1
|
Hamilton CA, Gallagher P, Ciafone J, Barnett N, Barker SAH, Donaghy PC, O'Brien JT, Taylor JP, Thomas AJ. Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer's disease. J Int Neuropsychol Soc 2024; 30:421-427. [PMID: 38017617 DOI: 10.1017/s1355617723000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer's disease (MCI-AD), and any performance deficits which emerged with sustained effort. METHOD We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years). RESULTS While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1-4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3-2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2-8.8). CONCLUSIONS Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sally A H Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Wyman-Chick KA, Chaudhury P, Bayram E, Abdelnour C, Matar E, Chiu SY, Ferreira D, Hamilton CA, Donaghy PC, Rodriguez-Porcel F, Toledo JB, Habich A, Barrett MJ, Patel B, Jaramillo-Jimenez A, Scott GD, Kane JPM. Differentiating Prodromal Dementia with Lewy Bodies from Prodromal Alzheimer's Disease: A Pragmatic Review for Clinicians. Neurol Ther 2024:10.1007/s40120-024-00620-x. [PMID: 38720013 DOI: 10.1007/s40120-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer's disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)-parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.
Collapse
Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center and Center for Memory and Aging, Department of Neurology, HealthPartners/Park Nicollet, Bloomington, USA.
| | - Parichita Chaudhury
- Cleo Roberts Memory and Movement Center, Banner Sun Health Research Institute, Sun City, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, University of California San Diego, San Diego, USA
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shannon Y Chiu
- Department of Neurology, Mayo Clinic Arizona, Phoenix, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- Department of Radiology, Mayo Clinic Rochester, Rochester, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jon B Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Matthew J Barrett
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, USA
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, USA
- Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, USA
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- School of Medicine, Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Gregory D Scott
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, USA
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| |
Collapse
|
3
|
Hamilton CA, Matthews FE, Attems J, Donaghy PC, Erskine D, Taylor JP, Thomas AJ. Associations between multimorbidity and neuropathology in dementia: consideration of functional cognitive disorders, psychiatric illness and dementia mimics. Br J Psychiatry 2024:1-8. [PMID: 38584319 DOI: 10.1192/bjp.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Multimorbidity, the presence of two or more health conditions, has been identified as a possible risk factor for clinical dementia. It is unclear whether this is due to worsening brain health and underlying neuropathology, or other factors. In some cases, conditions may reflect the same disease process as dementia (e.g. Parkinson's disease, vascular disease), in others, conditions may reflect a prodromal stage of dementia (e.g. depression, anxiety and psychosis). AIMS To assess whether multimorbidity in later life was associated with more severe dementia-related neuropathology at autopsy. METHOD We examined ante-mortem and autopsy data from 767 brain tissue donors from the UK, identifying physical multimorbidity in later life and specific brain-related conditions. We assessed associations between these purported risk factors and dementia-related neuropathological changes at autopsy (Alzheimer's-disease related neuropathology, Lewy body pathology, cerebrovascular disease and limbic-predominant age-related TDP-43 encephalopathy) with logistic models. RESULTS Physical multimorbidity was not associated with greater dementia-related neuropathological changes. In the presence of physical multimorbidity, clinical dementia was less likely to be associated with Alzheimer's disease pathology. Conversely, conditions which may be clinical or prodromal manifestations of dementia-related neuropathology (Parkinson's disease, cerebrovascular disease, depression and other psychiatric conditions) were associated with dementia and neuropathological changes. CONCLUSIONS Physical multimorbidity alone is not associated with greater dementia-related neuropathological change; inappropriate inclusion of brain-related conditions in multimorbidity measures and misdiagnosis of neurodegenerative dementia may better explain increased rates of clinical dementia in multimorbidity.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Erskine
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Fernando R, Thomas AJ, Hamilton CA, Durcan R, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Petrides G, Colloby S, Allan LM, McKeith IG, O'Brien JT, Taylor JP, Donaghy PC. Identifying parkinsonism in mild cognitive impairment. J Neurol Sci 2024; 458:122941. [PMID: 38422782 DOI: 10.1016/j.jns.2024.122941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Clinical parkinsonism is a core diagnostic feature for mild cognitive impairment with Lewy bodies (MCI-LB) but can be challenging to identify. A five-item scale derived from the Unified Parkinson's Disease Rating Scale (UPDRS) has been recommended for the assessment of parkinsonism in dementia. This study aimed to determine whether the five-item scale is effective to identify parkinsonism in MCI. METHODS Participants with MCI from two cohorts (n = 146) had a physical examination including the UPDRS and [123I]-FP-CIT SPECT striatal dopaminergic imaging. Participants were classified as having clinical parkinsonism (P+) or no parkinsonism (P-), and with abnormal striatal dopaminergic imaging (D+) or normal imaging (D-). The five-item scale was the sum of UPDRS tremor at rest, bradykinesia, action tremor, facial expression, and rigidity scores. The ability of the scale to differentiate P+D+ and P-D- participants was examined. RESULTS The five-item scale had an AUROC of 0.92 in Cohort 1, but the 7/8 cut-off defined for dementia had low sensitivity to identify P+D+ participants (sensitivity 25%, specificity 100%). Optimal sensitivity and specificity was obtained at a 3/4 cut-off (sensitivity 83%, specificity 88%). In Cohort 2, the five-item scale had an AUROC of 0.97, and the 3/4 cut-off derived from Cohort 1 showed sensitivity of 100% and a specificity of 82% to differentiate P+D+ from P-D- participants. The five-item scale was not effective in differentiating D+ from D- participants. CONCLUSIONS The five-item scale is effective to identify parkinsonism in MCI, but a lower threshold must be used in MCI compared with dementia.
