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Tahedl M, Tan EL, Chipika RH, Hengeveld JC, Vajda A, Doherty MA, McLaughlin RL, Siah WF, Hardiman O, Bede P. Brainstem-cortex disconnection in amyotrophic lateral sclerosis: bulbar impairment, genotype associations, asymptomatic changes and biomarker opportunities. J Neurol 2023:10.1007/s00415-023-11682-6. [PMID: 37022479 DOI: 10.1007/s00415-023-11682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Bulbar dysfunction is a cardinal feature of ALS with important quality of life and management implications. The objective of this study is the longitudinal evaluation of a large panel imaging metrics pertaining to bulbar dysfunction, encompassing cortical measures, structural and functional cortico-medullary connectivity indices and brainstem metrics. METHODS A standardised, multimodal imaging protocol was implemented with clinical and genetic profiling to systematically appraise the biomarker potential of specific metrics. A total of 198 patients with ALS and 108 healthy controls were included. RESULTS Longitudinal analyses revealed progressive structural and functional disconnection between the motor cortex and the brainstem over time. Cortical thickness reduction was an early feature on cross-sectional analyses with limited further progression on longitudinal follow-up. Receiver operating characteristic analyses of the panel of MR metrics confirmed the discriminatory potential of bulbar imaging measures between patients and controls and area-under-the-curve values increased significantly on longitudinal follow-up. C9orf72 carriers exhibited lower brainstem volumes, lower cortico-medullary structural connectivity and faster cortical thinning. Sporadic patients without bulbar symptoms, already exhibit significant brainstem and cortico-medullary connectivity alterations. DISCUSSION Our results indicate that ALS is associated with multi-level integrity change from cortex to brainstem. The demonstration of significant corticobulbar alterations in patients without bulbar symptoms confirms considerable presymptomatic disease burden in sporadic ALS. The systematic assessment of radiological measures in a single-centre academic study helps to appraise the diagnostic and monitoring utility of specific measures for future clinical and clinical trial applications.
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Affiliation(s)
- Marlene Tahedl
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Room 5.43, Pearse Street, Dublin 2, Dublin, Ireland
| | - Ee Ling Tan
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Room 5.43, Pearse Street, Dublin 2, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Room 5.43, Pearse Street, Dublin 2, Dublin, Ireland
| | | | - Alice Vajda
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Mark A Doherty
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | | | - We Fong Siah
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Room 5.43, Pearse Street, Dublin 2, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Room 5.43, Pearse Street, Dublin 2, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group (CNG), Trinity Biomedical Sciences Institute, Trinity College Dublin, Room 5.43, Pearse Street, Dublin 2, Dublin, Ireland.
- Department of Neurology, St James's Hospital, Dublin, Ireland.
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McKenna MC, Tahedl M, Lope J, Chipika RH, Li Hi Shing S, Doherty MA, Hengeveld JC, Vajda A, McLaughlin RL, Hardiman O, Hutchinson S, Bede P. Mapping cortical disease-burden at individual-level in frontotemporal dementia: implications for clinical care and pharmacological trials. Brain Imaging Behav 2022; 16:1196-1207. [PMID: 34882275 PMCID: PMC9107414 DOI: 10.1007/s11682-021-00523-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 01/25/2023]
Abstract
Imaging studies of FTD typically present group-level statistics between large cohorts of genetically, molecularly or clinically stratified patients. Group-level statistics are indispensable to appraise unifying radiological traits and describe genotype-associated signatures in academic studies. However, in a clinical setting, the primary objective is the meaningful interpretation of imaging data from individual patients to assist diagnostic classification, inform prognosis, and enable the assessment of progressive changes compared to baseline scans. In an attempt to address the pragmatic demands of clinical imaging, a prospective computational neuroimaging study was undertaken in a cohort of patients across the spectrum of FTD phenotypes. Cortical changes were evaluated in a dual pipeline, using standard cortical thickness analyses and an individualised, z-score based approach to characterise subject-level disease burden. Phenotype-specific patterns of cortical atrophy were readily detected with both methodological approaches. Consistent with their clinical profiles, patients with bvFTD exhibited orbitofrontal, cingulate and dorsolateral prefrontal atrophy. Patients with ALS-FTD displayed precentral gyrus involvement, nfvPPA patients showed widespread cortical degeneration including insular and opercular regions and patients with svPPA exhibited relatively focal anterior temporal lobe atrophy. Cortical atrophy patterns were reliably detected in single individuals, and these maps were consistent with the clinical categorisation. Our preliminary data indicate that standard T1-weighted structural data from single patients may be utilised to generate maps of cortical atrophy. While the computational interpretation of single scans is challenging, it offers unrivalled insights compared to visual inspection. The quantitative evaluation of individual MRI data may aid diagnostic classification, clinical decision making, and assessing longitudinal changes.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Marlene Tahedl
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Psychology, University of Regensburg, Regensburg, Germany
| | - Jasmin Lope
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.
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Pinto-Grau M, Donohoe B, O'Connor S, Murphy L, Costello E, Heverin M, Vajda A, Hardiman O, Pender N. Patterns of Language Impairment in Early Amyotrophic Lateral Sclerosis. Neurol Clin Pract 2021; 11:e634-e644. [PMID: 34840877 DOI: 10.1212/cpj.0000000000001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/07/2020] [Indexed: 11/15/2022]
Abstract
Objective To investigate the incidence and nature of language change and its relationship to executive dysfunction in a population-based incident amyotrophic lateral sclerosis (ALS) sample, with the hypothesis that patterns of frontotemporal involvement in early ALS extend beyond areas of executive control to regions associated with language processing. Methods One hundred seventeen population-based incident ALS cases without dementia and 100 controls matched by age, sex, and education were included in the study. A detailed assessment of language processing including lexical processing, word spelling, word reading, word naming, semantic processing, and syntactic/grammatical processing was undertaken. Executive domains of phonemic verbal fluency, working memory, problem-solving, cognitive flexibility, and social cognition were also evaluated. Results Language processing was impaired in this incident cohort of individuals with ALS, with deficits in the domains of word naming, orthographic processing, and syntactic/grammatical processing. Conversely, phonological lexical processing and semantic processing were spared. Although executive dysfunction accounted in part for impairments in grammatical and orthographic lexical processing, word spelling, reading, and naming, primary language deficits were also present. Conclusions Language impairment is characteristic of ALS at early stages of the disease and can develop independently of executive dysfunction, reflecting selective patterns of frontotemporal involvement at disease onset. Language change is therefore an important component of the frontotemporal syndrome associated with ALS.
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Affiliation(s)
- Marta Pinto-Grau
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Bronagh Donohoe
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Sarah O'Connor
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Lisa Murphy
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Emmet Costello
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
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Bede P, Chipika RH, Christidi F, Hengeveld JC, Karavasilis E, Argyropoulos GD, Lope J, Li Hi Shing S, Velonakis G, Dupuis L, Doherty MA, Vajda A, McLaughlin RL, Hardiman O. Genotype-associated cerebellar profiles in ALS: focal cerebellar pathology and cerebro-cerebellar connectivity alterations. J Neurol Neurosurg Psychiatry 2021; 92:1197-1205. [PMID: 34168085 PMCID: PMC8522463 DOI: 10.1136/jnnp-2021-326854] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cerebellar disease burden and cerebro-cerebellar connectivity alterations are poorly characterised in amyotrophic lateral sclerosis (ALS) despite the likely contribution of cerebellar pathology to the clinical heterogeneity of the condition. METHODS A prospective imaging study has been undertaken with 271 participants to systematically evaluate cerebellar grey and white matter alterations, cerebellar peduncle integrity and cerebro-cerebellar connectivity in ALS. Participants were stratified into four groups: (1) patients testing positive for GGGGCC repeat expansions in C9orf72, (2) patients carrying an intermediate-length repeat expansion in ATXN2, (3) patients without established ALS-associated mutations and (4) healthy controls. Additionally, the cerebellar profile of a single patient with ALS who had an ATXN2 allele length of 62 was evaluated. Cortical thickness, grey matter and white matter volumes were calculated in each cerebellar lobule complemented by morphometric analyses to characterise genotype-associated atrophy patterns. A Bayesian segmentation algorithm was used for superior cerebellar peduncle volumetry. White matter diffusivity parameters were appraised both within the cerebellum and in the cerebellar peduncles. Cerebro-cerebellar connectivity was assessed using deterministic tractography. RESULTS Cerebellar pathology was confined to lobules I-V of the anterior lobe in patients with sporadic ALS in contrast to the considerable posterior lobe and vermis disease burden identified in C9orf72 mutation carriers. Patients with intermediate ATXN2 expansions did not exhibit significant cerebellar pathology. CONCLUSIONS Focal rather than global cerebellar degeneration characterises ALS. Pathognomonic ALS symptoms which are typically attributed to other anatomical regions, such as dysarthria, dysphagia, pseudobulbar affect, eye movement abnormalities and cognitive deficits, may be modulated, exacerbated or partially driven by cerebellar changes in ALS.
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Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Foteini Christidi
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
- National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Jasmin Lope
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Léonie Dupuis
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Mark A Doherty
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | | | - Orla Hardiman
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
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McKenna MC, Chipika RH, Li Hi Shing S, Christidi F, Lope J, Doherty MA, Hengeveld JC, Vajda A, McLaughlin RL, Hardiman O, Hutchinson S, Bede P. Infratentorial pathology in frontotemporal dementia: cerebellar grey and white matter alterations in FTD phenotypes. J Neurol 2021; 268:4687-4697. [PMID: 33983551 PMCID: PMC8563547 DOI: 10.1007/s00415-021-10575-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022]
Abstract
The contribution of cerebellar pathology to cognitive and behavioural manifestations is increasingly recognised, but the cerebellar profiles of FTD phenotypes are relatively poorly characterised. A prospective, single-centre imaging study has been undertaken with a high-resolution structural and diffusion tensor protocol to systematically evaluate cerebellar grey and white matter alterations in behavioural-variant FTD(bvFTD), non-fluent variant primary progressive aphasia(nfvPPA), semantic-variant primary progressive aphasia(svPPA), C9orf72-positive ALS-FTD(C9 + ALSFTD) and C9orf72-negative ALS-FTD(C9-ALSFTD). Cerebellar cortical thickness and complementary morphometric analyses were carried out to appraise atrophy patterns controlling for demographic variables. White matter integrity was assessed in a study-specific white matter skeleton, evaluating three diffusivity metrics: fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD). Significant cortical thickness reductions were identified in: lobule VII and crus I in bvFTD; lobule VI VII, crus I and II in nfvPPA; and lobule VII, crus I and II in svPPA; lobule IV, VI, VII and Crus I and II in C9 + ALSFTD. Morphometry revealed volume reductions in lobule V in all groups; in addition to lobule VIII in C9 + ALSFTD; lobule VI, VIII and vermis in C9-ALSFTD; lobule V, VII and vermis in bvFTD; and lobule V, VI, VIII and vermis in nfvPPA. Widespread white matter alterations were demonstrated by significant fractional anisotropy, axial diffusivity and radial diffusivity changes in each FTD phenotype that were more focal in those with C9 + ALSFTD and svPPA. Our findings indicate that FTD subtypes are associated with phenotype-specific cerebellar signatures with the selective involvement of specific lobules instead of global cerebellar atrophy.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Foteini Christidi
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Jasmin Lope
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Peter Bede, Room 5.43, Pearse Street, Dublin 2, Ireland. .,Department of Neurology, St James's Hospital, Dublin, Ireland.
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Costello E, Rooney J, Pinto-Grau M, Burke T, Elamin M, Bede P, McMackin R, Dukic S, Vajda A, Heverin M, Hardiman O, Pender N. Cognitive reserve in amyotrophic lateral sclerosis (ALS): a population-based longitudinal study. J Neurol Neurosurg Psychiatry 2021; 92:460-465. [PMID: 33563807 DOI: 10.1136/jnnp-2020-324992] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is often associated with cognitive and/or behavioural impairment. Cognitive reserve (CR) may play a protective role in offsetting cognitive impairment. This study examined the relationship between CR and longitudinal change in cognition in an Irish ALS cohort. METHODS Longitudinal neuropsychological assessment was carried out on 189 patients over 16 months using the Edinburgh cognitive and behavioural ALS screen (ECAS) and an additional battery of neuropsychological tests. CR was measured by combining education, occupation and physical activity data. Joint longitudinal and time-to-event models were fitted to investigate the associations between CR, performance at baseline and decline over time while controlling for non-random drop-out. RESULTS CR was a significant predictor of baseline neuropsychological performance, with high CR patients performing better than those with medium or low CR. Better cognitive performance in high CR individuals was maintained longitudinally for ECAS, social cognition, executive functioning and confrontational naming. Patients displayed little cognitive decline over the course of the study, despite controlling for non-random drop-out. CONCLUSIONS These findings suggest that CR plays a role in the presentation of cognitive impairment at diagnosis but is not protective against cognitive decline. However, further research is needed to examine the interaction between CR and other objective correlates of cognitive impairment in ALS.
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Affiliation(s)
- Emmet Costello
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - James Rooney
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Institute and Clinic for Occupational, Social- and Environmental Medicine, University Hospital, Munich, Germany
| | - Marta Pinto-Grau
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Marwa Elamin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Roisin McMackin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.,Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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Pinto-Grau M, O'Connor S, Murphy L, Heverin M, Vajda A, Hardiman O, Pender N. Development and Psychometric Evaluation of Alternate Short Forms of the Action Naming Test. Arch Clin Neuropsychol 2021:acab013. [PMID: 33822859 DOI: 10.1093/arclin/acab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The action naming test (ANT) is a confrontation naming task used to assess the ability to name action words. This study aimed to create two short forms of the ANT and assess their equivalence, reliability, and comparability to the long form. METHODS In total, 100 healthy adults (31 females and 69 males), aged 34-89 years (M = 64 and SD = 10.4) were recruited. Short forms were developed using a split-half procedure. RESULTS No significant differences were observed between short forms on mean performance and distribution of scores for correct spontaneous responses, responses after semantic cue and total correct responses after cueing, but a higher number of accurate responses were prompted after phonemic cueing for Form A. Significant strong correlations between short forms and with the full form were encountered, although a weak correlation was found between short forms on performance after semantic cueing. IQ and age were significant predictors of action word retrieval. Whereas IQ also predicted post-cueing performance in all ANT forms, age predicted performance only for Form B. CONCLUSION The two ANT short forms are equivalent when considering total spontaneous responses and total correct responses after cueing, but semantic and phonemic cues evoked different responses on the two forms. The two short forms were also affected differently by demographics. When the psychometric equivalence of Forms A and B was examined, the strict conditions for parallel forms were not met for all performance indices. Therefore, these newly developed short versions should be considered as alternate forms.
