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Hamilton CA, Gallagher P, Ciafone J, Barnett N, Barker SAH, Donaghy PC, O'Brien JT, Taylor JP, Thomas AJ. Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer's disease. J Int Neuropsychol Soc 2024; 30:421-427. [PMID: 38017617 DOI: 10.1017/s1355617723000772] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer's disease (MCI-AD), and any performance deficits which emerged with sustained effort. METHOD We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years). RESULTS While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1-4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3-2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2-8.8). CONCLUSIONS Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors.
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Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sally A H Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Fernando R, Thomas AJ, Hamilton CA, Durcan R, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Petrides G, Colloby S, Allan LM, McKeith IG, O'Brien JT, Taylor JP, Donaghy PC. Identifying parkinsonism in mild cognitive impairment. J Neurol Sci 2024; 458:122941. [PMID: 38422782 DOI: 10.1016/j.jns.2024.122941] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Clinical parkinsonism is a core diagnostic feature for mild cognitive impairment with Lewy bodies (MCI-LB) but can be challenging to identify. A five-item scale derived from the Unified Parkinson's Disease Rating Scale (UPDRS) has been recommended for the assessment of parkinsonism in dementia. This study aimed to determine whether the five-item scale is effective to identify parkinsonism in MCI. METHODS Participants with MCI from two cohorts (n = 146) had a physical examination including the UPDRS and [123I]-FP-CIT SPECT striatal dopaminergic imaging. Participants were classified as having clinical parkinsonism (P+) or no parkinsonism (P-), and with abnormal striatal dopaminergic imaging (D+) or normal imaging (D-). The five-item scale was the sum of UPDRS tremor at rest, bradykinesia, action tremor, facial expression, and rigidity scores. The ability of the scale to differentiate P+D+ and P-D- participants was examined. RESULTS The five-item scale had an AUROC of 0.92 in Cohort 1, but the 7/8 cut-off defined for dementia had low sensitivity to identify P+D+ participants (sensitivity 25%, specificity 100%). Optimal sensitivity and specificity was obtained at a 3/4 cut-off (sensitivity 83%, specificity 88%). In Cohort 2, the five-item scale had an AUROC of 0.97, and the 3/4 cut-off derived from Cohort 1 showed sensitivity of 100% and a specificity of 82% to differentiate P+D+ from P-D- participants. The five-item scale was not effective in differentiating D+ from D- participants. CONCLUSIONS The five-item scale is effective to identify parkinsonism in MCI, but a lower threshold must be used in MCI compared with dementia.
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Affiliation(s)
- Rishira Fernando
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sean Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
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Hamilton CA, O'Brien J, Heslegrave A, Laban R, Donaghy P, Durcan R, Lawley S, Barnett N, Roberts G, Firbank M, Taylor JP, Zetterberg H, Thomas A. Plasma biomarkers of neurodegeneration in mild cognitive impairment with Lewy bodies. Psychol Med 2023; 53:7865-7873. [PMID: 37489795 PMCID: PMC10755229 DOI: 10.1017/s0033291723001952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/17/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Blood biomarkers of Alzheimer's disease (AD) may allow for the early detection of AD pathology in mild cognitive impairment (MCI) due to AD (MCI-AD) and as a co-pathology in MCI with Lewy bodies (MCI-LB). However not all cases of MCI-LB will feature AD pathology. Disease-general biomarkers of neurodegeneration, such as glial fibrillary acidic protein (GFAP) or neurofilament light (NfL), may therefore provide a useful supplement to AD biomarkers. We aimed to compare the relative utility of plasma Aβ42/40, p-tau181, GFAP and NfL in differentiating MCI-AD and MCI-LB from cognitively healthy older adults, and from one another. METHODS Plasma samples were analysed for 172 participants (31 healthy controls, 48 MCI-AD, 28 possible MCI-LB and 65 probable MCI-LB) at baseline, and a subset (n = 55) who provided repeated samples after ≥1 year. Samples were analysed with a Simoa 4-plex assay for Aβ42, Aβ40, GFAP and NfL, and incorporated previously-collected p-tau181 from this same cohort. RESULTS Probable MCI-LB had elevated GFAP (p < 0.001) and NfL (p = 0.012) relative to controls, but not significantly lower Aβ42/40 (p = 0.06). GFAP and p-tau181 were higher in MCI-AD than MCI-LB. GFAP discriminated all MCI subgroups, from controls (AUC of 0.75), but no plasma-based marker effectively differentiated MCI-AD from MCI-LB. NfL correlated with disease severity and increased with MCI progression over time (p = 0.011). CONCLUSION Markers of AD and astrocytosis/neurodegeneration are elevated in MCI-LB. GFAP offered similar utility to p-tau181 in distinguishing MCI overall, and its subgroups, from healthy controls.
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Affiliation(s)
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute, London, UK
- Department of Neurodegenerative Disease, University College London, London, UK
| | | | - Paul Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute, London, UK
- Department of Neurodegenerative Disease, University College London, London, UK
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
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Schumacher J, Ray NJ, Hamilton CA, Bergamino M, Donaghy PC, Firbank M, Watson R, Roberts G, Allan L, Barnett N, O'Brien JT, Thomas AJ, Taylor JP. Free water imaging of the cholinergic system in dementia with Lewy bodies and Alzheimer's disease. Alzheimers Dement 2023; 19:4549-4563. [PMID: 36919460 DOI: 10.1002/alz.13034] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Degeneration of cortical cholinergic projections from the nucleus basalis of Meynert (NBM) is characteristic of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), whereas involvement of cholinergic projections from the pedunculopontine nucleus (PPN) to the thalamus is less clear. METHODS We studied both cholinergic projection systems using a free water-corrected diffusion tensor imaging (DTI) model in the following cases: 46 AD, 48 DLB, 35 mild cognitive impairment (MCI) with AD, 38 MCI with Lewy bodies, and 71 controls. RESULTS Free water in the NBM-cortical pathway was increased in both dementia and MCI groups compared to controls and associated with cognition. Free water along the PPN-thalamus tract was increased only in DLB and related to visual hallucinations. Results were largely replicated in an independent cohort. DISCUSSION While NBM-cortical projections degenerate early in AD and DLB, the thalamic cholinergic input from the PPN appears to be more selectively affected in DLB and might associate with visual hallucinations. HIGHLIGHTS Free water in the NBM-cortical cholinergic pathways is increased in AD and DLB. NBM-cortical pathway integrity is related to overall cognitive performance. Free water in the PPN-thalamus cholinergic pathway is only increased in DLB, not AD. PPN-thalamus pathway integrity might be related to visual hallucinations in DLB.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany
| | - Nicola J Ray
- Health, Psychology and Communities Research Centre, Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Maurizio Bergamino
- Barrow Neurological Institute, Neuroimaging Research, Phoenix, Arizona, USA
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Rosie Watson
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
- University of Exeter Medical School, Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
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Donaghy PC, Hamilton C, Durcan R, Lawley S, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Allan LM, Saha R, McKeith IG, O'Brien JT, Taylor J, Thomas AJ. Clinical symptoms in mild cognitive impairment with Lewy bodies: Frequency, time of onset, and discriminant ability. Eur J Neurol 2023; 30:1585-1593. [PMID: 36912421 PMCID: PMC10946617 DOI: 10.1111/ene.15783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment with Lewy bodies (MCI-LB) is associated with a range of cognitive, motor, neuropsychiatric, sleep, autonomic, and visual symptoms. We investigated the cumulative frequency of symptoms in a longitudinal cohort of MCI-LB compared with MCI due to Alzheimer disease (MCI-AD) and analysed the ability of a previously described 10-point symptom scale to differentiate MCI-LB and MCI-AD, in an independent cohort. METHODS Participants with probable MCI-LB (n = 70), MCI-AD (n = 51), and controls (n = 34) had a detailed clinical assessment and annual follow-up (mean duration = 1.7 years). The presence of a range of symptoms was ascertained using a modified version of the Lewy Body Disease Association Comprehensive LBD Symptom Checklist at baseline assessment and then annually. RESULTS MCI-LB participants experienced a greater mean number of symptoms (24.2, SD = 7.6) compared with MCI-AD (11.3, SD = 7.4) and controls (4.2, SD = 3.1; p < 0.001 for all comparisons). A range of cognitive, parkinsonian, neuropsychiatric, sleep, and autonomic symptoms were significantly more common in MCI-LB than MCI-AD, although when present, the time of onset was similar between the two groups. A previously defined 10-point symptom scale demonstrated very good discrimination between MCI-LB and MCI-AD (area under the receiver operating characteristic curve = 0.91, 95% confidence interval = 0.84-0.98), replicating our previous finding in a new cohort. CONCLUSIONS MCI-LB is associated with the frequent presence of a particular profile of symptoms compared to MCI-AD. Clinicians should look for evidence of these symptoms in MCI and be aware of the potential for treatment. The presence of these symptoms may help to discriminate MCI-LB from MCI-AD.
