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Yao CW, Fiamingo G, Lacourse K, Frenette S, Postuma RB, Montplaisir JY, Lina JM, Carrier J. Technical challenges in REM sleep microstructure classification: A study of patients with REM sleep behaviour disorder. J Sleep Res 2024:e14208. [PMID: 38606675 DOI: 10.1111/jsr.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
While commonly treated as a uniform state in practice, rapid eye movement sleep contains two distinct microstructures-phasic (presence of rapid eye movement) and tonic (no rapid eye movement). This study aims to identify technical challenges during rapid eye movement sleep microstructure visual classification in patients with rapid eye movement sleep behaviour disorder, and to propose solutions to enhance reliability between scorers. Fifty-seven sleep recordings were randomly allocated into three subsequent batches (n = 10, 13 and 34) for scoring. To reduce single-centre bias, we recruited three raters/scorers, with each trained from a different institution. Two raters independently scored each 30-s rapid eye movement sleep into 10 × fSEM3-s phasic/tonic microstructures based on the AASM guidelines. The third rater acted as an "arbitrator" to resolve opposite opinions persisting during the revision between batches. Besides interrater differences in artefact rejection rate, interrater variance frequently occurred due to transitioning between microstructures and moderate-to-severe muscular/electrode artefact interference. To enhance interrater agreement, a rapid eye movement scoring schematic graph was developed, incorporating proxy electrode use, filters and cut-offs for microstructure transitioning. To assess potential effectiveness of the schematic graph proposed, raters were instructed to systematically apply it in scoring for the third batch. Of the 34 recordings, 27 reached a Cohen's kappa score above 0.8 (i.e. almost perfect agreement between raters), significantly improved from the prior batches (p = 0.0003, Kruskal-Wallis test). Our study illustrated potential solutions and guidance for challenges that may be encountered during rapid eye movement sleep microstructure classification.
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Affiliation(s)
- C William Yao
- Psychology Department, Université de Montréal, Montréal, Québec, Canada
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
| | - Giuseppe Fiamingo
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Karine Lacourse
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
| | - Sonia Frenette
- Psychology Department, Université de Montréal, Montréal, Québec, Canada
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill, Montréal, Québec, Canada
- McGill University Health Center, Montréal, Québec, Canada
| | - Jacques Y Montplaisir
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
- Department Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill, Montréal, Québec, Canada
- McGill University Health Center, Montréal, Québec, Canada
- Department of Electrical Engineering, École de Technologie Supérieure, Montréal, Québec, Canada
- Centre de Recherches Mathématiques, Université de Montréal, Montréal, Québec, Canada
| | - Julie Carrier
- Psychology Department, Université de Montréal, Montréal, Québec, Canada
- Center for Advanced Research in Sleep Medicine, Research center of the CIUSS du Nord-de-l'Ile-de-Montréal Montréal, Montréal, Québec, Canada
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2
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Pagano G, Taylor KI, Anzures Cabrera J, Simuni T, Marek K, Postuma RB, Pavese N, Stocchi F, Brockmann K, Svoboda H, Trundell D, Monnet A, Doody R, Fontoura P, Kerchner GA, Brundin P, Nikolcheva T, Bonni A. Prasinezumab slows motor progression in rapidly progressing early-stage Parkinson's disease. Nat Med 2024; 30:1096-1103. [PMID: 38622249 PMCID: PMC11031390 DOI: 10.1038/s41591-024-02886-y] [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: 06/30/2023] [Accepted: 02/23/2024] [Indexed: 04/17/2024]
Abstract
Prasinezumab, a monoclonal antibody that binds aggregated α-synuclein, is being investigated as a potential disease-modifying therapy in early-stage Parkinson's disease. Although in the PASADENA phase 2 study, the primary endpoint (Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) sum of Parts I + II + III) was not met, prasinezumab-treated individuals exhibited slower progression of motor signs than placebo-treated participants (MDS-UPDRS Part III). We report here an exploratory analysis assessing whether prasinezumab showed greater benefits on motor signs progression in prespecified subgroups with faster motor progression. Prasinezumab's potential effects on disease progression were assessed in four prespecified and six exploratory subpopulations of PASADENA: use of monoamine oxidase B inhibitors at baseline (yes versus no); Hoehn and Yahr stage (2 versus 1); rapid eye movement sleep behavior disorder (yes versus no); data-driven subphenotypes (diffuse malignant versus nondiffuse malignant); age at baseline (≥60 years versus <60 years); sex (male versus female); disease duration (>12 months versus <12 months); age at diagnosis (≥60 years versus <60 years); motor subphenotypes (akinetic-rigid versus tremor-dominant); and motor subphenotypes (postural instability gait dysfunction versus tremor-dominant). In these subpopulations, the effect of prasinezumab on slowing motor signs progression (MDS-UPDRS Part III) was greater in the rapidly progressing subpopulations (for example, participants who were diffuse malignant or taking monoamine oxidase B inhibitors at baseline). This exploratory analysis suggests that, in a trial of 1-year duration, prasinezumab might reduce motor progression to a greater extent in individuals with more rapidly progressing Parkinson's disease. However, because this was a post hoc analysis, additional randomized clinical trials are needed to validate these findings.
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Affiliation(s)
- Gennaro Pagano
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland.
- University of Exeter Medical School, London, UK.
| | - Kirsten I Taylor
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland
| | | | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Fabrizio Stocchi
- The Institute for Research and Medical Care (IRCCS) San Raffaele Pisana, University San Raffaele Roma, Rome, Italy
| | - Kathrin Brockmann
- Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Hanno Svoboda
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland
- Roche Diagnostics GmbH, Penzberg, Germany
| | | | | | | | | | - Geoffrey A Kerchner
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland
| | - Patrik Brundin
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland
| | | | - Azad Bonni
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland
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Hernandez J, Lina JM, Dubé J, Lafrenière A, Gagnon JF, Montplaisir JY, Postuma RB, Carrier J. EEG rhythmic and arrhythmic spectral components and functional connectivity at resting state may predict the development of synucleinopathies in idiopathic REM sleep behavior disorder. Sleep 2024:zsae074. [PMID: 38497896 DOI: 10.1093/sleep/zsae074] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 03/19/2024] Open
Abstract
STUDY OBJECTIVES Idiopathic/isolated REM-sleep behavior disorder (iRBD) often precedes the onset of synucleinopathies. Here, we investigated whether baseline resting-state EEG advanced spectral power and functional connectivity differ between iRBD patients who converted towards a synucleinopathy at follow-up and those who did not. METHODS Eighty-one participants with iRBD (66.89±6.91 years) underwent a baseline resting-state EEG recording, a neuropsychological assessment and a neurological examination. We estimated EEG power spectral density using standard analyses and derived spectral estimates of rhythmic and arrhythmic components. Global and pairwise EEG functional connectivity analyses were computed using the weighted phase-lag index (wPLI). Pixel-based permutation tests were used to compare groups. RESULTS After a mean follow-up of 5.01±2.76 years, 34 patients were diagnosed with a synucleinopathy (67.81±7.34 years) and 47 remained disease-free (65.53±7.09 years). Among patients who converted, 22 were diagnosed with Parkinson's disease and 12 with dementia with Lewy bodies. As compared to patients who did not convert, patients who converted exhibited at baseline higher relative theta standard power, steeper slopes of the arrhythmic component and higher theta rhythmic power mostly in occipital regions. Furthermore, patients who converted showed higher beta global wPLI but lower alpha wPLI between left temporal and occipital regions. CONCLUSION Analyses of resting-state EEG rhythmic and arrhythmic components and functional connectivity suggest an imbalanced excitatory-to-inhibitory activity within large-scale networks, which is associated with later development of a synucleinopathy in iRBD patients.
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Affiliation(s)
- J Hernandez
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of Neuroscience, Université de Montréal, Montreal, Canada
| | - J-M Lina
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- École de technologie supérieure, Montreal Canada
| | - J Dubé
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - A Lafrenière
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - J-F Gagnon
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - J-Y Montplaisir
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of psychiatry, Université de Montréal, Montreal, Canada
| | - R B Postuma
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, Canada
| | - J Carrier
- Center for Advanced Research in Sleep Medicine, Research center, CIUSSS du Nord de l'Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Kulcsarova K, Skorvanek M, Postuma RB, Berg D. Defining Parkinson's Disease: Past and Future. J Parkinsons Dis 2024:JPD230411. [PMID: 38489197 DOI: 10.3233/jpd-230411] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Parkinson's disease (PD) is the second most common still relentlessly progressive neurodegenerative disorder with a long period in which the pathophysiological process is already spreading but cardinal motor symptoms are not present. This review outlines the major developments and milestones in our understanding of PD that have shaped the way we define this disorder. Past criteria and definitions of PD have been based on clinical motor manifestations enabling diagnosis of the disease only in later symptomatic stages. Nevertheless, with advancing knowledge of disease pathophysiology and aim of early disease detection, a major shift of the diagnostic paradigm is being advocated towards a biological definition similar to other neurodegenerative disorders including Alzheimer's disease and Huntington's disease, with the ultimate goal of an earlier, disease course modifying therapy. We summarize the major pillars of this possible approach including in vivo detection of neuronal α-synuclein aggregation, neurodegeneration and genetics and outline their possible application in different contexts of use in the frame of biological PD definition.
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Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, P. J. Safarik University, Kosice, Slovak Republic
- Department of Neurology, L. Pasteur University Hospital, Kosice, Slovak Republic
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, P. J. Safarik University, Kosice, Slovak Republic
| | - Matej Skorvanek
- Department of Neurology, P. J. Safarik University, Kosice, Slovak Republic
- Department of Neurology, L. Pasteur University Hospital, Kosice, Slovak Republic
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Daniela Berg
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Kiel, Germany
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Zolfaghari S, Postuma RB. Author Response: Effects of Season and Daylight Saving Time Shifts on Sleep Symptoms: Canadian Longitudinal Study on Aging. Neurology 2024; 102:e209233. [PMID: 38315964 DOI: 10.1212/wnl.0000000000209233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
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Šubert M, Novotný M, Tykalová T, Hlavnička J, Dušek P, Růžička E, Škrabal D, Pelletier A, Postuma RB, Montplaisir J, Gagnon JF, Galbiati A, Ferini-Strambi L, Marelli S, St Louis EK, Timm PC, Teigen LN, Janzen A, Oertel W, Heim B, Holzknecht E, Stefani A, Högl B, Dauvilliers Y, Evangelista E, Šonka K, Rusz J. Spoken Language Alterations can Predict Phenoconversion in Isolated Rapid Eye Movement Sleep Behavior Disorder: A Multicenter Study. Ann Neurol 2024; 95:530-543. [PMID: 37997483 DOI: 10.1002/ana.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE This study assessed the relationship between speech and language impairment and outcome in a multicenter cohort of isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS Patients with iRBD from 7 centers speaking Czech, English, German, French, and Italian languages underwent a detailed speech assessment at baseline. Story-tale narratives were transcribed and linguistically annotated using fully automated methods based on automatic speech recognition and natural language processing algorithms, leading to the 3 distinctive linguistic and 2 acoustic patterns of language deterioration and associated composite indexes of their overall severity. Patients were then prospectively followed and received assessments for parkinsonism or dementia during follow-up. The Cox proportional hazard was performed to evaluate the predictive value of language patterns for phenoconversion over a follow-up period of 5 years. RESULTS Of 180 patients free of parkinsonism or dementia, 156 provided follow-up information. After a mean follow-up of 2.7 years, 42 (26.9%) patients developed neurodegenerative disease. Patients with higher severity of linguistic abnormalities (hazard ratio [HR = 2.35]) and acoustic abnormalities (HR = 1.92) were more likely to develop a defined neurodegenerative disease, with converters having lower content richness (HR = 1.74), slower articulation rate (HR = 1.58), and prolonged pauses (HR = 1.46). Dementia-first (n = 16) and parkinsonism-first with mild cognitive impairment (n = 9) converters had higher severity of linguistic abnormalities than parkinsonism-first with normal cognition converters (n = 17). INTERPRETATION Automated language analysis might provide a predictor of phenoconversion from iRBD into synucleinopathy subtypes with cognitive impairment, and thus can be used to stratify patients for neuroprotective trials. ANN NEUROL 2024;95:530-543.
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Affiliation(s)
- Martin Šubert
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Tereza Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jan Hlavnička
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dominik Škrabal
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Amelie Pelletier
- Department of Neurology, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Department of Neurology, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Andrea Galbiati
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
- Department of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
- Department of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Sara Marelli
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Research Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Research Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
| | - Luke N Teigen
- Mayo Center for Sleep Medicine, and Sleep Behavior and Neurophysiology Research Laboratory, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
| | - Annette Janzen
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Wolfgang Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Wake Disorder Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM, University of Montpellier, Montpellier, France
| | - Elisa Evangelista
- National Reference Network for Narcolepsy, Sleep-Wake Disorder Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM, University of Montpellier, Montpellier, France
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Neurology & ARTORG Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Marras C, Fereshtehnejad SM, Berg D, Bohnen NI, Dujardin K, Erro R, Espay AJ, Halliday G, Van Hilten JJ, Hu MT, Jeon B, Klein C, Leentjens AFG, Mollenhauer B, Postuma RB, Rodríguez-Violante M, Simuni T, Weintraub D, Lawton M, Mestre TA. Transitioning from Subtyping to Precision Medicine in Parkinson's Disease: A Purpose-Driven Approach. Mov Disord 2024; 39:462-471. [PMID: 38243775 DOI: 10.1002/mds.29708] [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: 09/21/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
The International Parkinson and Movement Disorder Society (MDS) created a task force (TF) to provide a critical overview of the Parkinson's disease (PD) subtyping field and develop a guidance on future research in PD subtypes. Based on a literature review, we previously concluded that PD subtyping requires an ultimate alignment with principles of precision medicine, and consequently novel approaches were needed to describe heterogeneity at the individual patient level. In this manuscript, we present a novel purpose-driven framework for subtype research as a guidance to clinicians and researchers when proposing to develop, evaluate, or use PD subtypes. Using a formal consensus methodology, we determined that the key purposes of PD subtyping are: (1) to predict disease progression, for both the development of therapies (use in clinical trials) and prognosis counseling, (2) to predict response to treatments, and (3) to identify therapeutic targets for disease modification. For each purpose, we describe the desired product and the research required for its development. Given the current state of knowledge and data resources, we see purpose-driven subtyping as a pragmatic and necessary step on the way to precision medicine. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Connie Marras
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Nicolaas I Bohnen
- Departments of Radiology & Neurology, University of Michigan, University of Michigan Udall Center, Ann Arbor, Michigan, USA
| | - Kathy Dujardin
- Center of Excellence for Parkinson's Disease, CHU Lille, Univ Lille, Inserm, Lille Neuroscience & Cognition, Lille, France
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Glenda Halliday
- Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jacobus J Van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Oxford University and John Radcliffe Hospital, West Wing, Neurology Department, Level 3, Oxford, United Kingdom
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Department of Neurology, University Medical Center Goettingen, Kassel, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tiago A Mestre
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Research Institute, Ottawa, Ontario, Canada
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Cogné É, Postuma RB, Chasles MJ, De Roy J, Montplaisir J, Pelletier A, Rouleau I, Gagnon JF. Montreal Cognitive Assessment and the Clock Drawing Test to Identify MCI and Predict Dementia in Isolated REM Sleep Behavior Disorder. Neurology 2024; 102:e208020. [PMID: 38271662 DOI: 10.1212/wnl.0000000000208020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/03/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with isolated/idiopathic REM sleep behavior disorder (iRBD) are at high risk for developing mild cognitive impairment (MCI) and dementia with Lewy bodies (DLB). However, there is a lack of scientific knowledge regarding the accuracy of cognitive screening tools to identify these conditions in iRBD. This study aimed to determine in iRBD the psychometrics of 2 screening tests to discriminate patients with MCI and those at risk of DLB. METHODS We retrospectively selected and followed 64 patients with polysomnography-confirmed iRBD seen in sleep clinic between 2006 and 2021, 32 with MCI (mean age 68.44 years, 72% men), 32 without MCI (67.78 years, 66% men), and 32 controls (69.84 years, 47% men). Participants underwent a neurologic evaluation and neuropsychological assessment for MCI diagnosis. They also completed the Montreal Cognitive Assessment (MoCA) and Clock Drawing Test (CDT). Fifty-three patients were followed (mean of 5.10 ± 2.64 years); 6 developed DLB, and 16 developed Parkinson disease. An independent cohort of 10 patients with iRBD who later developed DLB was also recruited and followed. Receiver operating characteristic curves with area under the curve (AUC) were performed assessing the discriminant value of the MoCA and CDT. RESULTS The cut-off values that best differentiated patients who developed DLB from controls were on the MoCA total score (≤25/30 with 100% [95% CI 61%-100%] sensitivity and 78% [61%-89%] specificity, AUC = 0.888) and delayed recall (≤3/5 with 83% [44%-97%] sensitivity and 78% [61%-89%] specificity, AUC = 0.875). Both values yielded a sensitivity of 90% (60%-98%) to detect patients at risk of DLB in the independent cohort. Cutoffs that best discriminated patients with MCI from controls were: ≤25/30 (MoCA total score) with 72% [55%-84%] sensitivity, 78% [61%-89%] specificity, AUC = 0.803 and ≤2/5 (MoCA delayed recall) with 63% [45%-77%] sensitivity, 94% [80%-98%] specificity, AUC = 0.843. No acceptable optimal values were found for the CDT. DISCUSSION In iRBD, the MoCA demonstrates adequate psychometric properties to identify patients most at risk of developing DLB and to screen for MCI, whereas the CDT does not. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the MoCA, but not the CDT, is useful in screening patients with iRBD for the risk of developing DLB.
