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Al-Amrani F, Al Rawas A, Al-Ajmi E, Al Futaisi A. Case report: Cyclosporine A-induced extrapyramidal syndrome following hematopoietic stem cell transplantation. Front Neurol 2023; 14:1140732. [PMID: 37139067 PMCID: PMC10150064 DOI: 10.3389/fneur.2023.1140732] [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: 01/09/2023] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Cyclosporine A-associated neurotoxicity has been reported in up to 40% of patients and its wide range of neurological adverse effects have been reported, ranging from mild tremors to fatal leukoencephalopathy. Extrapyramidal (EP) neurotoxicity is a rare manifestation of cyclosporine. Cyclosporine-induced extrapyramidal syndrome remains a rare adverse reaction. Design/methods A database search was performed for studies in patients from all age groups. We found a total of 10 articles reporting EP as an adverse effect of cyclosporine A. A total of 16 patients were found, and a thorough review of these patients was performed. A comparison of patients was performed to highlight common clinical presentations, investigations during the symptomatic phase, and prognosis. In addition, we describe an 8-year-old boy who developed cyclosporine-related extrapyramidal signs on day 60 post-hematopoietic stem cell transplantation for beta-thalassemia. Conclusion Cyclosporine A can induce neurotoxicity resulting in diverse symptoms. Signs of EP are rare manifestations of cyclosporine neurotoxicity and should be considered when evaluating post-transplant recipients of cyclosporine when they are present with any EP symptoms. Discontinuation of cyclosporine results in good recovery in most patients.
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Affiliation(s)
- Fatema Al-Amrani
- Division of Neurology, Department of Pediatrics, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Abdulhakeem Al Rawas
- Division of Hematology, Department of Pediatrics, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Amna Al Futaisi
- Division of Neurology, Department of Pediatrics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
- *Correspondence: Amna Al Futaisi
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2
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Cuesta MJ, Lecumberri P, Moreno-Izco L, López-Ilundain JM, Ribeiro M, Cabada T, Lorente-Omeñaca R, de Erausquin G, García-Martí G, Sanjuan J, Sánchez-Torres AM, Gómez M, Peralta V. Motor abnormalities and basal ganglia in first-episode psychosis (FEP). Psychol Med 2021; 51:1625-1636. [PMID: 32114994 DOI: 10.1017/s0033291720000343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. METHODS We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used. RESULTS FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. CONCLUSIONS Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pablo Lecumberri
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
| | - Lucia Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Teresa Cabada
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Neuroradiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel de Erausquin
- Zachry Foundation, The Glenn Biggs Institute of Alzheimer's & Neurodegenerative Disorders, UT Heath San Antonio, Texas, USA
| | - Gracian García-Martí
- Radiology Department, CIBERSAM, Valencia, España, Quirón Salud Hospital, Valencia, España
| | - Julio Sanjuan
- Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
- Department of Psychiatric, University of Valencia School of Medicine, Valencia, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marisol Gómez
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
- Department of Statistics, Computer Science and Mathematics, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Victor Peralta
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
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Kociolek AJ, Fernandez KK, Jin Z, Cosentino S, Zhu CW, Gu Y, Stern Y. Extrapyramidal signs and Alzheimer's disease prognosis in a multiethnic, community-based sample of demented elders. Alzheimers Dement 2021; 17:1465-1473. [PMID: 33710771 DOI: 10.1002/alz.12309] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Extrapyramidal signs (EPS) are a common feature of Alzheimer's disease associated with worse outcomes in observational studies of dementia. Less research has been conducted on ethnic minority and non-clinic-based populations. METHODS One hundred and forty-two multiethnic community-dwelling participants with dementia were selected. Adjusted Cox models were fitted for mortality, cognitive (Mini Mental State Examination ≤10), functional (Blessed Dementia Rating Scale ≥10), and dependency (needs full-time care) endpoints with baseline EPS as predictor. RESULTS Thirty-seven participants (26.06%) had EPS at baseline. EPS predicted more rapid time to death (hazard ratio [HR] = 2.76, 95% confidence interval [CI] = 1.49, 5.42), and functional endpoint (HR = 3.88, 95% CI = 1.75, 8.62) but not cognitive and dependency endpoints. No evidence of interaction by ethnicity, age, sex, education, or apolipoprotein E ε4 polymorphism was found. DISCUSSION Our results partially confirm previous studies on predominantly White, clinic-based samples. Further research is needed to better understand the etiological role of EPS in AD.