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Affiliation(s)
- Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Calum Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Sally Barker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Joanna Ciafone
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Kirsty Olsen
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- Nuclear Medicine DepartmentNewcastle Upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Jim Lloyd
- Nuclear Medicine DepartmentNewcastle Upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Louise M. Allan
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Ranjan Saha
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Ian G. McKeith
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - John T. O'Brien
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
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Barnett N, Lucchini M, Thakur S, Fifer W. Links between parental education, infant nighttime sleep duration, and parental confidence in managing infant sleep. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.536] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Jang E, Kang S, Chung S, Barnett N, Gradisar M, Bei B, Suh S. Parental Report versus Auto-Videosomnography Assessment Of Children’s Sleep. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Berger S, Barnett N, Thakur S. Using Auto-Videosomnography to Study the Relation between Sleep and Nightwaking in Infancy. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.565] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lucchini M, Rodriguez D, Pini N, Thakur S, Fifer W, Barnett N. Nocturnal parental involvement in infant sleep is associated with worse parental sleep, but only among fathers. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.239] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Berger S, Barnett N, Thakur S. Parents’ Values Shape Parenting Practices and Beliefs that Impact Infant Sleep. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.544] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lucchini M, Rodriguez D, Pini N, Thakur S, Fifer W, Barnett N. Determinants of infant sleep health: bedtime behavioral factors, socioeconomic status and parental perceived stress but not infant race/ethnicity are associated with infant sleep. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.209] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Waldram R, Ho GC, Premakumar Y, Gabor C, Richards C, Kumar A, Colemeadow J, Kunduzi B, Clark K, Oddy J, Sran K, Barnett N. 668 Introduction of a Pre-Operative Assessment Clinic for Elective Procedures in a Renal Replacement Therapy Unit - Analysis of Effect on Cancellation of Procedures. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
In September 2020, our Renal and Transplant unit introduced a new formalised protocol for Pre-Operative Assessment Clinics (POACs), led by SHO-grade junior doctors. This study aims to investigate the efficacy of the new protocol.
Method
All elective operations including dialysis access procedures, transplant urology, parathyroidectomies and hernia repairs conducted by a single renal replacement therapy unit were examined over an 18-month period prior to POAC implementation, then a 12-month period following implementation. Living donor transplants and nephrectomies were excluded.
On-the day (OTD) cancellation causes were analysed and categorised into:
Results
Total cases performed:
Pre-implementation = 921, post-implementation = 415.
OTD cancellations:
Pre-implementation - total of 211/921 (22.9%). 90 (9.8%) were due to predictable patient factors, 54 (5.9%) for unpredictable patient factors and 67 (7.2%) for hospital factors.
Post-implementation - total of 58/415 (11.6%). 32 (7.7%) for unpredictable patient factors and 12 (2.9%) for hospital factors. Four (1%) were cancelled for predictable patient factors, two due to patients presenting with hypertension.
Conclusions
Patients with renal failure have multiple co-morbidities. Optimising pre-operative care is crucial to ensure they receive timely treatment. This audit has demonstrated that a redesigned POAC led to a reduction of OTD cancellation rates from 22.9% to 11.6%, with a marked reduction in predictable causes for cancellations. Further improvements and re-audit are planned.
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Affiliation(s)
- R Waldram
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - GC Ho
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - Y Premakumar
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - C Gabor
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - C Richards
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - A Kumar
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - J Colemeadow
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - B Kunduzi
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - K Clark
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - J Oddy
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - K Sran
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - N Barnett
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
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Donaghy PC, Firbank M, Petrides G, Lloyd J, Barnett N, Olsen K, Heslegrave A, Zetterberg H, Thomas AJ, O'Brien JT. The relationship between plasma biomarkers and amyloid PET in dementia with Lewy bodies. Parkinsonism Relat Disord 2022; 101:111-116. [PMID: 35872565 DOI: 10.1016/j.parkreldis.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/21/2022] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Amyloid-β (Aβ) deposition is common in dementia with Lewy bodies (DLB) and has been associated with more rapid disease progression. An effective biomarker that identified the presence of significant brain Aβ in people with DLB may be useful to identify and stratify participants for research studies and to inform prognosis in clinical practice. Plasma biomarkers are emerging as candidates to fulfil this role. METHODS Thirty-two participants with DLB had brain amyloid (18F-florbetapir) PET, of whom 27 also had an MRI to enable the calculation of 18F-florbetapir SUVR. Plasma Aβ42/40, phosphorylated tau (p-tau181), glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) were measured using single molecule array (Simoa). The plasma biomarkers were investigated for correlation with 18F-florbetapir SUVR, discriminant ability to identify Aβ-positive cases based on a predefined SUVR threshold of 1.10 and correlation with subsequent cognitive decline over one year. RESULTS All four plasma markers significantly correlated with 18F-florbetapir SUVR (|β| = 0.40-0.49; p < .05). NfL had the greatest area under the receiver operating characteristic curve to identify Aβ-positive cases (AUROC 0.84 (95% CI 0.66, 1); β = 0.46, p = .001), whereas Aβ42/40 had the smallest (AUROC 0.73 (95% CI 0.52, 0.95); β = -0.47, p = .01). Accuracy was highest when combining all four biomarkers (AUROC 0.92 (95% CI 0.80, 1)). Lower plasma Aβ42/40 was significantly associated with more rapid decline in cognition (β = 0.53, p < .01). CONCLUSIONS Plasma biomarkers have the potential to identify Aβ deposition in DLB. Further work in other cohorts is required to determine and validate optimal cut-offs for these biomarkers.
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Affiliation(s)
- Paul C Donaghy
- Translational and Cli nical Research Institute, Newcastle University, UK.
| | - Michael Firbank
- Translational and Cli nical Research Institute, Newcastle University, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Nicola Barnett
- Translational and Cli nical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Cli nical Research Institute, Newcastle University, UK
| | | | - Henrik Zetterberg
- Dementia Research Institute, University College London, London, UK; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Alan J Thomas
- Translational and Cli nical Research Institute, Newcastle University, UK
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Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett N, Firbank M, Roberts G, Taylor J, Allan LM, O’Brien J, Yarnall AJ, Thomas AJ. Blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre in mild cognitive impairment with Lewy bodies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5709. [PMID: 35388536 PMCID: PMC9321690 DOI: 10.1002/gps.5709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Orthostatic hypotension is a common feature of normal ageing, and age-related neurodegenerative diseases, in particular the synucleinopathies including dementia with Lewy bodies. Orthostatic hypotension and other abnormal cardiovascular responses may be early markers of Lewy body disease. We aimed to assess whether abnormal blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre would be more common in mild cognitive impairment with Lewy bodies (MCI-LB) than MCI due to Alzheimer's disease (MCI-AD). METHODS MCI patients (n = 89) underwent longitudinal clinical assessment with differential classification of probable MCI-LB, possible MCI-LB, or MCI-AD, with objective autonomic function testing at baseline. Blood pressure and heart rate responses to active stand and Valsalva manoeuvre were calculated from beat-to-beat cardiovascular data, with abnormalities defined by current criteria, and age-adjusted group differences estimated with logistic models. RESULTS Orthostatic hypotension and abnormal heart rate response to orthostatic challenge were not more common in probable MCI-LB than MCI-AD. Heart rate abnormalities were likewise not more common in response to Valsalva manoeuvre in probable MCI-LB. An abnormal blood pressure response to Valsalva (delayed return to baseline/absence of overshoot after release of strain) was more common in probable MCI-LB than MCI-AD. In secondary analyses, magnitude of blood pressure drop after active stand and 10-s after release of Valsalva strain were weakly correlated with cardiac sympathetic denervation. CONCLUSIONS Probable MCI-LB may feature abnormal blood pressure response to Valsalva, but orthostatic hypotension is not a clear distinguishing feature from MCI-AD.