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Affiliation(s)
- Marta Pinto-Grau
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Sarah O'Connor
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Lisa Murphy
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
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Finegan E, Siah WF, Shing SLH, Chipika RH, Chang KM, McKenna MC, Doherty MA, Hengeveld JC, Vajda A, Donaghy C, Hutchinson S, McLaughlin RL, Hardiman O, Bede P. Imaging and clinical data indicate considerable disease burden in 'probable' PLS: Patients with UMN symptoms for 2-4 years. Data Brief 2020; 32:106247. [PMID: 32944602 PMCID: PMC7481824 DOI: 10.1016/j.dib.2020.106247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
Primary lateral sclerosis (PLS) is an adult-onset upper motor neuron disease manifesting in progressive spasticity and gradually resulting in considerably motor disability. In the absence of early disease-specific diagnostic indicators, the majority of patients with PLS face a circuitous diagnostic journey. Until the recent publication of consensus diagnostic criteria, 4-year symptom duration was required to establish the diagnosis. The new diagnostic criteria introduced the category of ‘probable PLS’ for patients with a symptom duration of 2–4 years. “Evolving diagnostic criteria in primary lateral sclerosis: The clinical and radiological basis of "probable PLS" [1]. This dataset provides radiological metrics in a cohort of ‘probable PLS’ patients, ‘definite PLS’ patients and age-matched healthy controls. Region-of-interest radiological data include diffusivity metrics in the corticospinal tracts and corpus callosum as well as mean cortical thickness values in the pre- and para-central gyri in each hemisphere. Our data indicate considerable grey matter and relatively limited white matter involvement in ‘probable PLS’ which supports the rationale for this diagnostic category as a clinically useful entity. The introduction of this diagnostic category will likely facilitate the timely recruitment of PLS patients into research studies and pharmacological trials before widespread neurodegenerative change ensues.
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Affiliation(s)
- Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - We Fong Siah
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | | | - Kai Ming Chang
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Mark A. Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Jennifer C. Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Colette Donaghy
- Department of Neurology, Western Health & Social Care Trust, Belfast, United Kingdom
| | | | - Russel L. McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Corresponding author.
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Finegan E, Li Hi Shing S, Siah WF, Chipika RH, Chang KM, McKenna MC, Doherty MA, Hengeveld JC, Vajda A, Donaghy C, Hutchinson S, McLaughlin RL, Hardiman O, Bede P. Evolving diagnostic criteria in primary lateral sclerosis: The clinical and radiological basis of "probable PLS". J Neurol Sci 2020; 417:117052. [PMID: 32731060 DOI: 10.1016/j.jns.2020.117052] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Primary lateral sclerosis is a rare neurodegenerative disorder of the upper motor neurons. Diagnostic criteria have changed considerably over the years, and the recent consensus criteria introduced 'probable PLS' for patients with a symptom duration of 2-4 years. The objective of this study is the systematic evaluation of clinical and neuroimaging characteristics in early PLS by studying a group of 'probable PLS patients' in comparison to a cohort of established PLS patients. METHODS In a prospective neuroimaging study, thirty-nine patients were stratified by the new consensus criteria into 'probable' (symptom duration 2-4 years) or 'definite' PLS (symptom duration >4 years). Patients were evaluated with a standardised battery of clinical instruments (ALSFRS-r, Penn upper motor neuron score, the modified Ashworth spasticity scale), whole genome sequencing, and underwent structural and diffusion MRI. The imaging profile of the two PLS cohorts were contrasted to a dataset of 100 healthy controls. All 'probable PLS' patients subsequently fulfilled criteria for 'definite' PLS on longitudinal follow-up and none transitioned to develop ALS. RESULTS PLS patients tested negative for known ALS- or HSP-associated mutations on whole genome sequencing. Despite their shorter symptom duration, 'probable PLS' patients already exhibited considerable functional disability, upper motor neuron disease burden and the majority of them required walking aids for safe ambulation. Their ALSFRS-r, UMN and modified Ashworth score means were 83%, 98% and 85% of the 'definite' group respectively. Motor cortex thickness was significantly reduced in both PLS groups in comparison to controls, but cortical changes were less widespread in 'probable' PLS on morphometric analyses. Corticospinal tract and corpus callosum metrics were relatively well preserved in the 'probable' group in contrast to the widespread white matter degeneration observed in the 'definite' group. CONCLUSIONS Our clinical and radiological analyses support the recent introduction of the 'probable' PLS category, as this cohort already exhibits considerable disability and cerebral changes consistent with established PLS. Before the publication of the new consensus criteria, these patients would have not been diagnosed with PLS on the basis of their symptom duration despite their significant functional impairment and motor cortex atrophy. The introduction of this new category will facilitate earlier recruitment into clinical trials, and shorten the protracted diagnostic uncertainty the majority of PLS patients face.
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Affiliation(s)
- Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - We Fong Siah
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Kai Ming Chang
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland; Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Colette Donaghy
- Department of Neurology, Belfast, Western Health & Social Care Trust, UK
| | | | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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10
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Chipika RH, Christidi F, Finegan E, Li Hi Shing S, McKenna MC, Chang KM, Karavasilis E, Doherty MA, Hengeveld JC, Vajda A, Pender N, Hutchinson S, Donaghy C, McLaughlin RL, Hardiman O, Bede P. Amygdala pathology in amyotrophic lateral sclerosis and primary lateral sclerosis. J Neurol Sci 2020; 417:117039. [PMID: 32713609 DOI: 10.1016/j.jns.2020.117039] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 12/26/2022]
Abstract
Temporal lobe studies in motor neuron disease overwhelmingly focus on white matter alterations and cortical grey matter atrophy. Reports on amygdala involvement are conflicting and the amygdala is typically evaluated as single structure despite consisting of several functionally and cytologically distinct nuclei. A prospective, single-centre, neuroimaging study was undertaken to comprehensively characterise amygdala pathology in 100 genetically-stratified ALS patients, 33 patients with PLS and 117 healthy controls. The amygdala was segmented into groups of nuclei using a Bayesian parcellation algorithm based on a probabilistic atlas and shape deformations were additionally assessed by vertex analyses. The accessory basal nucleus (p = .021) and the cortical nucleus (p = .022) showed significant volume reductions in C9orf72 negative ALS patients compared to controls. The lateral nucleus (p = .043) and the cortico-amygdaloid transition (p = .024) were preferentially affected in C9orf72 hexanucleotide carriers. A trend of total volume reduction was identified in C9orf72 positive ALS patients (p = .055) which was also captured in inferior-medial shape deformations on vertex analyses. Our findings highlight that the amygdala is affected in ALS and our study demonstrates the selective involvement of specific nuclei as opposed to global atrophy. The genotype-specific patterns of amygdala involvement identified by this study are consistent with the growing literature of extra-motor clinical features. Mesial temporal lobe pathology in ALS is not limited to hippocampal pathology but, as a key hub of the limbic system, the amygdala is also affected in ALS.
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Affiliation(s)
- Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Foteini Christidi
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland; Department of Neurology, Aeginition Hospital, University of Athens, Greece
| | - Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Kai Ming Chang
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland; Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Efstratios Karavasilis
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland; 2nd Department of Radiology, Attikon University Hospital, University of Athens, Athens, Greece
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Niall Pender
- Department of psychology, Beaumont Hospital Dublin, Ireland
| | - Siobhan Hutchinson
- Department of Neurology, St James's Hospital, James's St, Ushers, Dublin 8 D08 NHY1, Ireland
| | - Colette Donaghy
- Department of Neurology, Belfast, Western Health & Social Care Trust, UK
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
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11
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Yang M, Liu M, Ding Y, Vajda A, Ma J, Cui H, O'Brien T, Henshall D, Hardiman O, Shen S. Generation of twelve induced pluripotent stem cell lines from two healthy controls and two patients with sporadic amyotrophic lateral sclerosis. Stem Cell Res 2020; 44:101752. [PMID: 32208303 DOI: 10.1016/j.scr.2020.101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022] Open
Abstract
The majority of amyotrophic lateral sclerosis are sporadic (sALS) with no familial history or known genetic association, therefore a large cohort of disease models are required to identify common mechanisms or to test therapeutic interventions. Here we generated twelve induced pluripotent stem cell (iPSC) lines from human dermal fibroblasts of two healthy individuals and two sALS patients lacking common ALS mutations, using non-integrational Sendai virus expressing reprogramming factors OCT3/4, KLF4, SOX2 and c-MYC. The iPSC lines highly expressed pluripotency markers could be spontaneously differentiated into three embryonic germ layers, with no gross chromosomal aberrations or specific copy number variations.
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Affiliation(s)
- Meimei Yang
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland; FutureNeuro, The SFI Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, D02, Dublin, Ireland
| | - Min Liu
- Department of Physiology, College of Life Science, Hebei Normal University, Shijiazhuang, Hebei 050024, China
| | - Yicheng Ding
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Jun Ma
- Hebei Medical University-NUI Galway Stem Cell Research Center, Hebei Research Center for Stem Cell Medical Translational Engineering, Human Anatomy Department, Hebei Medical University, Hebei 050017, China
| | - Huixian Cui
- Hebei Medical University-NUI Galway Stem Cell Research Center, Hebei Research Center for Stem Cell Medical Translational Engineering, Human Anatomy Department, Hebei Medical University, Hebei 050017, China
| | - Timothy O'Brien
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland; Hebei Medical University-NUI Galway Stem Cell Research Center, Hebei Medical University, Hebei 050017, China
| | - David Henshall
- FutureNeuro, The SFI Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, D02, Dublin, Ireland
| | - Orla Hardiman
- FutureNeuro, The SFI Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, D02, Dublin, Ireland; Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
| | - Sanbing Shen
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland (NUI) Galway, Galway, Ireland; FutureNeuro, The SFI Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, D02, Dublin, Ireland; Hebei Medical University-NUI Galway Stem Cell Research Center, Hebei Medical University, Hebei 050017, China.
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12
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Nasseroleslami B, Dukic S, Broderick M, Mohr K, Schuster C, Gavin B, McLaughlin R, Heverin M, Vajda A, Iyer PM, Pender N, Bede P, Lalor EC, Hardiman O. Characteristic Increases in EEG Connectivity Correlate With Changes of Structural MRI in Amyotrophic Lateral Sclerosis. Cereb Cortex 2020; 29:27-41. [PMID: 29136131 DOI: 10.1093/cercor/bhx301] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a terminal progressive adult-onset neurodegeneration of the motor system. Although originally considered a pure motor degeneration, there is increasing evidence of disease heterogeneity with varying degrees of extra-motor involvement. How the combined motor and nonmotor degeneration occurs in the context of broader disruption in neural communication across brain networks has not been well characterized. Here, we have performed high-density crossectional and longitudinal resting-state electroencephalography (EEG) recordings on 100 ALS patients and 34 matched controls, and have identified characteristic patterns of altered EEG connectivity that have persisted in longitudinal analyses. These include strongly increased EEG coherence between parietal-frontal scalp regions (in γ-band) and between bilateral regions over motor areas (in θ-band). Correlation with structural MRI from the same patients shows that disease-specific structural degeneration in motor areas and corticospinal tracts parallels a decrease in neural activity over scalp motor areas, while the EEG over the scalp regions associated with less extensively involved extra-motor regions on MRI exhibit significantly increased neural communication. Our findings demonstrate that EEG-based connectivity mapping can provide novel insights into progressive network decline in ALS. These data pave the way for development of validated cost-effective spectral EEG-based biomarkers that parallel changes in structural imaging.
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Affiliation(s)
- Bahman Nasseroleslami
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Michael Broderick
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Kieran Mohr
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Christina Schuster
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Brighid Gavin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Smurfit Institute of Genetics, Trinity College Dublin, the University of Dublin, College Street, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Parameswaran M Iyer
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Edmund C Lalor
- Trinity College Institute of Neuroscience, Trinity College Dublin, the University of Dublin, Lloyd Building, College Green, Dublin, Ireland.,Trinity Centre for Bioengineering, Trinity College Dublin, the University of Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin, Ireland.,Department of Biomedical Engineering and Department of Neuroscience, University of Rochester, Rochester, NY, USA
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin, Ireland.,Beaumont Hospital, Beaumont Road, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, the University of Dublin, Lloyd Building, College Green, Dublin, Ireland
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13
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Bede P, Chipika RH, Finegan E, Li Hi Shing S, Chang KM, Doherty MA, Hengeveld JC, Vajda A, Hutchinson S, Donaghy C, McLaughlin RL, Hardiman O. Progressive brainstem pathology in motor neuron diseases: Imaging data from amyotrophic lateral sclerosis and primary lateral sclerosis. Data Brief 2020; 29:105229. [PMID: 32083157 PMCID: PMC7016370 DOI: 10.1016/j.dib.2020.105229] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
A standardised, single-centre, longitudinal imaging protocol was used to evaluate longitudinal brainstem alterations in 100 patients with amyotrophic lateral sclerosis (ALS) with reference to 33 patients with primary lateral sclerosis (PLS), 30 patients with frontotemporal dementia (FTD) and 100 healthy controls. “Brainstem pathology in amyotrophic lateral sclerosis and primary lateral sclerosis: A longitudinal neuroimaging study” [1] ALS patients were scanned twice; 4 months apart. T1-weighted imaging data were acquired on a 3 T Philips Achieva MRI system, using a 3D Inversion Recovery prepared Spoiled Gradient Recalled echo (IR-SPGR) sequence. Raw MRI data underwent meticulous quality control before pre-processing. A Bayesian segmentation algorithm was utilised to parcellate the brainstem into the medulla oblongata, pons and mesencephalon before estimating the volume of each segment. Vertex-based shape analyses were carried out to characterise anatomical patterns of atrophy. Brainstem volume loss in ALS was dominated by medulla oblongata atrophy, but significant pontine pathology was also detected. Brainstem volume reductions were more significant in PLS than in ALS after correcting for demographic variables and total intracranial volume. Shape analyses revealed bilateral ‘flattening’ of the medullary pyramids in ALS compared to healthy controls. Our data demonstrate that computational neuroimaging readily detects brainstem pathology in vivo in both amyotrophic lateral sclerosis and primary lateral sclerosis.
