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Carlisle TC, Medina LD, Holden SK. Original research: initial development of a pragmatic tool to estimate cognitive decline risk focusing on potentially modifiable factors in Parkinson's disease. Front Neurosci 2023; 17:1278817. [PMID: 37942138 PMCID: PMC10628974 DOI: 10.3389/fnins.2023.1278817] [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: 08/16/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Cognitive decline is common in Parkinson's disease (PD). Calculating personalized risk of cognitive decline in PD would allow for appropriate counseling, early intervention with available treatments, and inclusion in disease-modifying trials. Methods Data were from the Parkinson's Progression Markers Initiative de novo cohort. Baseline scores were calculated for Lifestyle for Brain Health (LIBRA) and the Montreal Parkinson Risk of Dementia Scale (MoPaRDS) per prior literature and preliminary Parkinson's disease Risk Estimator for Decline In Cognition Tool (pPREDICT) by attributing a point for fourteen posited risk factors. Baseline and 5-year follow-up composite cognitive scores (CCSs) were calculated from a neuropsychological battery and used to define cognitive decliners (PD-decline) versus maintainers (PD-maintain). Results The PD-decline group (n = 44) had higher LIBRA (6.76 ± 0.57, p < 0.05), MoPaRDS (2.45 ± 1.41, p < 0.05) and pPREDICT (4.52 ± 1.66, p < 0.05) scores compared to the PD-maintain group (n = 263; LIBRA 4.98 ± 0.20, MoPaRDS 1.68 ± 1.16, pPREDICT 3.38 ± 1.69). Area-under-the-curve (AUC) for LIBRA was 0.64 (95% confidence interval [CI], 0.55-0.73), MoPaRDS was 0.66 (95% CI, 0.58-0.75) and for pPREDICT was 0.68 (95% CI, 0.61-0.76). In linear regression analyses, LIBRA (p < 0.05), MoPaRDS (p < 0.05) and pPREDICT (p < 0.05) predicted change in CCS. Only age stratified by sex (p < 0.05) contributed significantly to the model for LIBRA. Age and presence of hallucinations (p < 0.05) contributed significantly to the model for MoPaRDS. Male sex, older age, excessive daytime sleepiness, and moderate-severe motor symptoms (all p < 0.05) contributed significantly to the model for pPREDICT. Conclusion Although MoPaRDS is a PD-specific tool for predicting cognitive decline relying on only clinical features, it does not focus on potentially modifiable risk factors. LIBRA does focus on potentially modifiable risk factors and is associated with prediction of all-cause dementia in some populations, but pPREDICT potentially demonstrates improved performance in cognitive decline risk calculation in individuals with PD and may identify actionable risk factors. As pPREDICT incorporates multiple potentially modifiable risk factors that can be obtained easily in the clinical setting, it is a first step in developing an easily assessable tool for a personalized approach to reduce dementia risk in people with PD.
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Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- Department of Neurology, Movement Disorders Section, University of Colorado School of Medicine, Aurora, CO, United States
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Thaker AA, McConnell BV, Rogers DM, Carlson NE, Coughlan C, Jensen AM, Lopez-Paniagua D, Holden SK, Pressman PS, Pelak VS, Filley CM, Potter H, Solano DA, Heffernan KS, Bettcher BM. Astrogliosis, neuritic microstructure, and sex effects: GFAP is an indicator of neuritic orientation in women. Brain Behav Immun 2023; 113:124-135. [PMID: 37394144 PMCID: PMC10584366 DOI: 10.1016/j.bbi.2023.06.026] [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: 12/08/2022] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Data from human studies suggest that immune dysregulation is associated with Alzheimer's disease (AD) pathology and cognitive decline and that neurites may be affected early in the disease trajectory. Data from animal studies further indicate that dysfunction in astrocytes and inflammation may have a pivotal role in facilitating dendritic damage, which has been linked with negative cognitive outcomes. To elucidate these relationships further, we have examined the relationship between astrocyte and immune dysregulation, AD-related pathology, and neuritic microstructure in AD-vulnerable regions in late life. METHODS We evaluated panels of immune, vascular, and AD-related protein markers in blood and conducted in vivo multi-shell neuroimaging using Neurite Orientation Dispersion and Density Imaging (NODDI) to assess indices of neuritic density (NDI) and dispersion (ODI) in brain regions vulnerable to AD in a cohort of older adults (n = 109). RESULTS When examining all markers in tandem, higher plasma GFAP levels were strongly related to lower neurite dispersion (ODI) in grey matter. No biomarker associations were found with higher neuritic density. Associations between GFAP and neuritic microstructure were not significantly impacted by symptom status, APOE status, or plasma Aβ42/40 ratio; however, there was a large sex effect observed for neurite dispersion, wherein negative associations between GFAP and ODI were only observed in females. DISCUSSION This study provides a comprehensive, concurrent appraisal of immune, vascular, and AD-related biomarkers in the context of advanced grey matter neurite orientation and dispersion methodology. Sex may be an important modifier of the complex associations between astrogliosis, immune dysregulation, and brain microstructure in older adults.
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Affiliation(s)
- Ashesh A Thaker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brice V McConnell
- Department of Neurology, Behavioral Neurology Section, University of Colorado Alzheimer's & Cognition Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Dustin M Rogers
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Christina Coughlan
- Department of Neurology, University of Colorado Alzheimer's & Cognition Center, Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandria M Jensen
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dan Lopez-Paniagua
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Samantha K Holden
- Department of Neurology, Behavioral Neurology Section, University of Colorado Alzheimer's & Cognition Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Peter S Pressman
- Department of Neurology, Behavioral Neurology Section, University of Colorado Alzheimer's & Cognition Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Victoria S Pelak
- Department of Neurology, Behavioral Neurology Section, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Ophthalmology, Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher M Filley
- Behavioral Neurology Section, Departments of Neurology and Psychiatry, University of Colorado Alzheimer's & Cognition Center, Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Huntington Potter
- Department of Neurology, University of Colorado Alzheimer's & Cognition Center, Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D Adriana Solano
- Department of Neurology, University of Colorado Alzheimer's & Cognition Center, Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kate S Heffernan
- Division of Neuropharmacology and Neurological Disorders, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Brianne M Bettcher
- Department of Neurology, Behavioral Neurology Section, University of Colorado Alzheimer's & Cognition Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
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Feuerstein J, Heffernan B, Holden SK, Sillau S, Berman BD. Social Cognition Deficits in Cervical Dystonia, but not Blepharospasm: Focal Dystonias Diverge. Mov Disord Clin Pract 2023; 10:1231-1232. [PMID: 37635782 PMCID: PMC10450232 DOI: 10.1002/mdc3.13808] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Jeanne Feuerstein
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of NeurologyRocky Mountain Regional VA Medical CenterAuroraColoradoUSA
| | - Brooke Heffernan
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Samantha K. Holden
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Stefan Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Brian D. Berman
- Department of NeurologyVirginia Commonwealth UniversityRichmondVirginiaUSA
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Carlisle TC, Fought AJ, Olson KE, Lopez-Esquibel N, Simpson A, Medina LD, Holden SK. Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease. Front Neurosci 2023; 17:1200347. [PMID: 37434765 PMCID: PMC10330725 DOI: 10.3389/fnins.2023.1200347] [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: 04/04/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline. Objective The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD. Methods Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed. Results Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8). Conclusion The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.
