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Garg P, Würtz F, Hobbie F, Buttgereit K, Aich A, Leite K, Rehling P, Kügler S, Bähr M. Human serum-derived α-synuclein auto-antibodies mediate NMDA receptor-dependent degeneration of CNS neurons. J Neuroinflammation 2024; 21:62. [PMID: 38419079 PMCID: PMC10902935 DOI: 10.1186/s12974-024-03050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Presence of autoantibodies against α-synuclein (α-syn AAb) in serum of the general population has been widely reported. That such peripheral factors may be involved in central nervous system pathophysiology was demonstrated by detection of immunoglobulins (IgGs) in cerebrospinal fluid and brain of Parkinson's disease (PD) patients. Thus, blood-borne IgGs may reach the brain parenchyma through an impaired blood-brain barrier (BBB). FINDINGS The present study aims to evaluate the patho-physiological impact of α-syn AAbs on primary brain cells, i.e., on spontaneously active neurons and on astrocytes. Exposure of neuron-astrocyte co-cultures to human serum containing α-syn AAbs mediated a dose-dependent reduction of spontaneous neuronal activity, and subsequent neurodegeneration. Removal specifically of α-syn AAbs from the serum prevented neurotoxicity, while purified, commercial antibodies against α-syn mimicked the neurodegenerative effect. Mechanistically, we found a strong calcium flux into neurons preceding α-syn AAbs-induced cell death, specifically through NMDA receptors. NMDA receptor antagonists prevented neurodegeneration upon treatment with α-syn (auto)antibodies. α-syn (auto)antibodies did not affect astrocyte survival. However, in presence of α-syn, astrocytes reacted to α-syn antibodies by secretion of the chemokine RANTES. CONCLUSION These findings provide a novel basis to explain how a combination of BBB impairment and infiltration of IgGs targeting synuclein may contribute to neurodegeneration in PD and argue for caution with α-syn immunization therapies for treatment of PD.
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Affiliation(s)
- Pretty Garg
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
| | - Franziska Würtz
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Fabian Hobbie
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Klemens Buttgereit
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Abhishek Aich
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
- Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Kristian Leite
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Peter Rehling
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
- Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Sebastian Kügler
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany.
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
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Rukavina K, Batzu L, Boogers A, Abundes-Corona A, Bruno V, Chaudhuri KR. Non-motor complications in late stage Parkinson's disease: recognition, management and unmet needs. Expert Rev Neurother 2021; 21:335-352. [PMID: 33522312 DOI: 10.1080/14737175.2021.1883428] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson's disease (PD), particularly at its late stage.Areas covered: The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment.Expert opinion: The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty - the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.
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Affiliation(s)
- Katarina Rukavina
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Lucia Batzu
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Boogers
- Department of Neurology, University Hospital Leuven, Leuven, U.Z, Belgium
| | - Arturo Abundes-Corona
- Department of Neurology, Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico City, México.,Neurology Department, American British Cowdray Medical Center IAP, Mexico City, Mexico
| | - Veronica Bruno
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
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Zhang Y, Xu Y, Si G, Ran L, Xie Y, Yang J, Tan X. Physical and behavioural factors, negative emotion and cognitive function among near-centenarians and centenarians in China. Australas J Ageing 2019; 39:e344-e351. [PMID: 31663256 DOI: 10.1111/ajag.12740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the association among demographic, physical, behavioural parameters, psychosocial and cognitive function in near-centenarians and centenarians. METHODS The present study data originated from the 2014 wave of the largest nationwide longitudinal survey of the population aged 95 and above in China (N = 175). The aim of this study was to systematically identify the relationship among physical and behavioural variables, negative emotions and cognitive function. Cognitive function was evaluated by the modified Mini-Mental State Examination (mMMSE) Chinese version. Structured responses were obtained for the analysis of physical and behavioural factors and negative emotions. RESULTS The average age of the sample was 98.78 years (SD = 4.00, range: 95-112 years). The average score of the mMMSE was 20.71 (SD = 3.48), average activities of daily living (ADL) total score was 17.21 (SD = 1.72), average instrumental activities of daily living (IADL) total score was 17.90 (SD = 5.57), and average negative emotion score was 8.77 (SD = 2.69). In the combined multiple linear regression model, the quality of sleep, IADL and negative emotion of centenarians were significantly associated with cognitive function (P < 0.05). CONCLUSION The cognitive function of centenarians was significantly associated with the quality of sleep, IADL and negative emotion. Improving physical functioning and social resources can help emotional health and improve the overall cognition of centenarians.