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Affiliation(s)
- Anton J Kociolek
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kayri K Fernandez
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Epidemiology, Columbia University, New York, New York, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Abstract
There is an extensive literature relating to factors associated with the development of Alzheimer's disease (AD), but less is known about factors which may contribute to its progression. This review examined the literature with regard to 15 factors which were suggested by PubMed search to be positively associated with the cognitive and/or neuropathological progression of AD. The factors were grouped as potentially modifiable (vascular risk factors, comorbidities, malnutrition, educational level, inflammation, and oxidative stress), non-modifiable (age at clinical onset, family history of dementia, gender, Apolipoprotein E ɛ4, genetic variants, and altered gene regulation), and clinical (baseline cognitive level, neuropsychiatric symptoms, and extrapyramidal signs). Although conflicting results were found for the majority of factors, a positive association was found in nearly all studies which investigated the relationship of six factors to AD progression: malnutrition, genetic variants, altered gene regulation, baseline cognitive level, neuropsychiatric symptoms, and extrapyramidal signs. Whether these or other factors which have been suggested to be associated with AD progression actually influence the rate of decline of AD patients is unclear. Therapeutic approaches which include addressing of modifiable factors associated with AD progression should be considered.
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Affiliation(s)
- David A Loeffler
- Beaumont Research Institute, Department of Neurology, Beaumont Health, Royal Oak, MI, USA
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5
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Ogawa T, Ogaki K, Ishiguro M, Ando M, Yoshida T, Noda K, Hattori N, Okuma Y. Novel GFAP p. Glu206Ala Mutation in Alexander Disease with Decreased Dopamine Transporter Uptake. Mov Disord Clin Pract 2020; 7:720-722. [PMID: 32775528 DOI: 10.1002/mdc3.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Takashi Ogawa
- Department of Neurology Juntendo University Shizuoka Hospital Shizuoka Japan.,Department of Neurology Juntendo University School of Medicine Tokyo Japan
| | - Kotaro Ogaki
- Department of Neurology Juntendo University Shizuoka Hospital Shizuoka Japan.,Department of Neurology Juntendo University School of Medicine Tokyo Japan
| | - Mayu Ishiguro
- Department of Neurology Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Maya Ando
- Department of Neurology Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Tomokatsu Yoshida
- Department of Neurology, Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Kazuyuki Noda
- Department of Neurology Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Nobutaka Hattori
- Department of Neurology Juntendo University School of Medicine Tokyo Japan
| | - Yasuyuki Okuma
- Department of Neurology Juntendo University Shizuoka Hospital Shizuoka Japan
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6
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Park JH, Jang W, Youn J, Ki CS, Kim BJ, Kim HT, Louis ED, Cho JW. Prevalence of fragile X-associated tremor/ataxia syndrome: A survey of essential tremor patients with cerebellar signs or extrapyramidal signs. Brain Behav 2019; 9:e01337. [PMID: 31158927 PMCID: PMC6625470 DOI: 10.1002/brb3.1337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/14/2019] [Accepted: 05/18/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES In screening studies of Western patients with cerebellar dysfunction, FMR1 premutations have been detected. A screening study of East Asian patients with presumed essential tremor (ET) did not detect these mutations, possibly because the ET patients did not closely mimic the phenotype of fragile X-associated tremor/ataxia syndrome (FXTAS). The aim of this study was to estimate the prevalence of FMR1 premutations in a carefully recruited group of ET patients with additional phenotypic features of FXTAS. MATERIALS AND METHODS From April 2014 to April 2018, we prospectively recruited patients with ET diagnoses from three tertiary care centers. Demographic and clinical data were collected, as well as data on presence of cerebellar signs and extrapyramidal signs (EPS). Tremor, cerebellar signs, and EPS were evaluated using appropriate clinical rating scales. For ET patients with additional cerebellar signs or EPS, FMR1 mutation analysis and brain magnetic resonance imaging were performed. RESULTS Six hundred and three ET patients were recruited. Cerebellar signs or EPS were present in 168 (27.9%) of 603. FMR1 CGG repeat analysis was performed in 74 of 168 patients. Fifty-two of 74 had cerebellar signs only, three had EPS only, and 19 had both neurologic abnormalities. Two patients had a FMR1 premutation and fulfiled both clinical and radiological criteria of FXTAS. CONCLUSIONS Two (2.7%) of 74 patients with presumed ET and additional neurological features were discovered to have FXTAS. The possibility of FXTAS should be considered in patients with ET who exhibit mild cerebellar signs or EPS.