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Affiliation(s)
- Calum A. Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - James Frith
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Paul C. Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sally A. H. Barker
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Louise M. Allan
- College of Medicine and Health, St Luke's CampusExeter UniversityExeterUK
| | - John O’Brien
- Department of PsychiatryUniversity of Cambridge, Level E4, Addenbrooke's HospitalCambridgeUK
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
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15
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Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett N, Firbank M, Roberts G, Taylor J, Allan LM, O’Brien J, Yarnall AJ, Thomas AJ. Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5703. [PMID: 35302677 PMCID: PMC9311677 DOI: 10.1002/gps.5703] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI-LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI-AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI-LB from MCI-AD. METHODS Ninety-three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31-item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI-AD or MCI-LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub-scales were assessed, controlling for age. RESULTS Age-adjusted severity of overall autonomic symptomatology was greater in MCI-LB (Ratio = 2.01, 95% CI: 1.37-2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI-AD did not have significantly higher autonomic symptom severity than controls overall. A cut-off of 4/5 on the COMPASS was sensitive to MCI-LB (92%) but not specific to this (42% specificity vs. MCI-AD and 52% vs. healthy controls). CONCLUSIONS Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI-AD, but such autonomic symptoms are not a specific finding. The COMPASS-31 may therefore have value as a sensitive screening test for early-stage Lewy body disease.
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Affiliation(s)
- Calum A. Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James Frith
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sally A. H. Barker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - John O’Brien
- Department of PsychiatryUniversity of CambridgeAddenbrooke's HospitalCambridgeUK
| | - Alison J. Yarnall
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
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16
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Thomas AJ, Hamilton CA, Heslegrave A, Barker S, Durcan R, Lawley S, Barnett N, Lett D, Firbank M, Roberts G, Taylor JP, Donaghy PC, Zetterberg H, O'Brien J. A Longitudinal Study of Plasma pTau181 in Mild Cognitive Impairment with Lewy Bodies and Alzheimer's Disease. Mov Disord 2022; 37:1495-1504. [PMID: 35318733 PMCID: PMC9540809 DOI: 10.1002/mds.28994] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/04/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) co-pathology is common in dementia with Lewy bodies and is associated with increased decline. Plasma pTau181 is a blood-based biomarker that can detect AD co-pathology. OBJECTIVES We investigated whether pTau181 was associated with cognitive decline in mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with AD (MCI-AD). METHODS We assessed plasma pTau181 using a single-molecule array (Simoa) immunoassay at baseline and follow-up in a longitudinal cohort of MCI-LB, MCI-AD, and controls. RESULTS One hundred forty-six subjects (56 probable MCI-LB, 22 possible MCI-LB, 44 MCI-AD, and 24 controls) were reviewed for up to 5.7 years. Probable MCI-LB had significantly higher pTau181 (22.2% mean increase) compared with controls and significantly lower (24.4% mean decrease) levels compared with MCI-AD. Receiver operating characteristic analyses of pTau181 in discriminating probable MCI-LB from controls showed an area under the curve (AUC) of 0.68 (83% specificity, 57% sensitivity); for discriminating MCI-AD from healthy controls, AUC was 0.8 (83.3% specificity, 72.7% sensitivity). pTau181 concentration was less useful in discriminating between probable MCI-LB and MCI-AD: AUC of 0.64 (71.4% specificity, 52.3% sensitivity). There was an association between pTau181 and cognitive decline in MCI-AD but not in MCI-LB. In a subset with repeat samples there was a nonsignificant 3% increase per follow-up year in plasma pTau181. The rate of change in pTau181 was not significantly different in different diagnostic subgroups. CONCLUSIONS pTau181 was not associated with an increased decline assessed using either baseline or repeat pTau181. pTau181 partially discriminated probable MCI-LB from controls and MCI-AD from controls but was not useful in distinguishing probable MCI-LB from MCI-AD.
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Affiliation(s)
- Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Debbie Lett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Hamilton CA, Schumacher J, Matthews F, Taylor JP, Allan L, Barnett N, Cromarty RA, Donaghy PC, Durcan R, Firbank M, Lawley S, O'Brien JT, Roberts G, Thomas AJ. Slowing on quantitative EEG is associated with transition to dementia in mild cognitive impairment. Int Psychogeriatr 2021; 33:1321-1325. [PMID: 34551831 DOI: 10.1017/s1041610221001083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer's disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01-3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.
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Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Schumacher
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allan
- Institute of Health Research, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, Herschel Smith Building, University of Cambridge, Cambridge, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, McKeith IG, Thomas AJ. Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease. Psychol Med 2021; 51:2590-2598. [PMID: 32366348 DOI: 10.1017/s0033291720001130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD). METHODS A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function. RESULTS Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline. CONCLUSIONS These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms - particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.
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Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, Level E4, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SZ, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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Schumacher J, Ray NJ, Hamilton CA, Donaghy PC, Firbank M, Roberts G, Allan L, Durcan R, Barnett N, O'Brien JT, Taylor JP, Thomas AJ. Cholinergic white matter pathways in dementia with Lewy bodies and Alzheimer's disease. Brain 2021; 145:1773-1784. [PMID: 34605858 PMCID: PMC9166545 DOI: 10.1093/brain/awab372] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Patients who have dementia with Lewy bodies and Alzheimer’s disease show early degeneration of the cholinergic nucleus basalis of Meynert. However, how white matter projections between the nucleus basalis of Meynert and the cortex are altered in neurodegenerative disease is unknown. Tractography of white matter pathways originating from the nucleus basalis of Meynert was performed using diffusion-weighted imaging in 46 patients with Alzheimer’s disease dementia, 48 with dementia with Lewy bodies, 35 with mild cognitive impairment with Alzheimer’s disease, 38 with mild cognitive impairment with Lewy bodies and 71 control participants. Mean diffusivity of the resulting pathways was compared between groups and related to cognition, attention, functional EEG changes and dementia conversion in the mild cognitive impairment groups. We successfully tracked a medial and a lateral pathway from the nucleus basalis of Meynert. Mean diffusivity of the lateral pathway was higher in both dementia and mild cognitive impairment groups than controls (all P < 0.03). In the patient groups, increased mean diffusivity of this pathway was related to more impaired global cognition (β = −0.22, P = 0.06) and worse performance on an attention task (β = 0.30, P = 0.03). In patients with mild cognitive impairment, loss of integrity of both nucleus basalis of Meynert pathways was associated with increased risk of dementia progression [hazard ratio (95% confidence interval), medial pathway: 2.51 (1.24–5.09); lateral pathway: 2.54 (1.24–5.19)]. Nucleus basalis of Meynert volume was reduced in all clinical groups compared to controls (all P < 0.001), but contributed less strongly to cognitive impairment and was not associated with attention or dementia conversion. EEG slowing in the patient groups as assessed by a decrease in dominant frequency was associated with smaller nucleus basalis of Meynert volumes (β = 0.22, P = 0.02) and increased mean diffusivity of the lateral pathway (β = −0.47, P = 0.003). We show that degeneration of the cholinergic nucleus basalis of Meynert in Alzheimer’s disease and dementia with Lewy bodies is accompanied by an early reduction in integrity of white matter projections that originate from this structure. This is more strongly associated with cognition and attention than the volume of the nucleus basalis of Meynert itself and might be an early indicator of increased risk of dementia conversion in people with mild cognitive impairment.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola J Ray
- Health, Psychology and Communities Research Centre, Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Durcan R, Roberts G, Ciafone J, Barker SAH, Firbank M, McKeith IG, Thomas AJ. Progression to Dementia in Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease. Neurology 2021; 96:e2685-e2693. [PMID: 33875556 PMCID: PMC8205466 DOI: 10.1212/wnl.0000000000012024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 08/05/2020] [Accepted: 03/02/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To determine whether mild cognitive impairment with Lewy bodies or mild cognitive impairment with Alzheimer disease differ in their rates of clinical progression to dementia, we undertook longitudinal observation of mild cognitive impairment cases with detailed clinical assessment of Lewy body diagnostic characteristics. METHODS Two prospective longitudinal cohorts including 111 individuals ≥60 years of age with mild cognitive impairment were assessed annually to track cognitive and clinical progression, including the presence or absence of core clinical features and proposed biomarkers of dementia with Lewy bodies. Multistate modeling was used to assess the associations of diagnostic characteristics of dementia with Lewy bodies with clinical progression from mild cognitive impairment to dementia, with death as a competing outcome. RESULTS After a mean follow-up of 2.2 years (range 1-6.7 years), 38 of the 111 (34%) participants progressed to dementia: 10 with AD, 3 with possible dementia with Lewy bodies, and 25 with probable dementia with Lewy bodies. The presence of any Lewy body disease characteristic was associated with an increased hazard of transition to dementia; this risk further increased as more diagnostic characteristics were observed (hazard ratio 1.33 per characteristic, 95% confidence interval [CI] 1.11-1.60) and was especially high for those experiencing complex visual hallucinations (hazard ratio 1.98, 95% CI 0.92-4.29) or cognitive fluctuations (hazard ratio 3.99, 95% CI 2.03-7.84). CONCLUSIONS Diagnostic characteristics of Lewy body disease are associated with an increased risk of transition from mild cognitive impairment to dementia.