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Affiliation(s)
- Yuting Zhang
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yi Xu
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Guanglin Si
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Li Ran
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yaofei Xie
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Jinru Yang
- College of Clinical Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Xiaodong Tan
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
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Rosqvist K, Odin P, Hagell P, Iwarsson S, Nilsson MH, Storch A. Dopaminergic Effect on Non-Motor Symptoms in Late Stage Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:409-420. [PMID: 30056433 DOI: 10.3233/jpd-181380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-motor symptoms (NMS) are common in late stage Parkinson's disease (PD), as the frequency and severity of most of these symptoms increase with advancing disease. OBJECTIVE To assess effect of dopaminergic therapy on NMS in late stage PD and to investigate relationships between dopaminergic effect on NMS and on motor function. METHOD Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. Dopaminergic effect on non-motor symptomatology was assessed by the modified version of the Non-Motor Symptoms Scale (NMSS) in the "off" and the "on" state during a standardized L-dopa test, in parallel also assessing motor function. RESULTS NMS were common and many of the symptoms occurred in >80% of the individuals. The highest NMSS scores were seen within the NMSS domains 3: mood/apathy and 7: urinary in both the "off" and the "on" state. There was a statistically significant (p < 0.001) improvement in the modified NMSS total score (median) from 79 in "off" to 64 in "on". There were statistically significant differences between the "off" and the "on" state for domains 2: sleep/fatigue, 3: mood/apathy, 5: attention/memory, 6: gastrointestinal and 7: urinary. The differences in the NMSS score between the "off" and the "on" state were in general larger for motor responders than for motor non-responders. In motor non-responders, differences of the NMSS score between the "off" and the "on" state were found for the total score, domain 3: mood/apathy and its item 11-flat moods. CONCLUSION There is an effect of dopaminergic medication on NMS in late stage PD, to some extent also for those with a non-significant response on motor function during L-dopa test. It is therefore of importance to optimize dopaminergic therapy in order to give the most effective symptomatic treatment possible.
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van der Velden RMJ, Broen MPG, Kuijf ML, Leentjens AFG. Frequency of mood and anxiety fluctuations in Parkinson's disease patients with motor fluctuations: A systematic review. Mov Disord 2018; 33:1521-1527. [DOI: 10.1002/mds.27465] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Martijn P. G. Broen
- Department of Neurology; Maastricht University Medical Center; Maastricht the Netherlands
| | - Mark L. Kuijf
- Department of Neurology; Maastricht University Medical Center; Maastricht the Netherlands
| | - Albert F. G. Leentjens
- Department of Psychiatry; Maastricht University Medical Center; Maastricht the Netherlands
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Effectiveness of Intraindividual Variability in Detecting Subtle Cognitive Performance Deficits in Breast Cancer Patients. J Int Neuropsychol Soc 2018; 24:724-734. [PMID: 29880075 DOI: 10.1017/s1355617718000309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The purpose of this study was to determine if intraindividual variability would be more sensitive than speed or accuracy in detecting subtle cancer-related cognitive disturbance. METHODS Data were from a previous study in which 60 breast cancer (BC) patients underwent neuropsychological assessment before commencement of chemotherapy and again following each chemotherapy cycle. Sixty healthy controls were tested at equivalent intervals. Hierarchical linear modeling was used to compare the BC and control groups in terms of accuracy, mean reaction time, and intraindividual variability in reaction time on a computerized continuous performance test with three conditions: a simple reaction time task, a "1-back" task, and a "2-back" task. RESULTS An increase in accuracy and response speed over sessions was noted on some tasks in the sample as a whole but there were no differences in these parameters between the BC patients and the controls on any condition. There was a significant group difference in change in intraindividual variability across sessions (i.e., a "group × session interaction"), albeit only on the most complex "2-back" task. Intraindividual variability declined in the control group (i.e., consistency improved with practice) but this practice effect was significantly attenuated in the BC patients. There was no main effect of group on the "2-back" task. CONCLUSIONS Results support our hypothesis that intraindividual variability is a more sensitive indicator of subtle cognitive disturbance than conventional speed or accuracy measures and may have potential in the assessment of mild cognitive impairment in patients with non-central nervous system cancers. (JINS, 2018, 24, 724-734).
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Nonmotor fluctuations: phenotypes, pathophysiology, management, and open issues. J Neural Transm (Vienna) 2017; 124:1029-1036. [PMID: 28702850 DOI: 10.1007/s00702-017-1757-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/06/2017] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative multisystem disorder characterized by progressive motor symptoms such as bradykinesia, tremor and muscle rigidity. Over the course of the disease, numerous non-motor symptoms, sometimes preceding the onset of motor symptoms, significantly impair patients' quality of life. The significance of non-motor symptoms may outweigh the burden through progressive motor incapacity, especially in later stages of the disease. The advanced stage of the disease is characterized by motor complications such as fluctuations and dyskinesias induced by the long-term application of levodopa therapy. In recent years, it became evident that various non-motor symptoms such as psychiatric symptoms, fatigue and pain also show fluctuations after chronic levodopa therapy (named non-motor fluctuations or NMFs). Although NMFs have moved into the focus of interest, current national guidelines on the treatment of PD may refer to non-motor symptoms and their management, but do not mention NMF, and do not contain recommendations on their management. The present article summarizes major issues related to NMF including clinical phenomenology and pathophysiology, and outlines a number of open issues and topics for future research.
