioannis Seimenis
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Katerina Leftherioti
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Andrew C Papanicolaou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Bruce Miller
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Sokratis G Papageorgiou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - John D Papatriantafyllou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
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9
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Fabbrini G, Fabbrini A, Suppa A. Progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration. ACTA ACUST UNITED AC 2019; 165:155-177. [DOI: 10.1016/b978-0-444-64012-3.00009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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A preclinical screen to evaluate pharmacotherapies for the treatment of agitation in dementia. Behav Pharmacol 2018; 28:199-206. [PMID: 28234659 DOI: 10.1097/fbp.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Agitation associated with dementia is frequently reported clinically but has received little attention in preclinical models of dementia. The current study used a 7PA2 CM intracerebroventricular injection model of Alzheimer's disease (AD) to assess acute memory impairment, and a bilateral intrahippocampal (IH) injection model of AD (aggregated Aβ1-42 injections) and a bilateral IH injection model of dementia with Lewy bodies (aggregated NAC61-95 injections) to assess chronic memory impairment in the rat. An alternating-lever cyclic-ratio schedule of operant responding was used for data collection, where incorrect lever perseverations measured executive function (memory) and running response rates (RRR) measured behavioral output (agitation). The results indicate that bilateral IH injections of Aβ1-42 and bilateral IH injections of NAC61-95 decreased memory function and increased RRRs, whereas intracerebroventricular injections of 7PA2 CM decreased memory function but did not increase RRRs. These findings show that using the aggregated peptide IH injection models of dementia to induce chronic neurotoxicity, memory decline was accompanied by elevated behavioral output. This demonstrates that IH peptide injection models of dementia provide a preclinical screen for pharmacological interventions used in the treatment of increased behavioral output (agitation), which also establish detrimental side effects on memory.
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Hatzinger M, Hemmeter U, Hirsbrunner T, Holsboer-Trachsler E, Leyhe T, Mall JF, Mosimann U, Rach N, Trächsel N, Savaskan E. [Not Available]. PRAXIS 2018; 107:127-144. [PMID: 29382263 DOI: 10.1024/1661-8157/a002883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Diese Empfehlungen sollen dazu dienen, Fachpersonen das Wissen über die aktuelle Evidenz von Diagnostik und Therapie der Depression im Alter zur Verfügung zu stellen und damit zur frühzeitigen Erkennung und evidenzbasierten Behandlung beizutragen. Da für einige Behandlungsansätze nur rudimentär kontrollierte Studien vorliegen, wird auch das klinische Expertenwissen in die Beurteilung einbezogen. Im diagnostischen Vorgehen wird die besondere Symptomatik der Depression im Alter beleuchtet, auf die Suizidalität eingegangen und werden die häufig vorkommenden somatischen Komorbiditäten hervorgehoben. Auch Hypothesen zur Pathogenese, wie Neuroendokrinologie, Neurodegeneration und vaskuläre Faktoren, werden erläutert. In der Behandlung gilt heute ein integrierter biopsychosozialer Ansatz mit gezielten psychosozialen Interventionen, spezifischer Psychotherapie und einer antidepressiven Pharmakotherapie bei schweren Depressionen als sinnvoll. Daneben kommen auch chronobiologische oder Neurostimulationsverfahren zum Einsatz.