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Affiliation(s)
- Calum A Hamilton
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK.
| | - Fiona E Matthews
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - John T O'Brien
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Nicola Barnett
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Kirsty Olsen
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Rory Durcan
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Gemma Roberts
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sally A H Barker
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Michael Firbank
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Ian G McKeith
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
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Roberts G, Donaghy PC, Lloyd J, Durcan R, Petrides G, Colloby SJ, Lawley S, Ciafone J, Hamilton CA, Firbank M, Allan L, Barnett N, Barker S, Olsen K, Howe K, Ali T, Taylor JP, O'Brien J, Thomas AJ. Accuracy of dopaminergic imaging as a biomarker for mild cognitive impairment with Lewy bodies. Br J Psychiatry 2021; 218:276-282. [PMID: 33355065 DOI: 10.1192/bjp.2020.234] [Citation(s) in RCA: 13] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain. AIMS To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies. METHOD We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard. RESULTS At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52-77%), specificity 88% (76-95%) and accuracy 76% (68-84%), with positive likelihood ratio 5.3. CONCLUSIONS It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
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Affiliation(s)
- Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; and Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Jim Lloyd
- Translational and Clinical Research Institute, Newcastle University, UK; and Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kim Howe
- Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Tamir Ali
- Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
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Schumacher J, Taylor JP, Hamilton CA, Firbank M, Donaghy PC, Roberts G, Allan L, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Functional connectivity in mild cognitive impairment with Lewy bodies. J Neurol 2021; 268:4707-4720. [PMID: 33928432 PMCID: PMC8563567 DOI: 10.1007/s00415-021-10580-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/13/2022]
Abstract
Previous resting-state fMRI studies in dementia with Lewy bodies have described changes in functional connectivity in networks related to cognition, motor function, and attention as well as alterations in connectivity dynamics. However, whether these changes occur early in the course of the disease and are already evident at the stage of mild cognitive impairment is not clear. We studied resting-state fMRI data from 31 patients with mild cognitive impairment with Lewy bodies compared to 28 patients with mild cognitive impairment due to Alzheimer’s disease and 24 age-matched controls. We compared the groups with respect to within- and between-network functional connectivity. Additionally, we applied two different approaches to study dynamic functional connectivity (sliding-window analysis and leading eigenvector dynamic analysis). We did not find any significant changes in the mild cognitive impairment groups compared to controls and no differences between the two mild cognitive impairment groups, using static as well as dynamic connectivity measures. While patients with mild cognitive impairment with Lewy bodies already show clear functional abnormalities on EEG measures, the fMRI analyses presented here do not appear to be sensitive enough to detect such early and subtle changes in brain function in these patients.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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Roberts G, Durcan R, Donaghy PC, Lawley S, Ciafone J, Hamilton CA, Colloby SJ, Firbank MJ, Allan L, Barnett N, Barker S, Howe K, Ali T, Petrides GS, Lloyd J, Taylor JP, O'Brien J, Thomas AJ. Accuracy of Cardiac Innervation Scintigraphy for Mild Cognitive Impairment With Lewy Bodies. Neurology 2021; 96:e2801-e2811. [PMID: 33883238 PMCID: PMC8205462 DOI: 10.1212/wnl.0000000000012060] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 08/03/2020] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To provide evidence that cardiac I-123-metaiodobenzylguanidine sympathetic innervation imaging (MIBG) scintigraphy differentiates probable mild cognitive impairment with Lewy bodies (MCI-LB) from mild cognitive impairment due to Alzheimer disease (MCI-AD), we scanned patients with MCI and obtained consensus clinical diagnoses of their MCI subtype. We also performed baseline FP-CIT scans to compare the accuracy of MIBG and FP-CIT. Methods We conducted a prospective cohort study into the accuracy of cardiac MIBG scintigraphy in the diagnosis of MCI-LB. Follow-up clinical assessment was used to diagnose MCI-AD (no core features of MCI-LB and normal FP-CIT), probable MCI-LB (2 or more core features, or 1 core feature with abnormal FP-CIT), or possible MCI-LB (1 core feature or abnormal FP-CIT). For the comparison between MIBG and FP-CIT, only core clinical features were used for diagnosis. Results We recruited 95 people with mild cognitive impairment. Cardiac MIBG was abnormal in 22/37 probable and 2/15 possible MCI-LB cases and normal in 38/43 MCI-AD cases. The sensitivity in probable MCI-LB was 59% (95% confidence interval [CI], 42%–75%), specificity 88% (75%–96%), and accuracy 75% (64%–84%). The positive likelihood ratio was 5.1 and negative likelihood ratio 0.46. With symptom-only diagnoses, the accuracies were 79% for MIBG (95% CI, 68%–87%) and 76% for FP-CIT (95% CI, 65%–85%). Conclusions Cardiac MIBG appears useful in early disease, with an abnormal scan highly suggestive of MCI-LB. Validation in a multicenter setting is justified. Classification of Evidence This study provides Class I evidence that cardiac MIBG distinguishes MCI-LB from MCI-AD.
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Affiliation(s)
- Gemma Roberts
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK.
| | - Rory Durcan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sarah Lawley
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Calum A Hamilton
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sean J Colloby
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Michael J Firbank
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Louise Allan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Nicola Barnett
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sally Barker
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Kim Howe
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Tamir Ali
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - George S Petrides
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Jim Lloyd
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John O'Brien
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
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Schumacher J, Taylor JP, Hamilton CA, Firbank M, Cromarty RA, Donaghy PC, Roberts G, Allan L, Lloyd J, Durcan R, Barnett N, O'Brien JT, Thomas AJ. In vivo nucleus basalis of Meynert degeneration in mild cognitive impairment with Lewy bodies. Neuroimage Clin 2021; 30:102604. [PMID: 33711623 PMCID: PMC7972982 DOI: 10.1016/j.nicl.2021.102604] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/05/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
Nucleus basalis of Meynert (NBM) degeneration occurs early in Lewy body dementia. NBM degeneration is related to cognitive impairment in MCI with Lewy bodies. EEG slowing in MCI patients is related to the severity of NBM degeneration.