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Affiliation(s)
- Émile Cogné
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Ronald B Postuma
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Marie-Joëlle Chasles
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Jessie De Roy
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Jacques Montplaisir
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Amélie Pelletier
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Isabelle Rouleau
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
| | - Jean-François Gagnon
- From the Department of Psychology (É.C., M.-J.C., J.D.R., I.R., J.-F.G.), Université du Québec à Montréal; Centre for Advanced Research in Sleep Medicine (É.C., R.P., J.D.R., J.M., A.P., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P.), Montreal Neurological Institute; Centre de Recherche du CHUM (M.-J.C., I.R.), Montreal, and Department of Psychiatry (J.M.), Université de Montréal, Quebec, Canada
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Postuma RB. Beyond One-Size-Fits-All: Testing Insomnia Treatments in Special Populations. Ann Intern Med 2024; 177:251-252. [PMID: 38224593 DOI: 10.7326/m23-3448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Affiliation(s)
- Ronald B Postuma
- Montreal Neurological Institute and Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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10
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Zolfaghari S, Keil A, Pelletier A, Postuma RB. Sleep disorders and mortality: A prospective study in the Canadian longitudinal study on aging. Sleep Med 2024; 114:128-136. [PMID: 38183803 DOI: 10.1016/j.sleep.2023.12.023] [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] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/25/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Sleep disorders are commonly linked to various health conditions, although it remains unclear to what degree they are linked with overall mortality. We compared mortality in different self-reported sleep disorders in a large population-based prospective study. METHODS In this case-control study within the CLSA cohort, participants completed a questionnaire at baseline (2011-2015) measuring overall sleep satisfaction, daily sleep duration, sleep-onset and sleep-maintenance insomnia, daytime somnolence, REM sleep behavior disorder (RBD), restless leg syndrome (RLS), and obstructive sleep apnea (OSA). The vital status of participants was assessed in July 2019. Baseline sleep problems of participants who died (cases) were compared to those who survived (controls). For each case, five age/sex-matched controls were selected. Binary logistic regression was used to estimate the association between sleep symptoms and mortality, adjusting for age, sex, marital status, province, education, alcohol consumption, smoking, caffeine, and body mass index. In a complementary model, anxiety and depression were also added. RESULTS Among 30,097 participants at baseline, 974 deaths were reported in 2019 (60.7 % male, age = 72.3 ± 9.4 years). In the initial analysis, mortality cases reported more baseline sleep-maintenance insomnia (12.1 % vs. 8.0 %, Adjusted OR[95%CI] = 1.62[1.15,2.29]), daytime somnolence (2.4 % vs. 1.1 %, AOR = 2.70[1.34,5.44]), and higher possible RLS (16.4 % vs. 12.4 %, AOR = 1.50[1.09,2.05]). They were also more likely to screen positive for possible OSA (33.8 % vs. 24.2 %, AOR = 1.32[1.07,1.64]); however, this effect was not related to core apnea symptoms. Sleep durations exceeding 10 h/day were also associated with increased mortality (3.4 % vs. 1.9 %, AOR = 1.83[1.04,3.24]). Other sleep symptoms/disorders, such as sleep-onset insomnia (7.3 % vs. 4.3 %, AOR = 1.54 [1.00,2.37]), possible RBD (5.3 % vs. 5.1 %, AOR = 1.02[0.62,1.69]), and overall sleep dissatisfaction (26.5 % vs. 22.6 %, AOR = 1.14[0.93,1.41]) were not different among these groups. After adding anxiety and depression to the adjustment model, all differences attenuated to become statistically non-significant, except for daytime somnolence disorder. When stratified by sex, the association between sleep disorders and mortality was only observed in women, with men showing no association. DISCUSSION We confirm a relationship between numerous sleep disorders and mortality. This effect is most evident in women, and appears to be strongly related to co-existing anxiety and depression.
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Allison Keil
- Integrated Program in Neuroscience, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Canada; Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.
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11
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Cardoso F, Goetz CG, Mestre TA, Sampaio C, Adler CH, Berg D, Bloem BR, Burn DJ, Fitts MS, Gasser T, Klein C, de Tijssen MAJ, Lang AE, Lim SY, Litvan I, Meissner WG, Mollenhauer B, Okubadejo N, Okun MS, Postuma RB, Svenningsson P, Tan LCS, Tsunemi T, Wahlstrom-Helgren S, Gershanik OS, Fung VSC, Trenkwalder C. A Statement of the MDS on Biological Definition, Staging, and Classification of Parkinson's Disease. Mov Disord 2024; 39:259-266. [PMID: 38093469 DOI: 10.1002/mds.29683] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Tiago A Mestre
- Ottawa Hospital Research Institute; University of Ottawa Brain and Mind Research Institute; Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital Ottawa, Ottawa, Ontario, Canada
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Christian Albrechts-University of Kiel, Kiel, Germany
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael S Fitts
- UAB Libraries, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Marina A J de Tijssen
- Department of Neurology, Expertise Centre Movement Disorders, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France
- Univ. Bordeaux, CNRS, IMN, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center, Kassel, Germany
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Michael S Okun
- Adelaide Lackner Professor of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainsville, Florida, USA
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
| | | | | | - Taiji Tsunemi
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Oscar S Gershanik
- Movement Disorders Unit, Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
- Cognitive Neuroscience Laboratory, Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Claudia Trenkwalder
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center, Goettingen, Germany
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12
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Elliott JE, Ligman BR, Bryant-Ekstrand MD, Keil AT, Powers K, Olivo C, Neilson L, Postuma RB, Pelletier A, Gagnon JF, Gan-Or Z, Yu E, Liu L, St Louis EK, Forsberg LK, Fields JA, Ross OA, Huddleston DE, Bliwise DL, Avidan AY, Howell MJ, Schenck CH, McLeland J, Criswell SR, Videnovic A, During EH, Miglis MG, Shprecher DR, Lee-Iannotti JK, Boeve BF, Ju YES, Lim MM. Comorbid neurotrauma increases neurodegenerative-relevant cognitive, motor, and autonomic dysfunction in patients with REM sleep behavior disorder: A substudy of the North American Prodromal Synucleinopathy Consortium. Sleep 2024:zsae007. [PMID: 38181205 DOI: 10.1093/sleep/zsae007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Indexed: 01/07/2024] Open
Abstract
STUDY OBJECTIVES Rapid eye movement (REM) sleep behavior disorder (RBD) is strongly associated with phenoconversion to an overt synucleinopathy, e.g., Parkinson's disease (PD), Lewy Body Dementia (LBD), and related disorders. Comorbid traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) - henceforth "neurotrauma" (NT) - increase the odds of RBD by ~2.5-fold and is associated with an increased rate of service-connected PD in Veterans. Thus, RBD and NT are both independently associated with PD; however, it is unclear how NT influences neurological function in patients with RBD. METHODS Participants ≥18 years with overnight-polysomnogram-confirmed RBD were enrolled between 8/2018 to 4/2021 through the North American Prodromal Synucleinopathy (NAPS) Consortium. Standardized assessments for RBD, TBI, and PTSD history, as well as cognitive, motor, sensory and autonomic function were completed. This cross-sectional analysis compared cases (n=24; RBD+NT) to controls (n=96; RBD), matched for age (~60 years), sex (15% female), and years of education (~15 years). RESULTS RBD+NT reported earlier RBD symptom onset (37.5±11.9 vs. 52.2±15.1 years of age) and a more severe RBD phenotype. Similarly, RBD+NT reported more severe anxiety and depression, greater frequency of hypertension, and significantly worse cognitive, motor, and autonomic function compared to RBD. No differences in olfaction or color vision were observed. CONCLUSION This cross-sectional, matched case:control study shows individuals with RBD+NT have significantly worse neurological measures related to common features of an overt synucleinopathy. Confirmatory longitudinal studies are ongoing; however, these results suggest RBD+NT may be associated with more advanced neurological symptoms related to an evolving neurodegenerative process.
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Affiliation(s)
- Jonathan E Elliott
- VA Portland Health Care System, Research Service, Portland, OR, USA
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
| | | | | | - Allison T Keil
- VA Portland Health Care System, Research Service, Portland, OR, USA
- McGill University, Montreal Neurological Institute and Department of Neurology and Neurosurgery, Montréal, Québec, Canada
| | - Katherine Powers
- VA Portland Health Care System, Research Service, Portland, OR, USA
| | - Cosette Olivo
- VA Portland Health Care System, Research Service, Portland, OR, USA
| | - Lee Neilson
- VA Portland Health Care System, Research Service, Portland, OR, USA
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
| | - Ronald B Postuma
- McGill University, Montreal Neurological Institute and Department of Neurology and Neurosurgery, Montréal, Québec, Canada
- Université du Québec à Montréal, Département of Psychology, Montréal, Québec, Canada
- Hôpital du Sacré-Coeur de Montréal, Center for Advanced Research in Sleep Medicine, Montréal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Hôpital du Sacré-Coeur de Montréal, Center for Advanced Research in Sleep Medicine, Montréal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Université du Québec à Montréal, Département of Psychology, Montréal, Québec, Canada
- Hôpital du Sacré-Coeur de Montréal, Center for Advanced Research in Sleep Medicine, Montréal, Quebec, Canada
| | - Ziv Gan-Or
- McGill University, Montreal Neurological Institute and Department of Neurology and Neurosurgery, Montréal, Québec, Canada
- McGill University, Department of Human Genetics, Montréal, Québec, Canada
| | - Eric Yu
- McGill University, Montreal Neurological Institute and Department of Neurology and Neurosurgery, Montréal, Québec, Canada
- McGill University, Department of Human Genetics, Montréal, Québec, Canada
| | - Lang Liu
- McGill University, Montreal Neurological Institute and Department of Neurology and Neurosurgery, Montréal, Québec, Canada
- McGill University, Department of Human Genetics, Montréal, Québec, Canada
| | | | | | | | - Owen A Ross
- Mayo Clinic, Neurology and Medicine, Rochester, MN, USA
| | | | | | - Alon Y Avidan
- University of California Los Angeles, Neurology, Sleep Disorders Center, Los Angeles, CA, USA
| | - Michael J Howell
- University of Minnesota Medical Center, Neurology, Minneapolis, MN, USA
- Hennepin County Medical Center, Minnesota Regional Sleep Disorders Center, Minneapolis, MN, USA
| | - Carlos H Schenck
- University of Minnesota Medical Center, Neurology, Minneapolis, MN, USA
| | | | | | - Aleksandar Videnovic
- Massachusetts General Hospital, Movement Disorders Unit, Division of Sleep Medicine, Boston, MA, USA
- Harvard Medical School, Neurological Clinical Research Institute, Boston, MA, USA
| | - Emmanuel H During
- Stanford University, Psychiatry and Behavioral Sciences, Redwood City, CA, USA
- Stanford University, Neurology & Neurological Sciences, Palo Alto, CA, USA
- Mt Sinai School of Medicine, Neurology, New York, NY, USA
| | - Mitchell G Miglis
- Stanford University, Psychiatry and Behavioral Sciences, Redwood City, CA, USA
- Stanford University, Neurology & Neurological Sciences, Palo Alto, CA, USA
| | | | | | | | - Yo-El S Ju
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Miranda M Lim
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
- Oregon Health & Science University, Department of Behavioral Neuroscience; Department of Pulmonary and Critical Care Medicine; Oregon Institute of Occupational Health Sciences, Portland, OR, USA
- VA Portland Health Care System, Mental Illness Research Education and Clinical Center; Neurology; National Center for Rehabilitative Auditory Research, Portland, OR, USA
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Joza S, Hu MT, Jung K, Kunz D, Arnaldi D, Lee J, Ferini‐Strambi L, Antelmi E, Sixel‐Döring F, De Cock VC, Montplaisir JY, Welch J, Kim H, Bes F, Mattioli P, Woo KA, Marelli S, Plazzi G, Mollenhauer B, Pelletier A, Razzaque J, Sunwoo J, Girtler N, Trenkwalder C, Gagnon J, Postuma RB. Prodromal dementia with Lewy bodies in REM sleep behavior disorder: A multicenter study. Alzheimers Dement 2024; 20:91-102. [PMID: 37461299 PMCID: PMC10917000 DOI: 10.1002/alz.13386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/21/2023] [Accepted: 06/12/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) is a powerful early predictor of dementia with Lewy bodies (DLB) and Parkinson's disease (PD). This provides an opportunity to directly observe the evolution of prodromal DLB and to identify which cognitive variables are the strongest predictors of evolving dementia. METHODS IRBD participants (n = 754) from 10 centers of the International RBD Study Group underwent annual neuropsychological assessment. Competing risk regression analysis determined optimal predictors of dementia. Linear mixed-effect models determined the annual progression of neuropsychological testing. RESULTS Reduced attention and executive function, particularly performance on the Trail Making Test Part B, were the strongest identifiers of early DLB. In phenoconverters, the onset of cognitive decline began up to 10 years prior to phenoconversion. Changes in verbal memory best differentiated between DLB and PD subtypes. DISCUSSION In iRBD, attention and executive dysfunction strongly predict dementia and begin declining several years prior to phenoconversion. HIGHLIGHTS Cognitive decline in iRBD begins up to 10 years prior to phenoconversion. Attention and executive dysfunction are the strongest predictors of dementia in iRBD. Decline in episodic memory best distinguished dementia-first from parkinsonism-first phenoconversion.
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Affiliation(s)
- Stephen Joza
- Department of NeurologyMontreal Neurological InstituteMontrealCanada
| | - Michele T. Hu
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - Ki‐Young Jung
- Department of Neurology, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Dieter Kunz
- Clinic for Sleep & ChronomedicineSt. Hedwig‐KrankenhausBerlinGermany
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical NeurologyUniversity of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Jee‐Young Lee
- Department of NeurologySeoul National University College of MedicineSeoul Metropolitan Government‐Seoul National University Boramae Medical CenterSeoulSouth Korea
| | | | - Elena Antelmi
- DIMI Department of Engineering and Medicine of InnovationUniversity of VeronaVeronaItaly
| | - Friederike Sixel‐Döring
- Department of Neurology and Section on Clinical NeurosciencePhilipps University MarburgMarburgGermany
- Paracelsus Elena KlinikCentre for Movement DisordersKasselGermany
| | - Valérie Cochen De Cock
- EuroMov Digital Health in MotionUniversity of MontpellierIMT Mines AlesMontpellierFrance
- Department of Neurology and SleepBeau Soleil ClinicMontpellierFrance
| | - Jacques Y. Montplaisir
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontréalQuebecCanada
| | - Jessica Welch
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - Han‐Joon Kim
- Department of Neurology, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Frederik Bes
- Clinic for Sleep & ChronomedicineSt. Hedwig‐KrankenhausBerlinGermany
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical NeurologyUniversity of GenoaGenoaItaly
| | - Kyung Ah Woo
- Department of NeurologySeoul National University College of MedicineSeoul Metropolitan Government‐Seoul National University Boramae Medical CenterSeoulSouth Korea
| | - Sara Marelli
- Sleep Disorders CenterVita‐Salute San Raffaele UniversityMilanItaly
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio‐EmiliaModenaItaly
| | - Brit Mollenhauer
- Department of Neurology and Section on Clinical NeurosciencePhilipps University MarburgMarburgGermany
- Paracelsus Elena KlinikCentre for Movement DisordersKasselGermany
| | - Amelie Pelletier
- Department of NeurologyMontreal Neurological InstituteMontrealCanada
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
| | - Jamil Razzaque
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - Jun‐Sang Sunwoo
- Department of NeurologyKangbuk Samsung HospitalSeoulRepublic of Korea
| | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical NeurologyUniversity of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Claudia Trenkwalder
- Paracelsus Elena KlinikCentre for Movement DisordersKasselGermany
- Department of NeurosurgeryUniversity Medical Center GoettingenGöttingenGermany
| | - Jean‐François Gagnon
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontréalQuebecCanada
| | - Ronald B. Postuma
- Department of NeurologyMontreal Neurological InstituteMontrealCanada
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
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Cristini J, Potvin-Desrochers A, Seo F, Dagher A, Postuma RB, Rosa-Neto P, Carrier J, Amara AW, Steib S, Paquette C, Roig M. The Effect of Different Types of Exercise on Sleep Quality and Architecture in Parkinson Disease: A Single-Blinded Randomized Clinical Trial Protocol. Phys Ther 2024; 104:pzad073. [PMID: 37354450 PMCID: PMC10776310 DOI: 10.1093/ptj/pzad073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/17/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES The purpose of this trial is to (1) determine the best exercise modality to improve sleep quality and sleep architecture in people with Parkinson disease (PD); (2) investigate whether exercise-induced improvements in sleep mediate enhancements in motor and cognitive function as well as other non-motor symptoms of PD; and (3) explore if changes in systemic inflammation after exercise mediate improvements in sleep. METHODS This is a multi-site, superiority, single-blinded randomized controlled trial. One hundred fifty persons with PD and sleep problems will be recruited and randomly allocated into 4 intervention arms. Participants will be allocated into 12 weeks of either cardiovascular training, resistance training, multimodal training, or a waiting list control intervention. Assessments will be conducted at baseline, immediately after each intervention, and 8 weeks after each intervention by blinded assessors. Objective sleep quality and sleep architecture will be measured with polysomnography and electroencephalography. Motor and cognitive function will be assessed with the Unified PD Rating Scale and the Scale for Outcomes in PD-Cognition, respectively. Subjective sleep quality, fatigue, psychosocial functioning, and quality of life will be assessed with questionnaires. The concentration of inflammatory biomarkers in blood serum will be assessed with enzyme-linked immunosorbent assays. IMPACT This study will investigate the effect of different types of exercise on sleep quality and architecture in PD, exploring interactions between changes in sleep quality and architecture with motor and cognitive function and other non-motor symptoms of the disease as well as mechanistic interactions between systemic inflammation and sleep. The results will provide important practical information to guide physical therapists and other rehabilitation professionals in the selection of exercise and the design of more personalized exercise-based treatments aimed at optimizing sleep, motor, and cognitive function in people with PD.