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Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
| | - Angela J. Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Kaitlin E. Olson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | | | - Abigail Simpson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- Movement Disorders Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
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Chiu SY, Wyman-Chick KA, Ferman TJ, Bayram E, Holden SK, Choudhury P, Armstrong MJ. Sex differences in dementia with Lewy bodies: Focused review of available evidence and future directions. Parkinsonism Relat Disord 2023; 107:105285. [PMID: 36682958 PMCID: PMC10024862 DOI: 10.1016/j.parkreldis.2023.105285] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 09/13/2022] [Revised: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
In this review, we summarize the current knowledge on sex differences in dementia with Lewy bodies (DLB) relating to epidemiology, clinical features, neuropathology, biomarkers, disease progression, and caregiving. While many studies show a higher DLB prevalence in men, this finding is inconsistent and varies by study approach. Visual hallucinations may be more common and occur earlier in women with DLB, whereas REM sleep behavior disorder may be more common and occur earlier in men. Several studies report a higher frequency of parkinsonism in men with DLB, while the frequency of fluctuations appears similar between sexes. Women tend to be older, have greater cognitive impairment at their initial visit, and are delayed in meeting DLB criteria compared to men. Women are also more likely to have Lewy body disease with co-existing AD-related pathology than so-called "pure" Lewy body disease, while men may present with either. Research is mixed regarding the impact of sex on DLB progression. Biomarker and treatment research assessing for sex differences is lacking. Women provide the majority of caregiving in DLB but how this affects the caregiving experience is uncertain. Gaining a better understanding of sex differences will be instrumental in aiding future development of sex-specific strategies in DLB for early diagnosis, care, and drug development.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, FL, USA.
| | - Kathryn A Wyman-Chick
- Center for Memory and Aging, Department of Neurology, HealthPartners, Saint Paul, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Parichita Choudhury
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, FL, USA
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Wylie KP, Kluger BM, Medina LD, Holden SK, Kronberg E, Tregellas JR, Buard I. Hippocampal, basal ganglia and olfactory connectivity contribute to cognitive impairments in Parkinson's disease. Eur J Neurosci 2023; 57:511-526. [PMID: 36516060 PMCID: PMC9970048 DOI: 10.1111/ejn.15899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Cognitive impairment is increasingly recognized as a characteristic feature of Parkinson's disease (PD), yet relatively little is known about its underlying neurobiology. Previous investigations suggest that dementia in PD is associated with subcortical atrophy, but similar studies in PD with mild cognitive impairment have been mixed. Variability in cognitive phenotypes and diversity of PD symptoms suggest that a common neuropathological origin results in a multitude of impacts within the brain. These direct and indirect impacts of disease pathology can be investigated using network analysis. Functional connectivity, for instance, may be more sensitive than atrophy to decline in specific cognitive domains in the PD population. Fifty-eight participants with PD underwent a neuropsychological test battery and scanning with structural and resting state functional MRI in a comprehensive whole-brain association analysis. To investigate atrophy as a potential marker of impairment, structural gray matter atrophy was associated with cognitive scores in each cognitive domain using voxel-based morphometry. To investigate connectivity, large-scale networks were correlated with voxel time series and associated with cognitive scores using distance covariance. Structural atrophy was not associated with any cognitive domain, with the exception of visuospatial measures in primary sensory and motor cortices. In contrast, functional connectivity was associated with attention, executive function, language, learning and memory, visuospatial, and global cognition in the bilateral hippocampus, left putamen, olfactory cortex, and bilateral anterior temporal poles. These preliminary results suggest that cognitive domain-specific networks in PD are distinct from each other and could provide a network signature for different cognitive phenotypes.
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Affiliation(s)
- Korey P. Wylie
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Benzi M. Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eugene Kronberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason R. Tregellas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Isabelle Buard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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Holden SK, Bettcher BM, Filley CM, Lopez-Paniagua D, Pelak VS. Posterior white matter integrity and self-reported posterior cortical symptoms using the Colorado Posterior Cortical Questionnaire. Front Neurol 2023; 14:1072938. [PMID: 36816576 PMCID: PMC9929951 DOI: 10.3389/fneur.2023.1072938] [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: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Background The Colorado Posterior Cortical Questionnaire (CPC-Q) is a self-report, 15-item screening questionnaire for posterior cortical symptoms, including visuospatial and visuoperceptual difficulties. Changes in white matter connectivity may precede obvious gray matter atrophy in neurodegenerative conditions, especially posterior cortical atrophy. Integration of CPC-Q scores and measures of white matter integrity could contribute to earlier detection of posterior cortical syndromes. Methods We investigated the relationships between posterior cortical symptoms as captured by the CPC-Q and diffusion tensor imaging fractional anisotropy (DTI FA) of white matter regions of interest localized to posterior brain regions (posterior thalamic radiations, splenium of corpus callosum, tapetum). Comparisons were also made by diagnostic group [healthy older adult (n = 31), amnestic Alzheimer's disease (AD, n = 18), and posterior cortical atrophy (PCA, n = 9)] and by SENAS battery visuospatial composite score quartile. Exploratory comparisons of all available individual white matter region DTI FA to CPC-Q, as well as comparisons of DTI FA between diagnostic groups and visuospatial quartiles, were also made. Results CPC-Q score was correlated with the average DTI FA for the averaged posterior white matter regions of interest (r = -0.31, p = 0.02). Posterior thalamic radiation DTI FA was most strongly associated with CPC-Q (r = -0.34, p = 0.01) and visuospatial composite (r = 0.58, p < 0.01) scores and differed between the PCA and AD groups and the lower and higher visuospatial quartiles. The DTI FA of body and splenium of the corpus callosum also demonstrated this pattern but not the DTI FA of the tapetum. Conclusion The integrity of posterior white matter tracts is associated with scores on the CPC-Q, adding to the validation evidence for this new questionnaire. White matter regions that may be related to posterior cortical symptoms detected by the CPC-Q, and distinct from those affected in amnestic syndromes, include the posterior thalamic radiations and body and splenium of the corpus callosum. These findings are in line with previous neuroimaging studies of PCA and support continued research on white matter in posterior cortical dysfunction.
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Affiliation(s)
- Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States,Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States,Department of Neurology, Movement Disorders Section, University of Colorado School of Medicine, Aurora, CO, United States,*Correspondence: Samantha K. Holden ✉
| | - Brianne M. Bettcher
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States,Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
| | - Christopher M. Filley
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States,Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States,Marcus Institute for Brain Health, Aurora, CO, United States
| | - Dan Lopez-Paniagua
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Victoria S. Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States,Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
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Abstract
Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson's disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer's disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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Holden SK, Bedenfield N, Taylor AS, Bayram E, Schwilk C, Fleisher J, Duda J, Shill H, Paulson HL, Stacy K, Wood J, Corsentino P, Sha SJ, Litvan I, Irwin DJ, Quinn JF, Goldman JG, Amodeo K, Taylor JP, Boeve BF, Armstrong MJ. Research Priorities of Individuals and Caregivers With Lewy Body Dementia: A Web-based Survey. Alzheimer Dis Assoc Disord 2023; 37:50-58. [PMID: 36821177 PMCID: PMC9971616 DOI: 10.1097/wad.0000000000000545] [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: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Lewy body dementia (LBD) is common, yet under-recognized and under-researched. To plan studies with the highest impact, engagement of the community personally affected by these conditions is essential. METHODS A web-based survey of people living with LBD and current and former caregivers of people with LBD queried research priorities through forced ranking and exploration of burden of LBD symptoms. Specific caregiving needs in LBD and perceptions of research participation were also investigated. RESULTS Between April 7, 2021 and July 1, 2021, 984 responses were recorded. Top research priorities included disease-modifying therapies and improved disease detection and staging. People with LBD were interested in pathophysiology and more bothered by motor symptoms; caregivers were interested in risk factors and symptomatic therapies and more bothered by neuropsychiatric symptoms. Few available LBD treatments and resources were rated as helpful, and many valuable services were never received. Previous participation in LBD research was infrequent, but interest was high. DISCUSSION People with LBD and caregivers highlighted the need for research across all aspects of LBD, from pathophysiology and disease modification to prognosis, education, symptomatic treatments, and caregiver support. Funders should increase support for all aspects of LBD research to target the many needs identified by individuals and families living with LBD.