Objectives To investigate in vivo degeneration of the cholinergic system in mild cognitive impairment with Lewy bodies (MCI-LB), we studied nucleus basalis of Meynert (NBM) volumes from structural MR images and its relation to EEG slowing and cognitive impairment. Methods We studied the NBM using structural MR images in 37 patients with MCI-LB, 34 patients with MCI with Alzheimer’s disease (MCI-AD), and 31 healthy control participants. We also tested correlations between NBM volumes and measures of overall cognition and measures of EEG slowing in the MCI groups. Results Overall NBM volume was reduced in MCI-LB compared to controls with no significant difference between MCI-AD and controls or between the two MCI groups. The voxel-wise analysis revealed bilateral clusters of reduced NBM volume in MCI-LB compared to controls and smaller clusters in MCI-AD compared to controls. There was a significant association between overall NBM volume and measures of overall cognition in MCI-LB, but not in MCI-AD. In both MCI groups, reduced NBM volume was correlated with more severe EEG slowing. Conclusions This study provides in vivo evidence that early cholinergic degeneration in DLB occurs at the MCI stage and is related to the severity of cognitive impairment. Furthermore, the results suggest that early EEG slowing in MCI-LB might be in part cholinergically driven. Importantly, these findings suggest an early cholinergic deficit in MCI-LB that may motivate further testing of the effectiveness of cholinesterase inhibitors in this group.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom; Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NFS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge CB2 0SP, United Kingdom
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
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25
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Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Lloyd J, Petrides G, McKeith IG, Thomas AJ. Cognitive Decline in Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease: A Prospective Cohort Study. Am J Geriatr Psychiatry 2021; 29:272-284. [PMID: 32863138 DOI: 10.1016/j.jagp.2020.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/16/2019] [Revised: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We explored whether the mild cognitive impairment (MCI) stages of dementia with Lewy bodies (DLB) and Alzheimer disease (AD) differ in their cognitive profiles, and longitudinal progression. DESIGN A prospective, longitudinal design was utilized with annual follow-up (Max 5 years, Mean 1.9, standard deviation 1.1) after diagnosis. Participants underwent repeated cognitive testing, and review of their clinical diagnosis and symptoms, including evaluation of core features of DLB. SETTING This was an observational study of independently living individuals, recruited from local healthcare trusts in North East England, UK. PARTICIPANTS An MCI cohort (n = 76) aged ≥60 years was utilized, differentially diagnosed with MCI due to AD (MCI-AD), or possible/probable MCI with Lewy bodies (MCI-LB). MEASUREMENTS A comprehensive clinical and neuropsychological testing battery was administered, including ACE-R, trailmaking tests, FAS verbal fluency, and computerized battery of attention and perception tasks. RESULTS Probable MCI-LB presented with less impaired recognition memory than MCI-AD, greater initial impairments in verbal fluency and perception of line orientation, and thereafter demonstrated an expedited decline in visuo-constructional functions in the ACE-R compared to MCI-AD. No clear diagnostic group differences were found in deterioration speeds for global cognition, language, overall memory, attention or other executive functions. CONCLUSION These findings provide further evidence for differences in severity and decline of visuospatial dysfunctions in DLB compared with AD; further exploration is required to clarify when and how differences in attention, executive, and memory functions emerge, as well as speed of decline to dementia.
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Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom.
| | - Fiona E Matthews
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University (FEM), Newcastle upon Tyne, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, Level E4, University of Cambridge School of Clinical Medicine (JTO), Cambridge, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - Jim Lloyd
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust (JL, GP), Newcastle upon Tyne, United Kingdom
| | - George Petrides
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust (JL, GP), Newcastle upon Tyne, United Kingdom
| | - Ian G McKeith
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
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Bobat A, Anderson V, Barnett N, Beattie V, Bostock L, Clayton K, Cole T, Foreman H, Holden S, Kefyalew S, Overton G, Roberts J, Ross J, Shepherd P, Smerdon E, Ward M. P28.03 An Autoethnographic Study Exploring the Role of the Lung Cancer Nurse Specialist in the National Optimal Lung Cancer Pathway. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thomas AJ, Hamilton CA, Donaghy PC, Martin-Ruiz C, Morris CM, Barnett N, Olsen K, Taylor JP, O'Brien JT. Prospective longitudinal evaluation of cytokines in mild cognitive impairment due to AD and Lewy body disease. Int J Geriatr Psychiatry 2020; 35:1250-1259. [PMID: 32557792 DOI: 10.1002/gps.5365] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We conducted a prospective longitudinal study of plasma cytokines during the Mild Cognitive Impairment (MCI) stage of Lewy body disease and Alzheimer's disease, hypothesizing that cytokine levels would decrease over time and that this would be correlated with decline in cognition. METHODS Older (≥60) people with MCI were recruited from memory services in healthcare trusts in North East England, UK. MCI was diagnosed as due to Alzheimer's disease (MCI-AD) or Lewy body disease (MCI-LB). Baseline and repeat annual clinical and cognitive assessments were undertaken and plasma samples were obtained at the same time. Cytokine assays were performed on all samples using the Meso Scale Discovery V-Plex Plus Proinflammatory Panel 1, which included IFNγ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13 and TNFα. RESULTS Fifty-six patients (21 MCI-AD, 35 MCI-LB) completed prospective evaluations and provided samples up to 3 years after baseline. Six cytokines (IFNγ, IL-1β, IL-2, IL-4, IL-6 and IL-10) showed highly significant (P < .002) decreases over time. AD and LB did not differ in rate of decrease nor were there any effects related to age or general morbidity. Decrease in five of these cytokines (IFNγ, IL-1β, IL-2, IL-4, and IL-10) was highly correlated with decrease in cognition (P < .003). CONCLUSIONS Peripheral inflammation decreased in both disease groups during MCI suggesting this may be a therapeutic window for future anti-inflammatory agents.
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Affiliation(s)
- Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Carmen Martin-Ruiz
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris M Morris
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Donaghy PC, Firbank M, Petrides G, Lloyd J, Barnett N, Olsen K, Thomas AJ, O'Brien JT. Diffusion imaging in dementia with Lewy bodies: Associations with amyloid burden, atrophy, vascular factors and clinical features. Parkinsonism Relat Disord 2020; 78:109-115. [PMID: 32814228 DOI: 10.1016/j.parkreldis.2020.07.025] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/03/2020] [Accepted: 07/25/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION White matter disruption in dementia has been linked to a variety of factors including vascular disease and cortical pathology. We aimed to examine the relationship between white matter changes on diffusion tensor imaging (DTI) in DLB and factors including vascular disease, structural atrophy and amyloid burden. METHODS Participants with DLB (n = 29), Alzheimer's disease (AD, n = 17) and healthy controls (n = 20) had clinical and neuropsychological assessments followed by structural and diffusion tensor 3T MRI and 18F-Florbetapir PET-CT imaging. Voxelwise statistical analysis of white matter fractional anisotropy (FA) and mean diffusivity (MD) was carried out using Tract-Based Spatial Statistics with family-wise error correction (p < 0.05). RESULTS DLB and AD groups demonstrated widespread increased MD and decreased FA when compared with controls. There were no differences between the DLB and AD groups. In DLB, increased MD and decreased FA correlated with decreased grey matter and hippocampal volumes as well as vascular disease. There was no correlation with cortical florbetapir SUVR. The relationship between DTI changes and grey matter/hippocampal volumes remained after including Cumulative Illness Rating Scale-Geriatric vascular score as a covariate. CONCLUSIONS Widespread disruption of white matter tracts is present in DLB and is associated with vascular disease, reduced hippocampal volume and reduced grey matter volume, but not with cortical amyloid deposition. The mechanism behind the correlation observed between hippocampal volume and white matter tract disruption should be investigated in future cohorts using tau imaging, as hippocampal atrophy has been shown to correlate with tau deposition in DLB.
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Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
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Schumacher J, Taylor JP, Hamilton CA, Firbank M, Cromarty RA, Donaghy PC, Roberts G, Allan L, Lloyd J, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Quantitative EEG as a biomarker in mild cognitive impairment with Lewy bodies. Alzheimers Res Ther 2020; 12:82. [PMID: 32641111 PMCID: PMC7346501 DOI: 10.1186/s13195-020-00650-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
Objectives To investigate using quantitative EEG the (1) differences between patients with mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with Alzheimer’s disease (MCI-AD) and (2) its utility as a potential biomarker for early differential diagnosis. Methods We analyzed eyes-closed, resting-state, high-density EEG data from highly phenotyped participants (39 MCI-LB, 36 MCI-AD, and 31 healthy controls). EEG measures included spectral power in different frequency bands (delta, theta, pre-alpha, alpha, and beta), theta/alpha ratio, dominant frequency, and dominant frequency variability. Receiver operating characteristic (ROC) analyses were performed to assess diagnostic accuracy. Results There was a shift in power from beta and alpha frequency bands towards slower frequencies in the pre-alpha and theta range in MCI-LB compared to healthy controls. Additionally, the dominant frequency was slower in MCI-LB compared to controls. We found significantly increased pre-alpha power, decreased beta power, and slower dominant frequency in MCI-LB compared to MCI-AD. EEG abnormalities were more apparent in MCI-LB cases with more diagnostic features. There were no significant differences between MCI-AD and controls. In the ROC analysis to distinguish MCI-LB from MCI-AD, beta power and dominant frequency showed the highest area under the curve values of 0.71 and 0.70, respectively. While specificity was high for some measures (up to 0.97 for alpha power and 0.94 for theta/alpha ratio), sensitivity was generally much lower. Conclusions Early EEG slowing is a specific feature of MCI-LB compared to MCI-AD. However, there is an overlap between the two MCI groups which makes it difficult to distinguish between them based on EEG alone.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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Donaghy PC, Firbank MJ, Thomas AJ, Lloyd J, Petrides G, Barnett N, Olsen K, O'Brien JT. Amyloid Imaging and Longitudinal Clinical Progression in Dementia With Lewy Bodies. Am J Geriatr Psychiatry 2020; 28:573-577. [PMID: 31953009 DOI: 10.1016/j.jagp.2019.12.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Significant amyloid deposition is present in approximately half of all cases of dementia with Lewy bodies (DLB). We sought to determine whether amyloid deposition was associated with more rapid clinical decline over 1 year. METHODS Twenty-eight participants had a baseline clinical assessment and amyloid PET scan, followed by a further clinical assessment after 1 year. Changes in clinical measures were compared with amyloid deposition assessed by visual rating and cortical standardized uptake value ratio. RESULTS Amyloid deposition on visual rating was associated with greater decline in Mini-Mental State Examination and daily function over 1 year. There was no correlation between cortical standardized uptake value ratio and clinical measures. CONCLUSIONS This study provides further evidence for a link between amyloid deposition and clinical progression in DLB. Pathologies such as amyloid, and their interaction with α-synuclein, remain possible treatment targets in DLB.
