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Mahlknecht P, Peball M, Mair K, Werkmann M, Nocker M, Wolf E, Eisner W, Bajaj S, Quirbach S, Peralta C, Eschlböck S, Wenning GK, Willeit P, Seppi K, Poewe W. Has Deep Brain Stimulation Changed the Very Long-Term Outcome of Parkinson's Disease? A Controlled Longitudinal Study. Mov Disord Clin Pract 2020; 7:782-787. [PMID: 33033735 PMCID: PMC7533994 DOI: 10.1002/mdc3.13039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/26/2020] [Accepted: 05/23/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The long-term impact of deep brain stimulation (DBS) on Parkinson's disease (PD) is difficult to assess and has not yet been rigorously evaluated in comparison to its natural history. OBJECTIVE Comparison of key disability milestones (recurrent falls, psychosis, dementia, and institutionalization) and death in patients with PD with versus without DBS. METHODS We collected retrospective information from clinical notes of patients with PD at our center that were implanted with subthalamic DBS >8 years ago (1999-2010) and a control group of PD patients without DBS similar in age at onset, age at baseline, sex distribution, and number of comorbidities at baseline (extracted from a registry study performed in 2004). Cox regression models were used to calculate hazard ratios, adjusted for potential baseline confounding variables (age, sex, disease duration, disease severity, and number of comorbidities). RESULTS A total of 74 DBS-treated and 61 control patients with PD were included. For a median observational period of 14 years, patients treated with DBS were at lower risk of experiencing recurrent falls (hazard ratio = 0.57; 95% confidence interval, 0.37-0.90; P = 0.015) and psychosis (hazard ratio = 0.26; 95% confidence interval, 0.12-0.59; P = 0.001) compared with control patients. There was no significant difference in risk for dementia, institutionalization, or death. Disease progression as assessed by Hoehn and Yahr scores was not slower in DBS-treated patients. CONCLUSIONS Treatment with chronic subthalamic DBS was associated with lower risk for recurrent falls and psychotic symptoms, effects that may be mediated through improved motor symptom control and reduction in dopaminergic therapies, respectively. There was no evidence for DBS effects on underlying disease progression.
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Affiliation(s)
| | - Marina Peball
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Katherina Mair
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Mario Werkmann
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Michael Nocker
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Elisabeth Wolf
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Wilhelm Eisner
- Department of NeurosurgeryInnsbruck Medical UniversityInnsbruckAustria
| | - Sweta Bajaj
- Department of NeurosurgeryInnsbruck Medical UniversityInnsbruckAustria
| | | | - Cecilia Peralta
- Movement Disorder and Parkinson's Disease ProgramCEMIC (Centro de Educación Médica e Investigaciones Clínicas) University HospitalBuenos AiresArgentina
| | - Sabine Eschlböck
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Peter Willeit
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Klaus Seppi
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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Illsinger S, Korenke GC, Boesch S, Nocker M, Karall D, Nuoffer JM, Laugwitz L, Mayr JA, Scholl-Bürgi S, Freisinger P, Kowald T, Kölker S, Prokisch H, Haack TB. Paroxysmal and non-paroxysmal dystonia in 3 patients with biallelic ECHS1 variants: Expanding the neurological spectrum and therapeutic approaches. Eur J Med Genet 2020; 63:104046. [PMID: 32858208 DOI: 10.1016/j.ejmg.2020.104046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/16/2020] [Accepted: 08/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND ECHS1 encodes the mitochondrial short chain enoyl CoA hydratase 1 (SCEH). Biallelic ECHS1 variants have been associated with Leigh-like presentations and milder phenotypes with paroxysmal exercise-induced dystonia. PATIENTS/METHODS We used exome sequencing to investigate molecular bases of paroxysmal and non-paroxysmal dystonia in three patients and performed functional studies in fibroblasts. Disease presentation and response upon dietary interventions were documented. RESULTS We identified compound heterozygous ECHS1 missense variants in all individuals; all of them harbouring an c.518C > T (p.Ala173Val) variant. SCEH activity was impaired in patients' fibroblasts, respiratory chain-, and pyruvate-dehydrogenase-complex activities were normal in one individual. Patient 1 presented from the age of 2.5 years on with paroxysmal opisthotonic posturing. Patient 2 had a first metabolic crisis at the age 20 months developing recurrent exercise-induced dystonic episodes. Disease history of patient 3 was unremarkable for neurological findings until he first presented at the age of 20 years with persistent dystonia. Ketogenic diet had beneficial effects in patient 1. Neither ketogenic nor low protein diets led to milder symptoms in patient 2. Patient 3 benefits from low protein diet with improvement of his torticollis. CONCLUSIONS In line with literature, our findings corroborate that the pathogenic ECHS1 variant c.518C > T (p.Ala173Val) is associated with milder phenotypes characterized by paroxysmal and non-paroxysmal dystonia. Because of the potentially treatable defect, especially in milder affected patients, it is important to consider SCEH deficiency not only in patients with Leigh-like syndrome but also in patients with paroxysmal dystonia and normal neurological findings between episodes.