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Affiliation(s)
- Ji-Hyung Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee-Tae Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
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7
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Salem H, Nagpal C, Pigott T, Teixeira AL. Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges. Curr Neuropharmacol 2017; 15:789-798. [PMID: 27928948 PMCID: PMC5771055 DOI: 10.2174/1570159x14666161208153644] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.] Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. CONCLUSION Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.
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Affiliation(s)
- Haitham Salem
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Caesa Nagpal
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Teresa Pigott
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Antonio Lucio Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
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8
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Park JH, Myung W, Choi J, Kim S, Chung JW, Kang HS, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim SY, Kim DK. Extrapyramidal Signs and Cognitive Subdomains in Alzheimer Disease. Am J Geriatr Psychiatry 2016; 24:566-74. [PMID: 27067071 DOI: 10.1016/j.jagp.2016.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Extrapyramidal signs (EPS), commonly observed in Alzheimer disease (AD), predict cognitive impairment and functional decline. This study investigated the association between EPS and five cognitive subdomains in a large number of participants with AD. DESIGN Cross-sectional analyses of the nationwide Clinical Research of Dementia of South Korea (CREDOS) study, 2005-2012. SETTING Multicenter clinical settings. PARTICIPANTS 1,737 participants with AD drawn from the CREDOS study. MEASUREMENTS The EPS group was defined by the presence of at least one EPS based on neurologic examination. We assessed five cognitive subdomains: attention, language, visuospatial function, memory, and frontal/executive function using the Seoul Neuropsychological Screening Battery-Dementia version. The associations of EPS with each cognitive subdomain were analyzed with a multiple linear regression model after controlling for confounding factors: sex, age, years of education, severity of dementia (Clinical Dementia Rating Sum of Boxes), and white matter hyperintensities. RESULTS 164 AD participants (9.4%) had EPS. AD participants with EPS showed lower performance compared with those without EPS in two cognitive subdomains: attention and visuospatial function. The language, memory, and frontal/executive subdomains did not differ between the EPS-positive and the EPS-negative groups. In addition, we found a significant moderating relationship between EPS and deep white matter hyperintensities on visuospatial function score. CONCLUSIONS EPS in AD are associated with severe cognitive impairment in attention and visuospatial function. Careful screening for EPS in patients with AD may assist in prediction of cognitive profile.
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Affiliation(s)
- Jin Hong Park
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woojae Myung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junbae Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangha Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Won Chung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo Shin Kang
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Sang Yun Kim
- Department of Neurology, Seoul National University Bundang Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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9
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Caixeta L, Vieira RT, Paes F, Carta MG, Nardi AE, Arias-Carrión O, Rocha NBF, Budde H, Machado S. Comparative study of subcortical atrophy in patients with frontotemporal dementia and dementia with extrapyramidal signs. Clin Pract Epidemiol Ment Health 2015; 11:125-9. [PMID: 25870648 PMCID: PMC4391205 DOI: 10.2174/1745017901511010125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/02/2014] [Revised: 09/22/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022]
Abstract
Objectives :
To investigate the severity of subcortical atrophy in frontotemporal dementia (FTD) without extrapyramidal symptoms (EPS) and dementia with EPS. In addition, we aim to verify if there is correlation between demographic and clinical characteristics and subcortical atrophy in the groups. Methodology : The sample was composed of 21 patients with dementia and EPS as well as 19 patients with FTD without EPS. A linear assessment was conducted in order to identify the degree of subcortical atrophy (i.e., bifrontal index - BFI) using MRI. Moreover, the Mini-Mental State Examination (MMSE), Pfeffer Functional Activities Questionnaire (FAQ) and the Clinical Dementia Rating (CDR) were used to investigate clinical aspects. Results : It was verified that patients with dementia and EPS was older than the patients with FTD (p=0.01). The severity of cognitive deficits was associated with BFI, as well as the dementia severity in the EPS group. Conclusion : FTD group presented mean BFI scores above the cutoff for normal elderly population, indicating the presence of subcortical atrophy in this group. Mean BFI was higher (although not statistically significant) in FTD group than in dementia with EPS, which can suggest at least that subcortical pathology in FTD may be as important as in the dementia with EPS group. Subcortical atrophy is a good biological marker for cognitive deterioration in FTD and in dementia with EPS.