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Affiliation(s)
- Paul C Donaghy
- Institute of Neuroscience, Newcastle University (PCD, MJF, AJT, NB, KO), Newcastle upon Tyne, United Kingdom.
| | - Michael J Firbank
- Institute of Neuroscience, Newcastle University (PCD, MJF, AJT, NB, KO), Newcastle upon Tyne, United Kingdom
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University (PCD, MJF, AJT, NB, KO), Newcastle upon Tyne, United Kingdom
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals National Health Service Foundation Trust (JL, GP), Newcastle upon Tyne, United Kingdom
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals National Health Service Foundation Trust (JL, GP), Newcastle upon Tyne, United Kingdom
| | - Nicola Barnett
- Institute of Neuroscience, Newcastle University (PCD, MJF, AJT, NB, KO), Newcastle upon Tyne, United Kingdom
| | - Kirsty Olsen
- Institute of Neuroscience, Newcastle University (PCD, MJF, AJT, NB, KO), Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge (JTO), Cambridge, United Kingdom
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Donaghy PC, Firbank M, Mitra D, Petrides G, Lloyd J, Barnett N, Olsen K, Thomas AJ, O'Brien JT. Microbleeds in dementia with Lewy bodies. J Neurol 2020; 267:1491-1498. [PMID: 32016624 PMCID: PMC7184053 DOI: 10.1007/s00415-020-09736-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Microbleeds are associated with the development of dementia in older people and are common in Alzheimer's disease (AD). Their prevalence and clinical importance in dementia with Lewy bodies (DLB) is unclear. The objective of this study was to compare the rates of microbleeds in DLB with those in AD and healthy older people, and investigate associations between microbleeds and amyloid deposition, vascular risk and disease severity in DLB. METHODS DLB (n = 30), AD (n = 18) and control (n = 20) participants underwent clinical assessment at baseline and 1 year in this longitudinal observational study. 3T MRI (including T2* susceptibility weighted imaging) and florbetapir PET were carried out at baseline. Microbleeds were rated visually and a standardised uptake value ratio (SUVR) was calculated from florbetapir PET scans. RESULTS 40% of DLB subjects had microbleeds compared with 50% of AD and 15% of controls. Compared to DLB without microbleeds, those with microbleeds had higher systolic BP (156 ± 26 v. 135 ± 19 mmHg; p = 0.03), but did not have greater levels of vascular disease or amyloid deposition (SUVR 1.25 ± 0.24 v. 1.25 ± 0.22; p = 0.33). There was evidence of less severe dementia in DLB participants with microbleeds, but these differences may have been driven by a shorter disease duration in those with microbleeds. CONCLUSION The presence of microbleeds in DLB is associated with higher blood pressure, but not with other measures of vascular disease or amyloid deposition. The relationship between microbleeds and clinical presentation remains unclear.
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Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Pillion M, Kahn M, Barnett N, Glazer A, Ivry T, Gradisar M. Are parents of infants with sleep problems at risk for daytime dysfunction? Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.845] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gradisar M, Kahn M, Barnett N, Ivry T, Glazer A. Checking-in: what factors predict parents visiting their infants during the night? Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.371] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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King E, O'Brien J, Donaghy P, Williams-Gray CH, Lawson RA, Morris CM, Barnett N, Olsen K, Martin-Ruiz C, Burn D, Yarnall AJ, Taylor JP, Duncan G, Khoo TK, Thomas A. Inflammation in mild cognitive impairment due to Parkinson's disease, Lewy body disease, and Alzheimer's disease. Int J Geriatr Psychiatry 2019; 34:1244-1250. [PMID: 30993722 DOI: 10.1002/gps.5124] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 06/08/2018] [Accepted: 04/05/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inflammation appears to play a role in the progression of neurodegenerative diseases. However, little is known about inflammation during early stages of cognitive decline or whether this differs in different disease groups. We sought to investigate this by assessing the inflammatory profile in patients with Parkinson disease with the early stages of cognitive impairment (PD-MCI), patients with prodromal Alzheimer disease (MCI-AD), prodromal Lewy body disease (MCI-LB), and controls. METHODS We obtained venous blood samples from participants with PD-MCI (n = 44), PD-normal cognition (n = 112), MCI-LB (n = 38), MCI-AD (n = 21), and controls (n = 84). We measured 10 cytokines using Meso Scale Discovery V-Plex Plus including interferon gamma, interleukin (IL)-10, IL-12p70, IL-13, IL-1beta, IL-2, IL-4, IL-6, IL-8, and tumour necrosis factor alpha. High-sensitivity C-reactive protein was measured. RESULTS There was a higher level of inflammation in patients with MCI-AD and MCI-LB compared with controls. PD noncognitively impaired had higher inflammatory markers than controls, but there was no difference between PD-MCI and controls. There was a decrease in inflammatory markers with increasing motor severity based on the Unified Parkinson's Disease Rating Scale. CONCLUSIONS Inflammation may be involved in the onset of cognitive decline in patients with MCI-AD and MCI-LB but appears to be less prominent PD-MCI albeit in a small data set. This suggests that anti-inflammatory medications may have most benefit at the earliest stages of neurodegenerative diseases. For PD cases, this might be in advance of the development of MCI.
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Affiliation(s)
- Eleanor King
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - John O'Brien
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Paul Donaghy
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Caroline H Williams-Gray
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Rachael A Lawson
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Christopher M Morris
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Carmen Martin-Ruiz
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - David Burn
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
| | - Gordan Duncan
- Department of Medicine for the Elderly, Western General Hospital, Edinburgh, UK
| | - Tien K Khoo
- School of Medicine & Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Alan Thomas
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle upon Tyne, UK
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Clayton K, Byatte A, Barnett N, Guerin C. P3.07-03 Lung Cancer Clinical Nurse Specialist and Palliative Care Nurse Specialist – A Dual Role. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1739] [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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Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Colloby SJ, Lloyd J, Petrides G, McKeith IG, Thomas AJ. Neuropsychiatric symptoms and cognitive profile in mild cognitive impairment with Lewy bodies. Psychol Med 2018; 48:2384-2390. [PMID: 29362011 DOI: 10.1017/s0033291717003956] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The accurate clinical characterisation of mild cognitive impairment (MCI) is becoming increasingly important. The aim of this study was to compare the neuropsychiatric symptoms and cognitive profile of MCI with Lewy bodies (MCI-LB) with Alzheimer's disease MCI (MCI-AD). METHODS Participants were ⩾60 years old with MCI. Each had a thorough clinical and neuropsychological assessment and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single photon emission computed tomography FP-CIT SPECT). MCI-LB was diagnosed if two or more diagnostic features of dementia with Lewy bodies were present (visual hallucinations, cognitive fluctuations, motor parkinsonism, rapid eye movement sleep behaviour disorder or positive FP-CIT SPECT). A Lewy body Neuropsychiatric Supportive Symptom Count (LBNSSC) was calculated based on the presence or absence of the supportive neuropsychiatric symptoms defined by the 2017 DLB diagnostic criteria: non-visual hallucinations, delusions, anxiety, depression and apathy. RESULTS MCI-LB (n = 41) had a higher LBNSSC than MCI-AD (n = 24; 1.8 ± 1.1 v. 0.7 ± 0.9, p = 0.001). 67% of MCI-LB had two or more of those symptoms, compared with 16% of MCI-AD (Likelihood ratio = 4.2, p < 0.001). MCI-LB subjects scored lower on tests of attention, visuospatial function and verbal fluency. However, cognitive test scores alone did not accurately differentiate MCI-LB from MCI-AD. CONCLUSIONS MCI-LB is associated with neuropsychiatric symptoms and a cognitive profile similar to established DLB. This supports the concept of identifying MCI-LB based on the presence of core diagnostic features of DLB and abnormal FP-CIT SPECT imaging. The presence of supportive neuropsychiatric clinical features identified in the 2017 DLB diagnostic criteria was helpful in differentiating between MCI-LB and MCI-AD.