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Affiliation(s)
- Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
| | - Alexandra Potvin-Desrochers
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
- Department of Kinesiology & Physical Education, McGill University, Montreal, Québec, Canada
- Human Brain Control of Locomotion Laboratory, McGill University, Montreal, Québec, Canada
| | - Freddie Seo
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, Québec, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Québec, Canada
| | - Ronald B Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Québec, Canada
| | - Pedro Rosa-Neto
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Québec, Canada
| | - Julie Carrier
- Département de Psychologie, Université de Montréal, Montreal, Québec, Canada
- Centre d'Études Avancées en Médecine du Sommeil (CÉAMS), Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada
| | - Amy W Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Simon Steib
- Department of Exercise, Training and Active Aging, Institute of Sport and Sport Science, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Caroline Paquette
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
- Department of Kinesiology & Physical Education, McGill University, Montreal, Québec, Canada
- Human Brain Control of Locomotion Laboratory, McGill University, Montreal, Québec, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
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15
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Wickens RH, Postuma RB, de Villers-Sidani É, Pelletier A, Blinder S, Gagnon JF, Soucy JP, Montplaisir J, Bedard MA. Increased brain cholinergic innervation in isolated REM sleep behaviour disorder from prodromal multiple system atrophy. Parkinsonism Relat Disord 2023; 117:105923. [PMID: 37939636 DOI: 10.1016/j.parkreldis.2023.105923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Rebekah H Wickens
- NeuroQAM Research Center, Université du Québec à Montréal (UQAM), Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute (MNI), Montreal, QC, Canada.
| | - Ronald B Postuma
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | - Amélie Pelletier
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Stephan Blinder
- McConnell Brain Imaging Centre, Montreal Neurological Institute (MNI), Montreal, QC, Canada; PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Jean-François Gagnon
- NeuroQAM Research Center, Université du Québec à Montréal (UQAM), Montreal, QC, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- McConnell Brain Imaging Centre, Montreal Neurological Institute (MNI), Montreal, QC, Canada; PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Marc-André Bedard
- NeuroQAM Research Center, Université du Québec à Montréal (UQAM), Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute (MNI), Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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16
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Senkevich K, Pelletier A, Sato C, Liu L, Keil A, Gan-Or Z, Lang AE, Postuma RB, Rogaeva E. DNA Methylation Age Acceleration as a Potential Biomarker for Early Onset of Rapid Eye Movement Sleep Behavior Disorder. Ann Neurol 2023. [PMID: 37794693 DOI: 10.1002/ana.26811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
Rapid eye movement sleep behavior disorder (RBD) is the strongest prodromal marker for α-synucleinopathies. The Horvath DNA methylation age (DNAm-age) is an epigenetic clock reflecting biological aging. We found an association of DNAm-age acceleration with RBD age at onset at baseline (N = 162, B = -0.68, standard error [SE] = 0.12, p = 2.59e-08) and follow-up (n = 45, B = -1.07, SE = 0.21, p = 9.73e-06). The result remained similar after accounting for genetic risk factors (eg, RBD polygenic risk score). On average, RBD patients with faster versus slow/normal epigenetic aging had a 5.2-year earlier phenoconversion, and the Cox regression analysis revealed a trend toward significance (n = 53, hazard ratio = 1.05, 95% confidence interval = 0.99-1.11, p = 0.06). Our findings suggest that DNAm-age acceleration is a potential biomarker for earlier RBD onset. ANN NEUROL 2023.
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Affiliation(s)
- Konstantin Senkevich
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Amélie Pelletier
- Center for Advanced Studies in Sleep Medicine, Montreal Sacre Coeur Hospital, Montreal, QC, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Lang Liu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Allison Keil
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Anthony E Lang
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, ON, Canada
- Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ronald B Postuma
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Center for Advanced Studies in Sleep Medicine, Montreal Sacre Coeur Hospital, Montreal, QC, Canada
- Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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17
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Joza S, Iranzo A, Stefani A, Pelletier A, Serradell M, Muñoz‐Lopetegi A, Ibrahim A, Holzknecht E, Montplaisir JY, Mayà G, Santamaria J, Gaig C, Bergmann M, Brandauer E, Högl B, Gagnon J, Postuma RB. Is REM Sleep Behavior Disorder Changing? Secular Changes Versus Referral Patterns. Mov Disord Clin Pract 2023; 10:1519-1524. [PMID: 37868932 PMCID: PMC10585963 DOI: 10.1002/mdc3.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background Since 2014, there has been increasing public outreach effort regarding isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) in Montreal. Objective To assess if, over time, milder iRBD cases are presenting earlier. Methods Disease-free survival was compared in two iRBD recruitment epochs: 2004 to 2013 ("earlier") versus 2014to 2022 ("later") and by referral type ("self-referral" vs. "conventional-referral") in three large centers. Results In Montreal, among 209 subjects followed prospectively, shorter time to phenoconversion was observed in the earlier epoch (5-year phenoconversion = 42% earlier vs. 23% later); diagnosis before 2014 had a 1.8-fold phenoconversion hazard. However, no difference was observed in 248 subjects from Barcelona and 166 from Innsbruck. Analysis of Montreal data found that increased survival in the later epoch was driven by an increasing number of self-referrals, who phenoconverted at 1/3 the rate of physician-referred subjects. Conclusions Increased patient awareness of iRBD results in earlier presentation to clinical attention, with a longer time to phenoconversion.
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Affiliation(s)
- Stephen Joza
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
| | - Alex Iranzo
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Ambra Stefani
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Amelie Pelletier
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
| | - Monica Serradell
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Amaia Muñoz‐Lopetegi
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Abubaker Ibrahim
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Evi Holzknecht
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Jacques Y. Montplaisir
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Gerard Mayà
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Joan Santamaria
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Carles Gaig
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Melanie Bergmann
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Birgit Högl
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Jean‐François Gagnon
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Ronald B. Postuma
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
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18
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Jackson H, Anzures-Cabrera J, Simuni T, Postuma RB, Marek K, Pagano G. Identifying prodromal symptoms at high specificity for Parkinson's disease. Front Aging Neurosci 2023; 15:1232387. [PMID: 37810617 PMCID: PMC10556459 DOI: 10.3389/fnagi.2023.1232387] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction To test drugs with the potential to prevent the onset of Parkinson's disease (PD), it is key to identify individuals in the general population at high risk of developing PD. This is often difficult because most of the clinical markers are non-specific, common in PD but also common in older adults (e.g., sleep problems). Objective We aimed to identify the clinical markers at high specificity for developing PD by comparing individuals with PD or prodromal PD to healthy controls. Methods We investigated motor and non-motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale Part 1 and 2 items) in 64 prodromal PD and 422 PD individuals calculating the odds ratios, adjusting for age and gender, for PD and prodromal PD versus 195 healthy controls. Symptoms at high specificity were defined as having an adjusted odds ratio ≥ 6. Results Constipation had an adjusted odds ratio, 6.14 [95% CI: 2.94-12.80] showing high specificity for prodromal PD, and speech difficulties had an adjusted odds ratio, 9.61 [95% CI: 7.88-48.81] showing high specificity for PD. The proportion of participants showing these specific markers was moderate (e.g., prevalence of constipation was 43.75% in prodromal PD, and speech difficulties was 33.89% in PD), suggesting these symptoms may make robust predictors of prodromal PD and PD, respectively. Discussion Clinical markers at high specificity for developing PD could be used as tools in the screening of general populations to identify individuals at higher risk of developing PD.
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Affiliation(s)
- Holly Jackson
- Roche Products Ltd, Welwyn Garden City, United Kingdom
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ronald B. Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, United States
| | - Gennaro Pagano
- Roche Pharma Research and Early Development (pRED), Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, Basel, Switzerland
- University of Exeter Medical School, London, United Kingdom
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19
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Yu E, Krohn L, Ruskey JA, Asayesh F, Spiegelman D, Shah Z, Chia R, Arnulf I, Hu MTM, Montplaisir JY, Gagnon J, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Heidbreder A, Sonka K, Dusek P, Kemlink D, Oertel W, Janzen A, Plazzi G, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel‐Döring F, Cochen De Cock V, Ferini‐Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Rouleau GA, Postuma RB, Scholz SW, Gan‐Or Z. HLA in isolated REM sleep behavior disorder and Lewy body dementia. Ann Clin Transl Neurol 2023; 10:1682-1687. [PMID: 37401389 PMCID: PMC10502660 DOI: 10.1002/acn3.51841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
Synucleinopathies-related disorders such as Lewy body dementia (LBD) and isolated/idiopathic REM sleep behavior disorder (iRBD) have been associated with neuroinflammation. In this study, we examined whether the human leukocyte antigen (HLA) locus plays a role in iRBD and LBD. In iRBD, HLA-DRB1*11:01 was the only allele passing FDR correction (OR = 1.57, 95% CI = 1.27-1.93, p = 2.70e-05). We also discovered associations between iRBD and HLA-DRB1 70D (OR = 1.26, 95%CI = 1.12-1.41, p = 8.76e-05), 70Q (OR = 0.81, 95%CI = 0.72-0.91, p = 3.65e-04) and 71R (OR = 1.21, 95%CI = 1.08-1.35, p = 1.35e-03). Position 71 (pomnibus = 0.00102) and 70 (pomnibus = 0.00125) were associated with iRBD. Our results suggest that the HLA locus may have different roles across synucleinopathies.
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Affiliation(s)
- Eric Yu
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
| | - Lynne Krohn
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
| | - Jennifer A. Ruskey
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Farnaz Asayesh
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Dan Spiegelman
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Zalak Shah
- Neurodegenerative Diseases Research UnitNational Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
| | - Ruth Chia
- Neuromuscular Diseases Research SectionNational Institute on AgingBethesdaMarylandUSA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière HospitalParis Brain Institute and Sorbonne UniversityParisFrance
| | - Michele T. M. Hu
- Oxford Parkinson's Disease Centre (OPDC)University of OxfordOxfordUK
- Division of Neurology, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Jacques Y. Montplaisir
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
- Department of PsychiatryUniversité de MontréalMontréalQuébecCanada
| | - Jean‐François Gagnon
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
- Department of PsychologyUniversité du Québec à MontréalMontréalQuébecCanada
| | - Alex Desautels
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
- Department of NeurosciencesUniversité de MontréalMontréalQuébecCanada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui‐de‐Chauliac Hospital, CHU MontpellierUniversity of Montpellier, Inserm U1061MontpellierFrance
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
- Department of Medicine (DAME)University of UdineUdineItaly
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
- Department of Medicine (DAME)University of UdineUdineItaly
| | - Francesco Janes
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of NeurosciencesUniversity Hospital of UdineUdineItaly
| | - Birgit Högl
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department for Sleep Medicine and Neuromuscular diseaseUniversity Hospital MuensterMuensterGermany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, First Faculty of Medicine and General University HospitalPragueCzech Republic
| | - Petr Dusek
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, First Faculty of Medicine and General University HospitalPragueCzech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical NeuroscienceCharles University, First Faculty of Medicine and General University HospitalPragueCzech Republic
| | | | - Annette Janzen
- Department of NeurologyPhilipps UniversityMarburgGermany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio‐EmiliaModenaItaly
- IRCCS, Institute of Neurological Sciences of BolognaBolognaItaly
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research CenterUniversity of CagliariCagliariItaly
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research CenterUniversity of CagliariCagliariItaly
| | - Brit Mollenhauer
- Paracelsus‐Elena‐KlinikKasselGermany
- Department of NeurosurgeryUniversity Medical Centre GöttingenGöttingenGermany
| | - Claudia Trenkwalder
- Paracelsus‐Elena‐KlinikKasselGermany
- Department of NeurosurgeryUniversity Medical Centre GöttingenGöttingenGermany
| | - Friederike Sixel‐Döring
- Department of NeurologyPhilipps UniversityMarburgGermany
- Paracelsus‐Elena‐KlinikKasselGermany
| | - Valérie Cochen De Cock
- Sleep and Neurology UnitBeau Soleil ClinicMontpellierFrance
- EuroMov Digital Health in MotionUniversity of Montpellier IMT Mines AlesMontpellierFrance
| | - Luigi Ferini‐Strambi
- Department of Neurological SciencesUniversità Vita‐Salute San RaffaeleMilanItaly
| | - Femke Dijkstra
- Laboratory for Sleep DisordersSt. Dimpna Regional HospitalGeelBelgium
- Department of NeurologySt. Dimpna Regional HospitalGeelBelgium
- Department of NeurologyUniversity Hospital AntwerpEdegemAntwerpBelgium
| | - Mineke Viaene
- Laboratory for Sleep DisordersSt. Dimpna Regional HospitalGeelBelgium
- Department of NeurologySt. Dimpna Regional HospitalGeelBelgium
| | - Beatriz Abril
- Sleep disorder UnitCarémeau Hospital, University Hospital of NîmesNîmesFrance
| | | | - Guy A. Rouleau
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
| | - Ronald B. Postuma
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
- Center for Advanced Research in Sleep MedicineCentre Intégré Universitaire de Santé et de Services Sociaux du Nord‐de‐l'Île‐de‐Montréal – Hôpital du Sacré‐Coeur de MontréalMontréalQuébecCanada
| | | | - Sonja W. Scholz
- Neurodegenerative Diseases Research UnitNational Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
- Department of NeurologyJohns Hopkins University Medical CenterBaltimoreMarylandUSA
| | - Ziv Gan‐Or
- Department of Human GeneticsMcGill UniversityMontréalQuébecCanada
- The Neuro (Montréal Neurological Institute‐Hospital)McGill UniversityMontréalQuébecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontréalQuébecCanada
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Rahayel S, Tremblay C, Vo A, Misic B, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Gagnon JF, Postuma RB, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Hansen AK, Monchi O, Gan-Or Z, Dagher A. Mitochondrial function-associated genes underlie cortical atrophy in prodromal synucleinopathies. Brain 2023; 146:3301-3318. [PMID: 36826230 PMCID: PMC10393413 DOI: 10.1093/brain/awad044] [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: 09/20/2022] [Revised: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Isolated rapid eye movement sleep behaviour disorder (iRBD) is a sleep disorder characterized by the loss of rapid eye movement sleep muscle atonia and the appearance of abnormal movements and vocalizations during rapid eye movement sleep. It is a strong marker of incipient synucleinopathy such as dementia with Lewy bodies and Parkinson's disease. Patients with iRBD already show brain changes that are reminiscent of manifest synucleinopathies including brain atrophy. However, the mechanisms underlying the development of this atrophy remain poorly understood. In this study, we performed cutting-edge imaging transcriptomics and comprehensive spatial mapping analyses in a multicentric cohort of 171 polysomnography-confirmed iRBD patients [67.7 ± 6.6 (49-87) years; 83% men] and 238 healthy controls [66.6 ± 7.9 (41-88) years; 77% men] with T1-weighted MRI to investigate the gene expression and connectivity patterns associated with changes in cortical thickness and surface area in iRBD. Partial least squares regression was performed to identify the gene expression patterns underlying cortical changes in iRBD. Gene set enrichment analysis and virtual histology were then done to assess the biological processes, cellular components, human disease gene terms, and cell types enriched in these gene expression patterns. We then used structural and functional neighbourhood analyses to assess whether the atrophy patterns in iRBD were constrained by the brain's structural and functional connectome. Moreover, we used comprehensive spatial mapping analyses to assess the specific neurotransmitter systems, functional networks, cytoarchitectonic classes, and cognitive brain systems associated with cortical changes in iRBD. All comparisons were tested against null models that preserved spatial autocorrelation between brain regions and compared to Alzheimer's disease to assess the specificity of findings to synucleinopathies. We found that genes involved in mitochondrial function and macroautophagy were the strongest contributors to the cortical thinning occurring in iRBD. Moreover, we demonstrated that cortical thinning was constrained by the brain's structural and functional connectome and that it mapped onto specific networks involved in motor and planning functions. In contrast with cortical thickness, changes in cortical surface area were related to distinct genes, namely genes involved in the inflammatory response, and to different spatial mapping patterns. The gene expression and connectivity patterns associated with iRBD were all distinct from those observed in Alzheimer's disease. In summary, this study demonstrates that the development of brain atrophy in synucleinopathies is constrained by specific genes and networks.