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Affiliation(s)
- Sabine Illsinger
- University Children's Hospital Oldenburg, Department of Neuropaediatric and Metabolic Diseases, Oldenburg, Germany.
| | - G Christoph Korenke
- University Children's Hospital Oldenburg, Department of Neuropaediatric and Metabolic Diseases, Oldenburg, Germany
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Daniela Karall
- Department of Paediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Jean M Nuoffer
- University Institute of Clinical Chemistry, Bern University Hospital, Bern, Switzerland; Pediatric Endocrinology, Diabetology and Metabolism, University Children's Hospital Bern, Switzerland
| | - Lucia Laugwitz
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany; Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, University of Tübingen, 72076, Tübingen, Germany
| | - Johannes A Mayr
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sabine Scholl-Bürgi
- Department of Paediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Freisinger
- Department of Pediatrics, Klinikum Reutlingen, Reutlingen, Germany
| | - Tobias Kowald
- Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
| | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Holger Prokisch
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany; Institute of Human Genetics, Technische Universität München, Munich, Germany; Centre for Rare Diseases, University of Tuebingen, Tübingen, Germany
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Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Kremser C, Wildauer M, Schocke M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic Potential of Multimodal MRI Markers in Atypical Parkinsonian Disorders. JPD 2019; 9:681-691. [DOI: 10.3233/jpd-181568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Mueller
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Schocke
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R. Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K. Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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Peball M, Mahlknecht P, Werkmann M, Marini K, Murr F, Herzmann H, Stockner H, de Marzi R, Heim B, Djamshidian A, Willeit P, Willeit J, Kiechl S, Valent D, Krismer F, Wenning G, Nocker M, Mair K, Poewe W, Seppi K. Prevalence and Associated Factors of Sarcopenia and Frailty in Parkinson’s Disease: A Cross-Sectional Study. Gerontology 2018; 65:216-228. [DOI: 10.1159/000492572] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Sarcopenia and frailty are found in up to one-third of the general elderly population. Both are associated with major adverse health outcomes such as nursing home placement, disability, decreased quality of life, and death. Data on the frequency of both syndromes in Parkinson’s disease (PD), however, are very limited. Objective: We aimed to screen for sarcopenia and frailty in PD patients and to assess potential associations of both geriatric syndromes with demographic and clinical parameters as well as quality of life. Methods: In this observational, cross-sectional study, we included 104 PD patients from a tertiary center and 330 non-PD controls from a population-based cohort aged > 65 years. All groups were screened for sarcopenia using the SARC-F score and for frailty using the Clinical Frailty Scale of the Canadian Study of Health and Aging (CSHA CFS). Prevalence rates of sarcopenia and frailty were also assessed in 18 PD patients from a population-based cohort aged > 65 years. Moreover, PD patients from the tertiary center were evaluated for motor and non-motor symptoms, quality of life, and dependency. Results: The prevalence of sarcopenia was 55.8% (95% CI: 46.2–64.9%) in PD patients from the tertiary center and 8.2% (5.7–11.7%; p < 0.001) in non-PD controls. Frailty was detected in 35.6% (27.0–45.2%) and 5.2% (3.2–8.1%; p < 0.001). Prevalence rates for sarcopenia and frailty were 33.3% (16.1–56.4%; p = 0.004) and 22.2% (8.5–45.8%; p = 0.017) in the community-based PD sample. Both sarcopenia and frailty were significantly associated with longer disease duration, higher motor impairment, higher Hoehn and Yahr stages, decreased quality of life, higher frequency of falls, a higher non-motor symptom burden, institutionalization, and higher care levels in PD patients from a tertiary center compared to not affected PD patients (all p < 0.05). Conclusions: Both frailty and sarcopenia are more common in PD patients than in the general community and are associated with a more adverse course of the disease. Future studies should look into underlying risk factors for the occurrence of sarcopenia and frailty in PD patients and into adequate management to prevent and mitigate them.