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Affiliation(s)
- Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Noheli Bedenfield
- Department of Neurology, University of Florida, Dorothy Mangurian Clinical-Research Headquarters for Lewy Body Dementia, Gainesville, FL
| | | | - Ece Bayram
- Department of Neurosciences, University of California San Diego, San Diego, CA
| | | | - Jori Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - John Duda
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Holly Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ
| | | | - Kelly Stacy
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Julia Wood
- Lewy Body Dementia Association, Liliburn, GA
| | | | - Sharon J. Sha
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, San Diego, CA
| | - David J. Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR
| | - Jennifer G. Goldman
- Shirley Ryan AbilityLab, Parkinson’s Disease and Movement Disorders Program, Northwestern University, Chicago, IL
| | - Katherine Amodeo
- Department of Neurology, Westchester Medical Center- MidHudson Regional Hospital, Poughkeepsie, NY
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Melissa J. Armstrong
- Department of Neurology, University of Florida, Dorothy Mangurian Clinical-Research Headquarters for Lewy Body Dementia, Gainesville, FL
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Pelak VS, Paez YM, Patnaik JL, Holden SK, Subramanian PS, Mathias MT, Mandava N, Lynch AM. An Exploratory Study to Investigate the Utility of Clinical Screening for Neurodegenerative Disease in Age-Related Eye Disease Research. J Neuroophthalmol 2022; 42:346-352. [PMID: 35483065 PMCID: PMC9529756 DOI: 10.1097/wno.0000000000001550] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unrecognized neurodegenerative diseases (NDD) in age-related eye disease research studies have the potential to confound vision-specific quality of life and retinal optical coherence tomography (OCT) outcome measures. The aim of this exploratory study was to investigate relationships between NDD screening tools and visual outcome measures in a small cohort of controls from the Colorado Age-Related Macular Degeneration Registry (CO-AMD), to consider the utility of future studies. METHODS Twenty-nine controls from the CO-AMD were screened using the Montreal Cognitive Assessment (MoCA), a Colorado Parkinsonian Checklist, and the Lewy Body Composite Risk Score. Univariate and multivariable linear regression modeling was used to assess associations between screening tools and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and macular OCT outcome measures, and t tests were used to evaluate outcome measure differences between those with normal vs abnormal MoCA scores. RESULTS One patient withdrew. The average age was 72.8 years, and 68% were female patients. Ten participants (36%) had abnormal MoCA scores, and their VFQ-25 scores were only 1 point less and not statistically different than those with normal MoCA scores. Macular OCT volumes and thicknesses for retinal nerve fiber layer (RNFL) and retinal ganglion cell layer were consistently and moderately lower for those with abnormal MoCA scores, and a positive association between MoCA and macular RNFL volume was observed, although differences and regression were not significant. Parkinson screening tests were abnormal for only 4 participants and were not associated with OCT or VFQ-25 measures by regression modeling. CONCLUSIONS Given the degree and direction of observed differences, further investigation is warranted regarding the relationship between cognitive screening tools and macular OCT measures in age-related eye disease research, but future investigations regarding the relationship between NDD screening tools and VFQ-25 seem unwarranted.
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Affiliation(s)
- Victoria S. Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yosbelkys Martin Paez
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Prem S. Subramanian
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Surgery, Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marc T. Mathias
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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11
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Holden SK, Pelak VS, Sooy T, Heffernan KS, McConnell BV, Pressman PS, Bettcher BM. Development of the Colorado posterior cortical questionnaire within an Alzheimer's disease study cohort. J Clin Exp Neuropsychol 2022; 44:226-236. [PMID: 35913095 PMCID: PMC9420807 DOI: 10.1080/13803395.2022.2105820] [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] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Non-amnestic presentations of neurodegenerative dementias, including posterior- and visual-predominant cognitive forms, are under-recognized. Specific screening measures for posterior cortical symptoms could allow for earlier, more accurate diagnosis and directed treatment. METHODS Based on clinical experience with posterior cortical atrophy evaluations, high-yield screening questions were collected and organized into a 15-item self-report questionnaire, titled the Colorado Posterior Cortical Questionnaire (CPC-Q). The CPC-Q was then piloted within a longitudinal cohort of cognitive aging, including 63 older adults, including healthy older adults (n = 33) and adults with either amnestic Alzheimer's disease (n = 21) or posterior cortical atrophy (PCA, n = 9). RESULTS The CPC-Q demonstrated acceptable psychometric properties (internal consistency, α = 0.89; mean item-total correlation = 0.62), correlated strongly with visuospatial measures on cognitive testing (p < 0.001), and could distinguish PCA from non-PCA groups (p < 0.001; AUC 0.95 (95% CI 0.88, 1.0)). CONCLUSIONS The CPC-Q captured posterior cortical symptoms in older adults, using a gold standard of expert consensus PCA diagnosis. Future studies will validate the CPC-Q in a larger cohort, with recruitment of additional PCA participants, to evaluate its convergent and discriminant validity more thoroughly. As a short, self-report tool, the CPC-Q demonstrates potential to improve detection of non-amnestic neurodegenerative dementias in the clinical setting.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Trevor Sooy
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kate S Heffernan
- Neuroscience Graduate Program, Division of Biological and Biomedical Sciences, Emory Laney Graduate School, Atlanta, GA, USA
| | - Brice V McConnell
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter S Pressman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brianne M Bettcher
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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Kletenik I, Holden SK, Sillau SH, O'Connell N, MacGillivray L, Mack J, Haddock B, Ashworth Dirac M, David AS, Nicholson TR, Attaripour Isfahani SN, Maurer CW, Lidstone SC, Hallett M, LaFaver K, Berman BD, Stone J. Gender disparity and abuse in functional movement disorders: a multi-center case-control study. J Neurol 2022; 269:3258-3263. [PMID: 35098346 PMCID: PMC10202134 DOI: 10.1007/s00415-021-10943-6] [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: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine gender differences in rates of sexual and physical abuse in functional movement disorders compared to controls and evaluate if the gender disparity of functional movement disorders is associated with abuse history. METHODS We performed a retrospective case-control study of self-reported trauma data from 696 patients (512 women) with functional movement disorders from six clinical sites compared to 141 controls (98 women) and population data. Chi-square was used to assess gender and disorder associations; logistic regression was used to model additive effects of abuse and calculate the attributable fraction of abuse to disorder prevalence. RESULTS Higher rates of sexual abuse were reported by women (35.3%) and men (11.5%) with functional movement disorders compared to controls (10.6% of women; 5.6% of men). History of sexual abuse increased the likelihood of functional movement disorders among women by an odds ratio of 4.57 (95% confidence interval 2.31-9.07; p < 0.0001) and physical abuse by an odds ratio of 2.80 (95% confidence interval 1.53-5.12; p = 0.0007). Population attributable fraction of childhood sexual abuse to functional movement disorders in women was 0.12 (0.05-0.19). No statistically significant associations were found in men, but our cohort of men was underpowered despite including multiple sites. CONCLUSIONS Our study suggests that violence against women may account for some of the gender disparity in rates of functional movement disorders. Most people with functional movement disorders do not report a history of abuse, so it remains just one among many relevant risk factors to consider.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicola O'Connell