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Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
| | - Christina Tremblay
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Andrew Vo
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Bratislav Misic
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Stéphane Lehéricy
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Isabelle Arnulf
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Marie Vidailhet
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Jean-Christophe Corvol
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal H2X 3P2, Canada
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Neurology, Montreal General Hospital, Montreal H3G 1A4, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Psychiatry, University of Montreal, Montreal H3T 1J4, Canada
| | - Simon Lewis
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Elie Matar
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
- Department of Kinesiology, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
- Department of Radiology, Radio-Oncology, and Nuclear Medicine, University of Montreal, Montreal H3T 1A4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
- Department of Human Genetics, McGill University, Montreal H3A 0C7, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
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Madge V, Fonov VS, Xiao Y, Zou L, Jackson C, Postuma RB, Dagher A, Fon EA, Collins DL. A dataset of multi-contrast unbiased average MRI templates of a Parkinson's disease population. Data Brief 2023; 48:109141. [PMID: 37213552 PMCID: PMC10197003 DOI: 10.1016/j.dib.2023.109141] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/23/2023] Open
Abstract
Parkinson's disease (PD) is a complex neurodegenerative disorder affecting regions such as the substantia nigra (SN), red nucleus (RN) and locus coeruleus (LC). Processing MRI data from patients with PD requires anatomical structural references for spatial normalization and structural segmentation. Extending our previous work, we present multi-contrast unbiased MRI templates using nine 3T MRI modalities: T1w, T2*w, T1-T2* fusion, R2*, T2w, PDw, fluid-attenuated inversion recovery (FLAIR), susceptibility-weighted imaging, and neuromelanin-sensitive MRI (NM). One mm isotropic voxel size templates were created, along with 0.5 mm isotropic whole brain templates and 0.3 mm isotropic templates of the midbrain. All templates were created from 126 PD patients (44 female; ages=40-87), and 17 healthy controls (13 female; ages=39-84), except the NM template, which was created from 85 PD patients and 13 controls, respectively. The dataset is available on the NIST MNI Repository via the following link: http://nist.mni.mcgill.ca/multi-contrast-pd126-and-ctrl17-templates/. The data is also available on NITRC at the following link: https://www.nitrc.org/projects/pd126/.
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Affiliation(s)
- Victoria Madge
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Corresponding authors.
| | - Vladimir S Fonov
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Lucy Zou
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Courtney Jackson
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Ronald B Postuma
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Edward A Fon
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - D Louis Collins
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Corresponding authors.
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Zolfaghari S, Cyr M, Pelletier A, Postuma RB. Effects of Season and Daylight Savings Time Shifts on Sleep Symptoms: Canadian Longitudinal Study on Aging. Neurology 2023:WNL.0000000000207342. [PMID: 37137725 DOI: 10.1212/wnl.0000000000207342] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/09/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There has been conflicting evidence regarding the association between seasonal changes and daylight-savings time and sleep disorders. This topic is of current particular interest, as the United States and Canada are considering the elimination of seasonal clock changes. The aim of this study is to compare sleep symptoms among participants who were interviewed in different seasons, and before/after the transition into daylight saving time (DST) and standard time (ST). METHODS 30,097 people aged 45-85 years taking part in the Canadian Longitudinal Study on Aging (CLSA) were studied. Participants completed a questionnaire on sleep duration, satisfaction, sleep-onset insomnia, sleep-maintenance insomnia, and hypersomnolence symptoms. Sleep disorders were compared between participants who were interviewed during different seasons and at different times of the year (DST/ST). Data was analyzed using Chi Square, ANOVA, binary logistic, and linear regression tests. RESULTS Among participants interviewed in different seasons, we found no difference in dissatisfaction with sleep, sleep-onset, sleep-maintenance, and hypersomnolence. Those interviewed in summer had slightly shorter sleep duration compared to winter (6.76±1.2 vs. 6.84±1.3 hours). Participants interviewed one week before versus one week after DST transition showed no difference in sleep symptoms, except for a 9-minute decrease in sleep duration a week after transition. However, those who were interviewed a week after transition to ST compared to a week before reported more dissatisfaction with sleep (28% vs. 22.6%, adjusted odds ratio [95%CI]=1.34 [1.02,1.76]), higher sleep-onset insomnia (7.1% vs. 3.3%, AOR=2.26 [1.19,4.27]), higher sleep-maintenance insomnia (12.9% vs. 8.2%, AOR=1.64 [1.02,2.66]), and more hypersomnolence with adequate sleep (7.3% vs. 3.6%, AOR=2.08 [1.14,3.79]. DISCUSSION We found small seasonal variations in sleep duration but no difference in other sleep symptoms. The transition from DST to ST was associated with a transient increase in sleep disorders.
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Mariève Cyr
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Ronald B Postuma
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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23
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Rahayel S, Postuma RB, Gagnon JF. Cholinergic Nucleus 4 Degeneration in Isolated Rapid Eye Movement Sleep Behavior Disorder: One Piece of the Puzzle. Mov Disord 2023; 38:913-914. [PMID: 37303096 DOI: 10.1002/mds.29400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
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24
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Yu E, Krohn L, Ruskey JA, Asayesh F, Spiegelman D, Shah Z, Chia R, Arnulf I, Hu MT, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Heidbreder A, Sonka K, Dusek P, Kemlink D, Oertel W, Janzen A, Plazzi G, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, De Cock VC, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Rouleau GA, Postuma RB, Scholz SW, Gan-Or Z. HLA in isolated REM sleep behavior disorder and Lewy body dementia. medRxiv 2023:2023.01.31.23284682. [PMID: 36778313 PMCID: PMC9915822 DOI: 10.1101/2023.01.31.23284682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and Objectives Isolated/idiopathic REM sleep behavior disorder (iRBD) and Lewy body dementia (LBD) are synucleinopathies that have partial genetic overlap with Parkinson's disease (PD). Previous studies have shown that neuroinflammation plays a substantial role in these disorders. In PD, specific residues of the human leukocyte antigen ( HLA ) were suggested to be associated with a protective effect. This study examined whether the HLA locus plays a similar role in iRBD, LBD and PD. Methods We performed HLA imputation on iRBD genotyping data (1,072 patients and 9,505 controls) and LBD whole-genome sequencing (2,604 patients and 4,032 controls) using the multi-ethnic HLA reference panel v2 from the Michigan Imputation Server. Using logistic regression, we tested the association of HLA alleles, amino acids and haplotypes with disease susceptibility. We included age, sex and the top 10 principal components as covariates. We also performed an omnibus test to examine which HLA residue positions explain the most variance. Results In iRBD, HLA-DRB1 *11:01 was the only allele passing FDR correction (OR=1.57, 95% CI=1.27-1.93, p =2.70e-05). We also discovered associations between iRBD and HLA-DRB1 70D (OR=1.26, 95%CI=1.12-1.41, p =8.76e-05), 70Q (OR=0.81, 95% CI=0.72-0.91, p =3.65e-04) and 71R (OR=1.21, 95% CI=1.08-1.35, p =1.35e-03). In HLA-DRB1 , position 71 ( p omnibus =0.00102) and 70 ( p omnibus =0.00125) were associated with iRBD. We found no association in LBD. Discussion This study identified an association between HLA-DRB1 11:01 and iRBD, distinct from the previously reported association in PD. Therefore, the HLA locus may play different roles across synucleinopathies. Additional studies are required better to understand HLA's role in iRBD and LBD.
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Affiliation(s)
- Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Jennifer A. Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Dan Spiegelman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Zalak Shah
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Ruth Chia
- Neuromuscular Diseases Research Section, National Institute on Aging, Bethesda, MD, USA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière Hospital, Paris Brain Institute and Sorbonne University, Paris, France
| | - Michele T.M. Hu
- Oxford Parkinson’s Disease Centre (OPDC), University of Oxford, Oxford, United Kingdom
- Division of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jacques Y. Montplaisir
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montreal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Universite de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Inserm U1061, Montpellier, France
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department for Sleep Medicine and Neuromuscular disease, University Hospital Muenster, Muenster, Germany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Centre Gættingen, Gottingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Centre Gættingen, Gottingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University, Marburg, Germany
- Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France
- EuroMov Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, France
| | | | - Guy A. Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Ronald B. Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal – Hopital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Sonja W. Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | | | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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25
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Postuma RB, Lang AE. The Clinical Diagnosis of Parkinson's Disease-We Are Getting Better. Mov Disord 2023; 38:515-517. [PMID: 37061881 DOI: 10.1002/mds.29319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/17/2023] Open
Affiliation(s)
- Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto, Ontario, Canada
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26
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Elliott JE, Lim MM, Keil AT, Postuma RB, Pelletier A, Gagnon J, St. Louis EK, Forsberg LK, Fields JA, Huddleston DE, Bliwise DL, Avidan AY, Howell MJ, Schenck CH, McLeland J, Criswell SR, Videnovic A, During EH, Miglis MG, Shprecher DR, Lee‐Iannotti JK, Boeve BF, Ju YS. Baseline characteristics of the North American prodromal Synucleinopathy cohort. Ann Clin Transl Neurol 2023; 10:520-535. [PMID: 36751940 PMCID: PMC10109527 DOI: 10.1002/acn3.51738] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Rapid eye movement (REM) sleep behavior disorder (RBD) is widely considered a prodromal synucleinopathy, as most with RBD develop overt synucleinopathy within ~10 years. Accordingly, RBD offers an opportunity to test potential treatments at the earliest stages of synucleinopathy. The North American Prodromal Synucleinopathy (NAPS) Consortium has created a multisite RBD participant, primarily clinic-based cohort to better understand characteristics at diagnosis, and in future work, identify predictors of phenoconversion, develop synucleinopathy biomarkers, and enable early stage clinical trial enrollment. METHODS Participants ≥18 years of age with overnight polysomnogram-confirmed RBD without Parkinson's disease, dementia, multiple system atrophy, or narcolepsy were enrolled from nine sites across North America (8/2018 to 4/2021). Data collection included family/personal history of RBD and standardized assessments of cognitive, motor, sensory, and autonomic function. RESULTS Outcomes are primarily reported based on sex (361 total: n = 295 male, n = 66 female), and secondarily based on history of antidepressant use (n = 200 with, n = 154 without; with correction for sex differences) and based on extent of synucleinopathy burden (n = 56 defined as isolated RBD, n = 305 defined as RBD+ [i.e., exhibiting ≥1 abnormality]). Overall, these participants commonly demonstrated abnormalities in global cognition (MoCA; 38%), motor function (alternate tap test; 48%), sensory (BSIT; 57%), autonomic function (orthostatic hypotension, 38.8%), and anxiety/depression (BAI and PHQ-9; 39.3% and 31%, respectively). INTERPRETATION These RBD participants, assessed with extensive history, demographic, cognitive, motor, sensory, and autonomic function demonstrated a lack of sex differences and high frequency of concomitant neurological abnormalities. These participants will be valuable for future longitudinal study and neuroprotective clinical trials.
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Affiliation(s)
- Jonathan E. Elliott
- VA Portland Health Care SystemResearch ServicePortlandOregonUSA
- Oregon Health & Science UniversityNeurology, PortlandOregonUSA
| | - Miranda M. Lim
- Oregon Health & Science UniversityNeurology, PortlandOregonUSA
- Behavioral NeuroscienceOregon Health & Science UniversityPortlandOregonUSA
- Department of Pulmonary and Critical Care MedicineOregon Health & Science UniversityPortlandOregonUSA
- Oregon Institute of Occupational Health SciencesOregon Health & Science UniversityPortlandOregonUSA
- NeurologyVA Portland Health Care SystemPortlandOregonUSA
- Mental Illness Research Education and Clinical CenterVA Portland Health Care SystemPortlandOregonUSA
- National Center for Rehabilitative Auditory ResearchVA Portland Health Care SystemPortlandOregonUSA
| | - Allison T. Keil
- VA Portland Health Care SystemResearch ServicePortlandOregonUSA
| | - Ronald B. Postuma
- Montreal Neurological InstituteMcGill UniversityMontrealQuébecCanada
- PsychologyUniversité du Québec à MontréalMontrealQuébecCanada
| | - Amelie Pelletier
- Hôpital du Sacré‐Coeur de MontréalCenter for Advanced Research in Sleep MedicineMontrealQuébecCanada
| | - Jean‐François Gagnon
- PsychologyUniversité du Québec à MontréalMontrealQuébecCanada
- Hôpital du Sacré‐Coeur de MontréalCenter for Advanced Research in Sleep MedicineMontrealQuébecCanada
| | | | | | | | | | | | - Alon Y. Avidan
- Neurology, Sleep Disorders CenterUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Michael J. Howell
- NeurologyUniversity of Minnesota Medical CenterMinneapolisMinnesotaUSA
- Hennepin County Medical Center, Minnesota Regional Sleep Disorders CenterMinneapolisMinnesotaUSA
| | - Carlos H. Schenck
- NeurologyUniversity of Minnesota Medical CenterMinneapolisMinnesotaUSA
| | | | | | - Aleksandar Videnovic
- Movement Disorders Unit, Division of Sleep MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolNeurological Clinical Research InstituteBostonMassachusettsUSA
| | - Emmanuel H. During
- Psychiatry and Behavioral SciencesStanford UniversityRedwood CityCaliforniaUSA
- Neurology & Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Mitchell G. Miglis
- Psychiatry and Behavioral SciencesStanford UniversityRedwood CityCaliforniaUSA
- Neurology & Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | | | | | | | - Yo‐El S. Ju
- Washington University School of MedicineSt. LouisMissouriUSA
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27
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Joza S, Hu MT, Jung KY, Kunz D, Stefani A, Dušek P, Terzaghi M, Arnaldi D, Videnovic A, Schiess MC, Hermann W, Lee JY, Ferini-Strambi L, Lewis SJG, Leclair-Visonneau L, Oertel WH, Antelmi E, Sixel-Döring F, Cochen De Cock V, Liguori C, Liu J, Provini F, Puligheddu M, Nicoletti A, Bassetti CLA, Bušková J, Dauvilliers Y, Ferri R, Montplaisir JY, Lawton M, Kim HJ, Bes F, Högl B, Šonka K, Fiamingo G, Pietro M, Lavadia ML, Suescun J, Woo KA, Marelli S, Ehgoetz Martens K, Janzen A, Plazzi G, Mollenhauer B, Fernandes M, Li Y, Cortelli P, Figorilli M, Cicero CE, Schaefer C, Guiraud L, Lanza G, Gagnon JF, Sunwoo JS, Ibrahim A, Girtler N, Trenkwalder C, Baldelli L, Pelletier A, Postuma RB. Progression of clinical markers in prodromal Parkinson's disease and dementia with Lewy bodies: a multicentre study. Brain 2023:7071614. [PMID: 36881989 DOI: 10.1093/brain/awad072] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/09/2023] Open
Abstract
The neurodegenerative synucleinopathies, including Parkinson's disease and dementia with Lewy bodies, are characterized by a typically lengthy prodromal period of progressive subclinical motor and non-motor manifestations. Among these, idiopathic REM sleep behavior disorder (iRBD) is a powerful early predictor of eventual phenoconversion, and therefore represents a critical opportunity to intervene with neuroprotective therapy. To inform the design of randomized trials, it is essential to study the natural progression of clinical markers during the prodromal stages of disease in order to establish optimal clinical endpoints. In this study, we combined prospective follow-up data from 28 centers of the International REM Sleep Behavior Disorder Study Group representing 12 countries. Polysomnogram-confirmed REM sleep behavior disorder subjects were assessed for prodromal Parkinson's disease using the Movement Disorder Society criteria and underwent periodic structured sleep, motor, cognitive, autonomic and olfactory testing. We used linear mixed-effect modelling to estimate annual rates of clinical marker progression stratified by disease subtype, including prodromal Parkinson's disease and prodromal dementia with Lewy bodies. In addition, we calculated sample size requirements to demonstrate slowing of progression under different anticipated treatment effects. Overall, 1160 subjects were followed over an average of 3.3 ± 2.2 years. Among clinical variables assessed continuously, motor variables tended to progress faster and required the lowest sample sizes, ranging from 151-560 per group (at 50% drug efficacy and 2-year follow-up). By contrast, cognitive, olfactory, and autonomic variables showed modest progression with higher variability, resulting in high sample sizes. The most efficient design was a time-to-event analysis using combined milestones of motor and cognitive decline, estimating 117 per group at 50% drug efficacy and 2-year trial duration. Finally, while phenoconverters showed overall greater progression than non-converters in motor, olfactory, cognitive, and certain autonomic markers, the only robust difference in progression between Parkinson's disease and dementia with Lewy bodies phenoconverters was in cognitive testing. This large multicenter study demonstrates the evolution of motor and non-motor manifestations in prodromal synucleinopathy. These findings provide optimized clinical endpoints and sample size estimates to inform future neuroprotective trials.