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Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Steiger R, Wildauer M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic potential of dentatorubrothalamic tract analysis in progressive supranuclear palsy. Parkinsonism Relat Disord 2018; 49:81-87. [PMID: 29463454 DOI: 10.1016/j.parkreldis.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The differentiation of progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) remains a major clinical challenge. OBJECTIVES To evaluate the diagnostic potential of observer-independent assessments of microstructural integrity within infratentorial brain regions to differentiate PSP-Richardson's syndrome (PSP-RS), PSP-P and PD. METHODS 3T MRI parameters of mean diffusivity, fractional anisotropy, grey and white matter volumes from patients with PSP-RS (n = 12), PSP-P (n = 12) and mean disease duration of 2.4 ± 1.7 years were compared with PD patients (n = 20) and healthy controls (n = 23) by using statistical parametric mapping and the spatially unbiased infratentorial template. Subsequently MRI measurements of the dentatorubrothalamic tract were determined observer-independently by a validated probabilistic infratentorial atlas. The impairment of gait and postural stability was evaluated by a sum-score derived from the Unified Parkinson Disease Rating Scale. RESULTS Significant mean diffusivity increases, fractional anisotropy decreases and corresponding volume loss were localized in mesencephalic tegmentum, superior cerebellar peduncle, decussation of superior cerebellar peduncle and dentate nucleus in PSP-RS and PSP-P compared to PD and healthy controls. Altered microstructural integrity of the dentatorubrothalamic tract in PSP-RS was significantly more pronounced compared to PSP-P and correlated significantly with the gait and postural stability sum-score. Linear discriminant analysis identified diffusion tensor imaging measures of the dentatorubrothalamic tract and the gait and postural stability sum-score to classify correctly 95.5% of PRP-RS, PSP-P and PD patients. CONCLUSIONS Observer-independent analysis of microstructural integrity within the dentatorubrothalamic tract in combination with assessments of gait and postural stability differentiate PSP-P from PSP-RS and PD in early to moderately advanced stages.
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Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria.
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | | | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Ruth Steiger
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
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Krismer F, Pinter B, Mueller C, Mahlknecht P, Nocker M, Reiter E, Djamshidian-Tehrani A, Boesch SM, Wenning GK, Scherfler C, Poewe W, Seppi K. Sniffing the diagnosis: Olfactory testing in neurodegenerative parkinsonism. Parkinsonism Relat Disord 2016; 35:36-41. [PMID: 27890451 DOI: 10.1016/j.parkreldis.2016.11.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 10/19/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the diagnostic utility of olfactory testing in patients with neurodegenerative parkinsonism. METHODS The Sniffin' Sticks test battery for assessment of odor identification, discrimination, and threshold was applied to patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) as well as healthy controls (HC). Two different cohorts were analyzed: A PD/healthy control that included PD patients and HC as well as a PD/diseased control cohort for which patients PD, MSA and PSP were recruited. The former cohort was exploited to calculate cut-off values that discriminate PD patients from HC with a sensitivity (sensitivity-weighted cut-off) or specificity (specificity-weighted cut-off) exceeding 95%, respectively. The PD/diseased controls cohort was used to determine the diagnostic accuracy using these cut-off values in discriminating patients with neurodegenerative parkinsonism. RESULTS PD patients (n = 67) performed significantly worse in olfactory testing than HC (n = 41) and patients with MSA (n = 23) or PSP (n = 23). There was no significant difference in olfactory function between MSA and PSP patients. Diagnostic performance of the identification subscore was similar to the sum score of the Sniffin' Sticks test (AUC identification test 0.94, AUC sum score 0.96), while threshold and discrimination subscores were inferior. In patients with parkinsonism, the specificity-weighted cut-off predicted a diagnosis of PD with a sensitivity and specificity of 76.6 and 87.0%, respectively. The discriminative value of this cut-off in separating PD from MSA was 76.7% (sensitivity) and 95.7% (specificity). The corresponding, prevalence-adjusted positive predictive value of olfactory testing exceeded 95%. CONCLUSIONS Our data suggest that assessment of olfactory function, particularly odor identification, can be useful to discriminate PD from atypical parkinsonian disorders, particularly MSA patients.