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Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
- Corresponding author.
| | - Rangariroyashe H. Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Kai Ming Chang
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
- Electronics and Computer Science, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Mark A. Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Jennifer C. Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Siobhan Hutchinson
- Department of Neurology, St James's Hospital, James's St, Ushers, Dublin 8, D08 NHY1, Ireland
| | - Colette Donaghy
- Department of Neurology, Belfast, Western Health & Social Care Trust, UK
| | - Russell L. McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
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14
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Finegan E, Hi Shing SL, Chipika RH, McKenna MC, Doherty MA, Hengeveld JC, Vajda A, Donaghy C, McLaughlin RL, Hutchinson S, Hardiman O, Bede P. Thalamic, hippocampal and basal ganglia pathology in primary lateral sclerosis and amyotrophic lateral sclerosis: Evidence from quantitative imaging data. Data Brief 2020; 29:105115. [PMID: 32055654 PMCID: PMC7005372 DOI: 10.1016/j.dib.2020.105115] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/26/2019] [Accepted: 01/03/2020] [Indexed: 01/12/2023] Open
Abstract
Primary lateral sclerosis and amyotrophic lateral sclerosis are primarily associated with motor cortex and corticospinal tract pathology. A standardised, prospective, single-centre neuroimaging protocol was used to characterise thalamic, hippocampal and basal ganglia involvement in 33 patients with primary lateral sclerosis (PLS), 100 patients with amyotrophic lateral sclerosis (ALS), and 117 healthy controls. “Widespread subcortical grey matter degeneration in primary lateral sclerosis: a multimodal imaging study with genetic profiling” [1] Imaging data were acquired on a 3 T MRI system using a 3D Inversion Recovery prepared Spoiled Gradient Recalled echo sequence. Model based segmentation was used to estimate the volumes of the thalamus, hippocampus, amygdala, caudate, pallidum, putamen and accumbens nucleus in each hemisphere. The hippocampus was further parcellated into cytologically-defined subfields. Total intracranial volume (TIV) was estimated for each participant to aid the interpretation of subcortical volume alterations. Group comparisons were corrected for age, gender, TIV, education and symptom duration. Considerable thalamic, hippocampal and accumbens nucleus atrophy was detected in PLS compared to healthy controls and selective dentate, molecular layer, CA1, CA3, and CA4 hippocampal pathology was also identified. In ALS, additional volume reductions were noted in the amygdala, left caudate and the hippocampal-amygdala transition area of the hippocampus. Our imaging data provide evidence of extensive and phenotype-specific patterns of subcortical degeneration in PLS.
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Affiliation(s)
- Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mary C McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 1-5 College Green, Dublin 2, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 1-5 College Green, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 1-5 College Green, Dublin 2, Ireland
| | | | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 1-5 College Green, Dublin 2, Ireland
| | - Siobhan Hutchinson
- Department of Neurology, St James's Hospital, James's St, Ushers, Dublin 8, D08 NHY1, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
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15
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Finegan E, Li Hi Shing S, Chipika RH, Doherty MA, Hengeveld JC, Vajda A, Donaghy C, Pender N, McLaughlin RL, Hardiman O, Bede P. Widespread subcortical grey matter degeneration in primary lateral sclerosis: a multimodal imaging study with genetic profiling. Neuroimage Clin 2019; 24:102089. [PMID: 31795059 PMCID: PMC6978214 DOI: 10.1016/j.nicl.2019.102089] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/02/2019] [Accepted: 11/09/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary lateral sclerosis (PLS) is a low incidence motor neuron disease which carries a markedly better prognosis than amyotrophic lateral sclerosis (ALS). Despite sporadic reports of extra-motor symptoms, PLS is widely regarded as a pure upper motor neuron disorder. The post mortem literature of PLS is strikingly sparse and very little is known of subcortical grey matter pathology in this condition. METHODS A prospective imaging study was undertaken with 33 PLS patients, 117 healthy controls and 100 ALS patients to specifically assess the integrity of subcortical grey matter structures and determine whether PLS and ALS have divergent thalamic, hippocampal and basal ganglia signatures. Volumetric, morphometric, segmentation and vertex-wise analyses were carried out in the three study groups to evaluate the integrity of thalamus, hippocampus, caudate, amygdala, pallidum, putamen and accumbens nucleus in each hemisphere. The hippocampus was further parcellated to characterise the involvement of specific subfields. RESULTS Considerable thalamic, caudate, and hippocampal atrophy was detected in PLS based on both volumetric and vertex analyses. Significant volume reductions were also detected in the accumbens nuclei. Hippocampal atrophy in PLS was dominated by dentate gyrus, hippocampal tail and CA4 subfield volume reductions. The morphometric comparison of ALS and PLS cohorts revealed preferential medial bi-thalamic pathology in PLS compared to the predominant putaminal degeneration detected in ALS. Another distinguishing feature between ALS and PLS was the preferential atrophy of the amygdala in ALS. CONCLUSIONS PLS is associated with considerable subcortical grey matter degeneration and due to the extensive extra-motor involvement, it should no longer be regarded a pure upper motor neuron disorder. Given its unique pathological features and a clinical course which differs considerably from ALS, dedicated research studies and disease-specific therapeutic strategies are urgently required in PLS.
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Affiliation(s)
- Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | | | - Niall Pender
- Department of Psychology, Beaumont Hospital Dublin, Ireland
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
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16
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Bede P, Chipika RH, Finegan E, Li Hi Shing S, Doherty MA, Hengeveld JC, Vajda A, Hutchinson S, Donaghy C, McLaughlin RL, Hardiman O. Brainstem pathology in amyotrophic lateral sclerosis and primary lateral sclerosis: A longitudinal neuroimaging study. Neuroimage Clin 2019; 24:102054. [PMID: 31711033 PMCID: PMC6849418 DOI: 10.1016/j.nicl.2019.102054] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 01/06/2023]
Abstract
Computational neuroimaging captures focal brainstem pathology in motor neuron diseases in contrast to both healthy- and disease controls. ALS patients exhibit progressive medulla oblongata, pontine and mesencephalic volume loss over time. Brainstem atrophy in ALS and PLS is dominated by medulla oblongata volume reductions. Vertex analyses of ALS patients reveal flattening of the medullary pyramids bilaterally. Morphometric analyses in ALS detect density reductions in the mesencephalic crura consistent with corticospinal tract degeneration.
Background Brainstem pathology is a hallmark feature of ALS, yet most imaging studies focus on cortical grey matter alterations and internal capsule white matter pathology. Brainstem imaging in ALS provides a unique opportunity to appraise descending motor tract degeneration and bulbar lower motor neuron involvement. Methods A prospective longitudinal imaging study has been undertaken with 100 patients with ALS, 33 patients with PLS, 30 patients with FTD and 100 healthy controls. Volumetric, vertex and morphometric analyses were conducted correcting for demographic factors to characterise disease-specific patterns of brainstem pathology. Using a Bayesian segmentation algorithm, the brainstem was segmented into the medulla, pons and mesencephalon to measure regional volume reductions, shape analyses were performed to ascertain the atrophy profile of each study group and region-of-interest morphometry was used to evaluate focal density alterations. Results ALS and PLS patients exhibit considerable brainstem atrophy compared to both disease- and healthy controls. Volume reductions in ALS and PLS are dominated by medulla oblongata pathology, but pontine atrophy can also be detected. In ALS, vertex analyses confirm the flattening of the medullary pyramids bilaterally in comparison to healthy controls and widespread pontine shape deformations in contrast to PLS. The ALS cohort exhibit bilateral density reductions in the mesencephalic crura in contrast to healthy controls, central pontine atrophy compared to disease controls, peri-aqueduct mesencephalic and posterior pontine changes in comparison to PLS patients. Conclus ions: Computational brainstem imaging captures the degeneration of both white and grey matter components in ALS. Our longitudinal data indicate progressive brainstem atrophy over time, underlining the biomarker potential of quantitative brainstem measures in ALS. At a time when a multitude of clinical trials are underway worldwide, there is an unprecedented need for accurate biomarkers to monitor disease progression and detect response to therapy. Brainstem imaging is a promising addition to candidate biomarkers of ALS and PLS.
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Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mark A Doherty
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Jennifer C Hengeveld
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Siobhan Hutchinson
- Department of Neurology, St James's Hospital, James's St, Ushers, Dublin 8 D08 NHY1, Ireland
| | - Colette Donaghy
- Department of Neurology, Western Health & Social Care Trust, Belfast, UK
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
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Yang M, Liu M, Vajda A, O'Brien T, Henshall D, Hardiman O, Shen S. Generation of six induced pluripotent stem cell (iPSC) lines from two patients with amyotrophic lateral sclerosis (NUIGi043-A, NUIGi043-B, NUIGi043-C, NUIGi044-A, NUIGi044-B, NUIGi044-C). Stem Cell Res 2019; 40:101558. [PMID: 31514057 DOI: 10.1016/j.scr.2019.101558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022] Open
Abstract
In this study, we generated 6 induced pluripotent stem cell (iPSC) lines derived from dermal fibroblasts of patients with sporadic amyotrophic lateral sclerosis (sALS). The fibroblasts were reprogrammed using non-integrating Sendai viruses containing four reprogramming factors OCT3/4, SOX2, KLF4 and C-MYC. The iPSC lines displayed normal molecular karyotype, expressed pluripotency markers and were capable of differentiating into three embryonic germ layers.
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Affiliation(s)
- Meimei Yang
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland; FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin D02, Ireland
| | - Min Liu
- Department of Physiology, College of Life Science, Hebei Normal University, Shijiazhuang, China
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Timothy O'Brien
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - David Henshall
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin D02, Ireland
| | - Orla Hardiman
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin D02, Ireland; Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
| | - Sanbing Shen
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland; FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin D02, Ireland.
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18
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Crockford C, Newton J, Lonergan K, Chiwera T, Booth T, Chandran S, Colville S, Heverin M, Mays I, Pal S, Pender N, Pinto-Grau M, Radakovic R, Shaw CE, Stephenson L, Swingler R, Vajda A, Al-Chalabi A, Hardiman O, Abrahams S. ALS-specific cognitive and behavior changes associated with advancing disease stage in ALS. Neurology 2018; 91:e1370-e1380. [PMID: 30209236 PMCID: PMC6177274 DOI: 10.1212/wnl.0000000000006317] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/28/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To elucidate the relationship between disease stage in amyotrophic lateral sclerosis (ALS), as measured with the King's Clinical Staging System, and cognitive and behavioral change, measured with the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Methods A large multicenter observational cohort of 161 cross-sectional patients with ALS and 80 healthy matched controls were recruited across 3 research sites (Dublin, Edinburgh, and London). Participants were administered the ECAS and categorized into independent groups based on their King's clinical disease stage at time of testing. Results Significant differences were observed between patients and controls on all subtests of the ECAS except for visuospatial functioning. A significant cross-sectional effect was observed across disease stages for ALS-specific functions (executive, language, letter fluency) and ECAS total score but not for ALS-nonspecific functions (memory, visuospatial). Rates of ALS-specific impairment and behavioral change were also related to disease stage. The relationship between cognitive function and disease stage may be due to letter fluency impairment, whereas higher rates of all behavioral domains were seen in later King's stage. The presence of bulbar signs, but not site of onset, was significantly related to ALS-specific, ECAS total, and behavioral scores. Conclusion ALS-specific cognitive deficits and behavioral impairment are more frequent with more severe disease stage. By end-stage disease, only a small percentage of patients are free of neuropsychological impairment. The presence of bulbar symptoms exaggerates the differences observed between disease stages. These findings suggest that cognitive and behavioral change should be incorporated into ALS diagnostic criteria and should be included in future staging systems.
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Affiliation(s)
- Christopher Crockford
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Judith Newton
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Katie Lonergan
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Theresa Chiwera
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Tom Booth
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Siddharthan Chandran
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Shuna Colville
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Mark Heverin
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Iain Mays
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Suvankar Pal
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Niall Pender
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Marta Pinto-Grau
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Ratko Radakovic
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Christopher E Shaw
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Laura Stephenson
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Robert Swingler
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Alice Vajda
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Ammar Al-Chalabi
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Orla Hardiman
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Sharon Abrahams
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK.
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19
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Chiò A, Mazzini L, D'Alfonso S, Corrado L, Canosa A, Moglia C, Manera U, Bersano E, Brunetti M, Barberis M, Veldink JH, van den Berg LH, Pearce N, Sproviero W, McLaughlin R, Vajda A, Hardiman O, Rooney J, Mora G, Calvo A, Al-Chalabi A. The multistep hypothesis of ALS revisited: The role of genetic mutations. Neurology 2018; 91:e635-e642. [PMID: 30045958 PMCID: PMC6105040 DOI: 10.1212/wnl.0000000000005996] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 05/16/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) incidence rates are consistent with the hypothesis that ALS is a multistep process. We tested the hypothesis that carrying a large effect mutation might account for ≥1 steps through the effect of the mutation, thus leaving fewer remaining steps before ALS begins. METHODS We generated incidence data from an ALS population register in Italy (2007-2015) for which genetic analysis for C9orf72, SOD1, TARDBP, and FUS genes was performed in 82% of incident cases. As confirmation, we used data from ALS cases diagnosed in the Republic of Ireland (2006-2014). We regressed the log of age-specific incidence against the log of age with least-squares regression for the subpopulation carrying disease-associated variation in each separate gene. RESULTS Of the 1,077 genetically tested cases, 74 (6.9%) carried C9orf72 mutations, 20 (1.9%) had SOD1 mutations, 15 (1.4%) had TARDBP mutations, and 3 (0.3%) carried FUS mutations. In the whole population, there was a linear relationship between log incidence and log age (r2 = 0.98) with a slope estimate of 4.65 (4.37-4.95), consistent with a 6-step process. The analysis for C9orf72-mutated patients confirmed a linear relationship (r2 = 0.94) with a slope estimate of 2.22 (1.74-2.29), suggesting a 3-step process. This estimate was confirmed by data from the Irish ALS register. The slope estimate was consistent with a 2-step process for SOD1 and with a 4-step process for TARDBP. CONCLUSION The identification of a reduced number of steps in patients with ALS with genetic mutations compared to those without mutations supports the idea of ALS as a multistep process and is an important advance for dissecting the pathogenic process in ALS.