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Affiliation(s)
- Martin Hatzinger
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
- 2 Schweizerische Gesellschaft für Biologische Psychiatrie (SGBP)
| | - Ulrich Hemmeter
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Therese Hirsbrunner
- 4 Schweizerischer Berufsverband der Pflegefachfrauen und Pflegefachmänner (SBK)
| | | | - Thomas Leyhe
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Jean-Frédéric Mall
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Urs Mosimann
- 2 Schweizerische Gesellschaft für Biologische Psychiatrie (SGBP)
| | - Nicole Rach
- 5 Schweizerische Fachgesellschaft für Gerontopsychologie (SFGP)
| | - Nathalie Trächsel
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
| | - Egemen Savaskan
- 1 Schweizerische Gesellschaft für Alterspsychiatrie und Alterspsychotherapie (SGAP)
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12
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Brown JA, Hua AY, Trujillo A, Attygalle S, Binney RJ, Spina S, Lee SE, Kramer JH, Miller BL, Rosen HJ, Boxer AL, Seeley WW. Advancing functional dysconnectivity and atrophy in progressive supranuclear palsy. Neuroimage Clin 2017; 16:564-574. [PMID: 28951832 PMCID: PMC5605489 DOI: 10.1016/j.nicl.2017.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023]
Abstract
Progressive supranuclear palsy syndrome (PSP-S) results from neurodegeneration within a network of brainstem, subcortical, frontal and parietal cortical brain regions. It is unclear how network dysfunction progresses and relates to longitudinal atrophy and clinical decline. In this study, we evaluated patients with PSP-S (n = 12) and healthy control subjects (n = 20) at baseline and 6 months later. Subjects underwent structural MRI and task-free functional MRI (tf-fMRI) scans and clinical evaluations at both time points. At baseline, voxel based morphometry (VBM) revealed that patients with mild-to-moderate clinical symptoms showed structural atrophy in subcortex and brainstem, prefrontal cortex (PFC; supplementary motor area, paracingulate, dorsal and ventral medial PFC), and parietal cortex (precuneus). Tf-fMRI functional connectivity (FC) was examined in a rostral midbrain tegmentum (rMT)-anchored intrinsic connectivity network that is compromised in PSP-S. In healthy controls, this network contained a medial parietal module, a prefrontal-paralimbic module, and a subcortical-brainstem module. Baseline FC deficits in PSP-S were most severe in rMT network integrative hubs in the prefrontal-paralimbic and subcortical-brainstem modules. Longitudinally, patients with PSP-S had declining intermodular FC between the subcortical-brainstem and parietal modules, while progressive atrophy was observed in subcortical-brainstem regions (midbrain, pallidum) and posterior frontal (perirolandic) cortex. This suggested that later-stage subcortical-posterior cortical change may follow an earlier-stage subcortical-anterior cortical disease process. Clinically, patients with more severe baseline impairment showed greater subsequent prefrontal-parietal cortical FC declines and posterior frontal atrophy rates, while patients with more rapid longitudinal clinical decline showed coupled prefrontal-paralimbic FC decline. VBM and FC can augment disease monitoring in PSP-S by tracking the disease through stages while detecting changes that accompany heterogeneous clinical progression.
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Affiliation(s)
- Jesse A. Brown
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Alice Y. Hua
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew Trujillo
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Suneth Attygalle
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Richard J. Binney
- Temple University, Eleanor M. Saffran Center for Cognitive Neuroscience, Department of Communication Sciences and Disorders, Philadelphia, PA, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Suzee E. Lee
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, USA
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13
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Strafella AP, Bohnen NI, Perlmutter JS, Eidelberg D, Pavese N, Van Eimeren T, Piccini P, Politis M, Thobois S, Ceravolo R, Higuchi M, Kaasinen V, Masellis M, Peralta MC, Obeso I, Pineda-Pardo JÁ, Cilia R, Ballanger B, Niethammer M, Stoessl JA. Molecular imaging to track Parkinson's disease and atypical parkinsonisms: New imaging frontiers. Mov Disord 2017; 32:181-192. [DOI: 10.1002/mds.26907] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 12/23/2022] Open
Affiliation(s)
- Antonio P. Strafella
- Morton and Gloria Shulman Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Neurology Div/Dept. Medicine, Toronto Western Hospital, UHN; Krembil Research Institute, UHN; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH; University of Toronto; Ontario Canada
| | - Nicolaas I. Bohnen
- University of Michigan & Veterans Administration Medical Center; Ann Arbor Michigan USA
| | - Joel S. Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy & Occupational Therapy; Washington University in St. Louis; St. Louis Missouri USA