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - Lindsey MacGillivray
- Division of Psychiatry, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Joel Mack
- Department of Psychiatry, Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, OR, USA
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Beatrix Haddock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Departments of Health Metrics and Family Medicine, University of Washington, Seattle, WA, USA
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Carine W Maurer
- Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kathrin LaFaver
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, Movement Disorder Division, University of Louisville, Louisville, KY, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Goldman JG, Holden SK. Cognitive Syndromes Associated With Movement Disorders. Continuum (Minneap Minn) 2022; 28:726-749. [PMID: 35678400 DOI: 10.1212/con.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recognition and management of cognitive syndromes in movement disorders, including those with parkinsonism, chorea, ataxia, dystonia, and tremor. RECENT FINDINGS Cognitive and motor syndromes are often intertwined in neurologic disorders, including neurodegenerative diseases such as Parkinson disease, atypical parkinsonian syndromes, Huntington disease, and other movement disorders. Cognitive symptoms often affect attention, working memory, and executive and visuospatial functions preferentially, rather than language and memory, but heterogeneity can be seen in the various movement disorders. A distinct cognitive syndrome has been recognized in patients with cerebellar syndromes. Appropriate recognition and screening for cognitive changes in movement disorders may play a role in achieving accurate diagnoses and guiding patients and their families regarding progression and management decisions. SUMMARY In the comprehensive care of patients with movement disorders, recognition of cognitive syndromes is important. Pharmacologic treatments for the cognitive syndromes, including mild cognitive impairment and dementia, in these movement disorders lag behind the therapeutics available for motor symptoms, and more research is needed. Patient evaluation and management require a comprehensive team approach, often linking neurologists as well as neuropsychologists, psychologists, psychiatrists, social workers, and other professionals.
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14
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Buard I, Lopez-Esquibel N, Carey FJ, Brown MS, Medina LD, Kronberg E, Martin CS, Rogers S, Holden SK, Greher MR, Kluger BM. Does Prefrontal Glutamate Index Cognitive Changes in Parkinson's Disease? Front Hum Neurosci 2022; 16:809905. [PMID: 35496064 PMCID: PMC9039312 DOI: 10.3389/fnhum.2022.809905] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/18/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Cognitive impairment is a highly prevalent non-motor feature of Parkinson's disease (PD). A better understanding of the underlying pathophysiology may help in identifying therapeutic targets to prevent or treat dementia. This study sought to identify metabolic alterations in the prefrontal cortex (PFC), a key region for cognitive functioning that has been implicated in cognitive dysfunction in PD. Methods Proton Magnetic Resonance Spectroscopy was used to investigate metabolic changes in the PFC of a cohort of cognitively normal individuals without PD (CTL), as well as PD participants with either normal cognition (PD-NC), mild cognitive impairment (PD-MCI), or dementia (PDD). Ratios to Creatine (Cre) resonance were obtained for glutamate (Glu), glutamine and glutamate combined (Glx), N-acetylaspartate (NAA), myoinositol (mI), and total choline (Cho), and correlated with cognitive scores across multiple domains (executive function, learning and memory, language, attention, visuospatial function, and global cognition) administered to the PD participants only. Results When individuals retain cognitive capabilities, the presence of Parkinson's disease does not create metabolic disturbances in the PFC. However, when cognitive symptoms are present, PFC Glu/Cre ratios decrease with significant differences between the PD-NC and PPD groups. In addition, Glu/Cre ratios and memory scores were marginally associated, but not after Bonferroni correction. Conclusion These preliminary findings indicate that fluctuations in prefrontal glutamate may constitute a biomarker for the progression of cognitive impairments in PD. We caution for larger MRS investigations of carefully defined PD groups.
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Affiliation(s)
- Isabelle Buard
- Department of Neurology, University of Colorado, Denver, Aurora, CO, United States,*Correspondence: Isabelle Buard,
| | | | - Finnuella J. Carey
- Department of Medicine, University of Wisconsin–Madison, Madison, WI, United States
| | - Mark S. Brown
- Department of Psychiatry, University of Colorado, Denver, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Eugene Kronberg
- Department of Neurology, University of Colorado, Denver, Aurora, CO, United States
| | - Christine S. Martin
- Department of Neurology, University of Colorado, Denver, Aurora, CO, United States
| | - Sarah Rogers
- Department of Neurology, University of Colorado, Denver, Aurora, CO, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado, Denver, Aurora, CO, United States
| | - Michael R. Greher
- Department of Neurosurgery, University of Colorado, Denver, Aurora, CO, United States
| | - Benzi M. Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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15
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Scott GD, Arnold MR, Beach TG, Gibbons CH, Kanthasamy AG, Lebovitz RM, Lemstra AW, Shaw LM, Teunissen CE, Zetterberg H, Taylor AS, Graham TC, Boeve BF, Gomperts SN, Graff-Radford NR, Moussa C, Poston KL, Rosenthal LS, Sabbagh MN, Walsh RR, Weber MT, Armstrong MJ, Bang JA, Bozoki AC, Domoto-Reilly K, Duda JE, Fleisher JE, Galasko DR, Galvin JE, Goldman JG, Holden SK, Honig LS, Huddleston DE, Leverenz JB, Litvan I, Manning CA, Marder KS, Pantelyat AY, Pelak VS, Scharre DW, Sha SJ, Shill HA, Mari Z, Quinn JF, Irwin DJ. Fluid and Tissue Biomarkers of Lewy Body Dementia: Report of an LBDA Symposium. Front Neurol 2022; 12:805135. [PMID: 35173668 PMCID: PMC8841880 DOI: 10.3389/fneur.2021.805135] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
The Lewy Body Dementia Association (LBDA) held a virtual event, the LBDA Biofluid/Tissue Biomarker Symposium, on January 25, 2021, to present advances in biomarkers for Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLBs) and Parkinson's disease dementia (PDD). The meeting featured eight internationally known scientists from Europe and the United States and attracted over 200 scientists and physicians from academic centers, the National Institutes of Health, and the pharmaceutical industry. Methods for confirming and quantifying the presence of Lewy body and Alzheimer's pathology and novel biomarkers were discussed.