Collapse
Affiliation(s)
- Rishira Fernando
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sean Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
| |
Collapse
|
5
|
Katanga JA, Hamilton CA, Walker L, Attems J, Thomas AJ. Age-related hearing loss and dementia-related neuropathology: An analysis of the United Kingdom brains for dementia research cohort. Brain Pathol 2023; 33:e13188. [PMID: 37551936 PMCID: PMC10580004 DOI: 10.1111/bpa.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 08/09/2023] Open
Abstract
Age-related hearing loss frequently precedes or coexists with mild cognitive impairment and dementia. The role specific neuropathologies play in this association, as either a cause or a consequence, is unclear. We therefore aimed to investigate whether specific dementia related neuropathologies were associated with hearing impairment in later life. We analysed data on ante-mortem hearing impairment with post-mortem neuropathological data for 442 participants from the Brains for Dementia Research Cohort. Binary logistic regression models were used to estimate the association of hearing impairment with the presence of each dementia-related neuropathology overall, and with specific staged changes. All analyses adjusted for age and sex, and several sensitivity analyses were conducted to test the robustness of findings. Presence and density of neuritic plaques were associated with higher odds of hearing impairment ante-mortem (OR = 3.65, 95% CI 1.78-7.46 for frequent density of plaques). Presence of any LB disease was likewise associated with hearing impairment (OR = 2.10, 95% CI 1.27-3.48), but this did not increase with higher cortical pathology (OR = 1.53, 95% CI 0.75-3.11). Nonspecific amyloid deposition, neurofibrillary tangle staging, overall AD neuropathology level, and cerebrovascular disease were not clearly associated with increased risks of hearing impairment. Our results provide some support for an association between dementia-related neuropathology and hearing loss and suggest that hearing loss may be associated with a high neuritic plaque burden and more common in Lewy body disease.
Collapse
Affiliation(s)
- Jessica A. Katanga
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Calum A. Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Lauren Walker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Johannes Attems
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
6
|
Schumacher J, Ray NJ, Hamilton CA, Bergamino M, Donaghy PC, Firbank M, Watson R, Roberts G, Allan L, Barnett N, O'Brien JT, Thomas AJ, Taylor JP. Free water imaging of the cholinergic system in dementia with Lewy bodies and Alzheimer's disease. Alzheimers Dement 2023; 19:4549-4563. [PMID: 36919460 DOI: 10.1002/alz.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Degeneration of cortical cholinergic projections from the nucleus basalis of Meynert (NBM) is characteristic of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), whereas involvement of cholinergic projections from the pedunculopontine nucleus (PPN) to the thalamus is less clear. METHODS We studied both cholinergic projection systems using a free water-corrected diffusion tensor imaging (DTI) model in the following cases: 46 AD, 48 DLB, 35 mild cognitive impairment (MCI) with AD, 38 MCI with Lewy bodies, and 71 controls. RESULTS Free water in the NBM-cortical pathway was increased in both dementia and MCI groups compared to controls and associated with cognition. Free water along the PPN-thalamus tract was increased only in DLB and related to visual hallucinations. Results were largely replicated in an independent cohort. DISCUSSION While NBM-cortical projections degenerate early in AD and DLB, the thalamic cholinergic input from the PPN appears to be more selectively affected in DLB and might associate with visual hallucinations. HIGHLIGHTS Free water in the NBM-cortical cholinergic pathways is increased in AD and DLB. NBM-cortical pathway integrity is related to overall cognitive performance. Free water in the PPN-thalamus cholinergic pathway is only increased in DLB, not AD. PPN-thalamus pathway integrity might be related to visual hallucinations in DLB.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany
| | - Nicola J Ray
- Health, Psychology and Communities Research Centre, Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Maurizio Bergamino
- Barrow Neurological Institute, Neuroimaging Research, Phoenix, Arizona, USA
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Rosie Watson
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