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Affiliation(s)
- Adriano Chiò
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK.
| | - Letizia Mazzini
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Sandra D'Alfonso
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Lucia Corrado
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Antonio Canosa
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Cristina Moglia
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Umberto Manera
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Enrica Bersano
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Maura Brunetti
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Marco Barberis
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Jan H Veldink
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Leonard H van den Berg
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Neil Pearce
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - William Sproviero
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Russell McLaughlin
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Alice Vajda
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Orla Hardiman
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - James Rooney
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Gabriele Mora
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Andrea Calvo
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
| | - Ammar Al-Chalabi
- From the "Rita Levi Montalcini" Department of Neuroscience (A. Chiò, A. Canosa, C.M., U.M., M.B., M.B., A. Calvo), University of Torino; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; ALS Center (L.M., E.B.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità; Department of Health Sciences (S.D., L.C.), Interdisciplinary Research Center of Autoimmune Diseases, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK; Centre for Public Health Research (N.P.), Massey University Wellington Campus, New Zealand; Department of Neurology and Neurosurgery (J.H.V., L.H.v.d.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Academic Unit of Neurology (R.M., A.V., O.H., J.R.), Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Italy (Gabriele Mora); and King's College London (W.S., A.A.-C.), Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, UK
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Ryan M, Heverin M, Doherty MA, Davis N, Corr EM, Vajda A, Pender N, McLaughlin R, Hardiman O. Determining the incidence of familiality in ALS: A study of temporal trends in Ireland from 1994 to 2016. Neurol Genet 2018; 4:e239. [PMID: 29845113 PMCID: PMC5961194 DOI: 10.1212/nxg.0000000000000239] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/06/2018] [Indexed: 11/15/2022]
Abstract
Objective To assess temporal trends in familial amyotrophic lateral sclerosis (FALS) incidence rates in an Irish population and to determine factors influencing FALS ascertainment. Methods Population-based data collected over 23 years, using the Irish amyotrophic lateral sclerosis (ALS) register and DNA biobank, were analyzed and age-standardized rates of FALS and associated familial neuropsychiatric endophenotypes were identified. Results Between 1994 and 2016, 269 patients with a family history of ALS from 197 unique families were included on the register. Using stringent diagnostic criteria for FALS, the mean age-standardized FALS incidence rate for the study period was 11.1% (95% confidence interval [CI], 8.8-13.4). The FALS incidence rate increased steadily from 5.2% in 1994 to 19.1% in 2016, an annual increase of 0.7% (95% CI, 0.5-0.9, p < 0.0001). Inclusion of the presence of neuropsychiatric endophenotypes within kindreds increased the FALS incidence rate to 30%. The incidence of FALS in newly diagnosed individuals from known families increased significantly with time, accounting for 50% of all FALS diagnoses by 2016. The mean annual rate of recategorization from "sporadic ALS" to "FALS" was 3% (95% CI, 2.6-3.8). Conclusions The true population-based rate of FALS is at least 20%. Inclusion of extended endophenotypes within kindreds increases the rate of FALS to 30%. Cross-sectional analysis of clinic-based cohorts and stringent definitions of FALS underestimate the true rate of familial disease. This has implications for genetic counseling and in the recognition of presymptomatic stages of ALS.
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Affiliation(s)
- Marie Ryan
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Mark A Doherty
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Nicola Davis
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Emma M Corr
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology (M.R., M.H., N.D., E.M.C., A.V., O.H.), Trinity College; Department of Genetics (M.A.D., R.M.), Trinity College; and Department of Psychology (N.P.), Beaumont Hospital, Dublin, Ireland
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21
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Westeneng HJ, Debray TPA, Visser AE, van Eijk RPA, Rooney JPK, Calvo A, Martin S, McDermott CJ, Thompson AG, Pinto S, Kobeleva X, Rosenbohm A, Stubendorff B, Sommer H, Middelkoop BM, Dekker AM, van Vugt JJFA, van Rheenen W, Vajda A, Heverin M, Kazoka M, Hollinger H, Gromicho M, Körner S, Ringer TM, Rödiger A, Gunkel A, Shaw CE, Bredenoord AL, van Es MA, Corcia P, Couratier P, Weber M, Grosskreutz J, Ludolph AC, Petri S, de Carvalho M, Van Damme P, Talbot K, Turner MR, Shaw PJ, Al-Chalabi A, Chiò A, Hardiman O, Moons KGM, Veldink JH, van den Berg LH. Prognosis for patients with amyotrophic lateral sclerosis: development and validation of a personalised prediction model. Lancet Neurol 2018; 17:423-433. [PMID: 29598923 DOI: 10.1016/s1474-4422(18)30089-9] [Citation(s) in RCA: 289] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/06/2018] [Accepted: 02/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive, fatal motor neuron disease with a variable natural history. There are no accurate models that predict the disease course and outcomes, which complicates risk assessment and counselling for individual patients, stratification of patients for trials, and timing of interventions. We therefore aimed to develop and validate a model for predicting a composite survival endpoint for individual patients with ALS. METHODS We obtained data for patients from 14 specialised ALS centres (each one designated as a cohort) in Belgium, France, the Netherlands, Germany, Ireland, Italy, Portugal, Switzerland, and the UK. All patients were diagnosed in the centres after excluding other diagnoses and classified according to revised El Escorial criteria. We assessed 16 patient characteristics as potential predictors of a composite survival outcome (time between onset of symptoms and non-invasive ventilation for more than 23 h per day, tracheostomy, or death) and applied backward elimination with bootstrapping in the largest population-based dataset for predictor selection. Data were gathered on the day of diagnosis or as soon as possible thereafter. Predictors that were selected in more than 70% of the bootstrap resamples were used to develop a multivariable Royston-Parmar model for predicting the composite survival outcome in individual patients. We assessed the generalisability of the model by estimating heterogeneity of predictive accuracy across external populations (ie, populations not used to develop the model) using internal-external cross-validation, and quantified the discrimination using the concordance (c) statistic (area under the receiver operator characteristic curve) and calibration using a calibration slope. FINDINGS Data were collected between Jan 1, 1992, and Sept 22, 2016 (the largest data-set included data from 1936 patients). The median follow-up time was 97·5 months (IQR 52·9-168·5). Eight candidate predictors entered the prediction model: bulbar versus non-bulbar onset (univariable hazard ratio [HR] 1·71, 95% CI 1·63-1·79), age at onset (1·03, 1·03-1·03), definite versus probable or possible ALS (1·47, 1·39-1·55), diagnostic delay (0·52, 0·51-0·53), forced vital capacity (HR 0·99, 0·99-0·99), progression rate (6·33, 5·92-6·76), frontotemporal dementia (1·34, 1·20-1·50), and presence of a C9orf72 repeat expansion (1·45, 1·31-1·61), all p<0·0001. The c statistic for external predictive accuracy of the model was 0·78 (95% CI 0·77-0·80; 95% prediction interval [PI] 0·74-0·82) and the calibration slope was 1·01 (95% CI 0·95-1·07; 95% PI 0·83-1·18). The model was used to define five groups with distinct median predicted (SE) and observed (SE) times in months from symptom onset to the composite survival outcome: very short 17·7 (0·20), 16·5 (0·23); short 25·3 (0·06), 25·2 (0·35); intermediate 32·2 (0·09), 32·8 (0·46); long 43·7 (0·21), 44·6 (0·74); and very long 91·0 (1·84), 85·6 (1·96). INTERPRETATION We have developed an externally validated model to predict survival without tracheostomy and non-invasive ventilation for more than 23 h per day in European patients with ALS. This model could be applied to individualised patient management, counselling, and future trial design, but to maximise the benefit and prevent harm it is intended to be used by medical doctors only. FUNDING Netherlands ALS Foundation.
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Affiliation(s)
- Henk-Jan Westeneng
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Thomas P A Debray
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; Cochrane Netherlands, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Anne E Visser
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - James P K Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Torino, Italy
| | - Sarah Martin
- Maurice Wohl Clinical Neuroscience Institute, and United Kingdom Dementia Research Institute at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Susana Pinto
- Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Xenia Kobeleva
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Helma Sommer
- Neuromuscular Diseases Centre/ALS Clinic, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Bas M Middelkoop
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Annelot M Dekker
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Joke J F A van Vugt
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Wouter van Rheenen
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Mbombe Kazoka
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Hannah Hollinger
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Marta Gromicho
- Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Sonja Körner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Thomas M Ringer
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Annekathrin Rödiger
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Anne Gunkel
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christopher E Shaw
- Maurice Wohl Clinical Neuroscience Institute, and United Kingdom Dementia Research Institute at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annelien L Bredenoord
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Michael A van Es
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Philippe Corcia
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Tours, Tours, France
| | - Philippe Couratier
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, Limoges, France
| | - Markus Weber
- Neuromuscular Diseases Centre/ALS Clinic, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Julian Grosskreutz
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Mamede de Carvalho
- Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Philip Van Damme
- Department of Neurology, University Hospital Leuven, Leuven, Belgium; Department of Neurosciences, Katholieke Universiteit, Leuven (University of Leuven) and Centre for Brain and Disease Research, VIB, Leuven, Belgium
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, and United Kingdom Dementia Research Institute at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Torino, Italy
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Beaumont, Ireland
| | - Karel G M Moons
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; Cochrane Netherlands, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.
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22
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O'Brien M, Burke T, Heverin M, Vajda A, McLaughlin R, Gibbons J, Byrne S, Pinto-Grau M, Elamin M, Pender N, Hardiman O. Clustering of Neuropsychiatric Disease in First-Degree and Second-Degree Relatives of Patients With Amyotrophic Lateral Sclerosis. JAMA Neurol 2017; 74:1425-1430. [PMID: 29049464 DOI: 10.1001/jamaneurol.2017.2699] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition primarily involving the motor system. There is increasing epidemiologic evidence of an association between ALS and a wider spectrum of neurodegenerative and neuropsychiatric disorders among family members, including schizophrenia and psychotic illness and suicidal behavior. Objective To examine the frequency and range of neuropsychiatric conditions that occur within individual first-degree and second-degree relatives of patients with ALS. Design, Setting, and Participants In this population-based, case-control family aggregation study, all 202 patients included in the Irish ALS Register between January 1, 2012, and January 31, 2014, with definite, probable, or possible ALS as defined by El Escorial criteria were invited to participate. A total of 75 patients were unable or refused to participate and were excluded; the remaining 127 patients with incident ALS were genotyped for the C9orf72 repeat expansion and 132 age- and sex-matched controls were included in the study. Main Outcome and Measures The prevalence of defined neuropsychiatric disease in first-degree and second-degree relatives of patients with ALS and matched controls was determined. Results Mean (SD) age at diagnosis of the 127 patients in the study (58 women and 69 men) was 64.2 (10.7) years. Data from 2116 relatives of patients with ALS were reported, including 924 first-degree relatives, 1128 second-degree relatives, and 64 third-degree relatives. Data from controls were reported from 829 first-degree and 1310 second-degree relatives. A total of 77 patients with ALS (61.4%) and 51 control participants (38.6%) reported at least 1 first-degree or second-degree relative with a history of schizophrenia, psychosis, suicide, depression, alcoholism, or autism (relative risk [RR], 1.50; 95% CI, 1.08-2.17; P = .02). Cluster analysis suggested the following 2 subgroups based on the number of family members with a neuropsychiatric condition: expected (0-2) and high (≥3). Within the high subgroup, ALS kindreds presented a significantly higher rate of psychiatric illness than did controls (28 of 39 [71.8%]; mean [SD] number of siblings, 4.29 [1.41]; P = .001). A strong family history of schizophrenia (RR, 3.40; 95% CI, 1.27-9.30; P = .02), suicide (RR, 3.30; 95% CI, 1.07-10.05; P = .04), autism (RR, 10.10; 95% CI, 1.30-78.80; P = .03), and alcoholism (RR, 1.48; 95% CI, 1.01-2.17; P = .045) was reported in ALS kindreds. A total of 5 of 29 probands (17.2%) with a strong family history of neuropsychiatric conditions (≥3 first-degree or second-degree relatives) carried the C9orf72 repeat expansion. Conclusions and Relevance Neuropsychiatric symptoms in addition to schizophrenia, including obsessive-compulsive disorder, autism, and alcoholism, occur more frequently in ALS kindreds than in controls. The presence of the C9orf72 repeat expansion does not fully account for this finding, suggesting the presence of additional pleiotropic genes associated with both ALS and neuropsychiatric disease in the Irish population.