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Affiliation(s)
- Gregory D. Scott
- Department of Pathology, Oregon Health and Science University, Portland, OR, United States
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, OR, United States
| | - Moriah R. Arnold
- Graduate Program in Biomedical Sciences, School of Medicine M.D./Ph.D. Program, Oregon Health and Science University, Portland, OR, United States
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology and Brain and Body Donation Program, Banner Sun Health Research Institute, Sun City, AZ, United States
| | - Christopher H. Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Anumantha G. Kanthasamy
- Department of Physiology and Pharmacology, Center for Brain Sciences and Neurodegenerative Diseases, University of Georgia, Athens, GA, United States
| | | | - Afina W. Lemstra
- Department of Neurology, Amsterdam University Medical Center (UMC), Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leslie M. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | | | - Todd C. Graham
- Lewy Body Dementia Association, Lilburn, GA, United States
| | - Bradley F. Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
| | - Stephen N. Gomperts
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Charbel Moussa
- Department of Neurology, Georgetown University Medical Center, Washington DC, CA, United States
| | - Kathleen L. Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Liana S. Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Marwan N. Sabbagh
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Ryan R. Walsh
- Barrow Neurological Institute and Muhammed Ali Parkinson Center, Phoenix, AZ, United States
| | - Miriam T. Weber
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jee A. Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrea C. Bozoki
- Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | | | - John E. Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jori E. Fleisher
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States
| | - Douglas R. Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jennifer G. Goldman
- Shirley Ryan Abilitylab and Department of Physical Medicine and Rehabilitation and Neurology, Parkinson's Disease and Movement Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lawrence S. Honig
- Columbia University Irving Medical Center, New York, NY, United States
| | - Daniel E. Huddleston
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - James B. Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, United States
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Carol A. Manning
- Department of Neurology, University of Virginia, Charlottesville, VA, United States
| | - Karen S. Marder
- Columbia University Irving Medical Center, New York, NY, United States
| | - Alexander Y. Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Victoria S. Pelak
- Departments of Neurology and Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Douglas W. Scharre
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Sharon J. Sha
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Holly A. Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic Lerner College of Medicine, Las Vegas, NV, United States
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Neurology, VA Portland Medical Center, Portland, OR, United States
| | - David J. Irwin
- Department of Neurology, University of Pennsylvania Health System, Philadelphia, PA, United States
- Digital Neuropathology Laboratory, Philadelphia, PA, United States
- Lewy Body Disease Research Center of Excellence, Philadelphia, PA, United States
- Frontotemporal Degeneration Center, Philadelphia, PA, United States
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Holden SK, Domen CH, Sillau S, Liu Y, Leehey MA. Higher risk, higher reward? Self‐reported effects of real‐world cannabis use in Parkinson's disease. Mov Disord Clin Pract 2022; 9:340-350. [PMID: 35392299 PMCID: PMC8974868 DOI: 10.1002/mdc3.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Samantha K. Holden
- University of Colorado Anschutz Medical Campus, Department of Neurology Aurora CO
| | - Christopher H. Domen
- University of Colorado Anschutz Medical Campus, Department of Neurosurgery Aurora CO
| | - Stefan Sillau
- University of Colorado Anschutz Medical Campus, Department of Neurology Aurora CO
| | - Ying Liu
- University of Colorado Anschutz Medical Campus, Department of Neurology Aurora CO
| | - Maureen A. Leehey
- University of Colorado Anschutz Medical Campus, Department of Neurology Aurora CO
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Simon OB, Rojas DC, Ghosh D, Yang X, Rogers SE, Martin CS, Holden SK, Kluger BM, Buard I. Profiling Parkinson's disease cognitive phenotypes via resting-state magnetoencephalography. J Neurophysiol 2022; 127:279-289. [PMID: 34936515 PMCID: PMC8782645 DOI: 10.1152/jn.00316.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aberrant brain oscillations are a hallmark of Parkinson's disease (PD) pathophysiology and may be related to both motor and nonmotor symptoms. Mild cognitive impairment (MCI) affects many people with PD even at the time of diagnosis and conversion risks to PD dementia (PDD) are very high. Unfortunately, pharmacotherapies are not addressing cognitive symptoms in PD. Profiling PD cognitive phenotypes (e.g., MCI, PDD, etc.) may therefore help inform future treatments. Neurophysiological methods, such as magnetoencephalography (MEG), offer the advantage of observing oscillatory patterns, whose regional and temporal profiles may elucidate how cognitive changes relate to neural mechanisms. We conducted a resting-state MEG cross-sectional study of 89 persons with PD stratified into three phenotypic groups: normal cognition, MCI, and PDD, to identify brain regions and frequencies most associated with each cognitive profile. In addition, a neuropsychological battery was administered to assess each domain of cognition. Our data showed higher power in lower frequency bands (delta and theta) observed along with more severe cognitive impairment and associated with memory, language, attention, and global cognition. Of the total 119 brain parcels assessed during source analysis, widespread group differences were found in the beta band, with significant changes mostly occurring between the normal cognition and MCI groups. Moreover, bilateral frontal and left-hemispheric regions were particularly affected in the other frequencies as cognitive decline becomes more pronounced. Our results suggest that MCI and PDD may be qualitatively distinct cognitive phenotypes, and most dramatic changes seem to have happened when the PD brain shows mild cognitive decline.NEW & NOTEWORTHY Can we better stage cognitive decline in patients with Parkinson's disease (PD)? Here, we provide evidence that mild cognitive impairment, rather than being simply a milder form of dementia, may be a qualitatively distinct phase in its development. We suggest that the most dramatic neurophysiological changes may occur during the time the PD brain transitions from normal cognition to MCI, then compensatory changes further occur as the brain "switches" to a dementia state.
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Affiliation(s)
- Olivier B. Simon
- 1Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, Colorado
| | - Donald C. Rojas
- 2Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Debashis Ghosh
- 1Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, Colorado
| | - Xinyi Yang
- 1Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, Colorado
| | - Sarah E. Rogers
- 3Department of Neurology, University of Colorado Denver, Aurora, Colorado
| | | | - Samantha K. Holden
- 3Department of Neurology, University of Colorado Denver, Aurora, Colorado
| | - Benzi M. Kluger
- 4Department of Neurology, University of Rochester Medical Center Rochester, Rochester, New York
| | - Isabelle Buard
- 3Department of Neurology, University of Colorado Denver, Aurora, Colorado
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18
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Pelak VS, Holden SK, Crutch SJ, Yong KX. Survey outcomes on neuropsychological testing in posterior cortical atrophy. Alzheimers Dement 2021. [DOI: 10.1002/alz.050826] [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: 11/09/2022]
Affiliation(s)
| | | | - Sebastian J. Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London London United Kingdom
| | - Keir X.X. Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
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19
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Simon OB, Buard I, Rojas DC, Holden SK, Kluger BM, Ghosh D. A novel approach to understanding Parkinsonian cognitive decline using minimum spanning trees, edge cutting, and magnetoencephalography. Sci Rep 2021; 11:19704. [PMID: 34611218 PMCID: PMC8492620 DOI: 10.1038/s41598-021-99167-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
Graph theory-based approaches are efficient tools for detecting clustering and group-wise differences in high-dimensional data across a wide range of fields, such as gene expression analysis and neural connectivity. Here, we examine data from a cross-sectional, resting-state magnetoencephalography study of 89 Parkinson’s disease patients, and use minimum-spanning tree (MST) methods to relate severity of Parkinsonian cognitive impairment to neural connectivity changes. In particular, we implement the two-sample multivariate-runs test of Friedman and Rafsky (Ann Stat 7(4):697–717, 1979) and find it to be a powerful paradigm for distinguishing highly significant deviations from the null distribution in high-dimensional data. We also generalize this test for use with greater than two classes, and show its ability to localize significance to particular sub-classes. We observe multiple indications of altered connectivity in Parkinsonian dementia that may be of future use in diagnosis and prediction.