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Affiliation(s)
- F Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Pinter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Mueller
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - P Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Nocker
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Reiter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - S M Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - G K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - W Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Nocker M, Seppi K, Boesch S, Donnemiller E, Virgolini I, Wenning GK, Poewe W, Scherfler C. Topography of Dopamine Transporter Availability in the Cerebellar Variant of Multiple System Atrophy. Mov Disord Clin Pract 2016; 4:389-396. [PMID: 30363469 DOI: 10.1002/mdc3.12446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/09/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 11/06/2022] Open
Abstract
Background Voxel-wise comparison of [123I]-2β-carbomethoxy-3beta-(4-iodophenyl)tropane ([123I]β-CIT) radioligand distribution measured by single-photon emission computed tomography (SPECT) revealed distinct patterns of reduced dopamine transporter (DAT) availability in the Parkinson's variant of MSA (MSA-P). The aim of this study was to identify the monoamine transporter distribution pattern in patients with the cerebellar variant of MSA (MSA-C). Additionally, monoamine transporter availability was investigated in a small cohort of patients with sporadic adult-onset ataxia (SAOA). Methods [123I]β-CIT SPECT was performed in patients with MSA-C (n = 12), MSA-P (n = 14), SAOA (n = 5), and controls (n = 15) matched for age. Parametric images of [123I]β-CIT binding potential (BPND) were generated and analyzed by statistical parametric mapping (SPM) and region of interest (ROI) analysis. Results SPM localized significant reductions of [123I]β-CIT BPND in the striatum, midbrain, and pons in MSA-C compared to controls. When compared with MSA-P, the striatal DAT decline was significantly less affected in MSA-C. ROI analysis revealed reductions of striatal and midbrain [123I]β-CIT binding in MSA-C compared to SAOA, whereas no significant difference was apparent between the SAOA and control groups. Conclusions Midbrain and pontine monoaminergic transporter binding was severely impaired in MSA-C, matching the underlying pathological features. Striatal DAT availability was relatively less affected in MSA-C compared to MSA-P, reflecting measureable, but less-profound, degeneration of the nigrostriatal dopaminergic projections. Preliminary results of reduced striatal and midbrain [123I]β-CIT binding in MSA-C, compared to SAOA, suggest that the potential of DAT-SPECT as a surrogate marker in the diagnostic workup of patients with adult-onset cerebellar ataxia should be further investigated.
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Affiliation(s)
- Michael Nocker
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Klaus Seppi
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Sylvia Boesch
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Eveline Donnemiller
- Department of Nuclear Medicine Medical University of Innsbruck Innsbruck Austria
| | - Irene Virgolini
- Department of Nuclear Medicine Medical University of Innsbruck Innsbruck Austria
| | - Gregor K Wenning
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Werner Poewe
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
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Stefani A, Mahlknecht P, Seppi K, Nocker M, Mair KJ, Hotter A, Stockner H, Willeit J, Kiechl S, Rungger G, Gasperi A, Poewe W, Högl B. Consistency of "Probable RBD" Diagnosis with the RBD Screening Questionnaire: A Follow-up Study. Mov Disord Clin Pract 2016; 4:403-405. [PMID: 30363451 DOI: 10.1002/mdc3.12448] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/30/2016] [Accepted: 09/08/2016] [Indexed: 01/01/2023] Open
Abstract
Introduction The aim of this study was to evaluate the consistency of "probable RBD" diagnosis with the RBD screening questionnaire (RBDSQ) assessed 2 years apart in a population-based study. Methods Probable RBD was assessed by RBDSQ in 2008 and in 2010 in the Bruneck Study Cohort, with participants aged ≥60 years. Results A total of 437 participants completed the RBDSQ in 2008 and 2010. There were 29 (6.6%) and 23 (5.3%) participants with probable RBD in 2008 and in 2010, respectively. Only eight (1.8%) screened positive on both occasions. RBDSQ values 2 years apart showed low correlation with each other (Spearman rank coefficient r = 0.348, P < 0.001) and low agreement (intraclass correlation coefficient 0.388, P < 0.001). Conclusions We found low agreement between the two assessments. Possible explanations are the fluctuation of untreated RBD expression and the poor utility of the RBDSQ to detect RBD in the general population. Until further PSG validation of the RBDSQ in population-based studies, investigators must be aware of the inherent uncertainty of questionnaire-based RBD diagnosis.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Philipp Mahlknecht
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Klaus Seppi
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Michael Nocker
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Katherina J Mair
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Anna Hotter
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Heike Stockner
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Johann Willeit
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Stefan Kiechl
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Gregor Rungger
- Department of Neurology Hospital of Bruneck Bruneck Italy
| | - Arno Gasperi
- Department of Neurology Hospital of Bruneck Bruneck Italy
| | - Werner Poewe
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Birgit Högl
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