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Affiliation(s)
- Stephen Joza
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease Centre, University of Oxford, UK
| | - Ki-Young Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dieter Kunz
- Clinic for Sleep & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Ambra Stefani
- Medical University Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mya C Schiess
- Department of Neurology, The University of Texas Health Science Center at Houston, Texas, USA
| | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jee-Young Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Laurène Leclair-Visonneau
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France.,Nantes Université, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - Wolfgang H Oertel
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany.,Institute for Neurogenomics, Helmholtz Center for Health and Environment, München-Neuherberg, Germany
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Friederike Sixel-Döring
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany.,Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
| | - Valérie Cochen De Cock
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, 34090 Montpellier, France.,Department of Neurology and Sleep, Beau Soleil Clinic, Montpellier, France
| | - Claudio Liguori
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Monica Puligheddu
- Sleep Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandra Nicoletti
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Claudio L A Bassetti
- Department of Neurology, University Hospital Bern (Inselspital), 3010, Bern, Switzerland
| | - Jitka Bušková
- National Institute of Mental Health, Klecany, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061, Montpellier, F-34093 Cedex 5 France
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS. Via Conte Ruggero 73, 94018, Troina, Italy
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Michael Lawton
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
| | - Han-Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Frederik Bes
- Clinic for Sleep & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Birgit Högl
- Medical University Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Karel Šonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Giuseppe Fiamingo
- Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mattioli Pietro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa
| | - Maria Lorena Lavadia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessika Suescun
- Department of Neurology, The University of Texas Health Science Center at Houston, Texas, USA
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sara Marelli
- Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy
| | - Kaylena Ehgoetz Martens
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Annette Janzen
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Brit Mollenhauer
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany.,Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
| | - Mariana Fernandes
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Yuanyuan Li
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michela Figorilli
- Sleep Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Calogero Edoardo Cicero
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Carolin Schaefer
- Department of Neurology, University Hospital Bern (Inselspital), 3010, Bern, Switzerland
| | - Lily Guiraud
- Sleep Unit, Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061, Montpellier, F-34093 Cedex 5 France
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS. Via Conte Ruggero 73, 94018, Troina, Italy.,Department of Surgery and Medical-Surgical Specialties, University of Catania. Via Santa Sofia 78, 95123, Catania, Italy
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Abubaker Ibrahim
- Medical University Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical Neurology, University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Trenkwalder
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany.,Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Amelie Pelletier
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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28
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Somerville EN, Krohn L, Yu E, Rudakou U, Senkevich K, Ruskey JA, Asayesh F, Ahmad J, Spiegelman D, Dauvilliers Y, Arnulf I, Hu MT, Montplaisir JY, Gagnon JF, Desautels A, Ibrahim A, Stefani A, Hogl B, Gigli GL, Valente M, Janes F, Bernardini A, Dusek P, Sonka K, Kemlink D, Plazzi G, Antelmi E, Biscarini F, Mollenhauer B, Trenkwalder C, Sixel-Doring F, Figorilli M, Puligheddu M, De Cock VC, Ferini-Strambi L, Heibreder A, Monaca CC, Abril B, Dijkstra F, Viaene M, Boeve BF, Postuma RB, Rouleau GA, Gan-Or Z. NPC1 variants are not associated with Parkinson’s disease, REM-sleep behaviour disorder or Dementia with Lewy bodies in European cohorts. Neurobiol Aging 2023; 127:94-98. [PMID: 37032242 DOI: 10.1016/j.neurobiolaging.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
NPC1 encodes a lysosomal protein involved in cholesterol transport. Biallelic mutations in this gene may lead to Niemann-Pick disease type C (NPC), a lysosomal storage disorder. The role of NPC1 in alpha synucleinopathies is still unclear, as different genetic, clinical, and pathological studies have reported contradictory results. This study aimed to evaluate the association of NPC1 variants with the synucleinopathies Parkinson's disease (PD), dementia with Lewy bodies (DLB), and rapid eye movement-sleep behavior disorder (RBD). We analyzed common and rare variants from 3 cohorts of European descent: 1084 RBD cases and 2945 controls, 2852 PD cases and 1686 controls, and 2610 DLB cases and 1920 controls. Logistic regression models were used to assess common variants while optimal sequence Kernel association tests were used to assess rare variants, both adjusted for sex, age, and principal components. No variants were associated with any of the synucleinopathies, supporting that common and rare NPC1 variants do not play an important role in alpha synucleinopathies.
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29
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Bohn L, McFall GP, Gee M, Postuma RB, Dixon RA, Camicioli R. Dementia Risk Prediction in a Longitudinal Geriatric Parkinson's Disease Cohort: Evaluation and Application of the Montreal Parkinson Risk of Dementia Scale. Can Geriatr J 2023; 26:176-186. [PMID: 36865405 PMCID: PMC9953498 DOI: 10.5770/cgj.26.617] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Parkinson's disease (PD) increases risk for dementia and cascading adverse outcomes. The eight-item Montreal Parkinson Risk of Dementia Scale (MoPaRDS) is a rapid, in-office dementia screening tool. We examine predictive validity and other characteristics of the MoPaRDS in a geriatric PD cohort by testing a series of alternative versions and modelling risk score change trajectories. Methods Participants were 48 initially non-demented PD patients (Mage = 71.6 years, range = 65-84) from a three-year, three-wave prospective Canadian cohort study. A dementia diagnosis at Wave 3 was used to stratify two baseline groups: PD with Incipient Dementia (PDID) and PD with No Dementia (PDND). We aimed to predict dementia three years prior to diagnosis using baseline data for eight indicators that harmonized with the original report, plus education. Results Three MoPaRDS items (age, orthostatic hypotension, mild cognitive impairment [MCI]) discriminated the groups both independently and as a composite three-item scale (area under the curve [AUC] = 0.88). The eight-item MoPaRDS reliably discriminated PDID from PDND (AUC = 0.81). Education did not improve predictive validity (AUC = 0.77). Performance of the eight-item MoPaRDS varied across sex (AUCfemales = 0.91; AUCmales = 0.74), whereas the three-item configuration did not (AUCfemales = 0.88; AUCmales = 0.91). Risk scores of both configurations increased over time. Conclusions We report new data on the application of the MoPaRDS as a dementia prediction tool for a geriatric PD cohort. Results support the viability of the full MoPaRDS, and indicate that an empirically determined brief version is a promising complement.
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Affiliation(s)
- Linzy Bohn
- Department of Psychology, University of Alberta, Edmonton, AB,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB
| | - G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, AB,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB
| | - Myrlene Gee
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB
| | | | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, AB,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB
| | - Richard Camicioli
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB,Department of Medicine (Neurology), University of Alberta, Edmonton, AB
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30
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Marras C, Alcalay RN, Siderowf A, Postuma RB. Challenges in the study of individuals at risk for Parkinson disease. Handb Clin Neurol 2023; 192:219-229. [PMID: 36796944 DOI: 10.1016/b978-0-323-85538-9.00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Identifying individuals at high risk for developing neurodegenerative disease opens the possibility of conducting clinical trials that intervene at an earlier stage of neurodegeneration than has been possible to date, and in doing so hopefully improves the odds of efficacy for interventions aimed at slowing or stopping the disease process. The long prodromal phase of Parkinson disease presents opportunities and challenges to establishing cohorts of at-risk individuals. Recruiting people with genetic variants conferring increased risk and people with REM sleep behavior disorder currently constitutes the most promising strategies, but multistage screening of the general population may also be feasible capitalizing on known risk factors and prodromal features. This chapter discusses the challenges involved in identifying, recruiting, and retaining these individuals, and provides insights into possible solutions using examples from studies to date.
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Affiliation(s)
- Connie Marras
- The Edmond J Safra Program in PD, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States; Division of Movement Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal, QC, Canada
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31
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Yao CW, Szpindel A, Pelletier A, Postuma RB. Hearing impairment and development of parkinsonism and possible rapid eye movement sleep behaviour disorder: A CLSA prospective population-based study. Eur J Neurol 2023; 30:287-289. [PMID: 36103188 DOI: 10.1111/ene.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Chun W Yao
- Integrated Program in Neuroscience, McGill University, Montréal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Research Center of the Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Aliya Szpindel
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Research Center of the Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Ronald B Postuma
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
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32
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Krohn L, Heilbron K, Blauwendraat C, Reynolds RH, Yu E, Senkevich K, Rudakou U, Estiar MA, Gustavsson EK, Brolin K, Ruskey JA, Freeman K, Asayesh F, Chia R, Arnulf I, Hu MTM, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Högl B, Stefani A, Ibrahim A, Šonka K, Kemlink D, Oertel W, Janzen A, Plazzi G, Biscarini F, Antelmi E, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, Cochen De Cock V, Monaca CC, Heidbreder A, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Scholz SW, Ryten M, Bandres-Ciga S, Noyce A, Cannon P, Pihlstrøm L, Nalls MA, Singleton AB, Rouleau GA, Postuma RB, Gan-Or Z. Genome-wide association study of REM sleep behavior disorder identifies polygenic risk and brain expression effects. Nat Commun 2022; 13:7496. [PMID: 36470867 PMCID: PMC9722930 DOI: 10.1038/s41467-022-34732-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/03/2022] [Indexed: 12/11/2022] Open
Abstract
Rapid-eye movement (REM) sleep behavior disorder (RBD), enactment of dreams during REM sleep, is an early clinical symptom of alpha-synucleinopathies and defines a more severe subtype. The genetic background of RBD and its underlying mechanisms are not well understood. Here, we perform a genome-wide association study of RBD, identifying five RBD risk loci near SNCA, GBA, TMEM175, INPP5F, and SCARB2. Expression analyses highlight SNCA-AS1 and potentially SCARB2 differential expression in different brain regions in RBD, with SNCA-AS1 further supported by colocalization analyses. Polygenic risk score, pathway analysis, and genetic correlations provide further insights into RBD genetics, highlighting RBD as a unique alpha-synucleinopathy subpopulation that will allow future early intervention.
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Affiliation(s)
- Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | | | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Regina H Reynolds
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Konstantin Senkevich
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Mehrdad A Estiar
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Emil K Gustavsson
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Kajsa Brolin
- Lund University, Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund, Sweden
| | - Jennifer A Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Kathryn Freeman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
| | - Ruth Chia
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Isabelle Arnulf
- Sleep Disorders Unit, Pitié Salpêtrière Hospital, APHP-Sorbonne, Paris Brain Insitute and Sorbonne University, Paris, France
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre (OPDC), University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alex Desautels
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Institute Neuroscience Montpellier Inserm, Montpellier, France
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Centre Goettingen, Goettingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps-University, Marburg, Germany
- Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France
- EuroMov Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France
| | - Christelle Charley Monaca
- University Lille North of France, Department of Clinical Neurophysiology and Sleep Center, CHU Lille, Lille, France
| | - Anna Heidbreder
- Institute of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium
- Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, Nîmes, France
| | | | | | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Mina Ryten
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Institute of Neurology, London, UK
| | | | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mike A Nalls
- Data Tecnica International, Glen Echo, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ronald B Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada.
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montréal, QC, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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Choudhury P, Busicescu A, Lee‐Iannotti J, Rangan P, Shprecher D, Ju Y, Boeve BF, Postuma RB. Development and Validation of a clinical scale for defining RBD severity in participants of the North American Prodromal Synucleinopathy (NAPS) consortium. Alzheimers Dement 2022. [DOI: 10.1002/alz.063998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | - Yo‐El Ju
- Washington University School of Medicine St.Louis MO USA
| | | | - Ronald B Postuma
- Montreal Neurological Institute, McGill University Montreal QC Canada
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Madge V, Fonov VS, Xiao Y, Zou L, Jackson C, Postuma RB, Dagher A, Fon EA, Collins DL. Multi‐contrast unbiased MRI template of a Parkinson’s disease population. Alzheimers Dement 2022. [DOI: 10.1002/alz.066612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Victoria Madge
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | - Vladimir S Fonov
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | | | - Lucy Zou
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | - Courtney Jackson
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | - Ronald B Postuma
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | - Alain Dagher
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | - Edward A Fon
- Montreal Neurological Institute, McGill University Montreal QC Canada
| | - D Louis Collins
- Montreal Neurological Institute, McGill University Montreal QC Canada
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Zhao JL, Cross N, Yao CW, Carrier J, Postuma RB, Gosselin N, Kakinami L, Dang-Vu TT. Insomnia disorder increases the risk of subjective memory decline in middle-aged and older adults: a longitudinal analysis of the Canadian Longitudinal Study on Aging. Sleep 2022; 45:zsac176. [PMID: 35877203 PMCID: PMC9644124 DOI: 10.1093/sleep/zsac176] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/13/2022] [Indexed: 07/27/2023] Open
Abstract
STUDY OBJECTIVES To examine the longitudinal association between probable insomnia status and both subjective and objective memory decline in middle-aged and older adults. METHODS 26 363 participants, ≥45 years, completed baseline and follow-up (3 years after baseline) self-reported evaluations of sleep and memory, and neuropsychological testing in the following cognitive domains: memory, executive functions, and psychomotor speed. Participants were categorized as having probable insomnia disorder (PID), insomnia symptoms only (ISO), or no insomnia symptoms (NIS), based on sleep questionnaires. Participants were further grouped based on their sleep change over time. Prospective odds of self-reported memory worsening were assessed using logistic regression, and associations between insomnia and cognitive performance were assessed via linear mixed-effects modeling, adjusted for demographic, lifestyle, and medical factors. RESULTS An increased odds (OR 1.70; 95% CI 1.29-2.26) of self-reported memory worsening was observed for NIS participants at baseline who developed PID at follow-up compared to those who developed ISO or remained NIS. Additionally, participants whose sleep worsened from baseline to follow-up (i.e. transitioned from NIS to ISO, ISO to PID, or NIS to PID) displayed increased odds (OR 1.22; 95% CI 1.10-1.34) of subjective memory worsening at follow-up compared to those who remained insomnia-free or improved their sleep. There were no significant associations between the development of PID or worsening sleep and performance on neuropsychological tests. CONCLUSIONS These findings of an increased odds for subjective memory decline in middle-aged and older adults with insomnia disorder suggest insomnia may be an important target for early interventions addressing age-related cognitive decline.