| | - David Eidelberg
- Center for Neurosciences; The Feinstein Institute for Medical Research; Manhasset New York USA
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre; Newcastle University; Campus for Ageing & Vitality Newcastle upon Tyne United Kingdom
| | - Thilo Van Eimeren
- Multimodal Neuroimaging Group-Department of Nuclear Medicine Department of Neurology-University of Cologne; Institute of Neuroscience and Medicine, Jülich Research Center, German Center for Neurodegenerative Diseases (DZNE); Germany
| | - Paola Piccini
- Neurology Imaging Unit, Centre of Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Hammersmith Campus; Imperial College London; United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry; Psychology and Neuroscience, King's College London; London United Kingdom
| | - Stephane Thobois
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer; Université Lyon 1; CNRS, Centre de Neurosciences Cognitives; UMR 5229 Lyon France
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Movement Disorders and Parkinson Center; University of Pisa; Italy
| | - Makoto Higuchi
- National Institute of Radiological Sciences; National Institutes for Quantum and Radiological Science and Technology; Chiba Japan
| | - Valtteri Kaasinen
- Division of Clinical Neurosciences, Turku University Hospital; Department of Neurology; University of Turku; Turku PET Centre, University of Turku; Turku Finland
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; University of Toronto; Toronto Ontario Canada
| | - M. Cecilia Peralta
- Movement Disorder and Parkinson's Disease Program; CEMIC University Hospital; Buenos Aires Argentina
| | - Ignacio Obeso
- Centro Integral de Neurociencias (CINAC), Hospitales Madrid Puerta del Sur & Centro de Investigación Biomédica en Red; Enfermedades Neurodegenerativas (CIBERNED); Madrid Spain
| | - Jose Ángel Pineda-Pardo
- Centro Integral de Neurociencias (CINAC), Hospitales Madrid Puerta del Sur & Centro de Investigación Biomédica en Red; Enfermedades Neurodegenerativas (CIBERNED); Madrid Spain
| | - Roberto Cilia
- Parkinson Institute; ASST Gaetano Pini-CTO; Milan Italy
| | - Benedicte Ballanger
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Neuroplasticity & Neuropathology of Olfactory Perception Team; University Lyon; France
| | - Martin Niethammer
- Center for Neurosciences; The Feinstein Institute for Medical Research; Manhasset New York USA
| | - Jon A. Stoessl
- Pacific Parkinson's Research Centre & National Parkinson Foundation Centre of Excellence; University of British Columbia & Vancouver Coastal Health; Vancouver British Columbia Canada
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14
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Bondulich MK, Guo T, Meehan C, Manion J, Rodriguez Martin T, Mitchell JC, Hortobagyi T, Yankova N, Stygelbout V, Brion JP, Noble W, Hanger DP. Tauopathy induced by low level expression of a human brain-derived tau fragment in mice is rescued by phenylbutyrate. Brain 2016; 139:2290-306. [PMID: 27297240 PMCID: PMC4958900 DOI: 10.1093/brain/aww137] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/01/2016] [Indexed: 12/11/2022] Open
Abstract
Human neurodegenerative tauopathies exhibit pathological tau aggregates in the brain along with diverse clinical features including cognitive and motor dysfunction. Post-translational modifications including phosphorylation, ubiquitination and truncation, are characteristic features of tau present in the brain in human tauopathy. We have previously reported an N-terminally truncated form of tau in human brain that is associated with the development of tauopathy and is highly phosphorylated. We have generated a new mouse model of tauopathy in which this human brain-derived, 35 kDa tau fragment (Tau35) is expressed in the absence of any mutation and under the control of the human tau promoter. Most existing mouse models of tauopathy overexpress mutant tau at levels that do not occur in human neurodegenerative disease, whereas Tau35 transgene expression is equivalent to less than 10% of that of endogenous mouse tau. Tau35 mice recapitulate key features of human tauopathies, including aggregated and abnormally phosphorylated tau, progressive cognitive and motor deficits, autophagic/lysosomal dysfunction, loss of synaptic protein, and reduced life-span. Importantly, we found that sodium 4-phenylbutyrate (Buphenyl®), a drug used to treat urea cycle disorders and currently in clinical trials for a range of neurodegenerative diseases, reverses the observed abnormalities in tau and autophagy, behavioural deficits, and loss of synapsin 1 in Tau35 mice. Our results show for the first time that, unlike other tau transgenic mouse models, minimal expression of a human disease-associated tau fragment in Tau35 mice causes a profound and progressive tauopathy and cognitive changes, which are rescued by pharmacological intervention using a clinically approved drug. These novel Tau35 mice therefore represent a highly disease-relevant animal model in which to investigate molecular mechanisms and to develop novel treatments for human tauopathies.