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Affiliation(s)
- Olivier B Simon
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Isabelle Buard
- Department of Neurology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Donald C Rojas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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20
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Buard I, Lattanzio L, Stewart R, Thompson S, Sjoberg K, Hookstadt K, Morrow M, Holden SK, Sillau S, Thaut M, Kluger B. Randomized controlled trial of neurologic music therapy in Parkinson's disease: research rehabilitation protocols for mechanistic and clinical investigations. Trials 2021; 22:577. [PMID: 34454592 PMCID: PMC8403394 DOI: 10.1186/s13063-021-05560-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/20/2021] [Indexed: 11/12/2022] Open
Abstract
Background Presently available medications and surgical treatments for Parkinson’s disease have limited effects on fine motor problems and often leave patients with significant fine motor disability. Standard of care occupational therapy (OT) yields low efficacy, potentially due to a lack of standard protocols. Neurologic music therapy (NMT) techniques, especially rhythmic auditory stimulation which relies on interaction between rhythm and movement, have shown to be effective in PD gait rehabilitation possibly through their reliance on neural pathways that are not affected by PD. Therapeutic instrumental music performance (TIMP) is one other NMT technique that holds promise but which mode of action and efficacy has not been investigated in PD yet. Methods One hundred PD participants will be randomly assigned to receive 15 sessions of either TIMP with rhythm or TIMP without rhythm, standard of care OT, or to be waitlisted (control) over 5 consecutive weeks. Brain oscillatory responses will be collected using magnetoencephalography during an auditory-motor task to understand the underlying mechanisms. The Grooved Pegboard, the UPDRS III finger tap, and the finger-thumb opposition will be assessed to investigate clinical changes related to fine motor function. This project will also serve to confirm or refute our pilot data findings suggesting NMT relies on compensatory brain networks utilized by the PD brain to bypass the dysfunctional basal ganglia. Discussion This study aims to use standardized TIMP and OT research protocols for investigating the neuronal pathways utilized by each intervention and possibly study their efficacy with respect to fine motor rehabilitation via a randomized control trial in the PD population. Trial registration ClinicalTrials.gov NCT03049033. Registered on September 29, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05560-7.
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Affiliation(s)
- Isabelle Buard
- Department of Neurology, University of Colorado Denver, Fitzsimons Building, Mailstop F548, 13001 E. 17th Place, R24-002, Aurora, CO, 80045, USA.
| | - Lucas Lattanzio
- Department of Neurology, University of Colorado Denver, Fitzsimons Building, Mailstop F548, 13001 E. 17th Place, R24-002, Aurora, CO, 80045, USA
| | | | | | | | | | | | - Samantha K Holden
- Department of Neurology, University of Colorado Denver, Fitzsimons Building, Mailstop F548, 13001 E. 17th Place, R24-002, Aurora, CO, 80045, USA
| | - Stefan Sillau
- Department of Neurology, University of Colorado Denver, Fitzsimons Building, Mailstop F548, 13001 E. 17th Place, R24-002, Aurora, CO, 80045, USA
| | - Michael Thaut
- Faculty of Music, University of Toronto, Toronto, Canada
| | - Benzi Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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21
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Lattanzio L, Seames A, Holden SK, Buard I. The emergent relationship between temporoparietal junction and anosognosia in Alzheimer's disease. J Neurosci Res 2021; 99:2091-2096. [PMID: 34131953 DOI: 10.1002/jnr.24904] [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: 01/25/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022]
Abstract
Anosognosia and impairment of insight are characteristic features of Alzheimer's disease (AD), which can lead to delays in appropriate medical care and significant family discord. The default mode network (DMN), a distributed but highly connected network of brain regions more active during rest than during task, is integrally involved in awareness. DMN dysfunction is common in AD, and disrupted communication between memory-related and self-related DMN networks is associated with anosognosia in AD patients. In addition, the temporoparietal junction (TPJ) is a key region of the "social brain" and also contributes to representations of the self. The exact classification of the TPJ within the DMN is unclear, though connections between the TPJ and DMN have been highlighted in multiple avenues of research. Here we discuss the relationship between the TPJ, DMN, and AD, as well as the potential involvement of the TPJ in anosognosia in AD. We review past and present findings to raise attention to the TPJ, with a specific emphasis on neuroimaging technologies which suggest a pivotal role of the TPJ within large-scale brain networks linked to anosognosia in AD.
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Affiliation(s)
- Lucas Lattanzio
- Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander Seames
- Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Samantha K Holden
- Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Isabelle Buard
- Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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22
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Macchi ZA, Kletenik I, Olvera C, Holden SK. Psychiatric Comorbidities in Functional Movement Disorders: A Retrospective Cohort Study. Mov Disord Clin Pract 2021; 8:725-732. [PMID: 34307745 DOI: 10.1002/mdc3.13226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023] Open
Abstract
Background Functional movement disorders (FMD) are characterized by abnormal movements and motor symptoms incongruent with a known structural neurologic cause. While psychological stressors have long been considered an important risk factor for developing FMD, little is known about the impact of psychiatric comorbidities on disease manifestations or complexity. Objectives To compare characteristics of FMD patients with co-occurring mood and trauma-related psychiatric conditions to FMD patients without psychiatric conditions. Methods We performed a retrospective cohort study of patients seen in the University of Colorado Health system between January 1, 2015 and December 31, 2019. Patients were included if they had a diagnosis of FMD, determined by ICD-10 coding and ≥1 phenomenology-related diagnostic code (tremor, gait disturbances, ataxia, spasms, and weakness), and at least one encounter with a neurology specialist. Fisher's exact and unpaired t-tests were used to compare demographics, healthcare utilization, and phenomenologies of patients with psychiatric conditions to those with none. Results Our review identified 551 patients with a diagnosis of FMD who met inclusion criteria. Patients with psychiatric conditions (N = 417, 75.7%) had increased five-year healthcare utilization (mean emergency room encounters 9.9 vs. 3.5, P = 0.0001) and more prevalent non-epileptic seizures (18.2% vs. 7.5%, P = 0.001). Suicidal ideation (8.4%) and self-harm (4.1%) were only observed amongst patients with comorbid psychiatric conditions. Conclusions Patients with FMD and comorbid psychiatric conditions require more healthcare resources and have greater disease complexity than patients without psychiatric illness. This may have implications for treatment of patients without comorbid psychiatric conditions who may benefit from targeted physiotherapy alone.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, Section of Behavioral Neurology University of Colorado Anschutz Aurora Colorado USA.,Department of Internal Medicine, Division of General Internal Medicine University of Colorado Anschutz Aurora Colorado USA
| | - Isaiah Kletenik
- Brigham and Women's Hospital, Department of Neurology, Division of Cognitive and Behavioral Neurology Harvard Medical School Boston Massachusetts USA
| | - Caroline Olvera
- Department of Neurological Sciences, Section of Movement Disorders Rush University Medical Center Chicago Illinois USA
| | - Samantha K Holden
- Department of Neurology, Section of Behavioral Neurology University of Colorado Anschutz Aurora Colorado USA
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23