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Affiliation(s)
- Paul C Donaghy
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - John-Paul Taylor
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - John T O'Brien
- Department of Psychiatry,University of Cambridge,Cambridge,UK
| | - Nicola Barnett
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Kirsty Olsen
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Sean J Colloby
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Jim Lloyd
- Nuclear Medicine Department,Newcastle upon Tyne Hospitals NHS Foundation Trust,Newcastle upon Tyne,UK
| | - George Petrides
- Nuclear Medicine Department,Newcastle upon Tyne Hospitals NHS Foundation Trust,Newcastle upon Tyne,UK
| | - Ian G McKeith
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - Alan J Thomas
- Institute for Ageing and Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
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Donaghy PC, Firbank MJ, Thomas AJ, Lloyd J, Petrides G, Barnett N, Olsen K, O'Brien JT. Clinical and imaging correlates of amyloid deposition in dementia with Lewy bodies. Mov Disord 2018; 33:1130-1138. [PMID: 29672930 PMCID: PMC6175485 DOI: 10.1002/mds.27403] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 10/20/2017] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 01/06/2023] Open
Abstract
Background: Amyloid deposition is common in dementia with Lewy bodies, but its pathophysiological significance is unclear. Objective: The objective of this study was to investigate the relationship between amyloid deposition and clinical profile, gray matter volume, and brain perfusion in dementia with Lewy bodies. Methods: Dementia with Lewy bodies (n = 37), Alzheimer's disease (n = 20), and controls (n = 20) underwent a thorough clinical assessment, 3T MRI, and early‐ and late‐phase 18F‐Florbetapir PET‐CT to assess cortical perfusion and amyloid deposition, respectively. Amyloid scans were visually categorized as positive or negative. Image analysis was carried out using statistical parametric mapping (SPM) 8. Results: There were no significant differences between amyloid‐positive and amyloid‐negative dementia with Lewy bodies cases in age (P = .78), overall cognitive impairment (P = .83), level of functional impairment (P = .80), or any other clinical or cognitive scale. There were also no significant differences in hippocampal or gray matter volumes. However, amyloid‐positive dementia with Lewy bodies cases had lower medial temporal lobe perfusion (P = .03) than amyloid‐negative cases, although a combination of medial temporal lobe perfusion, hippocampal volume, and cognitive measures was unable to accurately predict amyloid status in dementia with Lewy bodies. Conclusions: Amyloid deposition was not associated with differences in clinical or neuropsychological profiles in dementia with Lewy bodies, but was associated with imaging evidence of medial temporal lobe dysfunction. The presence of amyloid in dementia with Lewy bodies cannot be identified on the basis of clinical and other imaging features and will require direct assessment via PET imaging or CSF. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Paul C Donaghy
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Michael J Firbank
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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King E, O'Brien JT, Donaghy P, Morris C, Barnett N, Olsen K, Martin-Ruiz C, Taylor JP, Thomas AJ. Peripheral inflammation in prodromal Alzheimer's and Lewy body dementias. J Neurol Neurosurg Psychiatry 2018; 89:339-345. [PMID: 29248892 PMCID: PMC5869446 DOI: 10.1136/jnnp-2017-317134] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES There is growing evidence for the role of systemic inflammation in Alzheimer's disease (AD) and other neurodegenerative diseases; however the systemic inflammatory profile in dementia with Lewy bodies (DLB) has never before been investigated. This study aimed to characterise systemic inflammatory mediators in established DLB and AD, as well as in their prodromal, mild cognitive impairment (MCI) phases. METHODS We obtained plasma samples from patients with DLB (n=37), AD (n=20), MCI with DLB profile (n=38), MCI with AD profile (n=20) and healthy control subjects (n=20). The following inflammatory biomarkers were measured using Roche cobas c702 and Meso Scale Discovery V-Plex Plus: high-sensitivity C-reactive protein, interferon-gamma, interleukin (IL)-10, IL-12p70, IL-13, IL-1beta, IL-2, IL-4, IL-6, IL-8 and tumour necrosis factor-alpha. RESULTS We found significantly higher levels of IL-10, IL-1beta, IL-4 and IL-2 in both MCI groups (P<0.001), while there was no significant difference in inflammatory markers between dementia groups and controls. Furthermore, increased disease severity was associated with lower levels of IL-1beta, IL-2 and IL-4 (P<0.05). INTERPRETATION We have shown for the first time that in both DLB and AD, increased peripheral inflammation occurs early at the MCI disease stages. These data support a role for inflammation early in the disease process, and have important implications for the stage of disease where trials of anti-inflammatory medication should be focused.
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Affiliation(s)
- Eleanor King
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John Tiernan O'Brien
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Donaghy
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Carmen Martin-Ruiz
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Donaghy PC, Barnett N, Olsen K, Taylor JP, McKeith IG, O'Brien JT, Thomas AJ. Symptoms associated with Lewy body disease in mild cognitive impairment. Int J Geriatr Psychiatry 2017; 32:1163-1171. [PMID: 28556415 DOI: 10.1002/gps.4742] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 12/19/2016] [Accepted: 04/19/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Dementia with Lewy bodies (DLB) is associated with a range of cognitive and non-cognitive symptoms. We aimed to identify if some of these symptoms might aid early diagnosis of Lewy body disease in cases of mild cognitive impairment (MCI). METHODS Lewy body MCI (MCI-LB; n = 36), Alzheimer's disease MCI (MCI-AD; n = 21), DLB (n = 36), AD (n = 21) and control (n = 20) participants were recruited. An interview-based questionnaire about the presence of symptoms thought to be associated with Lewy body disease was completed by participants with, where possible, their carer/relative. The prevalence of each symptom was compared between MCI-LB and MCI-AD and between established DLB and AD, and a symptom scale based on these findings was devised. RESULTS Fluctuating concentration/attention; episodes of confusion; muscle rigidity; changes in hand-writing, gait and posture; falls; drooling; weak voice; symptoms of REM sleep behaviour disorder (RBD) and misjudging objects were more common in MCI-LB compared with MCI-AD, and also in DLB compared with AD. Hyposmia, tremor, slowness and autonomic symptoms were not specific to Lewy body disease. REM sleep behaviour disorder and hyposmia were reported to develop several years prior to the onset of cognitive symptoms in Lewy body disease. A 10-point symptom scale differentiated between MCI-LB and MCI-AD with a sensitivity of 83% and a specificity of 100%. CONCLUSIONS Drooling, misjudging objects and symptoms related to parkinsonism, fluctuating cognition and RBD may be the most characteristic symptoms of MCI-LB. Slowness, tremor, autonomic symptoms and hyposmia are all common in MCI-LB but are not specific to the disease. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paul C Donaghy
- Institute for Ageing and Institute of Neuroscience, Newcastle University, UK
| | - Nicola Barnett
- Institute for Ageing and Institute of Neuroscience, Newcastle University, UK
| | - Kirsty Olsen
- Institute for Ageing and Institute of Neuroscience, Newcastle University, UK
| | - John-Paul Taylor
- Institute for Ageing and Institute of Neuroscience, Newcastle University, UK
| | - Ian G McKeith
- Institute for Ageing and Institute of Neuroscience, Newcastle University, UK
| | | | - Alan J Thomas
- Institute for Ageing and Institute of Neuroscience, Newcastle University, UK
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Barnett N, Taras J, Moharir M, Cole M, Ford-Jones L, Levin L. Speech and Language Support- How Physicians Can Seek and Treat Speech and Language Delays in the Office Setting. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.24ac] [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: 11/14/2022] Open
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Taylor JP, Firbank MJ, He J, Barnett N, Pearce S, Livingstone A, Vuong Q, McKeith IG, O’Brien JT. Visual cortex in dementia with Lewy bodies: magnetic resonance imaging study. Br J Psychiatry 2012; 200:491-8. [PMID: 22500014 PMCID: PMC3365275 DOI: 10.1192/bjp.bp.111.099432] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Visual hallucinations and visuoperceptual deficits are common in dementia with Lewy bodies, suggesting that cortical visual function may be abnormal. AIMS To investigate: (1) cortical visual function using functional magnetic resonance imaging (fMRI); and (2) the nature and severity of perfusion deficits in visual areas using arterial spin labelling (ASL)-MRI. METHOD In total, 17 participants with dementia with Lewy bodies (DLB group) and 19 similarly aged controls were presented with simple visual stimuli (checkerboard, moving dots, and objects) during fMRI and subsequently underwent ASL-MRI (DLB group n = 15, control group n = 19). RESULTS Functional activations were evident in visual areas in both the DLB and control groups in response to checkerboard and objects stimuli but reduced visual area V5/MT (middle temporal) activation occurred in the DLB group in response to motion stimuli. Posterior cortical perfusion deficits occurred in the DLB group, particularly in higher visual areas. CONCLUSIONS Higher visual areas, particularly occipito-parietal, appear abnormal in dementia with Lewy bodies, while there is a preservation of function in lower visual areas (V1 and V2/3).