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Affiliation(s)
- Margaret O'Brien
- Department of Neurology, Beaumont Hospital, Dublin, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tom Burke
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - John Gibbons
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Susan Byrne
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Marta Pinto-Grau
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Marwa Elamin
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Department of Neurology, Beaumont Hospital, Dublin, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
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23
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Crockford C, Newton J, Lonergan K, Madden C, Mays I, O'Sullivan M, Costello E, Pinto-Grau M, Vajda A, Heverin M, Pender N, Al-Chalabi A, Hardiman O, Abrahams S. Measuring reliable change in cognition using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:65-73. [PMID: 29214872 PMCID: PMC6510059 DOI: 10.1080/21678421.2017.1407794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Cognitive impairment affects approximately 50% of people with amyotrophic lateral sclerosis (ALS). Research has indicated that impairment may worsen with disease progression. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed to measure neuropsychological functioning in ALS, with its alternate forms (ECAS-A, B, and C) allowing for serial assessment over time. Objective: The aim of the present study was to establish reliable change scores for the alternate forms of the ECAS, and to explore practice effects and test-retest reliability of the ECAS’s alternate forms. Method: Eighty healthy participants were recruited, with 57 completing two and 51 completing three assessments. Participants were administered alternate versions of the ECAS serially (A-B-C) at four-month intervals. Intra-class correlation analysis was employed to explore test-retest reliability, while analysis of variance was used to examine the presence of practice effects. Reliable change indices (RCI) and regression-based methods were utilized to establish change scores for the ECAS alternate forms. Results: Test-retest reliability was excellent for ALS Specific, ALS Non-Specific, and ECAS Total scores of the combined ECAS A, B, and C (all > .90). No significant practice effects were observed over the three testing sessions. RCI and regression-based methods produced similar change scores. Conclusion: The alternate forms of the ECAS possess excellent test-retest reliability in a healthy control sample, with no significant practice effects. The use of conservative RCI scores is recommended. Therefore, a change of ≥8, ≥4, and ≥9 for ALS Specific, ALS Non-Specific, and ECAS Total score is required for reliable change.
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Affiliation(s)
- Christopher Crockford
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Judith Newton
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Katie Lonergan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Caoifa Madden
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Iain Mays
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Meabhdh O'Sullivan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Emmet Costello
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Marta Pinto-Grau
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Alice Vajda
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Mark Heverin
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Niall Pender
- e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Ammar Al-Chalabi
- f Department of Basic and Clinical Neuroscience , Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK , and
| | - Orla Hardiman
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,g Department of Neurology , Beaumont Hospital , Dublin , Ireland
| | - Sharon Abrahams
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
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24
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Iyer PM, Mohr K, Broderick M, Gavin B, Burke T, Bede P, Pinto-Grau M, Pender NP, McLaughlin R, Vajda A, Heverin M, Lalor EC, Hardiman O, Nasseroleslami B. Mismatch Negativity as an Indicator of Cognitive Sub-Domain Dysfunction in Amyotrophic Lateral Sclerosis. Front Neurol 2017; 8:395. [PMID: 28861032 PMCID: PMC5559463 DOI: 10.3389/fneur.2017.00395] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/25/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To evaluate the utility of mismatch negativity (MMN), a neurophysiologic marker of non-motor cognitive processing, in amyotrophic lateral sclerosis (ALS). Methods 89 patients, stratified into 4 different phenotypic presentations of ALS (67 spinal-onset, 15 bulbar-onset, 7 ALS-FTD, 7 C9ORF72 gene careers), and 19 matched controls underwent 128-channel EEG data recording. Subjects were presented with standard auditory tones interleaved with pitch-deviant tones in three recording blocks. The MMN response was quantified by peak amplitude, peak delay, average amplitude, and average delay, 100–300 ms after stimuli. 64 patients underwent cognitive screening using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS), and 38 participants underwent contemporaneous cognitive assessment using the Stroop Color–Word Interference test (CWIT), which measures attention shift, inhibitory control, and error monitoring. Results The MMN response was observed in frontal and frontocentral regions of patient and control groups. Compared to controls, waveforms were attenuated in early onset, and the average delay was significantly increased in all of the ALS subgroups, with no significant difference between subgroups. Comparing with the control response, the ALS MMN response clustered into four new subgroups characterized by differences in response latency. The increased average delay correlated with changes in the Stroop CWIT; however, it did not show a direct relationship with age, gender, traditional phenotypes, revised ALS Functional Rating Scale, or ECAS scores. Conclusion and significance The MMN response in ALS patients reflects the cognitive dysfunction in specific sub-domains, as the new patient subgroups, identified by cluster analysis, do not segregate with existing clinical or cognitive classifications. Event-related potentials can provide additional quantitative neurophysiologic measures of impairment in specific cognitive sub-domains from which it may be possible to generate novel biologically relevant subgroups of ALS.
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Affiliation(s)
- Parameswaran Mahadeva Iyer
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Kieran Mohr
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Michael Broderick
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Brighid Gavin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Tom Burke
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Marta Pinto-Grau
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Niall P Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Edmund C Lalor
- Trinity College Institute of Neuroscience, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Centre for Bioengineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Department of Biomedical Engineering and Department of Neuroscience, University of Rochester, Rochester, NY, United States
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Bahman Nasseroleslami
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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25
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Galvin M, Ryan P, Maguire S, Heverin M, Madden C, Vajda A, Normand C, Hardiman O. The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population- based study of consultations, interventions and costs. PLoS One 2017. [PMID: 28640860 PMCID: PMC5480998 DOI: 10.1371/journal.pone.0179796] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Amyotrophic Lateral Sclerosis (ALS) is a devastating neurological condition that requires coordinated, multidisciplinary clinical management. ALS is prone to misdiagnosis as its signs and symptoms may be non-specific, which may prolong patients’ journey to multidisciplinary ALS care. Methods Using chart review and national register data, we have detailed the journey of a national cohort of ALS patients (n = 155) from the time of first symptom to presentation at a multidisciplinary clinic (MDC). Key milestones were analysed, including frequency of consultations, clinical interventions, and associated economic cost. Results A majority of patients was male (60%), 65 years of age and over (54%), and had spinal onset ALS (72%). Time from onset of first symptoms to ALS diagnosis was a mean of 15.1 months (median, 11). There was a mean interval of 17.4 months (median 12.5) from first symptoms to arrival at the MDC, and a mean of 4.09 (median, 4) consultations with health care professionals. Electromyography and nerve conduction studies were among the most common interventions. Direct referral by a general practitioner (GP) to a neurologist was associated with reduced cost, but not reduced diagnostic delay. Bulbar ALS was associated with shorter time from symptom onset to diagnosis. Neurologist consultation in the first three consultations was associated with lower costs prior to the ALS clinic attendance but not a shorter time from first symptom to final diagnosis. Mean cost prior to attending the MDC was €3,486 per patient. Conclusions Expedited referral to the multidisciplinary ALS clinic would have reduced costs by an estimated €2,072 per patient. Development of a standardised pathway with early referral to neurology of patients with suspected symptoms of ALS could limit unnecessary interventions and reduce cost of care.
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Affiliation(s)
- Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- * E-mail:
| | - Padhraig Ryan
- Department of Health Policy and Management, Trinity College Dublin, Ireland
| | - Sinead Maguire
- National ALS ClinicDepartment of Neurology, National Neuroscience Centre Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Caoifa Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Charles Normand
- Department of Health Policy and Management, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- National ALS ClinicDepartment of Neurology, National Neuroscience Centre Beaumont Hospital, Dublin, Ireland
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26
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Madill M, McDonagh K, Ma J, Vajda A, McLoughlin P, O'Brien T, Hardiman O, Shen S. Amyotrophic lateral sclerosis patient iPSC-derived astrocytes impair autophagy via non-cell autonomous mechanisms. Mol Brain 2017; 10:22. [PMID: 28610619 PMCID: PMC5470320 DOI: 10.1186/s13041-017-0300-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/19/2017] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis, a devastating neurodegenerative disease, is characterized by the progressive loss of motor neurons and the accumulation of misfolded protein aggregates. The latter suggests impaired proteostasis may be a key factor in disease pathogenesis, though the underlying mechanisms leading to the accumulation of aggregates is unclear. Further, recent studies have indicated that motor neuron cell death may be mediated by astrocytes. Herein we demonstrate that ALS patient iPSC-derived astrocytes modulate the autophagy pathway in a non-cell autonomous manner. We demonstrate cells treated with patient derived astrocyte conditioned medium demonstrate decreased expression of LC3-II, a key adapter protein required for the selective degradation of p62 and ubiquitinated proteins targeted for degradation. We observed an increased accumulation of p62 in cells treated with patient conditioned medium, with a concomitant increase in the expression of SOD1, a protein associated with the development of ALS. Activation of autophagic mechanisms with Rapamycin reduces the accumulation of p62 puncta in cells treated with patient conditioned medium. These data suggest that patient astrocytes may modulate motor neuron cell death by impairing autophagic mechanisms, and the autophagy pathway may be a useful target in the development of novel therapeutics.
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Affiliation(s)
- Martin Madill
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Katya McDonagh
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jun Ma
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland.,Anatomy Department, Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Paul McLoughlin
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Timothy O'Brien
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
| | - Sanbing Shen
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland.
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Omer T, Finegan E, Hutchinson S, Doherty M, Vajda A, McLaughlin RL, Pender N, Hardiman O, Bede P. Neuroimaging patterns along the ALS-FTD spectrum: a multiparametric imaging study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:611-623. [DOI: 10.1080/21678421.2017.1332077] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Taha Omer
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Eoin Finegan
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Doherty
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Russell L. McLaughlin
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Niall Pender
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Rooney J, Burke T, Vajda A, Heverin M, Hardiman O. What does the ALSFRS-R really measure? A longitudinal and survival analysis of functional dimension subscores in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2017; 88:381-385. [PMID: 27888187 DOI: 10.1136/jnnp-2016-314661] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/01/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION ALS functional rating scale (revised) (ALSFRS-R) is the most widely used functional rating system in patients with amyotrophic lateral sclerosis (ALS). However, heterogeneity in ALSFRS-R progression renders analysis challenging. We have explored the characteristics of total ALSFRS-R, and ALSFRS-R subscores in longitudinal and survival models, to determine whether subscore analysis enhances the precision of the instrument. METHODS All cases with ALSFRS-R scores on the Irish ALS register were included. ALSFRS-R subscores were defined for bulbar, motor and respiratory domains. Longitudinal models were used to visualise fitted total ALSFRS-R and ALSFRS-R subscore progression. In addition, the prognostic value of convenience and computed ALSFRS-R slope and subscore slopes were compared. RESULTS 407 incident cases were identified with a complete ALSFRS-R measure. 233 (57%) patients were male, and 125 (31%) had bulbar-onset disease. ALSFRS-R bulbar and motor subscore slopes provided a better fit in prognostic models when combined over the total ALSFRS-R slope. Longitudinal analysis revealed that the ALSFRS-R motor subscore deteriorated earlier in spinal-onset disease over bulbar-onset disease, while in bulbar-onset disease the ALSFRS-R bulbar subscore deteriorated earlier and faster than in spinal-onset disease. DISCUSSION Our analysis builds on previous knowledge of ALSFRS-R subscores. Decline in ALSFRS-R motor subscores in patients with spinal-onset disease, and decline in ALSFRS-R bulbar subscores in patients with bulbar-onset disease, may predate reported disease onset dates. Respiratory subscores were not prognostically informative after adjustment for bulbar and motor subscores. These results provide robust evidence that the ALSFRS-R should not be reported as a single combined score, but rather as domain specific subscores.
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Affiliation(s)
- James Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Tom Burke
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
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Burke T, Pinto-Grau M, Lonergan K, Bede P, O'Sullivan M, Heverin M, Vajda A, McLaughlin RL, Pender N, Hardiman O. A Cross-sectional population-based investigation into behavioral change in amyotrophic lateral sclerosis: subphenotypes, staging, cognitive predictors, and survival. Ann Clin Transl Neurol 2017; 4:305-317. [PMID: 28491898 PMCID: PMC5420811 DOI: 10.1002/acn3.407] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Amyotrophic Lateral Sclerosis (ALS) is a clinically heterogeneous neurodegenerative disorder associated with cognitive and behavioral impairment. The primary aim of this study was to identify behavioral subphenotypes in ALS using a custom designed behavioral assessment tool (Beaumont Behavioural Inventory, BBI). Secondary aims were to (1) investigate the predictive nature of cognitive assessment on behavioral change, (2) report the behavioral profile associated with the C9orf72 expansion, (3) categorize behavioral change through disease staging, and (4) to investigate the relationship between cross‐sectional behavioral classification and survival. Methods A cross‐sectional population‐based research design was applied to examine behavioral data from ALS patients (n = 317) and healthy controls (n = 66). Patients were screened for the C9orf72 repeat expansion. A subcohort of ALS patients completed an extensive cognitive assessment battery (n = 65), to investigate predictors of behavior change. Principal component analysis (PCA) determined factors associated with altered behavior. Survival data were extracted from the Irish ALS register. Results No behavioral changes were reported in 180 patients (57%); 95 patients had mild‐moderate behavioral change (30%); 42 patients met the cut‐off for Clinically Severe Behavioral Change (13%), suggestive of a bvFTD diagnosis. The most frequently endorsed behaviors in ALS were reduced concern for hygiene (36.8%), irritability (36.2%), new unusual habits (33.4%), and increased apathy (31.1%). Five independent factors were identified through factor analysis. Social cognitive performance was predictive of behavior change (P = 0.031), yielding an R2 = 0.188. Behavioral categorization (mild/moderate/severe) at the time of assessment was not associated with survival (P = 0.198). Interpretation These data imply the presence of distinct subphenotypes of behavioral change in ALS, which most likely reflect subcategories of extramotor network disruption.