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Affiliation(s)
- Marie K Bondulich
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Tong Guo
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Christopher Meehan
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - John Manion
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Teresa Rodriguez Martin
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Jacqueline C Mitchell
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Tibor Hortobagyi
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Natalia Yankova
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Virginie Stygelbout
- 2 Laboratory of Histology, Neuroanatomy and Neuropathology (CP 620), ULB Neuroscience Institute, Université Libre de Bruxelles, Faculty of Medicine 808, route de Lennik, 1070 Brussels, Belgium
| | - Jean-Pierre Brion
- 2 Laboratory of Histology, Neuroanatomy and Neuropathology (CP 620), ULB Neuroscience Institute, Université Libre de Bruxelles, Faculty of Medicine 808, route de Lennik, 1070 Brussels, Belgium
| | - Wendy Noble
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Diane P Hanger
- 1 King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, 125 Coldharbour Lane, London SE5 9NU, UK
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15
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Baquero M, Martín N. Depressive symptoms in neurodegenerative diseases. World J Clin Cases 2015; 3:682-693. [PMID: 26301229 PMCID: PMC4539408 DOI: 10.12998/wjcc.v3.i8.682] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/12/2015] [Accepted: 05/27/2015] [Indexed: 02/05/2023] Open
Abstract
Depressive symptoms are very common in chronic conditions. This is true so for neurodegenerative diseases. A number of patients with cognitive decline and dementia due to Alzheimer’s disease and related conditions like Parkinson’s disease, Lewy body disease, vascular dementia, frontotemporal degeneration amongst other entities, experience depressive symptoms in greater or lesser grade at some point during the course of the illness. Depressive symptoms have a particular significance in neurological disorders, specially in neurodegenerative diseases, because brain, mind, behavior and mood relationship. A number of patients may develop depressive symptoms in early stages of the neurologic disease, occurring without clear presence of cognitive decline with only mild cognitive deterioration. Classically, depression constitutes a reliable diagnostic challenge in this setting. However, actually we can recognize and evaluate depressive, cognitive or motor symptoms of neurodegenerative disease in order to establish their clinical significance and to plan some therapeutic strategies. Depressive symptoms can appear also lately, when the neurodegenerative disease is fully developed. The presence of depression and other neuropsychiatric symptoms have a negative impact on the quality-of-life of patients and caregivers. Besides, patients with depressive symptoms also tend to further decrease function and reduce cognitive abilities and also uses to present more affected clinical status, compared with patients without depression. Depressive symptoms are treatable. Early detection of depressive symptoms is very important in patients with neurodegenerative disorders, in order to initiate the most adequate treatment. We review in this paper the main neurodegenerative diseases, focusing in depressive symptoms of each other entities and current recommendations of management and treatment.
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16
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Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr 2015; 27:7-17. [PMID: 25311499 PMCID: PMC4301197 DOI: 10.1017/s1041610214001963] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs. METHODS The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process. RESULTS Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as "strongly agree" or "somewhat agree" (68-88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications. CONCLUSIONS A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.
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17
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Aarsland D, Taylor JP, Weintraub D. Psychiatric issues in cognitive impairment. Mov Disord 2014; 29:651-62. [PMID: 24757113 DOI: 10.1002/mds.25873] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/20/2014] [Accepted: 03/03/2013] [Indexed: 01/08/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) such as depression, hallucinations and apathy commonly occur in Parkinson's disease (PD) and have major clinical consequences including a negative impact on quality of life. This review discusses the epidemiology, clinical features, diagnostic procedures and treatment issues of NPS in PD and related disorders in the perspective of cognitive impairment, focusing on depression, anxiety, visual hallucinations, apathy, sleep disturbances, impulse control disorder and non-motor fluctuations. The majority of NPS are more common in PD patients with dementia, possibly related to shared underlying pathologies. Recent studies also suggest that NPS are associated with mild cognitive impairment in PD, in particular with the amnestic type. Accurate diagnosis of NPS is important but can be difficult, due to overlapping symptoms and similar appearance of symptoms of motor symptoms of parkinsonism, cognitive impairment, mood disorders and apathy. There are few systematic studies focusing on the management of NPS in PD with cognitive impairment.