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Affiliation(s)
- Leonardo Caixeta
- Neuropsychiatry, School of Medicine, Federal University of Goiás (UFG). Dementia Outpatient Unit, Hospital das Clínicas-UFG, Brazil
| | - Renata Teles Vieira
- Behavioral and Cognitive Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Goiânia (GO), Brazil
| | - Flávia Paes
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
| | - Mauro Giovanni Carta
- Department of Public Health, Clinic and Molecular Medicine - University of Cagliari, Italy
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea Gonzalez, Secretaria de Salud, México, DF, México
| | - Nuno B F Rocha
- Polytechnic Institute of Porto, School of Allied Health Sciences, Portugal
| | - Henning Budde
- Medical School Hamburg, Faculty of Human Sciences, Department of Pedagogy, Germany; Reykjavik University, School of Science and Engineering, Department of Sport Science, Iceland
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil ; Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, RJ, Brazil
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10
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Abstract
Alzheimer's Disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline and dementia. Recent advances indicate that AD pathogenesis appears more complex than its mere neuropathology. Changes in synaptic plasticity, neuronal disarray and cell death are pathways commonly recognized as pathogenic mechanisms of AD. It is thought that the altered metabolism of certain membrane proteins may lead to the production of amyloid (Aβ) oligomers that are characterized by an highly toxic effect on neurotransmission pathways, such as those mediated by Acetylcholine. The interaction of Aβ oligomers with these neurotansmitters systems would in turn induce cell dysfunction, neurotransmitters signaling imbalance and finally lead to the appearance of neurological signs. In this perspective, it is still debated how and if these mechanisms may also engage the dopaminergic system in AD. Recent experimental work revealed that the dopaminergic system may well be involved in the occurrence of cognitive decline, often being predictive of rapidly progressive forms of AD. However, a clear idea on the role of the dopamine system in AD is still missing. Here we review the more recent evidences supporting the notion that the dopaminergic dysfunction has a pathogenic role in cognitive decline symptoms of AD.
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Affiliation(s)
- Alessandro Martorana
- Clinica Neurologica-Memory Clinic, System Medicine Department, Università di Roma "Tor Vergata" Rome, Italy ; Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS Rome, Italy
| | - Giacomo Koch
- Clinica Neurologica-Memory Clinic, System Medicine Department, Università di Roma "Tor Vergata" Rome, Italy ; Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS Rome, Italy
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Cuesta MJ, Sánchez-Torres AM, de Jalón EG, Campos MS, Ibáñez B, Moreno-Izco L, Peralta V. Spontaneous parkinsonism is associated with cognitive impairment in antipsychotic-naive patients with first-episode psychosis: a 6-month follow-up study. Schizophr Bull 2014; 40:1164-73. [PMID: 24072809 PMCID: PMC4133659 DOI: 10.1093/schbul/sbt125] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is now growing evidence that parkinsonism and other extrapyramidal signs are highly prevalent in patients with first-episode psychosis who have never been exposed to antipsychotic drugs. However, the neurocognitive correlates of parkinsonism in this population remained to be clarified. A sample comprising 100 consecutive drug-naive patients with first-episode psychosis were enrolled on the study and followed up for 6 months. Seventy-seven completed assessments at 3 time points (baseline, 1 mo, and 6 mo), involving clinical and cognitive examinations and a specific assessment of motor abnormalities. The Simpson-Angus Scale (SAS) was used for the assessment of extrapyramidal signs, and each motor domain was evaluated with a standard assessment scale. Linear mixed models were built to explore the longitudinal relationships between parkinsonism scores and cognitive impairment. Parkinsonism scores showed significant strong longitudinal associations with deficits in memory, executive functioning, and attention. Spontaneous parkinsonism (total SAS score and hypokinesia and rigidity subscores at baseline) showed high 6-month predictive values for cognitive impairment. In addition, they also had high predictive values for neurologic soft-sign abnormalities but not for dyskinesia, akathisia, and pure catatonic abnormalities. No predictive value was found for glabella-salivation or tremor subscores on the SAS scale. These results emphasize the relevance of the assessment of parkinsonism signs prior to starting to administer antipsychotic drugs, as core manifestations of psychotic illness with a high predictive value for cognitive impairment.