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Mahlknecht P, Gasperi A, Willeit P, Kiechl S, Stockner H, Willeit J, Rungger G, Sawires M, Nocker M, Rastner V, Mair KJ, Hotter A, Poewe W, Seppi K. Prodromal Parkinson's disease as defined per MDS research criteria in the general elderly community. Mov Disord 2016; 31:1405-8. [PMID: 27273736 DOI: 10.1002/mds.26674] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, the International Parkinson and Movement Disorder Society has defined research criteria for prodromal Parkinson's disease (PD), but to date their predictive value has not yet been tested in population-based cohorts. METHODS We retrospectively applied these criteria to the longitudinal Bruneck Study cohort aged 55-94 years using recorded data on all included risk and prodromal markers that are quick and easily assessable. RESULTS After excluding participants with idiopathic PD or secondary parkinsonism, prevalence of probable prodromal PD in the remaining 539 participants was 2.2% (95% confidence interval, 1.2%-3.9%). Of 488 participants followed up over 5 years, 11 developed incident PD. Sensitivity of "probable prodromal PD" status for incident PD was 54.6% (95% confidence interval, 28.0%-78.8%), specificity was 99.2% (97.8%-99.8%), positive predictive value was 60.0% (31.2%-83.3%), and negative predictive value was 99.0% (97.5%-99.6%). CONCLUSIONS Our findings suggest that the new research criteria for prodromal PD are a promising tool to identify cases of incident PD over 5 years, arguing for their usefulness in defining target populations for disease-prevention trials. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Bruneck, Italy
| | - Peter Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.,King's British Heart Foundation Centre, King's College London, London, United Kingdom.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Stefan Kiechl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Martin Sawires
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Verena Rastner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Katherina J Mair
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Hotter
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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10
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Mahlknecht P, Pechlaner R, Boesveldt S, Volc D, Pinter B, Reiter E, Müller C, Krismer F, Berendse HW, van Hilten JJ, Wuschitz A, Schimetta W, Högl B, Djamshidian A, Nocker M, Göbel G, Gasperi A, Kiechl S, Willeit J, Poewe W, Seppi K. Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease. Mov Disord 2016; 31:1408-13. [PMID: 27159493 PMCID: PMC5026160 DOI: 10.1002/mds.26637] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 01/08/2016] [Revised: 02/10/2016] [Accepted: 02/29/2016] [Indexed: 12/05/2022] Open
Abstract
Introduction The aim of this study was to evaluate odor identification testing as a quick, cheap, and reliable tool to identify PD. Methods Odor identification with the 16‐item Sniffin' Sticks test (SS‐16) was assessed in a total of 646 PD patients and 606 controls from three European centers (A, B, and C), as well as 75 patients with atypical parkinsonism or essential tremor and in a prospective cohort of 24 patients with idiopathic rapid eye movement sleep behavior disorder (center A). Reduced odor sets most discriminative for PD were determined in a discovery cohort derived from a random split of PD patients and controls from center A using L1‐regularized logistic regression. Diagnostic accuracy was assessed in the rest of the patients/controls as validation cohorts. Results Olfactory performance was lower in PD patients compared with controls and non‐PD patients in all cohorts (each P < 0.001). Both the full SS‐16 and a subscore of the top eight discriminating odors (SS‐8) were associated with an excellent discrimination of PD from controls (areas under the curve ≥0.90; sensitivities ≥83.3%; specificities ≥82.0%) and from non‐PD patients (areas under the curve ≥0.91; sensitivities ≥84.1%; specificities ≥84.0%) in all cohorts. This remained unchanged when patients with >3 years of disease duration were excluded from analysis. All 8 incident PD cases among patients with idiopathic rapid eye movement sleep behavior disorder were predicted with the SS‐16 and the SS‐8 (sensitivity, 100%; positive predictive value, 61.5%). Conclusions Odor identification testing provides excellent diagnostic accuracy in the distinction of PD patients from controls and diagnostic mimics. A reduced set of eight odors could be used as a quick tool in the workup of patients presenting with parkinsonism and for PD risk indication. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Raimund Pechlaner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sanne Boesveldt
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.,Divisions of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Dieter Volc
- Study Center Confraternitaet-PKJ Vienna, Vienna, Austria
| | - Bernardette Pinter
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Müller
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Henk W Berendse
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Wolfgang Schimetta
- Department of Applied Systems Research and Statistics, Johannes Kepler University Linz, Linz, Austria
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Bruneck, Italy
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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11
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Scherfler C, Göbel G, Müller C, Nocker M, Wenning GK, Schocke M, Poewe W, Seppi K. Diagnostic potential of automated subcortical volume segmentation in atypical parkinsonism. Neurology 2016; 86:1242-9. [PMID: 26935895 DOI: 10.1212/wnl.0000000000002518] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether automated and observer-independent volumetric MRI analysis is able to discriminate among patients with Parkinson disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) in early to moderately advanced stages of disease. METHODS T1-weighted volumetric MRI from patients with clinically probable PD (n = 40), MSA (n = 40), and PSP (n = 30) and a mean disease duration of 2.8 ± 1.7 y were examined using automated volume measures of 22 subcortical regions. The clinical follow-up period was 2.5 ± 1.2 years. The data were split into a training (n = 72) and a test set (n = 38). The training set was used to build a C4.5 decision tree model in order to classify patients as MSA, PSP, or PD. The classification algorithm was examined by the test set using the final clinical diagnosis at last follow-up as diagnostic gold standard. RESULTS The midbrain and putaminal volume as well as the cerebellar gray matter compartment were identified as the most significant brain regions to construct a prediction model. The diagnostic accuracy for PD vs MSA or PSP was 97.4%. In contrast, diagnostic accuracy based on validated clinical consensus criteria at the time of MRI acquisition was 62.9%. CONCLUSIONS Volume segmentation of subcortical brain areas differentiates PD from MSA and PSP and improves diagnostic accuracy in patients presenting with early to moderately advanced stage parkinsonism. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that automated MRI analysis accurately discriminates among early-stage PD, MSA, and PSP.