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Affiliation(s)
- Dag Aarsland
- Alzheimer's Disease Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway
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18
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Tassy S, Belzeaux R, Adida M, Micoulaud Franchi JA, Azorin JM. Troubles affectifs et comorbidités neurologiques. Encephale 2014; 40 Suppl 3:S51-6. [DOI: 10.1016/s0013-7006(14)70132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Jellinger KA, Attems J. Challenges of multimorbidity of the aging brain: a critical update. J Neural Transm (Vienna) 2014; 122:505-21. [DOI: 10.1007/s00702-014-1288-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
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20
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Burrell JR, Hodges JR, Rowe JB. Cognition in corticobasal syndrome and progressive supranuclear palsy: A review. Mov Disord 2014; 29:684-93. [DOI: 10.1002/mds.25872] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/18/2014] [Accepted: 02/27/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- James R. Burrell
- Neuroscience Research Australia; Sydney Australia
- University of New South Wales; Sydney Australia
| | - John R. Hodges
- Neuroscience Research Australia; Sydney Australia
- University of New South Wales; Sydney Australia
| | - James B. Rowe
- Department of Clinical Neurosciences; Cambridge University; Cambridge United Kingdom
- Behavioral and Clinical Neuroscience Institute; Cambridge United Kingdom
- Medical Research Council; Cognition and Brain Sciences Unit; Cambridge United Kingdom
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21
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Riedl L, Mackenzie IR, Förstl H, Kurz A, Diehl-Schmid J. Frontotemporal lobar degeneration: current perspectives. Neuropsychiatr Dis Treat 2014; 10:297-310. [PMID: 24600223 PMCID: PMC3928059 DOI: 10.2147/ndt.s38706] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The term frontotemporal lobar degeneration (FTLD) refers to a group of progressive brain diseases, which preferentially involve the frontal and temporal lobes. Depending on the primary site of atrophy, the clinical manifestation is dominated by behavior alterations or impairment of language. The onset of symptoms usually occurs before the age of 60 years, and the mean survival from diagnosis varies between 3 and 10 years. The prevalence is estimated at 15 per 100,000 in the population aged between 45 and 65 years, which is similar to the prevalence of Alzheimer's disease in this age group. There are two major clinical subtypes, behavioral-variant frontotemporal dementia and primary progressive aphasia. The neuropathology underlying the clinical syndromes is also heterogeneous. A common feature is the accumulation of certain neuronal proteins. Of these, the microtubule-associated protein tau (MAPT), the transactive response DNA-binding protein, and the fused in sarcoma protein are most important. Approximately 10% to 30% of FTLD shows an autosomal dominant pattern of inheritance, with mutations in the genes for MAPT, progranulin (GRN), and in the chromosome 9 open reading frame 72 (C9orf72) accounting for more than 80% of familial cases. Although significant advances have been made in recent years regarding diagnostic criteria, clinical assessment instruments, neuropsychological tests, cerebrospinal fluid biomarkers, and brain imaging techniques, the clinical diagnosis remains a challenge. To date, there is no specific pharmacological treatment for FTLD. Some evidence has been provided for serotonin reuptake inhibitors to reduce behavioral disturbances. No large-scale or high-quality studies have been conducted to determine the efficacy of non-pharmacological treatment approaches in FTLD. In view of the limited treatment options, caregiver education and support is currently the most important component of the clinical management.
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Affiliation(s)
- Lina Riedl
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ian R Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Hans Förstl
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Kurz
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Janine Diehl-Schmid
- Center for Cognitive Disorders, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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