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Affiliation(s)
- Manuel J Cuesta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain;
| | | | | | - Maria S Campos
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Berta Ibáñez
- Methodology Unit, Biomedical Research Center, Fundación Miguel Servet, Pamplona, Spain
| | - Lucía Moreno-Izco
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Víctor Peralta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona, Spain
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Morrens M, Docx L, Walther S. Beyond boundaries: in search of an integrative view on motor symptoms in schizophrenia. Front Psychiatry 2014; 5:145. [PMID: 25352812 PMCID: PMC4196470 DOI: 10.3389/fpsyt.2014.00145] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/26/2014] [Indexed: 12/29/2022] Open
Affiliation(s)
- Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp , Antwerp , Belgium ; Psychiatric Center Alexian Brothers , Boechout , Belgium
| | - Lise Docx
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp , Antwerp , Belgium ; Psychiatric Center Alexian Brothers , Boechout , Belgium
| | - Sebastian Walther
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
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Abstract
Organophosphorous (OP) compound poisoning is one of the most common causes for admission to the Medical Intensive Care Unit. The morbidity and mortality associated with OP poisoning is due to the action of the compound at the muscarinic, nicotinic receptors, and the central nervous system. Here is a rare case of extrapyramidal manifestations occurring in the intermediate phase of OP poisoning, use of amantidine led to subsiding of the symptoms.
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Affiliation(s)
- Balamurali Kalyanam
- Department of Pharmacology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
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Choi J, Myung W, Chung JW, Kang HS, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim S, Kim S, Carroll BJ, Kim DK. Association between functional impairment, depression, and extrapyramidal signs in neuroleptic-free patients with Alzheimer disease. J Geriatr Psychiatry Neurol 2013; 26:144-50. [PMID: 23733855 DOI: 10.1177/0891988713490993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Extrapyramidal signs (EPSs) are commonly observed in patients with Alzheimer disease (AD). We report here the base rate of EPS in a large cohort of patients with AD who were not receiving neuroleptic drugs, and the associations of EPS with functional outcomes and depressive symptoms. METHODS In a consortium involving 56 clinics, we recruited 2614 patients with AD. We estimated basic activities of daily living (ADL) and instrumental ADL by the Barthel index and the Seoul-Instrumental Activities of Daily Living (S-IADL) scales, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The EPS group was defined by the presence of at least 1 EPS based on a focused neurologic examination. RESULTS The prevalence of EPS-positive patients was 12%. These had lower Korean version of the Mini-Mental State Examination (K-MMSE) scores than the EPS-negative cases (P < .001). After controlling for demographic, medical, radiological, genetic, and cognitive (K-MMSE) factors, the proportion of patients with impaired ADL was significantly higher in the EPS group than in the non-EPS group (P < .001, odds ratio = 1.90, 95% confidence interval, 1.45-2.48, and logistic regression). The S-IADL scores were significantly higher in the EPS group than this in the non-EPS group (P < .001, regression coefficient = 3.19, and median regression). The GDS-15 scores were higher in the EPS group (P = .04, regression coefficient = 0.89, and median regression). CONCLUSION The presence of EPS in patients with AD who were not receiving neuroleptic drugs was associated with more impaired basic and instrumental ADL functioning and with greater depression symptoms.
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Affiliation(s)
- Junbae Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
We have described four patients with slowly progressive aphasia with striatal involvement occurring at different stages in the course of the illness. There were two males and two females, and their ages ranged from 68 to 76 (mean: 72) years. The extrapyramidal signs included tremors, bradykinesia, rigidity, and focal dystonia, and one had weakness resembling stroke. There is a heterogeniety among patients with slowly progressive aphasia and the clinical features correspond to the functional anatomy of the areas involved rather than to the pathology.
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Affiliation(s)
- Nages Nagaratnam
- Aged Care Services and Rehabilitation Services (Department of Medicine), Blacktown Mount Druitt Health, New South Wales, Australia
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