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Holden SK, Van Dok E, Pelak VS. Co-occurrence of Convergence Insufficiency and Cognitive Impairment in Parkinsonian Disorders: A Pilot Study. Front Neurol 2019; 10:864. [PMID: 31447772 PMCID: PMC6696607 DOI: 10.3389/fneur.2019.00864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Convergence insufficiency (CI) in parkinsonian conditions causes disabling visual symptoms during near tasks and usually manifests as double vision. Since double vision is more common in patients who report cognitive symptoms, we sought to determine if symptomatic CI, as opposed to asymptomatic CI, could serve as a marker of cognitive impairment in parkinsonian disorders. Methods: Twenty-four participants with parkinsonian disorders (18 Parkinson's disease, 5 progressive supranuclear palsy, 1 multiple system atrophy) and objective findings of convergence insufficiency on neuro-ophthalmologic examination were included. Subjective visual symptoms and cognitive complaints were recorded, and the Self-Administered Gerocognitive Examination was used as a global cognitive screening measure. Results: 54.1% of parkinsonian participants had cognitive impairment, but there were no significant differences in the degree of convergence insufficiency, measured by near point of convergence (NPC), or cognitive outcomes between those with symptomatic CI, and asymptomatic CI. However, NPC was greater for those with cognitive impairment (x = 18.4 cm), compared to those who were cognitively intact (x = 12.5 cm, p = 0.003). Conclusions: Cognitive impairment commonly co-occurs in parkinsonian disorders with convergence insufficiency and is associated with significantly greater NPC distances. Clinicians should have a high index of suspicion for cognitive impairment in patients with objective findings of convergence insufficiency, whether symptomatic or not. Further investigation of convergence insufficiency in relationship to cognitive impairment in parkinsonian disorders is warranted, as there may be a shared mechanism of dysfunction.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Erin Van Dok
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
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24
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Holden SK, Koljack CE, Prizer LP, Sillau SH, Miyasaki JM, Kluger BM. Measuring quality of life in palliative care for Parkinson's disease: A clinimetric comparison. Parkinsonism Relat Disord 2019; 65:172-177. [PMID: 31253494 PMCID: PMC6774894 DOI: 10.1016/j.parkreldis.2019.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Quality of life (QOL) assessments allow for more complete evaluation of patients' lived experiences in relation to chronic conditions, such as Parkinson's disease (PD). In palliative care, such instruments are vital to ensure QOL issues are catalogued and addressed for patients. However, little is known regarding the psychometric properties of quality of life scales for use in palliative care for PD, specifically. METHODS 210 participants with parkinsonian disorders, who participated in a larger palliative intervention clinical trial, completed four quality of life scales (PDQ-39, PROMIS-29, QOL-AD, and McGill QOL) at baseline and post-intervention. Psychometric properties, including internal consistency and concurrent validity, were examined. Factor analyses were performed to evaluate relationships between scale items. Minimal clinically important differences (MCID) and responsiveness were calculated for each scale. RESULTS All scales demonstrated good internal consistency and concurrent validity. Factor analyses revealed few deviations from the defined subdomains of the scales. Mean absolute MCID values were estimated at 12.7, 10.9, 3.9, and 18.9 for PDQ-39, PROMIS-29, QOL-AD, and McGill QOL, respectively. The PDQ-39 and PROMIS-29 demonstrated higher responsiveness to palliative intervention, while the QOL-AD was more responsive in the control group. CONCLUSIONS The PDQ-39, PROMIS-29, QOL-AD, and McGill QOL are all valid for use in PD palliative care, though subdomains of the scales in this population may differ slightly from those initially defined. We recommend the use of PDQ-39 and PROMIS-29 as outcome measures in clinical trials for palliative care in PD, though the QOL-AD may be superior for tracking disease progression.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Claire E Koljack
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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25
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Holden SK, Sheffler J, Stewart R, Thompson S, Persson J, Finseth T, Sillau S, Kluger BM. Feasibility of Home-Based Neurologic Music Therapy for Behavioral and Psychological Symptoms of Dementia: A Pilot Study. J Music Ther 2019; 56:265-286. [DOI: 10.1093/jmt/thz009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Family caregivers often feel ill-equipped to handle bothersome behavioral and psychological symptoms of dementia, such as agitation, apathy, and sleep disturbances, leading to increased caregiver distress and nursing home placement for people with dementia. Therapies for such symptoms are currently limited and non-pharmacological options are preferred, given potential side effects of medications. Neurologic music therapy (NMT) could provide an additional treatment option for managing behavioral and psychological symptoms for community-dwelling people with dementia and their caregivers. This pilot study sought to evaluate the feasibility, acceptability, and effectiveness of home-based NMT for behavioral and psychological symptoms of dementia. Eighteen persons with dementia-caregiver dyads were enrolled to receive one-hour weekly sessions of home-based NMT for 6 weeks. Demographic, quality of life, neuropsychiatric symptom, and caregiver burden and self-efficacy information was collected at baseline, 6 weeks, and 12 weeks. Seven dyads (38.9%) withdrew from therapy before completing all sessions; these participants had higher Neuropsychiatric Inventory scores and were of older age at baseline. For those who completed therapy, neuropsychiatric symptom scores improved at 6 weeks, an effect that was sustained at 12 weeks. No other outcome measures changed significantly after therapy. Initiating NMT too late in the course of dementia, when behavioral symptoms are already present, may be impractical for people with dementia and increase caregiver stress, even when provided within the home. Introducing and incorporating the principles of NMT earlier in the course of dementia could allow for increased comfort and benefit for people with dementia and their caregivers.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julia Sheffler
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | | | | | | | - Taylor Finseth
- Department of Neurology, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA
| | - Stefan Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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26
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Pelak VS, Tang-Wai DF, Bouwman FH, Onyike CU, Murray ME, Day GS, Migliaccio R, Olds J, Hills W, Bretsch C, Lusk J, Potter H, Boyd T, Pressman PS, Holden SK, Bettcher BM. P1-311: DEVELOPMENT OF AN INTERNATIONAL POSTERIOR CORTICAL ATROPHY BIOREGISTRY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.866] [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: 11/25/2022]
Affiliation(s)
| | - David F. Tang-Wai
- University of Toronto; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - Femke H. Bouwman
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience; VU University Medical Center; Amsterdam Netherlands
| | | | | | - Gregory S. Day
- Knight Alzheimer Disease Research Center; St. Louis MO USA
| | | | | | | | | | - Jerri Lusk
- University of Colorado School of Medicine; Aurora CO USA
| | - Huntington Potter
- University of Colorado School of Medicine; Aurora CO USA
- Linda Crnic Institute for Down Syndrome; Aurora CO USA
| | - Timothy Boyd
- University of Colorado School of Medicine; Aurora CO USA
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27