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Affiliation(s)
- Christoph Scherfler
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria.
| | - Georg Göbel
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
| | - Christoph Müller
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
| | - Michael Nocker
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
| | - Gregor K Wenning
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
| | - Michael Schocke
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
| | - Werner Poewe
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
| | - Klaus Seppi
- From the Departments of Neurology (C.S., C.M., M.N., G.K.W., W.P., K.S.), Medical Statistics, Informatics and Health Economics (G.G.), and Radiology (M.S.), Medical University of Innsbruck, Austria
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12
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Reiter E, Heim B, Scherfler C, Mueller C, Nocker M, Ndayisaba JP, Loescher W, Seppi K, Lees AJ, Warner T, Poewe W, Wenning GK, Djamshidian A. Clinical Heterogeneity in Cerebral Hemiatrophy Syndromes. Mov Disord Clin Pract 2016; 3:382-388. [PMID: 30713929 DOI: 10.1002/mdc3.12301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/15/2015] [Revised: 09/16/2015] [Accepted: 10/11/2015] [Indexed: 12/13/2022] Open
Abstract
Background Cerebral hemiatrophy syndromes can present with variable neurological symptoms. In childhood epilepsy, mental retardation and neuropsychiatric disorders are common while in adults movement disorders, such as highly asymmetric parkinsonism or hemidystonia as well as neuropsychiatric problems have been reported. Methods Here, we present three adult patients with features that expand the clinical spectrum and give an overview of the most common clinical signs associated with this rare condition. Results All three patients had prominent neuropsychiatric symptoms such as mood swings and increased irritability. Furthermore, one patient developed hemichorea which can be a rare presentation of cerebral hemiatrophy. Conclusions Cerebral hemiatrophy syndromes are a heterogeneous group of disorders that may also present with neuropsychiatric symptoms or hemichorea.
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Affiliation(s)
- Eva Reiter
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Beatrice Heim
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | | | - Christoph Mueller
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Michael Nocker
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | | | - Wolfgang Loescher
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Klaus Seppi
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Andrew J Lees
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies University of London London United Kingdom
| | - Thomas Warner
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies University of London London United Kingdom
| | - Werner Poewe
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Gregor K Wenning
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Atbin Djamshidian
- Department of Neurology Innsbruck Medical University Innsbruck Austria.,Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies University of London London United Kingdom
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13
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Sprenger FS, Seppi K, Djamshidian A, Reiter E, Nocker M, Mair K, Göbel G, Poewe W. Reply: Nonmotor symptoms in subjects without evidence of dopaminergic deficits. Mov Disord 2015; 30:1437-8. [PMID: 26227294 DOI: 10.1002/mds.26336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- F S Sprenger
- Department of Neurology, Innsbruck Medical University, Austria
| | - K Seppi
- Department of Neurology, Innsbruck Medical University, Austria
| | - A Djamshidian
- Department of Neurology, Innsbruck Medical University, Austria
| | - E Reiter
- Department of Neurology, Innsbruck Medical University, Austria
| | - M Nocker
- Department of Neurology, Innsbruck Medical University, Austria
| | - K Mair
- Department of Neurology, Innsbruck Medical University, Austria
| | - G Göbel
- Department of Neurology, Innsbruck Medical University, Austria
| | - W Poewe
- Department of Neurology, Innsbruck Medical University, Austria
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14
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Mahlknecht P, Seppi K, Frauscher B, Kiechl S, Willeit J, Stockner H, Djamshidian A, Nocker M, Rastner V, Defrancesco M, Rungger G, Gasperi A, Poewe W, Högl B. Probable RBD and association with neurodegenerative disease markers: A population-based study. Mov Disord 2015. [PMID: 26208108 DOI: 10.1002/mds.26350] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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: 11/09/2022] Open
Abstract
BACKGROUND The prevalence of rapid eye movement sleep behavior disorder (RBD) and its association with markers of neurodegeneration in the general population are poorly defined. METHODS We assessed the prevalence of probable RBD defined by two validated questionnaires, the RBD Screening Questionnaire (RBDSQ) and the Innsbruck RBD-Inventory (RBD-I), and studied its associations with clinical and imaging markers for neurodegeneration in the Bruneck Study cohort aged 60 y or older. RESULTS Of the 456 participants without Parkinson's disease, 4.6% (RBDSQ; 95%CI, 3.0%-7.0%) and 7.7% (RBD-I; 95%CI, 5.6%-10.5%) had probable RBD. Probable RBD diagnosed with either of the questionnaires was associated with hyposmia (trend; P < 0.1), anxiety (P < 0.05), depression (P < 0.05), antidepressant use (P < 0.05), and self-reported non-motor symptoms (P < 0.01), specifically, dribbling saliva, memory problems, apathy, concentration problems, and anxiety. CONCLUSIONS Our findings may provide a basis for future studies intending to identify cohorts at risk for Lewy body diseases through screening of the general elderly population for RBD.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Austria.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Austria.,Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, UK