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Affiliation(s)
- Tom Burke
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland.,Beaumont Hospital Dublin Ireland
| | - Marta Pinto-Grau
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland.,Beaumont Hospital Dublin Ireland
| | - Katie Lonergan
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland.,Beaumont Hospital Dublin Ireland
| | - Peter Bede
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland.,Beaumont Hospital Dublin Ireland
| | - Meabhdh O'Sullivan
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland
| | - Mark Heverin
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland
| | - Alice Vajda
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland
| | | | - Niall Pender
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland.,Beaumont Hospital Dublin Ireland
| | - Orla Hardiman
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin Dublin Ireland.,Beaumont Hospital Dublin Ireland
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Rooney J, Fogh I, Westeneng HJ, Vajda A, McLaughlin R, Heverin M, Jones A, van Eijk R, Calvo A, Mazzini L, Shaw C, Morrison K, Shaw PJ, Robberecht W, Van Damme P, Al-Chalabi A, van den Berg L, Chiò A, Veldink J, Hardiman O. C9orf72 expansion differentially affects males with spinal onset amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2017; 88:281. [PMID: 27663272 DOI: 10.1136/jnnp-2016-314093] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The C9orf72 repeat expansion has been reported as a negative prognostic factor in amyotrophic lateral sclerosis (ALS). We have examined the prognostic impact of the C9orf72 repeat expansion in European subgroups based on gender and site of onset. METHODS C9orf72 status and demographic/clinical data from 4925 patients with ALS drawn from 3 prospective ALS registers (Ireland, Italy and the Netherlands), and clinical data sets in the UK and Belgium. Flexible parametric survival models were built including known prognostic factors (age, diagnostic delay and site of onset), gender and the presence of an expanded repeat in C9orf72. These were used to explore the effects of C9orf72 on survival by gender and site of onset. Individual patient data (IPD) meta-analysis was used to estimate HRs for results of particular importance. RESULTS 457 (8.95%) of 4925 ALS cases carried the C9orf72 repeat expansion. A meta-analysis of C9orf72 estimated a survival HR of 1.36 (1.18 to 1.57) for those carrying the expansion. Models evaluating interaction between gender and C9orf72 repeat expansions demonstrated that the reduced survival due to C9orf72 expansion was being driven by spinal onset males (HR 1.56 (95% CI 1.25 to 1.96). CONCLUSIONS This study represents the largest combined analysis of the prognostic characteristics of the C9orf72 expansion. We have shown for the first time that the negative prognostic implication of this variant is driven by males with spinal onset disease, indicating a hitherto unrecognised gender-mediated effect of the variant that requires further exploration.
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Affiliation(s)
- James Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Isabella Fogh
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henk-Jan Westeneng
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Ashley Jones
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ruben van Eijk
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Calvo
- Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
| | - Letizia Mazzini
- Department of Neurology, ALS Center, Azienda Ospedaliera Universitaria Maggiore Della Carità, Novara, Italy
| | - Christopher Shaw
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karen Morrison
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Wim Robberecht
- Department of Neurosciences, Experimental Neurology-Laboratory of Neurobiology, KU Leuven-University of Leuven, Belgium.,Vlaams Instituut voor Biotechnologie (VIB), Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium
| | - Phillip Van Damme
- Department of Neurosciences, Experimental Neurology-Laboratory of Neurobiology, KU Leuven-University of Leuven, Belgium.,Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Leonard van den Berg
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriano Chiò
- Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
| | - Jan Veldink
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
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Vajda A, McLaughlin RL, Heverin M, Thorpe O, Abrahams S, Al-Chalabi A, Hardiman O. Genetic testing in ALS: A survey of current practices. Neurology 2017; 88:991-999. [PMID: 28159885 PMCID: PMC5333513 DOI: 10.1212/wnl.0000000000003686] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the degree of consensus among clinicians on the clinical use of genetic testing in amyotrophic lateral sclerosis (ALS) and the factors that determine decision-making. METHODS ALS researchers worldwide were invited to participate in a detailed online survey to determine their attitudes and practices relating to genetic testing. RESULTS Responses from 167 clinicians from 21 different countries were analyzed. The majority of respondents (73.3%) do not consider that there is a consensus definition of familial ALS (FALS). Fifty-seven percent consider a family history of frontotemporal dementia and 48.5% the presence of a known ALS genetic mutation as sufficient for a diagnosis of FALS. Most respondents (90.2%) offer genetic testing to patients they define as having FALS and 49.4% to patients with sporadic ALS. Four main genes (SOD1, C9orf72, TARDBP, and FUS) are commonly tested. A total of 55.2% of respondents would seek genetic testing if they had personally received a diagnosis of ALS. Forty-two percent never offer presymptomatic testing to family members of patients with FALS. Responses varied between ALS specialists and nonspecialists and based on the number of new patients seen per year. CONCLUSIONS There is a lack of consensus among clinicians as to the definition of FALS. Substantial variation exists in attitude and practices related to genetic testing of patients and presymptomatic testing of their relatives across geographic regions and between experienced specialists in ALS and nonspecialists.
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Affiliation(s)
- Alice Vajda
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK.
| | - Russell L McLaughlin
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK
| | - Mark Heverin
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK
| | - Owen Thorpe
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK
| | - Sharon Abrahams
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK
| | - Ammar Al-Chalabi
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK
| | - Orla Hardiman
- From the Academic Unit of Neurology (A.V., R.L.M., M.H., O.T., O.H.), Trinity College Dublin; Cognitive Aging and Epidemiology Centre (S.A.), University of Edinburgh; and Institute of Psychiatry, Psychology and Neuroscience (A.A.-C.), King's College London, UK
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Elamin M, Pinto-Grau M, Burke T, Bede P, Rooney J, O'Sullivan M, Lonergan K, Kirby E, Quinlan E, Breen N, Vajda A, Heverin M, Pender N, Hardiman O. Identifying behavioural changes in ALS: Validation of the Beaumont Behavioural Inventory (BBI). Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:68-73. [PMID: 27894191 DOI: 10.1080/21678421.2016.1248976] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Behavioural changes are an important part of amyotrophic lateral sclerosis (ALS). However, most tools do not account for the influence of motor impairment. Furthermore, they do not fully measure the broad range of behavioural changes specific to ALS. This study aimed to develop and validate an ALS specific behavioural inventory, the Beaumont Behavioural Inventory (BBI). METHODS The BBI was validated in a cohort of ALS patients (n = 85) and 78 age-, gender-, and education-matched controls. The scale was validated against the Frontal Systems Behaviour Scale (FrSBe) and The Frontal Assessment Battery (FAB) for convergent validity, and against other non-behavioural measures to assess discriminant validity. Reliability was assessed with Cronbach's alpha. RESULTS The instrument showed high internal consistency (Cronbach's alpha value =0.891). BBI scores highly correlated with the FrSBe and moderately with the FAB. However, the measure was independent from non-behavioural measures. Using a cut-off score of 7 for mild behavioural changes, the BBI displayed high sensitivity and specificity (87.9% and 78.85%, respectively). The cut-off score for moderate changes, consistent with a diagnosis of ALS-FTD, is set at 22.5, showing 90% sensitivity and 96% specificity. DISCUSSION The BBI is a sensitive and specific tool to assess the entire behavioural spectrum of ALS.
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Affiliation(s)
- Marwa Elamin
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Marta Pinto-Grau
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland.,b Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Tom Burke
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland.,b Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Peter Bede
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - James Rooney
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Meabhdh O'Sullivan
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Katie Lonergan
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland.,b Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Emma Kirby
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Emma Quinlan
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Nadia Breen
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Alice Vajda
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Mark Heverin
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
| | - Niall Pender
- b Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Orla Hardiman
- a Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Ireland
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Pinto-Grau M, Burke T, Lonergan K, McHugh C, Mays I, Madden C, Vajda A, Heverin M, Elamin M, Hardiman O, Pender N. Screening for cognitive dysfunction in ALS: validation of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) using age and education adjusted normative data. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:99-106. [DOI: 10.1080/21678421.2016.1249887] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marta Pinto-Grau
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
- Department of Psychology, Beaumont Hospital, Dublin, Ireland, and
| | - Tom Burke
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
- Department of Psychology, Beaumont Hospital, Dublin, Ireland, and
| | - Katie Lonergan
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
- Department of Psychology, Beaumont Hospital, Dublin, Ireland, and
| | | | - Iain Mays
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
| | - Caoifa Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
| | - Marwa Elamin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
| | - Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland,
- Department of Psychology, Beaumont Hospital, Dublin, Ireland, and
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van Rheenen W, Shatunov A, Dekker AM, McLaughlin RL, Diekstra FP, Pulit SL, van der Spek RAA, Võsa U, de Jong S, Robinson MR, Yang J, Fogh I, van Doormaal PT, Tazelaar GHP, Koppers M, Blokhuis AM, Sproviero W, Jones AR, Kenna KP, van Eijk KR, Harschnitz O, Schellevis RD, Brands WJ, Medic J, Menelaou A, Vajda A, Ticozzi N, Lin K, Rogelj B, Vrabec K, Ravnik-Glavač M, Koritnik B, Zidar J, Leonardis L, Grošelj LD, Millecamps S, Salachas F, Meininger V, de Carvalho M, Pinto S, Mora JS, Rojas-García R, Polak M, Chandran S, Colville S, Swingler R, Morrison KE, Shaw PJ, Hardy J, Orrell RW, Pittman A, Sidle K, Fratta P, Malaspina A, Topp S, Petri S, Abdulla S, Drepper C, Sendtner M, Meyer T, Ophoff RA, Staats KA, Wiedau-Pazos M, Lomen-Hoerth C, Van Deerlin VM, Trojanowski JQ, Elman L, McCluskey L, Basak AN, Tunca C, Hamzeiy H, Parman Y, Meitinger T, Lichtner P, Radivojkov-Blagojevic M, Andres CR, Maurel C, Bensimon G, Landwehrmeyer B, Brice A, Payan CAM, Saker-Delye S, Dürr A, Wood NW, Tittmann L, Lieb W, Franke A, Rietschel M, Cichon S, Nöthen MM, Amouyel P, Tzourio C, Dartigues JF, Uitterlinden AG, Rivadeneira F, Estrada K, Hofman A, Curtis C, Blauw HM, van der Kooi AJ, de Visser M, Goris A, Weber M, Shaw CE, Smith BN, Pansarasa O, Cereda C, Del Bo R, Comi GP, D'Alfonso S, Bertolin C, Sorarù G, Mazzini L, Pensato V, Gellera C, Tiloca C, Ratti A, Calvo A, Moglia C, Brunetti M, Arcuti S, Capozzo R, Zecca C, Lunetta C, Penco S, Riva N, Padovani A, Filosto M, Muller B, Stuit RJ, Blair I, Zhang K, McCann EP, Fifita JA, Nicholson GA, Rowe DB, Pamphlett R, Kiernan MC, Grosskreutz J, Witte OW, Ringer T, Prell T, Stubendorff B, Kurth I, Hübner CA, Leigh PN, Casale F, Chio A, Beghi E, Pupillo E, Tortelli R, Logroscino G, Powell J, Ludolph AC, Weishaupt JH, Robberecht W, Van Damme P, Franke L, Pers TH, Brown RH, Glass JD, Landers JE, Hardiman O, Andersen PM, Corcia P, Vourc'h P, Silani V, Wray NR, Visscher PM, de Bakker PIW, van Es MA, Pasterkamp RJ, Lewis CM, Breen G, Al-Chalabi A, van den Berg LH, Veldink JH. Genome-wide association analyses identify new risk variants and the genetic architecture of amyotrophic lateral sclerosis. Nat Genet 2016; 48:1043-8. [PMID: 27455348 PMCID: PMC5556360 DOI: 10.1038/ng.3622] [Citation(s) in RCA: 374] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/20/2016] [Indexed: 12/15/2022]
Abstract
To elucidate the genetic architecture of amyotrophic lateral sclerosis (ALS) and find associated loci, we assembled a custom imputation reference panel from whole-genome-sequenced patients with ALS and matched controls (n = 1,861). Through imputation and mixed-model association analysis in 12,577 cases and 23,475 controls, combined with 2,579 cases and 2,767 controls in an independent replication cohort, we fine-mapped a new risk locus on chromosome 21 and identified C21orf2 as a gene associated with ALS risk. In addition, we identified MOBP and SCFD1 as new associated risk loci. We established evidence of ALS being a complex genetic trait with a polygenic architecture. Furthermore, we estimated the SNP-based heritability at 8.5%, with a distinct and important role for low-frequency variants (frequency 1-10%). This study motivates the interrogation of larger samples with full genome coverage to identify rare causal variants that underpin ALS risk.