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Affiliation(s)
| | - Nathan Cross
- Corresponding author. Nathan Cross and Thien Thanh Dang-Vu, Center for Studies in Behavioral Neurobiology and PERFORM Center, Concordia University, 7141 Sherbrooke St. West, SP 165.30, Montreal, QC, Canada. ;
| | - Chun W Yao
- Canadian Sleep and Circadian Network, Montreal, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Research Institute of McGill University Health Center, Montreal, Canada
| | - Julie Carrier
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l’Ile-de-Montréal, Montreal, Canada
- Canadian Sleep and Circadian Network, Montreal, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montreal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Ronald B Postuma
- Canadian Sleep and Circadian Network, Montreal, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montreal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University—Montreal General Hospital, Montreal, Canada
| | - Nadia Gosselin
- Canadian Sleep and Circadian Network, Montreal, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montreal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Lisa Kakinami
- PERFORM Centre, Concordia University, Montreal, Canada
- Department of Mathematics and Statistics, Concordia University, Montreal, Canada
| | - Thien Thanh Dang-Vu
- Corresponding author. Nathan Cross and Thien Thanh Dang-Vu, Center for Studies in Behavioral Neurobiology and PERFORM Center, Concordia University, 7141 Sherbrooke St. West, SP 165.30, Montreal, QC, Canada. ;
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Marrie RA, Allegretta M, Barcellos LF, Bebo B, Calabresi PA, Correale J, Davis B, De Jager PL, Gasperi C, Greenbaum C, Helme A, Hemmer B, Kanellis P, Kostich W, Landsman D, Lebrun-Frenay C, Makhani N, Munger KL, Okuda DT, Ontaneda D, Postuma RB, Quandt JA, Roman S, Saidha S, Sormani MP, Strum J, Valentine P, Walton C, Zackowski KM, Zhao Y, Tremlett H. From the prodromal stage of multiple sclerosis to disease prevention. Nat Rev Neurol 2022; 18:559-572. [PMID: 35840705 DOI: 10.1038/s41582-022-00686-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/09/2022]
Abstract
A prodrome is an early set of signs or symptoms that indicate the onset of a disease before more typical symptoms develop. Prodromal stages are well recognized in some neurological and immune-mediated diseases such as Parkinson disease, schizophrenia, type 1 diabetes mellitus and rheumatoid arthritis. Emerging evidence indicates that a prodromal stage exists in multiple sclerosis (MS), raising the possibility of intervention at this stage to delay or prevent the development of classical MS. However, much remains unclear about the prodromal stage of MS and considerable research is needed to fully characterize the prodrome and develop standardized criteria to reliably identify individuals with prodromal MS who are at high risk of progressing to a diagnosis of MS. In this Roadmap, we draw on work in other diseases to propose a disease framework for MS that incorporates the prodromal stage, and set out key steps and considerations needed in future research to fully characterize the MS prodrome, identify early disease markers and develop standardized criteria that will enable reliable identification of individuals with prodromal MS, thereby facilitating trials of interventions to slow or stop progression beyond the prodrome.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | - Lisa F Barcellos
- Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California Berkeley, Berkeley, CA, USA
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Bruce Bebo
- National Multiple Sclerosis Society, New York, NY, USA
| | - Peter A Calabresi
- Johns Hopkins University School of Medicine, Departments of Neurology, Neuroscience and Ophthalmology, Baltimore, MD, USA
| | | | - Benjamin Davis
- Multiple Sclerosis Society of Canada, Toronto, Ontario, Canada
| | - Philip L De Jager
- Multiple Sclerosis Center, Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christiane Gasperi
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Carla Greenbaum
- Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA, USA
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Pamela Kanellis
- Multiple Sclerosis Society of Canada, Toronto, Ontario, Canada
| | | | | | | | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kassandra L Munger
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Dallas, TX, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal, Quebec, Canada
| | - Jacqueline A Quandt
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Roman
- Patient representative, Vancouver, British Columbia, Canada
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | | | | | - Yinshan Zhao
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Tremlett
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
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Postuma RB. Neuroprotective Trials in REM Sleep Behavior Disorder: The Way Forward Becomes Clearer. Neurology 2022; 99:19-25. [PMID: 35970587 DOI: 10.1212/wnl.0000000000200235] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 01/02/2023] Open
Abstract
As neuroprotective therapies continue to be advanced against neurodegenerative synucleinopathies, such as Parkinson disease (PD), dementia with Lewy bodies (DLBs), and multiple system atrophy, increasing attention is turning to the prodromal stages of disease. Treatments at the prodromal stage have the compelling advantages of being applied early enough to make a meaningful difference and can be tested without confounding by symptomatic therapies used for clinical PD/DLB. As it currently stands, patients with idiopathic/isolated REM sleep behavior disorder (iRBD) represent the only large existing cohort of untreated prodromal PD/DLB that would be ready to start a clinical trial now. Several thousand patients with RBD are currently being followed in research-based clinics, and more than 80% of them will develop a full neurodegenerative synucleinopathy. Research into RBD phenoconversion rates and predictors has advanced considerably, and we are now able to generate increasingly precise estimates of progression rates, can select stratification markers to enrich trials, and are able to understand the progression and sample size implications of different primary outcome measures. This review will outline the potential for neuroprotective trials in iRBD, including the pathophysiologic mechanisms with the most promise to target in iRBD, selection criteria for inclusion, and the optimal primary trial outcome measures to choose.
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Affiliation(s)
- Ronald B Postuma
- From the Department of Neurology, McGill University, Montreal, Quebec, Canada.
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Pagano G, Taylor KI, Anzures-Cabrera J, Marchesi M, Simuni T, Marek K, Postuma RB, Pavese N, Stocchi F, Azulay JP, Mollenhauer B, López-Manzanares L, Russell DS, Boyd JT, Nicholas AP, Luquin MR, Hauser RA, Gasser T, Poewe W, Ricci B, Boulay A, Vogt A, Boess FG, Dukart J, D'Urso G, Finch R, Zanigni S, Monnet A, Pross N, Hahn A, Svoboda H, Britschgi M, Lipsmeier F, Volkova-Volkmar E, Lindemann M, Dziadek S, Holiga Š, Rukina D, Kustermann T, Kerchner GA, Fontoura P, Umbricht D, Doody R, Nikolcheva T, Bonni A. Trial of Prasinezumab in Early-Stage Parkinson's Disease. N Engl J Med 2022; 387:421-432. [PMID: 35921451 DOI: 10.1056/nejmoa2202867] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Aggregated α-synuclein plays an important role in the pathogenesis of Parkinson's disease. The monoclonal antibody prasinezumab, directed at aggregated α-synuclein, is being studied for its effect on Parkinson's disease. METHODS In this phase 2 trial, we randomly assigned participants with early-stage Parkinson's disease in a 1:1:1 ratio to receive intravenous placebo or prasinezumab at a dose of 1500 mg or 4500 mg every 4 weeks for 52 weeks. The primary end point was the change from baseline to week 52 in the sum of scores on parts I, II, and III of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS; range, 0 to 236, with higher scores indicating greater impairment). Secondary end points included the dopamine transporter levels in the putamen of the hemisphere ipsilateral to the clinically more affected side of the body, as measured by 123I-ioflupane single-photon-emission computed tomography (SPECT). RESULTS A total of 316 participants were enrolled; 105 were assigned to receive placebo, 105 to receive 1500 mg of prasinezumab, and 106 to receive 4500 mg of prasinezumab. The baseline mean MDS-UPDRS scores were 32.0 in the placebo group, 31.5 in the 1500-mg group, and 30.8 in the 4500-mg group, and mean (±SE) changes from baseline to 52 weeks were 9.4±1.2 in the placebo group, 7.4±1.2 in the 1500-mg group (difference vs. placebo, -2.0; 80% confidence interval [CI], -4.2 to 0.2; P = 0.24), and 8.8±1.2 in the 4500-mg group (difference vs. placebo, -0.6; 80% CI, -2.8 to 1.6; P = 0.72). There was no substantial difference between the active-treatment groups and the placebo group in dopamine transporter levels on SPECT. The results for most clinical secondary end points were similar in the active-treatment groups and the placebo group. Serious adverse events occurred in 6.7% of the participants in the 1500-mg group and in 7.5% of those in the 4500-mg group; infusion reactions occurred in 19.0% and 34.0%, respectively. CONCLUSIONS Prasinezumab therapy had no meaningful effect on global or imaging measures of Parkinson's disease progression as compared with placebo and was associated with infusion reactions. (Funded by F. Hoffmann-La Roche and Prothena Biosciences; PASADENA ClinicalTrials.gov number, NCT03100149.).
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Affiliation(s)
- Gennaro Pagano
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Kirsten I Taylor
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Judith Anzures-Cabrera
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Maddalena Marchesi
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Tanya Simuni
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Kenneth Marek
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Ronald B Postuma
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Nicola Pavese
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Fabrizio Stocchi
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Jean-Philippe Azulay
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Brit Mollenhauer
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Lydia López-Manzanares
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - David S Russell
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - James T Boyd
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Anthony P Nicholas
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - María R Luquin
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Robert A Hauser
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Thomas Gasser
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Werner Poewe
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Benedicte Ricci
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Anne Boulay
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Annamarie Vogt
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Frank G Boess
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Juergen Dukart
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Giulia D'Urso
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Rebecca Finch
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Stefano Zanigni
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Annabelle Monnet
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Nathalie Pross
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Andrea Hahn
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Hanno Svoboda
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Markus Britschgi
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Florian Lipsmeier
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Ekaterina Volkova-Volkmar
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Michael Lindemann
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Sebastian Dziadek
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Štefan Holiga
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Daria Rukina
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Thomas Kustermann
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Geoffrey A Kerchner
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Paulo Fontoura
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Daniel Umbricht
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Rachelle Doody
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Tania Nikolcheva
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Azad Bonni
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
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Lang AE, Siderowf AD, Macklin EA, Poewe W, Brooks DJ, Fernandez HH, Rascol O, Giladi N, Stocchi F, Tanner CM, Postuma RB, Simon DK, Tolosa E, Mollenhauer B, Cedarbaum JM, Fraser K, Xiao J, Evans KC, Graham DL, Sapir I, Inra J, Hutchison RM, Yang M, Fox T, Budd Haeberlein S, Dam T. Trial of Cinpanemab in Early Parkinson's Disease. N Engl J Med 2022; 387:408-420. [PMID: 35921450 DOI: 10.1056/nejmoa2203395] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Aggregated α-synuclein plays an important role in Parkinson's disease pathogenesis. Cinpanemab, a human-derived monoclonal antibody that binds to α-synuclein, is being evaluated as a disease-modifying treatment for Parkinson's disease. METHODS In a 52-week, multicenter, double-blind, phase 2 trial, we randomly assigned, in a 2:1:2:2 ratio, participants with early Parkinson's disease to receive intravenous infusions of placebo (control) or cinpanemab at a dose of 250 mg, 1250 mg, or 3500 mg every 4 weeks, followed by an active-treatment dose-blinded extension period for up to 112 weeks. The primary end points were the changes from baseline in the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score (range, 0 to 236, with higher scores indicating worse performance) at weeks 52 and 72. Secondary end points included MDS-UPDRS subscale scores and striatal binding as assessed on dopamine transporter single-photon-emission computed tomography (DaT-SPECT). RESULTS Of the 357 enrolled participants, 100 were assigned to the control group, 55 to the 250-mg cinpanemab group, 102 to the 1250-mg group, and 100 to the 3500-mg group. The trial was stopped after the week 72 interim analysis owing to lack of efficacy. The change to week 52 in the MDS-UPDRS score was 10.8 points in the control group, 10.5 points in the 250-mg group, 11.3 points in the 1250-mg group, and 10.9 points in the 3500-mg group (adjusted mean difference vs. control, -0.3 points [95% confidence interval {CI}, -4.9 to 4.3], P = 0.90; 0.5 points [95% CI, -3.3 to 4.3], P = 0.80; and 0.1 point [95% CI, -3.8 to 4.0], P = 0.97, respectively). The adjusted mean difference at 72 weeks between participants who received cinpanemab through 72 weeks and the pooled group of those who started cinpanemab at 52 weeks was -0.9 points (95% CI, -5.6 to 3.8) for the 250-mg dose, 0.6 points (95% CI, -3.3 to 4.4) for the 1250-mg dose, and -0.8 points (95% CI, -4.6 to 3.0) for the 3500-mg dose. Results for secondary end points were similar to those for the primary end points. DaT-SPECT imaging at week 52 showed no differences between the control group and any cinpanemab group. The most common adverse events with cinpanemab were headache, nasopharyngitis, and falls. CONCLUSIONS In participants with early Parkinson's disease, the effects of cinpanemab on clinical measures of disease progression and changes in DaT-SPECT imaging did not differ from those of placebo over a 52-week period. (Funded by Biogen; SPARK ClinicalTrials.gov number, NCT03318523.).
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Affiliation(s)
- Anthony E Lang
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Andrew D Siderowf
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Eric A Macklin
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Werner Poewe
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - David J Brooks
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Hubert H Fernandez
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Olivier Rascol
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Nir Giladi
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Fabrizio Stocchi
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Caroline M Tanner
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Ronald B Postuma
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - David K Simon
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Eduardo Tolosa
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Brit Mollenhauer
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Jesse M Cedarbaum
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Kyle Fraser
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - James Xiao
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Karleyton C Evans
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Danielle L Graham
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Inbal Sapir
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Jennifer Inra
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - R Matthew Hutchison
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Minhua Yang
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Tara Fox
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Samantha Budd Haeberlein
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
| | - Tien Dam
- From the Edmond J. Safra Program in Parkinson's Disease, University Health Network, and the University of Toronto, Toronto (A.E.L.), and the Montreal Neurological Institute, Montreal (R.B.P.); the University of Pennsylvania, Philadelphia (A.D.S.); the Biostatistics Center, Massachusetts General Hospital (E.A.M.), Beth Israel Deaconess Medical Center (D.K.S.), and Harvard Medical School (E.A.M., D.K.S.), Boston, and Biogen, Cambridge (K.F., J.X., K.C.E., D.L.G., I.S., J.I., R.M.H., M.Y., S.B.H., T.D.) - all in Massachusetts; Medizinische Universität Innsbruck, Innsbruck, Austria (W.P.); Newcastle University, Newcastle upon Tyne (D.J.B.), and Biogen, Maidenhead (T.F.) - both in the United Kingdom; Aarhus University, Aarhus, Denmark (D.J.B.); the Center for Neurological Restoration, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine - both in Cleveland (H.H.F.); Clinical Investigation Center 1436, the Departments of Clinical Pharmacology and Neurosciences, NS-PARK-French Clinical Research Infrastructure Network, NeuroToul COEN Center, INSERM, University Hospital of Toulouse, and the University of Toulouse III - both in Toulouse, France (O.R.); Tel Aviv Sourasky Medical Center, and the Sackler School of Medicine and the Sagol School of Neuroscience, Tel Aviv University - both in Tel Aviv, Israel (N.G.); University San Raffaele and IRCCS San Raffaele - both in Rome (F.S.); the University of California, San Diego, La Jolla (C.M.T.), and the San Francisco Veterans Affairs Medical Center, San Francisco (C.M.T.); the University of Barcelona, Barcelona (E.T.); the Department of Neurology, University Medical Center Göttingen, Göttingen, and Paracelsus-Elena-Klinik, Kassel - both in Germany (B.M.); and Coeruleus Clinical Sciences, Woodbridge, CT (J.M.C.)
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Lipsmeier F, Taylor KI, Postuma RB, Volkova-Volkmar E, Kilchenmann T, Mollenhauer B, Bamdadian A, Popp WL, Cheng WY, Zhang YP, Wolf D, Schjodt-Eriksen J, Boulay A, Svoboda H, Zago W, Pagano G, Lindemann M. Reliability and validity of the Roche PD Mobile Application for remote monitoring of early Parkinson's disease. Sci Rep 2022; 12:12081. [PMID: 35840753 PMCID: PMC9287320 DOI: 10.1038/s41598-022-15874-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
Digital health technologies enable remote and therefore frequent measurement of motor signs, potentially providing reliable and valid estimates of motor sign severity and progression in Parkinson’s disease (PD). The Roche PD Mobile Application v2 was developed to measure bradykinesia, bradyphrenia and speech, tremor, gait and balance. It comprises 10 smartphone active tests (with ½ tests administered daily), as well as daily passive monitoring via a smartphone and smartwatch. It was studied in 316 early-stage PD participants who performed daily active tests at home then carried a smartphone and wore a smartwatch throughout the day for passive monitoring (study NCT03100149). Here, we report baseline data. Adherence was excellent (96.29%). All pre-specified sensor features exhibited good-to-excellent test–retest reliability (median intraclass correlation coefficient = 0.9), and correlated with corresponding Movement Disorder Society–Unified Parkinson's Disease Rating Scale items (rho: 0.12–0.71). These findings demonstrate the preliminary reliability and validity of remote at-home quantification of motor sign severity with the Roche PD Mobile Application v2 in individuals with early PD.