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Verena Rastner
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | | | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Italy
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Austria
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15
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Sprenger FS, Seppi K, Djamshidian A, Reiter E, Nocker M, Mair K, Göbel G, Poewe W. Nonmotor Symptoms in Subjects Without Evidence of Dopaminergic Deficits. Mov Disord 2015; 30:976-81. [DOI: 10.1002/mds.26204] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/05/2015] [Accepted: 02/08/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Klaus Seppi
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
| | - Atbin Djamshidian
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
| | - Eva Reiter
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
| | - Michael Nocker
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
| | - Katherina Mair
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
| | - Georg Göbel
- Department of Medical Statistics; Informatics and Health Economics, Innsbruck Medical University; Innsbruck Austria
| | - Werner Poewe
- Department of Neurology; Innsbruck Medical University; Innsbruck Austria
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16
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Scherfler C, Esterhammer R, Nocker M, Mahlknecht P, Stockner H, Warwitz B, Spielberger S, Pinter B, Donnemiller E, Decristoforo C, Virgolini I, Schocke M, Poewe W, Seppi K. Correlation of dopaminergic terminal dysfunction and microstructural abnormalities of the basal ganglia and the olfactory tract in Parkinson’s disease. Brain 2013; 136:3028-37. [DOI: 10.1093/brain/awt234] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Mahlknecht P, Seppi K, Stockner H, Nocker M, Scherfler C, Kiechl S, Willeit J, Schmidauer C, Gasperi A, Rungger G, Poewe W. Substantia nigra hyperechogenicity as a marker for Parkinson's disease: a population-based study. NEURODEGENER DIS 2013; 12:212-8. [PMID: 23689066 DOI: 10.1159/000348595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical diagnosis of Parkinson's disease (PD) is currently anchored in its cardinal motor symptoms. According to hospital-based studies, an enlarged echogenicity in the area of the substantia nigra (SN) assessed with transcranial sonography (TCS) may represent a useful biomarker in the diagnosis of PD. OBJECTIVE To evaluate SN hyperechogenicity as a marker for PD in the Bruneck Study cohort, which is representative of the general elderly community. METHODS The diagnostic accuracy of TCS in distinguishing clinically diagnosed PD from nonparkinsonian subjects was assessed in 574 subjects from this cohort. RESULTS There was a good diagnostic accuracy of TCS in distinguishing PD subjects from nonparkinsonian subjects with an area under the curve value of 0.82. At a receiver-operating characteristic curve analysis-based cutoff value for SN hyperechogenicity of 0.18 cm(2), TCS had a sensitivity of 88.2% (95% confidence interval, CI, 64.4-98.0), a specificity of 77.0% (95% CI 72.8-80.6), a positive predictive value of 12.7% (95% CI 7.8-20.0) and a negative predictive value of 99.4% (95% CI 97.8-100.0) for subjects with clinically definite PD at baseline. When analyzing the same population after 5 years with regard to the presence of known and newly diagnosed PD cases, baseline TCS yielded very similar diagnostic accuracy values. CONCLUSION SN hyperechogenicity may represent a useful biomarker for PD not only in a hospital-based setting but also in the general community.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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18
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Klug G, Mayr A, Schenk S, Esterhammer R, Schocke M, Nocker M, Jaschke W, Pachinger O, Metzler B. Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:46. [PMID: 22788728 PMCID: PMC3461427 DOI: 10.1186/1532-429x-14-46] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/12/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Early and late microvascular obstruction (MVO) assessed by cardiovascular magnetic resonance (CMR) are prognostic markers for short-term clinical endpoints after acute ST-elevation myocardial infarction (STEMI). However, there is a lack of studies with long-term follow-up periods (>24 months). METHODS STEMI patients reperfused by primary angioplasty (n = 129) underwent MRI at a median of 2 days after the index event. Early MVO was determined on dynamic Gd first-pass images directly after the administration of 0.1 mmol/kg bodyweight Gd-based contrast agent. Furthermore, ejection fraction (EF, %), left ventricular myocardial mass (LVMM) and total infarct size (% of LVMM) were determined with CMR. Clinical follow-up was conducted after a median of 52 months. The primary endpoint was defined as a composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization. RESULTS Follow-up was completed by 107 patients. 63 pre-defined events occurred during follow-up. Initially, 74 patients showed early MVO. Patients with early MVO had larger infarcts (mean: 24.9 g vs. 15.5 g, p = 0.002) and a lower EF (mean: 39% vs. 46%, p = 0.006). The primary endpoint occurred in 66.2% of patients with MVO and in 42.4% of patients without MVO (p < 0.05). The presence of early MVO was associated with a reduced event-free survival (log-rank p < 0.05). Early MVO was identified as the strongest independent predictor for the occurrence of the primary endpoint in the multivariable Cox regression analysis adjusting for age, ejection fraction and infarct size (hazard ratio: 2.79, 95%-CI 1.25-6.25, p = 0.012). CONCLUSION Early MVO, as assessed by first-pass CMR, is an independent long-term prognosticator for morbidity after AMI.