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Affiliation(s)
- John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, UK.
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Taylor JP, Firbank M, Barnett N, Pearce S, Livingstone A, Mosimann U, Eyre J, McKeith IG, O'Brien JT. Visual hallucinations in dementia with Lewy bodies: transcranial magnetic stimulation study. Br J Psychiatry 2011; 199:492-500. [PMID: 22016436 PMCID: PMC3227808 DOI: 10.1192/bjp.bp.110.090373] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/09/2011] [Accepted: 06/16/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aetiology of visual hallucinations is poorly understood in dementia with Lewy bodies. Pathological alterations in visual cortical excitability may be one contributory mechanism. AIMS To determine visual cortical excitability in people with dementia with Lewy bodies compared with aged-matched controls and also the relationship between visual cortical excitability and visual hallucinations in dementia with Lewy bodies. METHOD Visual cortical excitability was determined by using transcranial magnetic stimulation (TMS) applied to the occiput to elicit phosphenes (transient subjective visual responses) in 21 patients with dementia with Lewy bodies and 19 age-matched controls. RESULTS Phosphene parameters were similar between both groups. However, in the patients with dementia with Lewy bodies, TMS measures of visual cortical excitability correlated strongly with the severity of visual hallucinations (P = 0.005). Six patients with dementia with Lewy bodies experienced visual hallucination-like phosphenes (for example, seeing people or figures on stimulation) compared with none of the controls (P = 0.02). CONCLUSIONS Increased visual cortical excitability in dementia with Lewy bodies does not appear to explain visual hallucinations but it may be a marker for their severity.
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Affiliation(s)
- John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
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Barnett N, Nightingale A, Maggs T, Needs M, Williams E, Curran D, Mamode N. High anti-A titres may not preclude ABO-incompatible renal transplantation: an autoantibody could be the culprit. Nephrol Dial Transplant 2010; 25:3794-6. [DOI: 10.1093/ndt/gfq451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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McKinnon H, Miller S, Barnett N, McGregor K, Mallinson D, Davidson-Smith H, Bennett J, Davis H, Black D. MS536 IMPORTANCE OF NON-HUMAN PRIMATES IN PRE-CLINICAL EVALUATION OF LXR AGONISTS. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)71036-9] [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: 10/19/2022]
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Torrealday O, Stein LAR, Barnett N, Golembeske C, Lebeau R, Colby SM, Monti PM. Validation of the Marijuana Effect Expectancy Questionnaire-Brief. J Child Adolesc Subst Abuse 2008; 17:1-17. [PMID: 22058648 DOI: 10.1080/15470650802231861] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to evaluate a brief version of the Marijuana Effect Expectancy Questionnaire (MEEQ; Schafer & Brown, 1991). The original MEEQ was reduced to 6 items (MEEQ-B). Principal component analysis (PCA) was performed and two factors were identified (positive effects and negative effects) accounting for 52.3% of the variance. Internal consistencies (0.42 to 0.60) were slightly lower than those of the original MEEQ. The negative effect expectancy scale correlated with criterion variables that assess marijuana use (p ≤ .05). This measure is a helpful tool for clinicians to use when assessing youth expectancies. Replication across different samples of adjudicated youth is recommended.
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Affiliation(s)
- O Torrealday
- O. Torrealday, PhD, is Director, Office of Clinical Services, Juvenile Court of Memphis and Shelby County, Memphis, TN. L. A. R. Stein, PhD, is Assistant Professor, Cancer Prevention Research Center and Psychology Department, University of Rhode Island, Kingston, RI; and Rhode Island Training Institute, Cranston, RI. N. Barnett, PhD, is affiliated with the Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University, Providence, RI. C. Golembeske, PhD, is affiliated with the Rhode Island Training School, Cranston, RI. R. Lebeau, MPH, PhD, is affiliated with the Cancer Prevention Research Center, University of Rhode Island, Kingston, RI. S. M. Colby, PhD, is affiliated with the Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University, Providence, RI. P. M. Monti, PhD, is affiliated with the Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University, Providence, RI; and Providence VA Medical Center, Providence, RI
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Abstract
PROBLEM Medication management in the NHS has been highlighted by the UK Department of Health as an area for improvement. Pharmacist participation on post-take (post-admission) ward rounds was shown to reduce medication errors and reduced prescribing costs in the USA and in UK teaching hospitals, which can contribute to improved medication management. We sought to demonstrate the problem in our hospital by collecting data on prescribing practice from three consecutive general medical post-take ward rounds. SETTING Northwick Park Hospital, a district general hospital in north-west London, which provides acute medical services to a population of 300,000. STRATEGY FOR CHANGE A pharmacist was invited to become a member of the post-take ward round team that reviewed medical patients admitted within the preceding 24 hours. Patients also continued to receive care from a ward based pharmacist. Patient notes were analysed for cost of drugs on admission and discharge, discrepancies between admission drug history and pharmacist history, number of admission drugs stopped before discharge, and pharmacist recommendations. Pharmacist recommendations and actions were classified using a National Patient Safety Agency risk matrix. EFFECTS OF CHANGE Discrepancies between the admission and the pharmacist derived drug history were noted in 26 of 50 in the pre-intervention group and 52 of 53 in the intervention group. The annual drug cost per patient following discharge increased by pounds 181 in the pre-intervention group and by pounds 122 in the intervention group. Five pre-admission drugs were stopped in three pre-intervention patients saving pounds 276 per annum, while the 42 drugs stopped in 19 intervention patients saved pounds 4699 per annum. No ward based pharmacist recommendations were recorded in the pre-intervention group. Recommendations regarding drug choice, dose, and need for drug treatment were most common; 58 minor, 48 moderate and four major risks to patients were potentially avoided. LESSONS LEARNT The presence of a pharmacist on a post-take ward round improved the accuracy of drug history documentation, reduced prescribing costs, and decreased the potential risk to patients in our hospital. As a result of this work a full time pharmacist has now been funded to attend daily post-take ward rounds on a permanent basis.
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Barnett N, Hanafiah Z. A response to ?Lymphocyte contamination of laryngoscope blades ? a possible vector for transmission of variant Creutzfeldt-Jakob disease? Anaesthesia 2005; 60:1158-9; author reply 1159. [PMID: 16229718 DOI: 10.1111/j.1365-2044.2005.04426.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Curry CJ, Airheart C, Barnett N, Tartaglia M. 307 NOONAN SYNDROME AND CUTANEOUS FINDINGS WITHOUT A PTPN11 MUTATION? NOONAN SYNDROME II. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-307] [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: 11/04/2022]
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Abstract
Concerns that partnership in care was not really working brought about the need to establish new documentation. A written management plan of care which actively involves the child and family to identify the partnership in care component is essential. Integration of medical and nursing history forms the basic assessment for a jointly managed plan of care. A major culture change needed to be managed to ensure more purposeful and effective communication within the nursing team. The balance of power for nursing care delivery has shifted away from the children's nurse towards the child/parent/carer. The Blackburn PINC model has provided the structures to ensure partnership in care is a reality. Ongoing development and evaluation in response to nursing and parent comments ensures that the process is responsive to current needs.
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Affiliation(s)
- E Kenyon
- Paediatric Unit, Royal Infirmary, Blackburn, Lancashire.
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Peach H, Barnett N. Does smoking contribute to community acquired pneumonia? Aust Fam Physician 2001; 30:10. [PMID: 11211703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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