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Affiliation(s)
- Wouter van Rheenen
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aleksey Shatunov
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Annelot M Dekker
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Russell L McLaughlin
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Frank P Diekstra
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sara L Pulit
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rick A A van der Spek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Urmo Võsa
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Simone de Jong
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, Maudsley Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew R Robinson
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Jian Yang
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Isabella Fogh
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Perry Tc van Doormaal
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gijs H P Tazelaar
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max Koppers
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anna M Blokhuis
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - William Sproviero
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Ashley R Jones
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Kevin P Kenna
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kristel R van Eijk
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Oliver Harschnitz
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Raymond D Schellevis
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - William J Brands
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelena Medic
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Androniki Menelaou
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Tranplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | - Kuang Lin
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Boris Rogelj
- Department of Biotechnology, Jožef Stefan Institute, Ljubljana, Slovenia
- Biomedical Research Institute BRIS, Ljubljana, Slovenia
| | - Katarina Vrabec
- Department of Molecular Genetics, Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Metka Ravnik-Glavač
- Department of Molecular Genetics, Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Blaž Koritnik
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Janez Zidar
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lea Leonardis
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc Grošelj
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Stéphanie Millecamps
- Institut du Cerveau et de la Moelle Epinière, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06, UMRS 1127, Paris, France
| | - François Salachas
- Institut du Cerveau et de la Moelle Epinière, INSERM U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Université Paris 06, UMRS 1127, Paris, France
- Centre de Référence Maladies Rares SLA Ile de France, Département de Neurologie, Hôpital de la Pitié-Salpêtrière, Paris, France
- GRC-UPMC SLA et Maladies du Motoneurone, Paris, France
| | - Vincent Meininger
- Ramsay Generale de Santé, Hôpital Peupliers, Paris, France
- Réseau SLA Ile de France, Paris, France
| | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Department of Neurosciences, Hospital de Santa Maria-CHLN, Lisbon, Portugal
| | - Susana Pinto
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Department of Neurosciences, Hospital de Santa Maria-CHLN, Lisbon, Portugal
| | - Jesus S Mora
- Department of Neurology, Hospital San Rafael, Madrid, Spain
| | - Ricardo Rojas-García
- Neurology Department, Hospital de la Santa Creu i Sant Pau de Barcelona, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Meraida Polak
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory ALS Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Siddharthan Chandran
- Euan MacDonald Centre for Motor Neuron Disease Research, Edinburgh, UK
- Centre for Neuroregeneration and Medical Research Council Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Euan MacDonald Centre for Motor Neuron Disease Research, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neuron Disease Research, Edinburgh, UK
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - John Hardy
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Richard W Orrell
- Department of Clinical Neuroscience, Institute of Neurology, University College London, London, UK
| | - Alan Pittman
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
- Reta Lila Weston Institute, Institute of Neurology, University College London, London, UK
| | - Katie Sidle
- Department of Clinical Neuroscience, Institute of Neurology, University College London, London, UK
| | - Pietro Fratta
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Andrea Malaspina
- Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, UK
- North-East London and Essex Regional Motor Neuron Disease Care Centre, London, UK
| | - Simon Topp
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Abdulla
- Department of Neurology, Otto von Güricke University Magdeburg, Magdeburg, Germany
| | - Carsten Drepper
- Institute of Clinical Neurobiology, University Hospital Würzburg, Würzburg, Germany
| | - Michael Sendtner
- Institute of Clinical Neurobiology, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Meyer
- Department of Neurology, Charité University Hospital, Humboldt University, Berlin, Germany
| | - Roel A Ophoff
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Kim A Staats
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Martina Wiedau-Pazos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Catherine Lomen-Hoerth
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Vivianna M Van Deerlin
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren Elman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leo McCluskey
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A Nazli Basak
- Neurodegeneration Research Laboratory, Bo[gcaron]aziçi University, Istanbul, Turkey
| | - Ceren Tunca
- Neurodegeneration Research Laboratory, Bo[gcaron]aziçi University, Istanbul, Turkey
| | - Hamid Hamzeiy
- Neurodegeneration Research Laboratory, Bo[gcaron]aziçi University, Istanbul, Turkey
| | - Yesim Parman
- Neurology Department, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | | | | | - Cindy Maurel
- INSERM U930, Université François Rabelais, Tours, France
| | - Gilbert Bensimon
- AP-HP, Département de Pharmacologie Clinique, Hôpital de la Pitié-Salpêtrière, Paris, France
- UPMC, Pharmacologie, Paris VI, Paris, France
- BESPIM, CHU de Nîmes, Nîmes, France
| | | | - Alexis Brice
- INSERM U1127, Hôpital de la Pitié-Salpêtrière, Paris, France
- CNRS UMR 7225, Hôpital de la Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Paris 06, UMRS 1127, Hôpital de la Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- AP-HP, Département de Génétique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Christine A M Payan
- AP-HP, Département de Pharmacologie Clinique, Hôpital de la Pitié-Salpêtrière, Paris, France
- BESPIM, CHU de Nîmes, Nîmes, France
| | | | - Alexandra Dürr
- Department of Medical Genetics, Institut du Cerveau et de la Moelle Epinière, Hôptial Pitié-Salpêtrière, Paris, France
| | - Nicholas W Wood
- Department of Neurogenetics, Institute of Neurology, University College London, London, UK
| | - Lukas Tittmann
- PopGen Biobank and Institute of Epidemiology, Christian Albrechts University Kiel, Kiel, Germany
| | - Wolfgang Lieb
- PopGen Biobank and Institute of Epidemiology, Christian Albrechts University Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Sven Cichon
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life and Brain Center, Bonn, Germany
- Division of Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Neuroscience and Medicine INM-1, Research Center Juelich, Juelich, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life and Brain Center, Bonn, Germany
| | - Philippe Amouyel
- University of Lille, INSERM, CHU de Lille, Institut Pasteur de Lille, U1167-RID-AGE Risk Factor and Molecular Determinants of Aging Diseases, Lille, France
| | - Christophe Tzourio
- Bordeaux University, ISPED, Centre INSERM U1219-Epidemiologie Biostatistique et CIC-1401, CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Jean-François Dartigues
- Bordeaux University, ISPED, Centre INSERM U1219-Epidemiologie Biostatistique et CIC-1401, CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Andre G Uitterlinden
- Department of Internal Medicine, Genetics Laboratory, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Genetics Laboratory, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Karol Estrada
- Department of Internal Medicine, Genetics Laboratory, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Charles Curtis
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, Maudsley Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hylke M Blauw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marianne de Visser
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - An Goris
- Department of Neurosciences, Experimental Neurology, Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christopher E Shaw
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Bradley N Smith
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Orietta Pansarasa
- Laboratory of Experimental Neurobiology, IRCCS 'C. Mondino' National Institute of Neurology Foundation, Pavia, Italy
| | - Cristina Cereda
- Laboratory of Experimental Neurobiology, IRCCS 'C. Mondino' National Institute of Neurology Foundation, Pavia, Italy
| | - Roberto Del Bo
- Neurologic Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo P Comi
- Neurologic Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases, Università del Piemonte Orientale, Novara, Italy
| | - Cinzia Bertolin
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Letizia Mazzini
- Department of Neurology, Università del Piemonte Orientale, Novara, Italy
| | - Viviana Pensato
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Cinzia Gellera
- Unit of Genetics of Neurodegenerative and Metabolic Diseases, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Cinzia Tiloca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Tranplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
- Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
- Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Maura Brunetti
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
- Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Simona Arcuti
- Department of Clinical Research in Neurology, University of Bari 'A. Moro' at Pia Fondazione 'Card. G. Panico', Tricase, Italy
| | - Rosa Capozzo
- Department of Clinical Research in Neurology, University of Bari 'A. Moro' at Pia Fondazione 'Card. G. Panico', Tricase, Italy
| | - Chiara Zecca
- Department of Clinical Research in Neurology, University of Bari 'A. Moro' at Pia Fondazione 'Card. G. Panico', Tricase, Italy
| | - Christian Lunetta
- NEMO Clinical Center, Serena Onlus Foundation, Niguarda Ca' Granda Hostipal, Milan, Italy
| | - Silvana Penco
- Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Nilo Riva
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimiliano Filosto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Ian Blair
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Katharine Zhang
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Emily P McCann
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer A Fifita
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Garth A Nicholson
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- University of Sydney, ANZAC Research Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - Dominic B Rowe
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Roger Pamphlett
- Stacey MND Laboratory, Department of Pathology, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Thomas Ringer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Ingo Kurth
- Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | | | - P Nigel Leigh
- Department of Neurology, Brighton and Sussex Medical School Trafford Centre for Biomedical Research, University of Sussex, Falmer, UK
| | - Federico Casale
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
| | - Adriano Chio
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
- Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Ettore Beghi
- Laboratory of Neurological Diseases, Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Elisabetta Pupillo
- Laboratory of Neurological Diseases, Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, University of Bari 'A. Moro' at Pia Fondazione 'Card. G. Panico', Tricase, Italy
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro' at Pia Fondazione Cardinale G. Panico, Tricase, Italy
| | - John Powell
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | | | | | - Wim Robberecht
- Department of Neurosciences, Experimental Neurology, Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium
- Vesalius Research Center, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Philip Van Damme
- Department of Neurosciences, Experimental Neurology, Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium
- Vesalius Research Center, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Lude Franke
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Tune H Pers
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Genetics, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Basic Translational Obesity Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Robert H Brown
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jonathan D Glass
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory ALS Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John E Landers
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Peter M Andersen
- Department of Neurology, Ulm University, Ulm, Germany
- Department of Pharmacology and Clinical Neurosience, Umeå University, Umeå, Sweden
| | - Philippe Corcia
- INSERM U930, Université François Rabelais, Tours, France
- Centre SLA, CHRU de Tours, Tours, France
- Federation des Centres SLA Tours and Limoges, LITORALS, Tours, France
| | | | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Tranplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | - Naomi R Wray
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Peter M Visscher
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
- Diamantina Institute, University of Queensland Translational Research Institute, Brisbane, Queensland, Australia
| | - Paul I W de Bakker
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael A van Es
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Jeroen Pasterkamp
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cathryn M Lewis
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Gerome Breen
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, Maudsley Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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Tobin K, Gilthorpe MS, Rooney J, Heverin M, Vajda A, Staines A, Hardiman O. Age-period-cohort analysis of trends in amyotrophic lateral sclerosis incidence. J Neurol 2016; 263:1919-26. [PMID: 27372451 DOI: 10.1007/s00415-016-8215-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/13/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease with an unknown cause. Studies have reported that the incidence rate of ALS might be changing. As ALS is an age related disease, crude incidence could increase as population structure changes and overall life expectancy improves. Age-period-cohort (APC) models are frequently used to investigate trends in demographic rates such as incidence. Age-specific incidence rate for ALS from 1996 to 2014 were taken from a population-based ALS register in Ireland. To circumvent the well-known identifiability issue in APC models, we apply the method of Partial Least Squares Regression to separate the effects of Age, Period and Cohort on ALS incidence over time. This APC analysis shows no cohort effect and the initial signs of a period effect; increasing incidence of ALS in the most recently diagnosed group. As further years of data accrue to the Irish register it will become clear if this effect emerges as a strong trend in the incidence of ALS in Ireland and replication of these analyses in other populations will show if our findings on temporal patterns in ALS incidence are shared elsewhere.
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Affiliation(s)
- Katy Tobin
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland. .,Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland.
| | - Mark S Gilthorpe
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - James Rooney
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Health Sciences, Dublin City University, Dublin 9, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
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Rooney J, Heverin M, Vajda A, Burke T, Galvin M, Tobin K, Elamin M, Staines A, Hardiman O. Survival analysis of geospatial factors in the Irish ALS cohort. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:555-560. [PMID: 27145090 DOI: 10.1080/21678421.2016.1179326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Variations in environmental risk factors potentially influence incidence and progression in complex multifactorial diseases. Few studies have examined the association of survival in amyotrophic lateral sclerosis (ALS) with environmental geospatial variables. Here we use data from the Irish ALS cohort to perform such an analysis. Geographic data sources were used to generate small area values for four geospatial variables (population density, social deprivation, distance to coast, and distance to ALS multidisciplinary (MDT) clinic) for each ALS case on the Irish ALS register. These were combined with follow-up data and used as covariates in Royston-Parmar regression survival analysis including age of onset, site of onset, diagnostic delay, riluzole prescription and MDT clinic attendance as covariates. One thousand, two hundred and thirty-two patients with median survival of 2.31 years from disease onset were included. After addition of the individual geospatial variables in turn, none of the four variables was found to be associated with survival with a p-value <0.05. The results may reflect the public healthcare system that provides riluzole prescription and access to the MDT to all patients free of charge, and is also congruent with our recent finding that social deprivation is not associated with ALS incidence in Ireland.
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Affiliation(s)
- James Rooney
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Mark Heverin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Alice Vajda
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Tom Burke
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin.,c Beaumont Hospital , Dublin , Ireland
| | - Miriam Galvin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin.,b School of Nursing And Human Sciences , Dublin City University , Dublin , and
| | - Katy Tobin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Marwa Elamin
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Anthony Staines
- b School of Nursing And Human Sciences , Dublin City University , Dublin , and
| | - Orla Hardiman
- a Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin.,c Beaumont Hospital , Dublin , Ireland
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Rooney J, Vajda A, Heverin M, Crampsie A, Tobin K, McLaughlin R, Staines A, Hardiman O. No association between soil constituents and amyotrophic lateral sclerosis relative risk in Ireland. Environ Res 2016; 147:102-107. [PMID: 26855128 DOI: 10.1016/j.envres.2016.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/30/2015] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION We have recently mapped ALS spatial risk in Ireland using Bayesian and cluster analysis methods at electoral division (ED) and small area (SA) levels. As a number of metal elements (both minerals and toxins) have been proposed as risk factors for ALS, here we extend this analysis to include soil constituents from the Irish National Soils Database as Bayesian conditional auto-regression covariates to determine associations with small area ALS risk. METHODS Data on 45 different soil parameters were obtained under license from National Soils Database (via Irish EPA). We interpolated average values of each soil constituent for each small area using ordinary kriging. All cases of ALS in Ireland from January 1995 to December 2013 were identified from the Irish ALS register and observed and age and gender standardised expected cases were calculated for each SA. Besag-York-Mollié (BYM) models were then built including each parameter from the national soils database in turn as a Bayesian covariate in the BYM model. Models were compared using the deviance information criterion (DIC) and separate models were built for ALS subtypes. RESULTS 1701 ALS patients were included - 959 (56%) were male, 938 (55%) had limb onset ALS. 315 Bayesian models were built in total. Of the 315 models built, only one resulted in a coefficient that did not overlap zero. For limb onset cases, total magnesium had a mean coefficient of 0.319 (credible interval 0.033-0.607). DISCUSSION We report the first spatial analysis of potential association between ALS and soil minerals using a population-based dataset collected over 18 years. Our sole non-zero finding is likely a random finding due to the high number of models built. We did not find any evidence to support soil mineral and toxin levels as risk factors for ALS. However as soil parameters are an ecological assessment of exposure in a given area, individual level measures of exposure are required.
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Affiliation(s)
- James Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland.
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Arlene Crampsie
- School of Geography, University College Dublin Belfield, Dublin, Ireland
| | - Katy Tobin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland; Department of Neurology, Beaumont Hospital, Beaumont, Ireland
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Galvin M, Madden C, Maguire S, Heverin M, Vajda A, Staines A, Hardiman O. Patient journey to a specialist amyotrophic lateral sclerosis multidisciplinary clinic: an exploratory study. BMC Health Serv Res 2015; 15:571. [PMID: 26700026 PMCID: PMC4690216 DOI: 10.1186/s12913-015-1229-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022] Open
Abstract
Background The multidisciplinary approach in the management of Amyotrophic Lateral Sclerosis (ALS) has been shown to provide superior care to devolved care, with better survival, improved quality of care, and quality of life. Access to expert multidisciplinary management should be a standard for patients with ALS. This analysis explores the patient journey from symptom onset and first engagement with health services, to the initial visit to a specialist ALS Multidisciplinary Clinic (MDC) in Dublin, Ireland. Methods A retrospective exploratory multi-method study details the patient journey to the MDC. Data from medical interviews and systematic chart review identifies interactions with the health services and key timelines for thirty five new patients presenting with a diagnosis of ALS during a 6 month period in 2013. Results The time from first symptom to diagnosis was a mean of 16 months (median 13 months), with a mean interval of 19 months (median 14.6) from first symptoms to arrival at the MDC. The majority of patients were seen by a general practitioner, and subsequently by neurology services. There was an average of four contacts with health services and 4.8 investigations/tests, prior to their first Clinic visit. On the first visit to the MDC patients are linked into an integrated ‘system’ that can provide specialist care and link with voluntary, palliative and community services as required. Conclusions Engagement with a multidisciplinary team has implications for service utilization and quality of life of patients and their families. We have demonstrated that barriers exist that delay referral to specialist services. Comprehensive data recording and collection, using multiple data sources can reconstruct the timelines of the patient journey, which can in turn be used to identify pathways that can expedite early referral to specialist services.