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Affiliation(s)
- Gert Klug
- Cardiology, University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology I, Medical University Innsbruck, Innsbruck, Austria
| | - Sonja Schenk
- Cardiology, University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Regina Esterhammer
- Department of Radiology I, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Schocke
- Department of Radiology I, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Nocker
- Cardiology, University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Jaschke
- Department of Radiology I, Medical University Innsbruck, Innsbruck, Austria
| | - Otmar Pachinger
- Cardiology, University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Metzler
- Cardiology, University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
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Mahlknecht P, Stockner H, Nocker M, Kiechl S, Willeit J, Scherfler C, Sojer M, Gasperi A, Rungger G, Poewe W, Seppi K. A follow-up study of substantia nigra echogenicity in healthy adults. Mov Disord 2012; 27:1196-7. [PMID: 22700445 DOI: 10.1002/mds.25080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 05/04/2012] [Accepted: 05/13/2012] [Indexed: 11/07/2022] Open
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20
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Schocke M, Esterhammer R, Scherfler C, Nocker M, Poewe W, Seppi K. Multi-Parameter Bildgebung in der Substantia nigra bei Patienten mit Morbus Parkinson. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Scherfler C, Frauscher B, Schocke M, Nocker M, Gschliesser V, Ehrmann L, Niederreiter M, Esterhammer R, Seppi K, Brandauer E, Poewe W, Högl B. White and gray matter abnormalities in narcolepsy with cataplexy. Sleep 2012; 35:345-51. [PMID: 22379240 DOI: 10.5665/sleep.1692] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The authors applied diffusion-tensor imaging including measurements of mean diffusivity (MD), which is a parameter of brain tissue integrity, fractional anisotropy (FA), which is a parameter of neuronal fiber integrity, and voxel-based morphometry, which is a measure of gray and white matter volume, to detect brain tissue changes in patients with narcolepsy-cataplexy. DESIGN N/A. PATIENTS Patients with narcolepsy-cataplexy (n = 16) and age-matched healthy control subjects (n = 12) were studied. INTERVENTIONS Whole cerebral MD, FA measures, and the volumes of the gray and white matter compartments were analyzed using statistical parametric mapping. MEASUREMENT AND RESULTS Significant MD increases and concomitant FA decreases were localized in the fronto-orbital cortex (P < 0.001) and the anterior cingulate (FA, P < 0.001; MD, P = 0.03) in narcolepsy-cataplexy. Additional MD increases without FA changes were detected in the ventral tegmental area, the dorsal raphe nuclei (P < 0.001), and the hypothalamus (P < 0.01). FA signal decreases were observed in the white matter tracts of the inferior frontal and inferior temporal cortices of narcolepsy-cataplexy patients (P < 0.001). Brain volume loss was evident in focal areas of the inferior and superior temporal cortices (P < 0.001) and the cingulate (P = 0.038). CONCLUSIONS Areas of increased diffusivity in the hypothalamus appear consistent with hypocretinergic cell loss reported in narcolepsy-cataplexy. Signal abnormalities in the ventral tegmental area and the dorsal raphe nuclei correspond to major synaptic targets of hypocretin neurons that were associated with the regulation of the sleep-wake cycle. Brain tissue alterations identified in the frontal cortex and cingulate are crucial in the maintenance of attention and reward-dependent decision making, both known to be impaired in narcolepsy-cataplexy.
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Klug G, Trieb T, Schocke M, Nocker M, Skalla E, Mayr A, Nowosielski M, Pedarnig K, Bartel T, Moes N, Pachinger O, Metzler B. Quantification of regional functional improvement of infarcted myocardium after primary PTCA by contrast-enhanced magnetic resonance imaging. J Magn Reson Imaging 2009; 29:298-304. [DOI: 10.1002/jmri.21498] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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