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Affiliation(s)
- Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Kirsten I Taylor
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, QC, Canada
| | - Ekaterina Volkova-Volkmar
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Timothy Kilchenmann
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Atieh Bamdadian
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Werner L Popp
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Wei-Yi Cheng
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Yan-Ping Zhang
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Detlef Wolf
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Jens Schjodt-Eriksen
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Anne Boulay
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Hanno Svoboda
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Wagner Zago
- Prothena Biosciences Inc, South San Francisco, CA, USA
| | - Gennaro Pagano
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Michael Lindemann
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
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Rahayel S, Tremblay C, Vo A, Zheng YQ, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Gagnon JF, Postuma RB, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Hansen A, Monchi O, Misic B, Dagher A. Brain atrophy in prodromal synucleinopathy is shaped by structural connectivity and gene expression. Brain 2022; 145:3162-3178. [PMID: 35594873 DOI: 10.1093/brain/awac187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
Isolated REM sleep behaviour disorder (iRBD) is a synucleinopathy characterized by abnormal behaviours and vocalizations during REM sleep. Most iRBD patients develop dementia with Lewy bodies, Parkinson's disease, or multiple system atrophy over time. Patients with iRBD exhibit brain atrophy patterns that are reminiscent of those observed in overt synucleinopathies. However, the mechanisms linking brain atrophy to the underlying alpha-synuclein pathophysiology are poorly understood. Our objective was to investigate how the prion-like and regional vulnerability hypotheses of alpha-synuclein might explain brain atrophy in iRBD. Using a multicentric cohort of 182 polysomnography-confirmed iRBD patients who underwent T1-weighted MRI, we performed vertex-based cortical surface and deformation-based morphometry analyses to quantify brain atrophy in patients (67.8 years, 84% men) and 261 healthy controls (66.2 years, 75%) and investigated the morphological correlates of motor and cognitive functioning in iRBD. Next, we applied the agent-based Susceptible-Infected-Removed model (i.e., a computational model that simulates in silico the spread of pathologic alpha-synuclein based on structural connectivity and gene expression) and tested if it recreated atrophy in iRBD by statistically comparing simulated regional brain atrophy to the atrophy observed in patients. The impact of SNCA and GBA gene expression and brain connectivity was then evaluated by comparing the model fit to the one obtained in null models where either gene expression or connectivity was randomized. The results showed that iRBD patients present with cortical thinning and tissue deformation, which correlated with motor and cognitive functioning. Next, we found that the computational model recreated cortical thinning (r = 0.51, p = 0.0007) and tissue deformation (r = 0.52, p = 0.0005) in patients, and that the connectome's architecture along with SNCA and GBA gene expression contributed to shaping atrophy in iRBD. We further demonstrated that the full agent-based model performed better than network measures or gene expression alone in recreating the atrophy pattern in iRBD. In summary, atrophy in iRBD is extensive, correlates with motor and cognitive function, and can be recreated using the dynamics of agent-based modelling, structural connectivity, and gene expression. These findings support the concepts that both prion-like spread and regional susceptibility account for the atrophy observed in prodromal synucleinopathies. Therefore, the agent-based Susceptible-Infected-Removed model may be a useful tool for testing hypotheses underlying neurodegenerative diseases and new therapies aimed at slowing or stopping the spread of alpha-synuclein pathology.
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Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada
| | - Christina Tremblay
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Andrew Vo
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Ying-Qiu Zheng
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Stéphane Lehéricy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Isabelle Arnulf
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Marie Vidailhet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | | | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal H2X 3P2, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Neurology, Montreal General Hospital, Montreal H3G 1A4, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Psychiatry, Université de Montréal, Montreal H3 T 1J4, Canada
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Elie Matar
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia.,Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Allan Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada.,Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary T2N 4N1, Canada
| | - Bratislav Misic
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
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Sosero YL, Yu E, Estiar MA, Krohn L, Mufti K, Rudakou U, Ruskey JA, Asayesh F, Laurent SB, Spiegelman D, Trempe JF, Quinnell TG, Oscroft N, Arnulf I, Montplaisir JY, Gagnon JF, Desautels A, Dauvilliers Y, Gigli GL, Valente M, Janes F, Bernardini A, Sonka K, Kemlink D, Oertel W, Janzen A, Plazzi G, Antelmi E, Biscarini F, Figorilli M, Puligheddu M, Mollenhauer B, Trenkwalder C, Sixel-Döring F, Cochen De Cock V, Monaca CC, Heidbreder A, Ferini-Strambi L, Dijkstra F, Viaene M, Abril B, Boeve BF, Postuma RB, Rouleau GA, Ibrahim A, Stefani A, Högl B, Hu MTM, Gan-Or Z. Rare PSAP Variants and Possible Interaction with GBA in REM Sleep Behavior Disorder. J Parkinsons Dis 2022; 12:333-340. [PMID: 34690151 DOI: 10.3233/jpd-212867] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND PSAP encodes saposin C, the co-activator of glucocerebrosidase, encoded by GBA. GBA mutations are associated with idiopathic/isolated REM sleep behavior disorder (iRBD), a prodromal stage of synucleinopathy. OBJECTIVE To examine the role of PSAP mutations in iRBD. METHODS We fully sequenced PSAP and performed Optimized Sequence Kernel Association Test in 1,113 iRBD patients and 2,324 controls. We identified loss-of-function (LoF) mutations, which are very rare in PSAP, in three iRBD patients and none in controls (uncorrected p = 0.018). RESULTS Two variants were stop mutations, p.Gln260Ter and p.Glu166Ter, and one was an in-frame deletion, p.332_333del. All three mutations have a deleterious effect on saposin C, based on in silico analysis. In addition, the two carriers of p.Glu166Ter and p.332_333del mutations also carried a GBA variant, p.Arg349Ter and p.Glu326Lys, respectively. The co-occurrence of these extremely rare PSAP LoF mutations in two (0.2%) GBA variant carriers in the iRBD cohort, is unlikely to occur by chance (estimated co-occurrence in the general population based on gnomAD data is 0.00035%). Although none of the three iRBD patients with PSAP LoF mutations have phenoconverted to an overt synucleinopathy at their last follow-up, all manifested initial signs suggestive of motor dysfunction, two were diagnosed with mild cognitive impairment and all showed prodromal clinical markers other than RBD. Their probability of prodromal PD, according to the Movement Disorder Society research criteria, was 98% or more. CONCLUSION These results suggest a possible role of PSAP variants in iRBD and potential genetic interaction with GBA, which requires additional studies.
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Affiliation(s)
- Yuri L Sosero
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Eric Yu
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Mehrdad A Estiar
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Lynne Krohn
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Kheireddin Mufti
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Uladzislau Rudakou
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Farnaz Asayesh
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Sandra B Laurent
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Dan Spiegelman
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Jean-François Trempe
- Department of Pharmacology & Therapeutics and Centre de Recherche en Biologie Structurale, McGill University, Montréal, Québec, Canada
| | | | | | - Isabelle Arnulf
- Sleep Disorders Unit, Sorbonne University, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Gian Luigi Gigli
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Francesco Janes
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Department of Neurosciences, Clinical Neurology Unit, University Hospital of Udine, Udine, Italy
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Annette Janzen
- Department of Neurology, Philipps University, Marburg, Germany
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Neurosciences, Neurology Unit, Movement Disorders Division, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University, Marburg, Germany.,Paracelsus-Elena-Klinik, Kassel, Germany
| | - Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France.,EuroMov, University of Montpellier, Montpellier, France
| | - Christelle Charley Monaca
- Department of Clinical Neurophysiology and Sleep Center, University Lille North of France, CHU Lille, Lille, France
| | - Anna Heidbreder
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Femke Dijkstra
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium.,Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium.,Department of Neurology, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders, St. Dimpna Regional Hospital, Geel, Belgium.,Department of Neurology, St. Dimpna Regional Hospital, Geel, Belgium
| | - Beatriz Abril
- Sleep disorder Unit, Carémeau Hospital, University Hospital of Nîmes, France
| | | | - Ronald B Postuma
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Abubaker Ibrahim
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele T M Hu
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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Poggiolini I, Gupta V, Lawton M, Lee S, El-Turabi A, Querejeta-Coma A, Trenkwalder C, Sixel-Döring F, Foubert-Samier A, Pavy-Le Traon A, Plazzi G, Biscarini F, Montplaisir J, Gagnon JF, Postuma RB, Antelmi E, Meissner WG, Mollenhauer B, Ben-Shlomo Y, Hu MT, Parkkinen L. Diagnostic value of cerebrospinal fluid alpha-synuclein seed quantification in synucleinopathies. Brain 2022; 145:584-595. [PMID: 34894214 PMCID: PMC9014737 DOI: 10.1093/brain/awab431] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
Several studies have confirmed the α-synuclein real-time quaking-induced conversion (RT-QuIC) assay to have high sensitivity and specificity for Parkinson's disease. However, whether the assay can be used as a robust, quantitative measure to monitor disease progression, stratify different synucleinopathies and predict disease conversion in patients with idiopathic REM sleep behaviour disorder remains undetermined. The aim of this study was to assess the diagnostic value of CSF α-synuclein RT-QuIC quantitative parameters in regard to disease progression, stratification and conversion in synucleinopathies. We performed α-synuclein RT-QuIC in the CSF samples from 74 Parkinson's disease, 24 multiple system atrophy and 45 idiopathic REM sleep behaviour disorder patients alongside 55 healthy controls, analysing quantitative assay parameters in relation to clinical data. α-Synuclein RT-QuIC showed 89% sensitivity and 96% specificity for Parkinson's disease. There was no correlation between RT-QuIC quantitative parameters and Parkinson's disease clinical scores (e.g. Unified Parkinson's Disease Rating Scale motor), but RT-QuIC positivity and some quantitative parameters (e.g. Vmax) differed across the different phenotype clusters. RT-QuIC parameters also added value alongside standard clinical data in diagnosing Parkinson's disease. The sensitivity in multiple system atrophy was 75%, and CSF samples showed longer T50 and lower Vmax compared to Parkinson's disease. All RT-QuIC parameters correlated with worse clinical progression of multiple system atrophy (e.g. change in Unified Multiple System Atrophy Rating Scale). The overall sensitivity in idiopathic REM sleep behaviour disorder was 64%. In three of the four longitudinally followed idiopathic REM sleep behaviour disorder cohorts, we found around 90% sensitivity, but in one sample (DeNoPa) diagnosing idiopathic REM sleep behaviour disorder earlier from the community cases, this was much lower at 39%. During follow-up, 14 of 45 (31%) idiopathic REM sleep behaviour disorder patients converted to synucleinopathy with 9/14 (64%) of convertors showing baseline RT-QuIC positivity. In summary, our results showed that α-synuclein RT-QuIC adds value in diagnosing Parkinson's disease and may provide a way to distinguish variations within Parkinson's disease phenotype. However, the quantitative parameters did not correlate with disease severity in Parkinson's disease. The assay distinguished multiple system atrophy patients from Parkinson's disease patients and in contrast to Parkinson's disease, the quantitative parameters correlated with disease progression of multiple system atrophy. Our results also provided further evidence for α-synuclein RT-QuIC having potential as an early biomarker detecting synucleinopathy in idiopathic REM sleep behaviour disorder patients prior to conversion. Further analysis of longitudinally followed idiopathic REM sleep behaviour disorder patients is needed to better understand the relationship between α-synuclein RT-QuIC signature and the progression from prodromal to different synucleinopathies.
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Grants
- Wellcome Trust
- J-0901 Parkinson's UK
- MR/T046287/1 Medical Research Council
- EPSRC
- UKRI-MRC
- EU Horizon 2020 and Michael J. Fox Foundation
- IPMDS
- Canadian Institutes of Health Research and honoraria to serve on advisory boards for EISAI and JAZZ Pharma outside the present field of research
- Canadian Institutes in Health Research, Canada Research Chair, and National Institute on Aging
- Fonds de la Recherche en Sante
- Canadian Institute of Health Research
- The Parkinson Society of Canada
- Weston-Garfield Foundation
- Michael J. Fox Foundation and the Webster Foundation
- Takeda, Roche, Teva Neurosciences, Novartis Canada, Biogen, Boehringer Ingelheim, Theranexus, GE HealthCare, Jazz Pharmaceuticals, AbbVie, Jannsen, Otsuko, Phytopharmics and Inception Sciences
- Deutsche Forschungsgemeinschaft (DFG), EU (Horizon2020), Parkinson Fonds Deutschland, Deutsche Parkinson Vereinigung, Parkinson’s Foundation
- MRC, Wellcome Trust, NIHR and Parkinson’s UK
- Parkinson’s UK, NIHR Oxford Biomedical Research Centre, Cure Parkinson’s Trust, Lab10X, NIHR, Michael J Fox Foundation, H2020 European Union, GE Healthcare and PSP Association
- Parkinson’s UK, Weston Brain Institute and Michael J Fox Foundation
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Affiliation(s)
- Ilaria Poggiolini
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Vandana Gupta
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Michael Lawton
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
| | - Seoyun Lee
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Aadil El-Turabi
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Agustin Querejeta-Coma
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Claudia Trenkwalder
- Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
| | - Friederike Sixel-Döring
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
- Department of Neurology, Philipps-University Marburg, Germany
| | - Alexandra Foubert-Samier
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France
- Institute des Maladies Neurodégénératives, CHU Bordeaux and Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
| | - Anne Pavy-Le Traon
- French Reference Centre for MSA, University Hospital of Toulouse, Toulouse, France
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- IRCCS—Institute of the Neurological Sciences of Bologna, Bologna, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Wassilios G Meissner
- Institute des Maladies Neurodégénératives, CHU Bordeaux and Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Brit Mollenhauer
- Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Laura Parkkinen
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
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44
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Postuma RB, Pelletier A, Gagnon JF, Montplaisir J. Evolution of Prodromal Multiple System Atrophy from REM Sleep Behavior Disorder: A Descriptive Study. J Parkinsons Dis 2022; 12:983-991. [PMID: 35094998 PMCID: PMC9789475 DOI: 10.3233/jpd-213039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prodromal multiple system atrophy (MSA) has been characterized mainly by retrospective chart reviews. Direct observation and tracking of prodromal markers in MSA have been very limitedObjective:To report the baseline characteristics and evolution of prodromal markers of MSA as they were prospectively measured in patients with idiopathic/isolated REM sleep behavior disorder (iRBD)Methods:Patients with iRBD were evaluated as part of a comprehensive protocol repeated annually. The protocol included assessment of motor, sleep, psychiatric, and autonomic symptoms supplemented by motor examination, quantitative motor testing, neuropsychological examination, orthostatic blood pressure measurement, and tests of olfaction and color vision. Patients who eventually developed MSA were described and compared with those who phenoconverted to Lewy body disease (Parkinson's disease and dementia with Lewy bodies). RESULTS Of 67 phenocoverters, 4 developed MSA-P and 63 developed Lewy body disease. An additional 2 MSA-C patients were seen at baseline, already with cerebellar signs. Compared to those with Lewy body disease, those with MSA-P were younger, had less severe loss of tonic REM sleep atonia, more insomnia symptoms, and better olfaction. Clinically-evident autonomic dysfunction was not invariable in prodromal stages, often developing proximate to or after motor phenoconversion. Of the autonomic symptoms, genitourinary dysfunction was the first to develop in all cases. Olfaction and cognition remained normal throughout the prodromal and clinical disease course, in clear contrast to patients with Lewy body disease. CONCLUSION Prodromal MSA progresses rapidly, often without substantial autonomic dysfunction, and with preserved olfaction and cognition throughout its prodromal course.
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Affiliation(s)
- Ronald B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada,
Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada,Correspondence to: Dr. Ronald B. Postuma, MD, Department of Neurology, Montreal Neurological Institute, 3801 University Avenue NW107, Montreal, H3A 2B4, Canada. E-mail:
| | - Amelie Pelletier
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada,
Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Jaccques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada,
Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
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45
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Zolfaghari S, Lewandowski N, Pelletier A, Naeimi SA, Gagnon JF, Brillon-Corbeil M, Montplaisir JY, Postuma RB. Cardiovascular Risk Factors and Phenoconversion to Neurodegenerative Synucleinopathies in Idiopathic REM Sleep Behavior Disorder. J Parkinsons Dis 2022; 12:927-933. [PMID: 35001898 PMCID: PMC9789479 DOI: 10.3233/jpd-212984] [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] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Several studies have suggested that atherosclerotic diseases and diabetes may be risk factors for α-synucleinopathies. This prospective cohort study evaluated whether cardiovascular diseases and metabolic risk factors alter the rate or type of phenoconversion from idiopathic/isolated REM sleep behavior disorder (iRBD) to parkinsonism or dementia. Polysomnography-confirmed iRBD patients recruited between 2004 and 2020 were followed annually. Baseline history of cardiovascular disorders, hypertension, hypercholesterolemia, and diabetes were compared among patients who developed outcomes versus those who remained outcome-free. No atherosclerotic risk factors were associated with development of α-synucleinopathies. Patients with hypercholesterolemia were somewhat more likely to develop dementia with Lewy bodies rather than Parkinson's disease.