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Holden SK, Medina LD, Hoyt B, Sillau SH, Berman BD, Goldman JG, Weintraub D, Kluger BM. Validation of a performance-based assessment of cognitive functional ability in Parkinson's disease. Mov Disord 2018; 33:1760-1768. [PMID: 30306618 DOI: 10.1002/mds.27487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 08/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outcome measures that capture functional abilities related to cognition offer the potential to demonstrate real-world effectiveness of cognitive-enhancing treatments. However, distinguishing functional disability related to cognition from that attributed to motor symptoms can be difficult in PD. A performance-based functional assessment allows for direct observation of activity of daily living skills and separation of cognitive from motoric disabilities. OBJECTIVES Validate the University of California San Diego Performance-Based Skills Assessment in PD. METHODS One hundred PD participants, ranging from normal cognition to dementia, completed the University of California San Diego Performance-Based Skills Assessment, a performance-based measure of cognitively demanding activities of daily living, as well as a neuropsychological battery and motor examination. Cognitive classification was determined by consensus conference, blinded to University of California San Diego Performance-Based Skills Assessment scores. Psychometric properties of the University of California San Diego Performance-Based Skills Assessment, including internal consistency, test-retest and inter-rater reliability, and discriminant validity for dementia, were examined. RESULTS The University of California San Diego Performance-Based Skills Assessment demonstrated strong internal consistency (Cronbach's α = 0.82) and test-retest reliability (r = 0.89) and correlated strongly with global cognition (Mattis Dementia Rating Scale: r = 0.80; P < 0.001). University of California San Diego Performance-Based Skills Assessment regression models indicated greater contribution from cognitive explanatory variables (marginal partial: R2 = 0.33) than motor variables (marginal partial: R2 = 0.05), controlling for age, education, disease duration, and l-dopa equivalent dose. Additionally, the University of California San Diego Performance-Based Skills Assessment exhibited strong discriminant validity for dementia (area under the curve = 0.91). CONCLUSIONS The University of California San Diego Performance-Based Skills Assessment is a valid measure of functional abilities related to cognition rather than motor symptoms in PD. Furthermore, it reliably distinguishes demented from nondemented participants. The University of California San Diego Performance-Based Skills Assessment may be considered as an outcome measure that combines cognitive and functional abilities in treatment trials for cognitive impairment in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Brian Hoyt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Neurology Section, Denver VA Medical Center, Denver, Colorado, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Section of Parkinson's Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Weintraub
- Parkinson's Disease and Mental Illness Research Education, Clinical and Education Centers, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kluger BM, Persenaire MJ, Holden SK, Palmer LT, Redwine HM, Berk J, Anderson CA, Filley CM, Kutner J, Miyasaki J, Carter J. Implementation issues relevant to outpatient neurology palliative care. Ann Palliat Med 2018; 7:339-348. [DOI: 10.21037/apm.2017.10.06] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/12/2017] [Indexed: 11/06/2022]
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29
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Boeve BF, Armstrong M, Galvin JE, Goldman J, Irwin DJ, Kaufer D, Leverenz JB, Lunde AM, McKeith IG, Paulson HL, Siderowf AD, Barrett MJ, Kimiko DR, Duda J, Galasko DR, Gomperts S, Graff-Radford NR, Holden SK, Honig LS, Huddleston D, Lippa C, Litvan I, Manning CA, Marder K, E-H Moussa C, Onyike CU, Pagan F, Pantelyat A, Pelak VS, Poston K, Quinn JF, Richard I, Rosenthal L, Sabbagh MN, Scharre DW, Sha S, Shill H, Torres-Yaghi Y, Amodeo K, Christie T, Graham T, Koehler M, Peterson B, Richard I, Taylor A. O5‐03‐04: THE LEWY BODY DEMENTIA ASSOCIATION RESEARCH CENTERS OF EXCELLENCE PROGRAM: TOWARD OPTIMIZING CLINICAL CARE AND CLINICAL TRIAL INFRASTRUCTURE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.3010] [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: 10/28/2022]
Affiliation(s)
| | | | | | | | - David J. Irwin
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | - Ian G. McKeith
- Institute of NeuroscienceNewcastle University, Wolfson Research Centre, Campus for Ageing and VitalityNewcastle upon TyneUnited Kingdom
| | | | | | | | | | - John Duda
- University of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | | | | | | | | | - Irene Litvan
- University of California San DiegoSan DiegoCAUSA
| | | | | | | | | | | | - Alex Pantelyat
- Johns Hopkins University School of MedicineBaltimoreMDUSA
| | | | | | | | | | | | | | | | | | | | - Yasar Torres-Yaghi
- George Washington School of Medicine and Health SciencesWashingtonD.C.USA
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30
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Goldman JG, Holden SK, Litvan I, McKeith I, Stebbins GT, Taylor JP. Evolution of diagnostic criteria and assessments for Parkinson's disease mild cognitive impairment. Mov Disord 2018; 33:503-510. [DOI: 10.1002/mds.27323] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders; Rush University Medical Center; Chicago Illinois USA
| | - Samantha K. Holden
- Department of Neurology; University of Colorado, Department of Neurology; Aurora Colorado USA
| | - Irene Litvan
- Department of Neurosciences; University of California San Diego, Department of Neurosciences; San Diego California USA
| | - Ian McKeith
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne United Kingdom
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders; Rush University Medical Center; Chicago Illinois USA
| | - John-Paul Taylor
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne United Kingdom
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31
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Holden SK, Finseth T, Sillau SH, Berman BD. Progression of MDS-UPDRS Scores Over Five Years in De Novo Parkinson Disease from the Parkinson's Progression Markers Initiative Cohort. Mov Disord Clin Pract 2017; 5:47-53. [PMID: 29662921 DOI: 10.1002/mdc3.12553] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UDPRS) is a commonly used tool to measure Parkinson disease (PD) progression. Longitudinal changes in MDS-UPDRS scores in de novo PD have not been established. Objective Determine progression rates of MDS-UPDRS scores in de novo PD. Methods 362 participants from the Parkinson's Progression Markers Initiative, a multicenter longitudinal cohort study of de novo PD, were included. Longitudinal progression of MDS-UPDRS total and subscale scores were modeled using mixed model regression. Results MDS-UPDRS scores increased in a linear fashion over five years in de novo PD. MDS-UPDRS total score increased an estimated 4.0 points/year, Part I 0.25 points/year, Part II 1.0 points/year, and Part III 2.4 points/year. Conclusions The expected average progression of MDS-UPDRS scores in de novo PD from this study can assist in clinical monitoring and provide comparative data for detection of disease modification in treatment trials.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Taylor Finseth
- Department of Neurology, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA.,Neurology Section, Denver VA Medical Center, Denver, CO USA
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Abstract
BACKGROUND Parkinson's disease dementia (PDD) is a major cause of morbidity and mortality in Parkinson's disease (PD), which severely affects patient functioning and quality of life and increases the risk for nursing home admission. Unfortunately, current treatment options for PDD are limited and have only marginal therapeutic effects. As novel treatments are developed, there will be a need to assess their efficacy in well-designed randomized controlled trials. However, there is no consensus on the optimal outcome measures for use in PDD clinical trials. METHODS A systematic review of PDD clinical trials and empiric studies of outcome measures used in PDD was performed. Outcome measures were divided into five categories: 1) cognitive; 2) behavioral and mood; 3) activities of daily living and quality of life; 4) global; and 5) caregiver burden. FINDINGS A total of 20 PDD pharmacologic clinical trials were identified. These trials incorporated a broad array of outcome measures, which were used inconsistently across trials. We summarize the psychometric properties and other relevant data on outcome measures used, including their diagnostic utility, inter-rater reliability, test-retest reliability, responsiveness, clinically meaningful change, and availability of alternate forms. CONCLUSIONS We have identified the best-evidenced PDD outcome measures in each domain. Further research is needed to assess the validity, reliability, and clinically meaningful change of these measures in PDD to inform the design of future clinical trials and enhance the ability of clinicians, researchers and policy-makers to interpret study results. In addition, the development of outcome measures specific to PDD may be warranted.
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Affiliation(s)
- Samantha K Holden
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
| | - Wallace E Jones
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
| | - Keith A Baker
- St. Luke's University Health Network, Department of Emergency Medicine, Bethlehem, PA
| | - Isabel M Boersma
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
| | - Benzi M Kluger
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO
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