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Affiliation(s)
- M Galvin
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - C Madden
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - S Maguire
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland.
| | - M Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - A Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.
| | - A Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland.
| | - O Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin 9, Ireland.
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Affiliation(s)
- Russell Lewis McLaughlin
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Republic of Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Republic of Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Republic of Ireland
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Rooney JPK, Tobin K, Crampsie A, Vajda A, Heverin M, McLaughlin R, Staines A, Hardiman O. Social deprivation and population density are not associated with small area risk of amyotrophic lateral sclerosis. Environ Res 2015; 142:141-147. [PMID: 26142719 DOI: 10.1016/j.envres.2015.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/25/2015] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Evidence of an association between areal ALS risk and population density has been previously reported. We aim to examine ALS spatial incidence in Ireland using small areas, to compare this analysis with our previous analysis of larger areas and to examine the associations between population density, social deprivation and ALS incidence. METHODS Residential area social deprivation has not been previously investigated as a risk factor for ALS. Using the Irish ALS register, we included all cases of ALS diagnosed in Ireland from 1995-2013. 2006 census data was used to calculate age and sex standardised expected cases per small area. Social deprivation was assessed using the pobalHP deprivation index. Bayesian smoothing was used to calculate small area relative risk for ALS, whilst cluster analysis was performed using SaTScan. The effects of population density and social deprivation were tested in two ways: (1) as covariates in the Bayesian spatial model; (2) via post-Bayesian regression. RESULTS 1701 cases were included. Bayesian smoothed maps of relative risk at small area resolution matched closely to our previous analysis at a larger area resolution. Cluster analysis identified two areas of significant low risk. These areas did not correlate with population density or social deprivation indices. DISCUSSION Two areas showing low frequency of ALS have been identified in the Republic of Ireland. These areas do not correlate with population density or residential area social deprivation, indicating that other reasons, such as genetic admixture may account for the observed findings.
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Affiliation(s)
- James P K Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Katy Tobin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Arlene Crampsie
- School of Geography, Planning and Environmental Policy, University College Dublin Belfield, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Russell McLaughlin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland; Department of Neurology, Beaumont Hospital, Beaumont, Ireland
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Abstract
Abstract. Studying changes in storm-induced forest damage in Finland has not been possible previously due to the lack of continuous, long series of impact data. We overcome this by combining emergency rescue data from the Finnish rescue services "PRONTO" (2011-) with ERA-Interim reanalysis data of wind gusts and soil temperatures to define exceedance thresholds for potential forest damage days. These thresholds were applied as a proxy for the period 1979–2013 in order to study the spatial and decadal characteristics of forest damage in Finland due to windstorms. The results indicated that the area most impacted by potential forest damage was the south-western part of Finland along the coast, with 1–10 damaging storm cases per year. A decadal examination highlighted a lull period in the number of potential forest damage days during the 1990s compared to the 1980s and 2000s, albeit no trend was evident. The inclusion of emergency rescue data allowed us for the first time to estimate the spatial distribution and decadal variations of potential forest damage days due to windstorms in Finland. The results achieved will encourage further development of thresholds for potential forest damage by including additional data sources and applying them to future climate scenarios.
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McLaughlin RL, Kenna KP, Vajda A, Heverin M, Byrne S, Donaghy CG, Cronin S, Bradley DG, Hardiman O. Homozygosity mapping in an Irish ALS case–control cohort describes local demographic phenomena and points towards potential recessive risk loci. Genomics 2015; 105:237-41. [DOI: 10.1016/j.ygeno.2015.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/07/2015] [Accepted: 01/16/2015] [Indexed: 12/19/2022]
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Bede P, Elamin M, Byrne S, McLaughlin RL, Kenna K, Vajda A, Fagan A, Bradley DG, Hardiman O. Patterns of cerebral and cerebellar white matter degeneration in ALS. J Neurol Neurosurg Psychiatry 2015; 86:468-70. [PMID: 25053771 PMCID: PMC4392231 DOI: 10.1136/jnnp-2014-308172] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- P Bede
- Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - M Elamin
- Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - S Byrne
- Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - R L McLaughlin
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - K Kenna
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - A Vajda
- Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - A Fagan
- Centre for Advanced Medical Imaging, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - D G Bradley
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - O Hardiman
- Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Rooney J, Vajda A, Heverin M, Elamin M, Crampsie A, McLaughlin R, Staines A, Hardiman O. Spatial cluster analysis of population amyotrophic lateral sclerosis risk in Ireland. Neurology 2015; 84:1537-44. [PMID: 25770197 DOI: 10.1212/wnl.0000000000001477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/24/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Few spatial cluster analyses of amyotrophic lateral sclerosis (ALS) incidence have been conducted on prospective incident population-based cohorts; we report results of a formal cluster analysis of the Irish ALS cohort from January 1, 1995, to December 31, 2013. METHODS We identified 1,684 incident cases from the Irish ALS register. Population data from 4 census years were used to calculate age- and sex-standardized expected ALS cases for 3,355 areas. Spatial cluster analysis was performed to identify high-risk clusters using both SaTScan and FleXScan software. Poisson-based, time period-stratified statistics and time-stratified Bayesian smoothed risk mapping were used to audit completeness of case ascertainment of the register. RESULTS No significant high-risk clusters of incident ALS were identified. However, SaTScan revealed 2 significant areas of lower-than-average ALS risk-one centered on County Kilkenny (relative risk 0.53, p = 0.012) and a smaller area in County Clare (relative risk 0.0, p = 0.029). Audit of case ascertainment did not indicate any failure to detect cases in these areas. CONCLUSIONS The absence of high-risk ALS clusters in Ireland contrasts with previous studies. Our study has several advantages, notably the use of a long-running prospective ALS register with nationwide case ascertainment. The presence of 2 low-risk areas was unexpected. No obvious ascertainment, demographic, or common environmental factors explain this finding. However, we postulate that historical factors may have led to altered genetic admixture in these regions, possibly contributing to lower rates.
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Affiliation(s)
- James Rooney
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland.
| | - Alice Vajda
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
| | - Mark Heverin
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
| | - Marwa Elamin
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
| | - Arlene Crampsie
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
| | - Russell McLaughlin
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
| | - Anthony Staines
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
| | - Orla Hardiman
- From the Academic Unit of Neurology (J.R., A.V., M.H., M.E., R.M., O.H.), Trinity Biomedical Sciences Institute, Trinity College, Dublin; School of Geography, Planning & Environmental Policy (A.C.), University College Dublin Belfield, Dublin; School of Nursing and Human Sciences (A.S.), Dublin City University; and Department of Neurology (O.H.), Beaumont Hospital, Ireland
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McLaughlin RL, Kenna KP, Vajda A, Bede P, Elamin M, Cronin S, Donaghy CG, Bradley DG, Hardiman O. Second-generation Irish genome-wide association study for amyotrophic lateral sclerosis. Neurobiol Aging 2014; 36:1221.e7-13. [PMID: 25442119 DOI: 10.1016/j.neurobiolaging.2014.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/22/2014] [Accepted: 08/28/2014] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a heritable neurological disease for which the underlying genetic etiology is only partially understood. In Ireland, 83%-90% of cases are currently unexplained. Through large international collaborations, genome-wide association studies (GWASs) have succeeded in identifying a number of genomic loci that contribute toward ALS risk and age at onset. However, for the large proportion of risk that remains unexplained, population specificity of pathogenic variants could interfere with the detection of disease-associated loci. Single-population studies are therefore an important complement to larger international collaborations. In this study, we conduct a GWAS for ALS risk and age at onset in a large Irish ALS case-control cohort, using genome-wide imputation to increase marker density. Despite being adequately powered to detect associations of modest effect size, the study did not identify any locus associated with ALS risk or age at onset above the genome-wide significance threshold. Several speculative associations were, however, identified at loci that have been previously implicated in ALS. The lack of any clear association supports the conclusion that ALS is likely to be caused by multiple rare genetic risk factors. The findings of the present study highlight the importance of ongoing genetic research into the cause of ALS and its likely future challenges.
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Affiliation(s)
- Russell L McLaughlin
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, College Green, Dublin, Republic of Ireland.
| | - Kevin P Kenna
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, College Green, Dublin, Republic of Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Republic of Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Republic of Ireland
| | - Marwa Elamin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Republic of Ireland
| | - Simon Cronin
- Beaumont Hospital, Dublin, Republic of Ireland; Cork University Hospital, Cork, Republic of Ireland
| | - Colette G Donaghy
- Department of Neurology, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Daniel G Bradley
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, College Green, Dublin, Republic of Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Republic of Ireland
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Cvetinov M, Stojanović M, Obadović D, Rakić S, Vajda A, Fodor-Csorba K, Éber N. Powder diffraction data and mesomorphic properties of 4-butyloxyphenyl 4′-decyloxybenzoate. Russ J Phys Chem 2014. [DOI: 10.1134/s0036024414070115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rooney J, Heverin M, Vajda A, Crampsie A, Tobin K, Byrne S, Staines A, Hardiman O. An exploratory spatial analysis of ALS incidence in Ireland over 17.5 years (1995-July 2013). PLoS One 2014; 9:e96556. [PMID: 24867594 PMCID: PMC4035264 DOI: 10.1371/journal.pone.0096556] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/08/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction There has been much interest in spatial analysis of ALS to identify potential environmental or genetically caused clusters of disease. Results to date have been inconclusive. The Irish ALS register has been recently geocoded, presenting opportunity to perform a spatial analysis on national prospectively gathered data of incident cases over an 18-year period. Methods 1,645 cases of ALS in Ireland from January 1995 to July 2013 were identified from the Irish ALS register. 1,638 cases were successfully geocoded. Census data from four censuses: 1996, 2002, 2006 & 2011 were used to calculate an average population for the period and standardized incidence rates (SIRs) were calculated for 3,355 areas (Electoral Divisions). Bayesian conditional auto-regression was applied to produce smoothed relative risks (RR). These were then mapped for all cases, males & females separately, and those under 55 vs over 55 at diagnosis. Bayesian and linear regression were used to examine the relationship between population density and RR. Results Smoothed maps revealed no overall geographical pattern to ALS incidence in Ireland, although several areas of localized increased risk were identified. Stratified maps also suggested localized areas of increased RR, while dual analysis of the relationship between population density and RR of ALS yielded conflicting results, linear regression revealed a weak relationship. Discussion In contrast to some previous studies our analysis did not reveal any large-scale geographic patterns of incidence, yet localized areas of moderately high risk were found in both urban and rural areas. Stratified maps by age revealed a larger number of cases in younger people in the area of County Cork - possibly of genetic cause. Bayesian auto-regression of population density failed to find a significant association with risk, however weighted linear regression of post Bayesian smoothed Risk revealed an association between population density and increased ALS risk.
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Affiliation(s)
- James Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Arlene Crampsie
- School of Geography, Planning & Environmental Policy, University College Dublin Belfield, Dublin, Ireland
| | - Katy Tobin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Susan Byrne
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Beaumont, Ireland
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Bede P, Elamin M, Byrne S, McLaughlin RL, Kenna K, Vajda A, Pender N, Bradley DG, Hardiman O. Basal ganglia involvement in amyotrophic lateral sclerosis. Neurology 2013; 81:2107-15. [DOI: 10.1212/01.wnl.0000437313.80913.2c] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vajda A, Marignol L, Barrett C, Madden SF, Lynch TH, Hollywood D, Perry AS. Gene expression analysis in prostate cancer: the importance of the endogenous control. Prostate 2013; 73:382-90. [PMID: 22926970 DOI: 10.1002/pros.22578] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/02/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aberrant gene expression is a hallmark of cancer. Quantitative reverse-transcription PCR (qRT-PCR) is the gold-standard for quantifying gene expression, and commonly employs a house-keeping gene (HKG) as an endogenous control to normalize results; the choice of which is critical for accurate data interpretation. Many factors, including sample type, pathological state, and oxygen levels influence gene expression including putative HKGs. The aim of this study was to determine the suitability of commonly used HKGs for qRT-PCR in prostate cancer. METHODS Prostate cancer (LNCaP, 22Rv1, PC3, and DU145) and normal (PWR1E and RWPE1) cell lines were cultured in air and hypoxia. The performance of 16 HKGs was assessed using Normfinder and coefficient of variation. In silico promoter analysis was performed to identify putative hypoxia response elements (HREs). The impact of the endogenous control on expression levels of HIF1A and GSTP1 was investigated by qRT-PCR in cell lines and tissue specimens respectively. RESULTS Hypoxia altered expression of several HKGs: IPO8, B2M, and PGK1. The most stably expressed HKGs were ACTB, PPIA, and UBC. Both UBC and ACTB showed constitutive expression of HIF1A in air and hypoxia, while PGK1 falsely implied a sixfold hypoxia-induced down-regulation. In prostate tumors, UBC and PGK1 both revealed down-regulation of GSTP1 relative to matched benign, whereas ACTB showed variability. CONCLUSIONS This study demonstrates that no universal endogenous control exists for gene expression studies, even within one disease type. It highlights the importance of validating expression of intended HKGs between different sample types and environmental exposures.
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Affiliation(s)
- Alice Vajda
- Prostate Molecular Oncology, Academic Unit of Clinical and Molecular Oncology, Institute of Molecular Medicine, Trinity College Dublin, Ireland.
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Vajda A, Marignol L, Foley R, Lynch TH, Lawler M, Hollywood D. Clinical potential of gene-directed enzyme prodrug therapy to improve radiation therapy in prostate cancer patients. Cancer Treat Rev 2011; 37:643-54. [DOI: 10.1016/j.ctrv.2011.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/08/2011] [Accepted: 03/16/2011] [Indexed: 11/30/2022]
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