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Amelie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Seyed Ali Naeimi
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada,
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada,
Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Marina Brillon-Corbeil
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada,
Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Jacques Y. Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada,
Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Ronald B. Postuma
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada,
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada,Correspondence to: Dr. Ronald B. Postuma, Department of Neurology, L7-305, Montreal General Hospital, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. Tel.: +1 514 934 8026; Fax: +1 514 934 8265; E-mail:
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46
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Benatar M, Wuu J, McHutchison C, Postuma RB, Boeve BF, Petersen R, Ross CA, Rosen H, Arias JJ, Fradette S, McDermott MP, Shefner J, Stanislaw C, Abrahams S, Cosentino S, Andersen PM, Finkel RS, Granit V, Grignon AL, Rohrer JD, McMillan CT, Grossman M, Al-Chalabi A, Turner MR. Preventing amyotrophic lateral sclerosis: insights from pre-symptomatic neurodegenerative diseases. Brain 2022; 145:27-44. [PMID: 34677606 PMCID: PMC8967095 DOI: 10.1093/brain/awab404] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 06/07/2021] [Revised: 09/16/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Significant progress has been made in understanding the pre-symptomatic phase of amyotrophic lateral sclerosis. While much is still unknown, advances in other neurodegenerative diseases offer valuable insights. Indeed, it is increasingly clear that the well-recognized clinical syndromes of Alzheimer's disease, Parkinson's disease, Huntington's disease, spinal muscular atrophy and frontotemporal dementia are also each preceded by a pre-symptomatic or prodromal period of varying duration, during which the underlying disease process unfolds, with associated compensatory changes and loss of inherent system redundancy. Key insights from these diseases highlight opportunities for discovery in amyotrophic lateral sclerosis. The development of biomarkers reflecting amyloid and tau has led to a shift in defining Alzheimer's disease based on inferred underlying histopathology. Parkinson's disease is unique among neurodegenerative diseases in the number and diversity of non-genetic biomarkers of pre-symptomatic disease, most notably REM sleep behaviour disorder. Huntington's disease benefits from an ability to predict the likely timing of clinically manifest disease based on age and CAG-repeat length alongside reliable neuroimaging markers of atrophy. Spinal muscular atrophy clinical trials have highlighted the transformational value of early therapeutic intervention, and studies in frontotemporal dementia illustrate the differential role of biomarkers based on genotype. Similar advances in amyotrophic lateral sclerosis would transform our understanding of key events in pathogenesis, thereby dramatically accelerating progress towards disease prevention. Deciphering the biology of pre-symptomatic amyotrophic lateral sclerosis relies on a clear conceptual framework for defining the earliest stages of disease. Clinically manifest amyotrophic lateral sclerosis may emerge abruptly, especially among those who harbour genetic mutations associated with rapidly progressive amyotrophic lateral sclerosis. However, the disease may also evolve more gradually, revealing a prodromal period of mild motor impairment preceding phenoconversion to clinically manifest disease. Similarly, cognitive and behavioural impairment, when present, may emerge gradually, evolving through a prodromal period of mild cognitive impairment or mild behavioural impairment before progression to amyotrophic lateral sclerosis. Biomarkers are critically important to studying pre-symptomatic amyotrophic lateral sclerosis and essential to efforts to intervene therapeutically before clinically manifest disease emerges. The use of non-genetic biomarkers, however, presents challenges related to counselling, informed consent, communication of results and limited protections afforded by existing legislation. Experiences from pre-symptomatic genetic testing and counselling, and the legal protections against discrimination based on genetic data, may serve as a guide. Building on what we have learned-more broadly from other pre-symptomatic neurodegenerative diseases and specifically from amyotrophic lateral sclerosis gene mutation carriers-we present a road map to early intervention, and perhaps even disease prevention, for all forms of amyotrophic lateral sclerosis.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Joanne Wuu
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Caroline McHutchison
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Canada
| | | | | | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Howard Rosen
- Department of Neurology, University of California San Francisco, CA, USA
| | - Jalayne J Arias
- Department of Neurology, University of California San Francisco, CA, USA
| | | | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jeremy Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | | | - Peter M Andersen
- Department of Clinical Science, Neurosciences, Umeå University, Sweden
| | - Richard S Finkel
- Department of Pediatric Medicine, Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Volkan Granit
- Department of Neurology, University of Miami, Miami, FL, USA
| | | | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Corey T McMillan
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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47
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Yao CW, Pelletier A, Fereshtehnejad SM, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med 2022; 18:345-359. [PMID: 34314348 PMCID: PMC8804990 DOI: 10.5664/jcsm.9562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To identify the association between insomnia symptoms and signs of prodromal neurodegeneration, including an analysis of potential differences between sleep-onset and sleep-maintenance insomnia. METHODS We included those aged 45-85 years, living in 1 of 10 Canadian provinces between 2012 and 2015 (at the baseline), recruited via 3 population-based sampling methods. Insomnia symptoms were assessed using questions adapted/modified from the Pittsburgh Sleep Quality Index. A panel of potential prodromal neurodegenerative markers including self-reported symptoms and objective gait motor, cognitive, and autonomic variables were assessed cross sectionally. We compared those who endorsed insomnia symptoms ≥ 3 times per week to controls, adjusting for age, sex, and education via logistic regression. RESULTS Overall, 2,051/30,097 people screened positive for sleep-onset insomnia alone and 4,333 for sleep-maintenance insomnia alone, while 2,371 endorsed both subtypes. On objective gait tests, participants with sleep-onset insomnia, but not sleep-maintenance insomnia, had worse balance (odds ratio [OR] = 1.33, 95% confidence interval = [1.16, 1.52]) and slower gait speed (OR = 1.52 [1.34, 1.73]). Although participants with any insomnia subtype endorsed more motor symptoms, these were more severe in those with sleep-onset insomnia (OR onset vs maintenance = 1.13 [1.07, 1.18]). On objective cognitive tests, those with sleep-maintenance insomnia scored normally. However, participants with sleep-onset insomnia performed worse on tests of verbal fluency (OR = 1.24 [1.06, 1.43]), immediate memory (OR = 1.23 [1.08, 1.41]), and prospective memory task (OR = 1.29 [1.11, 1.50]). The sleep-onset insomnia group also had lower heart rate variability (OR = 1.23 [1.07, 1.43]). Secondary analyses found generally similar results in young vs older age of insomnia development. CONCLUSIONS Compared to maintenance insomnia, those with sleep-onset insomnia have more motor, cognitive, and autonomic signs/symptoms. When evaluating neurodegenerative risk, differentiating insomnia subtypes may increase precision. CITATION Yao CW, Pelletier A, Fereshtehnejad S-M, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med. 2022;18(2):345-359.
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Affiliation(s)
- Chun W Yao
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | - Nathan Cross
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Thanh Dang-Vu
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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48
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Liao C, Castonguay CE, Heilbron K, Vuokila V, Medeiros M, Houle G, Akçimen F, Ross JP, Catoire H, Diez-Fairen M, Kang J, Mueller SH, Girard SL, Hopfner F, Lorenz D, Clark LN, Soto-Beasley AI, Klebe S, Hallett M, Wszolek ZK, Pendziwiat M, Lorenzo-Betancor O, Seppi K, Berg D, Vilariño-Güell C, Postuma RB, Bernard G, Dupré N, Jankovic J, Testa CM, Ross OA, Arzberger T, Chouinard S, Louis ED, Mandich P, Vitale C, Barone P, García-Martín E, Alonso-Navarro H, Agúndez JAG, Jiménez-Jiménez FJ, Pastor P, Rajput A, Deuschl G, Kuhlenbaümer G, Meijer IA, Dion PA, Rouleau GA. Association of Essential Tremor With Novel Risk Loci: A Genome-Wide Association Study and Meta-analysis. JAMA Neurol 2022; 79:185-193. [PMID: 34982113 PMCID: PMC8728658 DOI: 10.1001/jamaneurol.2021.4781] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Question Can common genetic variants associated with essential tremor (ET) be identified? Findings In this genome-wide association study and meta-analysis including genetic data on 483 054 individuals, 5 genome-wide significant loci were associated with risk of ET and common variants were associated with approximately 18% of ET heritability. Meaning Findings of this study may help identify new genes and inform ET biology. Importance Essential tremor (ET) is one of the most common movement disorders, affecting 5% of the general population older than 65 years. Common variants are thought to contribute toward susceptibility to ET, but no variants have been robustly identified. Objective To identify common genetic factors associated with risk of ET. Design, Setting, and Participants Case-control genome-wide association study. Inverse-variance meta-analysis was used to combine cohorts. Multicenter samples collected from European populations were collected from January 2010 to September 2019 as part of an ongoing study. Included patients were clinically diagnosed with or reported having ET. Control individuals were not diagnosed with or reported to have ET. Of 485 250 individuals, data for 483 054 passed data quality control and were used. Main Outcomes and Measures Genotypes of common variants associated with risk of ET. Results Of the 483 054 individuals included, there were 7177 with ET (3693 [51.46%] female; mean [SD] age, 62.66 [15.12] years), and 475 877 control individuals (253 785 [53.33%] female; mean [SD] age, 56.40 [17.6] years). Five independent genome-wide significant loci and were identified and were associated with approximately 18% of ET heritability. Functional analyses found significant enrichment in the cerebellar hemisphere, cerebellum, and axonogenesis pathways. Genetic correlation (r), which measures the degree of genetic overlap, revealed significant common variant overlap with Parkinson disease (r, 0.28; P = 2.38 × 10−8) and depression (r, 0.12; P = 9.78 × 10−4). A separate fine-mapping of transcriptome-wide association hits identified genes such as BACE2, LRRN2, DHRS13, and LINC00323 in disease-relevant brain regions, such as the cerebellum. Conclusions and Relevance The results of this genome-wide association study suggest that a portion of ET heritability can be explained by common genetic variation and can help identify new common genetic risk factors for ET.
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Affiliation(s)
- Calwing Liao
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Charles-Etienne Castonguay
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - Veikko Vuokila
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Miranda Medeiros
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Houle
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Fulya Akçimen
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jay P Ross
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Helene Catoire
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Monica Diez-Fairen
- Fundació Docència i Recerca Mútua Terrassa, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain.,Movement Disorders Unit, Department of Neurology, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Jooeun Kang
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stefanie H Mueller
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Simon L Girard
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, Quebec, Canada.,Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - Delia Lorenz
- University Children's Hospital, University of Würzburg, Wurzburg, Germany
| | - Lorraine N Clark
- Department of Pathology and Cell Biology, Taub Institute, Columbia University, New York, New York
| | | | - Stephan Klebe
- Department of Neurology, University Hospital Würzburg, Wurzburg, Germany.,Department of Neurology, University Hospital Essen, Essen, Germany
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | | | - Manuela Pendziwiat
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany.,Department of Neuropediatrics, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Oswaldo Lorenzo-Betancor
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Department of Neurology, University of Washington School of Medicine, Seattle
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Carles Vilariño-Güell
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald B Postuma
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Geneviève Bernard
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Division of Pediatric Neurology, Departments of Pediatrics, Neurology and Neurosurgery, Montreal Children's Hospital, Montreal, Quebec, Canada.,Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Medical Genetics, Department of Specialized Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicolas Dupré
- Faculté de Médecine, Université Laval, Centre Hospitalier Universitaire de Québec (l'Enfant-Jésus), Quebec, Canada
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Claudia M Testa
- Parkinson's and Movement Disorders Center, Department of Neurology, Virginia Commonwealth University, Richmond
| | - Owen A Ross
- Departments of Neuroscience and Clinical Genomics, Mayo Clinic Florida, Jacksonville
| | - Thomas Arzberger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Elan D Louis
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genova, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico Policlinico, San Martino, Genova, Italy
| | - Carmine Vitale
- Department of Motor Sciences and Wellness, University Parthenope, Naples, Italy
| | - Paolo Barone
- Center for Neurodegenerative Disease (CEMAND), Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, UNEx, ARADyAL Instituto de Salud Carlos III, Caceres, Spain
| | | | - José A G Agúndez
- University Institute of Molecular Pathology Biomarkers, UNEx, ARADyAL Instituto de Salud Carlos III, Caceres, Spain
| | | | - Pau Pastor
- Fundació Docència i Recerca Mútua Terrassa, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Alex Rajput
- University of Saskatchewan, Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada
| | - Günther Deuschl
- Department of Neurology, University Medical Center Schleswig Holstein, University of Kiel, Kiel, Germany
| | - Gregor Kuhlenbaümer
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Inge A Meijer
- Department of Neuroscience and Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Patrick A Dion
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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49
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Zhang H, Iranzo A, Högl B, Arnulf I, Ferini‐Strambi L, Manni R, Miyamoto T, Oertel WH, Dauvilliers Y, Ju Y, Puligheddu M, Sonka K, Pelletier A, Montplaisir JY, Stefani A, Ibrahim A, Frauscher B, Leu‐Semenescu S, Zucconi M, Terzaghi M, Miyamoto M, Janzen A, Figorilli M, Fantini ML, Postuma RB. Risk factors for phenoconversion in
REM
sleep behavior disorder. Ann Neurol 2022; 91:404-416. [DOI: 10.1002/ana.26298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Hui Zhang
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
- Department of Neurology McGill University, Montreal General Hospital Montreal Canada
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona IDIBAPS, CIBERNED Barcelona Spain
| | - Birgit Högl
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Isabelle Arnulf
- Sorbonne University, Paris Brain Institute and sleep disorder unit Pitie‐Salpetriere Hospital, APHP Paris France
| | | | | | - Tomoyuki Miyamoto
- Department of Neurology, Dokkyo Medical University Saitama Medical Center Saitama Japan
| | | | - Yves Dauvilliers
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061 Montpellier F‐34093 Cedex 5 France
| | - Yo‐EI Ju
- Washington University School of Medicine, Department of Neurology St. Louis Missouri USA
| | - Monica Puligheddu
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
| | - Karel Sonka
- Department of Neurology First Faculty of Medicine, Charles University and General University Hospital Prague Czech Republic
| | - Amélie Pelletier
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
- Department of Psychiatry University of Montreal Montreal Canada
| | - Ambra Stefani
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Abubaker Ibrahim
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Birgit Frauscher
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Smaranda Leu‐Semenescu
- Sorbonne University, Paris Brain Institute and sleep disorder unit Pitie‐Salpetriere Hospital, APHP Paris France
| | - Marco Zucconi
- Sleep Disorders Center Università Vita‐Salute San Raffaele Milan Italy
| | | | - Masayuki Miyamoto
- Department of Neurology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Annette Janzen
- Department of Neurology Philipps‐Universität Marburg Germany
| | - Michela Figorilli
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
| | - Maria L Fantini
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
- Department of Neurology Université d'Auvergne Clermont‐Ferrand France
| | - Ronald B Postuma
- Department of Neurology McGill University, Montreal General Hospital Montreal Canada
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
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50
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Zolfaghari S, Thomann AE, Lewandowski N, Trundell D, Lipsmeier F, Pagano G, Taylor KI, Postuma RB. Self-Report versus Clinician Examination in Early Parkinson's Disease. Mov Disord 2021; 37:585-597. [PMID: 34897818 PMCID: PMC9299700 DOI: 10.1002/mds.28884] [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: 08/17/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Evaluating the discrepancies between patient‐reported measures and clinician examination has implications for formulating individual treatment regimens. Objective This study investigated the association between health outcomes and level of self‐reported motor‐related function impairment relative to clinician‐examined motor signs. Methods Recently diagnosed PD patients were evaluated using the Parkinson's Progression Marker Initiative (PPMI, N = 420) and the PASADENA phase II clinical trial (N = 316). We calculated the average normalized difference between each participant's part II and III MDS‐UPDRS (Movement Disorder Society Unified Parkinson's Disease Rating Scale) scores. Individuals with score differences <25th or >75th percentiles were labeled as low‐ and high‐self‐reporters, respectively (those between ranges were labeled intermediate‐self‐reporters). We compared a wide range of clinical/biomarker readouts among these three groups, using Kruskal–Wallis nonparametric and Pearson's χ2 tests. Spearman's correlations were tested for associations between MDS‐UPDRS subscales. Results In both cohorts, high‐self‐reporters reported the largest impairment/symptom experience for most motor and nonmotor patient‐reported variables. By contrast, these high‐self‐reporters were similar to or less impaired on clinician‐examined and biomarker measures. Patient‐reported nonmotor symptoms on MDS‐UPDRS part IB showed the strongest positive correlation with self‐reported motor‐related impairment (PPMI rs = 0.54, PASADENA rs = 0.52). This correlation was numerically stronger than the part II and clinician‐examined MDS‐UPDRS part III correlation (PPMI rs = 0.38, PASADENA rs = 0.28). Conclusion Self‐reported motor‐related impairments reflect not only motor signs/symptoms but also other self‐reported nonmotor measures. This may indicate (1) a direct impact of nonmotor symptoms on motor‐related functioning and/or (2) the existence of general response tendencies in how patients self‐rate symptoms. Our findings suggest further investigation into the suitability of MDS‐UPDRS II to assess motor‐related impairments. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alessandra E Thomann
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland
| | | | - Dylan Trundell
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center, Basel, Switzerland
| | - Gennaro Pagano
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland.,King's College London, London, United Kingdom
| | - Kirsten I Taylor
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland
| | - Ronald B Postuma
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
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