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Juhász A, Deli G, Aschermann Z, Janszky J, Harmat M, Makkos A, Kovács M, Komoly S, Balás I, Dóczi T, Büki A, Kovács N. How Efficient Is Subthalamic Deep Brain Stimulation in Reducing Dyskinesia in Parkinson's Disease? Eur Neurol 2017; 77:281-287. [DOI: 10.1159/000455208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
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Nonmotor Fluctuations in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:947-971. [DOI: 10.1016/bs.irn.2017.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lindstrøm JC, Wyller NG, Halvorsen MM, Hartberg S, Lundqvist C. Psychometric properties of a Norwegian adaption of the Barratt Impulsiveness Scale-11 in a sample of Parkinson patients, headache patients, and controls. Brain Behav 2017; 7:e00605. [PMID: 28127523 PMCID: PMC5256188 DOI: 10.1002/brb3.605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the psychometric properties of a Norwegian translation of the Barratt Impulsiveness Scale (BIS-11) for use in populations of headache, Parkinson's disease (PD), and healthy controls. MATERIALS AND METHODS The BIS-11 was forward and backward translated by native speakers of both Norwegian and English to give Norwegian BIS-11 (Nor-BIS-11). A convenience sample (110 subjects) of healthy controls (47), PD patients (43), and chronic headache patients (20) (the latter two recruited from a Neurology outpatient clinic), were asked to complete the scale (a subset twice for test-retest). Exploratory and confirmatory factor analyses were done for a single-factor model, the original three-factor model and a two-factor model. Test-retest results were analyzed using the Bland-Altman approach. RESULTS The Nor-BIS-11 scale showed good utility and acceptability as well as good test-retest reliability in this sample. Cronbach's α was .68, test-retest bias was -0.73, Cohen's δ = -.134, and limits of agreement were -11.48 to 10.01. The factor structure was found to fit better with a two-factor model than with the original model with three factors. The model fit indices indicated a moderate fit. CONCLUSIONS The Nor-BIS-11 scale is acceptable and reliable to use in Parkinson's disease patients, chronic headache patients, and healthy controls. The results should be interpreted in a two-factor model but with caution due to low construct validity. External validity needs to be further tested.
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Affiliation(s)
- Jonas C Lindstrøm
- Health Services Research Centre (HØKH)Akershus University HospitalLørenskogNorway; Institute of Clinical MedicineCampus Akershus University HospitalUniversity of OsloOsloNorway
| | - Nora G Wyller
- Health Services Research Centre (HØKH) Akershus University Hospital Lørenskog Norway
| | - Marianne M Halvorsen
- Health Services Research Centre (HØKH) Akershus University Hospital Lørenskog Norway
| | - Silje Hartberg
- Health Services Research Centre (HØKH) Akershus University Hospital Lørenskog Norway
| | - Christofer Lundqvist
- Health Services Research Centre (HØKH)Akershus University HospitalLørenskogNorway; Institute of Clinical MedicineCampus Akershus University HospitalUniversity of OsloOsloNorway; Department of NeurologyAkershus University HospitalLørenskogNorway
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Impact of Sex on the Nonmotor Symptoms and the Health-Related Quality of Life in Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:7951840. [PMID: 27293959 PMCID: PMC4884810 DOI: 10.1155/2016/7951840] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/27/2016] [Accepted: 04/12/2016] [Indexed: 12/30/2022]
Abstract
Background. Female Parkinson's disease (PD) patients seem to experience not only more severe motor complications and postural instability but also more pronounced depression, anxiety, pain, and sleep disturbances. Objective. The aim of the present study was to evaluate the role of sex as a possible independent predictor of HRQoL in PD. Methods. In this cross-sectional study, 621 consecutive patients treated at the University of Pécs were enrolled. Severity of PD symptoms was assessed by MDS-UPDRS, UDysRS, Non-Motor Symptoms Scale, PDSS-2, Hamilton Anxiety Scale, Montgomery-Asberg Depression Rating Scale, Lille Apathy Rating Scale, and Addenbrooke Cognitive Examination. HRQoL was assessed by PDQ-39 and EQ-5D. Multiple regression analysis was performed to estimate the PDQ-39 and EQ-5D index values based on various clinical factors. Results. Although females received significantly lower dosage of levodopa, they had significantly more disabling dyskinesia and worse postural instability. Anxiety, pain, sleep disturbances, and orthostatic symptoms were more frequent among females while sexual dysfunction, apathy, and daytime sleepiness were more severe among males. Women had worse HRQoL than men (EQ-5D index value: 0.620 ± 0.240 versus 0.663 ± 0.229, p = 0.025, and PDQ-39 SI: 27.1 ± 17.0 versus 23.5 ± 15.9, p = 0.010). Based on multiple regression analysis, sex was an independent predictor for HRQoL in PD. Conclusions. Based on our results, female sex is an independent predictor for having worse HRQoL in PD.
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