- University of Exeter Medical School, Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| |
Collapse
|
7
|
Durcan R, Roberts G, Hamilton CA, Donaghy PC, Howe K, Colloby SJ, Allan LM, Firbank M, Lawley S, Petrides GS, Lloyd JJ, Taylor JP, O'Brien JT, Thomas AJ. Serial Nigrostriatal Dopaminergic Imaging in Mild Cognitive Impairment With Lewy Bodies, Alzheimer Disease, and Age-Matched Controls. Neurology 2023; 101:e1196-e1205. [PMID: 37524532 PMCID: PMC10516282 DOI: 10.1212/wnl.0000000000207621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Progressive nigrostriatal pathway degeneration occurs in individuals with dementia with Lewy bodies (LB). Our objective was to investigate whether repeat 123[I]-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (FP-CIT) single photon emission computed tomography (SPECT) can identify progressive dopaminergic loss in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). METHODS Individuals with MCI-LB and MCI due to Alzheimer disease (MCI-AD) underwent comprehensive clinical assessment, 123[I]-FP-CIT SPECT at baseline and annual reviews, and baseline cardiac 123 iodine metaiodobenzylguanidine (I-MIBG). Mixed-effects models were used to investigate changes in 123[I]-FP-CIT specific binding ratio (SBR) in the striatum for each diagnostic group compared with controls. The time interval to the development of a quantitatively abnormal 123[I]-FP-CIT SPECT in the possible and probable MCI-LB groups was determined as the time it took for these groups to reach a striatal uptake 2 SDs below aged-matched controls. Test-retest variation was assessed using baseline and repeat scans in controls. RESULTS We recruited 20 individuals with MCI-AD, 11 with possible MCI-LB, 25 with probable MCI-LB, and 29 age-matched controls. The mean time between baseline and the final image was 1.6 years (SD = 0.9, range 1.0-4.3). The annual estimated change in SBR was 0.23 for controls (95% CI -0.07 to 0.53), -0.09 (-0.55 to 0.36) for MCI-AD, -0.50 (-1.03 to 0.04) for possible MCI-LB, and -0.48 (-0.89 to -0.06) for probable MCI-LB. The median annual percentage change in SBR in MCI-LB was -5.6% (95% CI -8.2% to -2.9%) and 2.1% (-3.5% to 8.0%) for MCI-AD. The extrapolated time for a normal scan to become abnormal was 6 years. Controls and MCI-AD showed no significant change in dopaminergic binding over time. The mean test-retest variation in controls was 12% (SD 5.5%), which cautions against overinterpretation of small changes on repeat scanning. DISCUSSION Progressive dopaminergic loss in the striatum is detectable using 123[I]-FP-CIT SPECT in MCI-LB at a group level. In clinical practice, individual change in striatal 123[I]-FP-CIT uptake seems to be of limited diagnostic value because of high test-retest variation. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that longitudinal declines in striatal uptake measured using 123[I]-FP-CIT SPECT are associated with MCI due to Lewy body disease but not MCI due to Alzheimer disease.
Collapse
Affiliation(s)
- Rory Durcan
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Gemma Roberts
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom.
| | - Calum A Hamilton
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Kim Howe
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Sean J Colloby
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Louise M Allan
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Michael Firbank
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Sarah Lawley
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - George S Petrides
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Jim J Lloyd
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - John T O'Brien
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (R.D., G.R., C.A.H., P.C.D., S.J.C., M.F., S.L., J.-P.T., A.J.T.), Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality; Nuclear Medicine Department (G.R., K.H., G.S.P., J.J.L.), Royal Victoria Infirmary, Newcastle Upon Tyne; University of Exeter Medical School (L.M.A.), St Luke's Campus, University of Exeter; and Department of Psychiatry (J.T.O.B.), University of Cambridge School of Clinical Medicine, United Kingdom
| |
Collapse
|
8
|
Kennedy RE, Hamilton CA, Rahimi SA, Ady JW. Simultaneous hybrid repair of symptomatic femoral, iliac, and abdominal aortic aneurysms. Vascular 2023:17085381231153245. [PMID: 36689328 DOI: 10.1177/17085381231153245] [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: 01/24/2023]
Abstract
BACKGROUND Focal peripheral arterial aneurysms, though rare, have a relatively high association with coexisting synchronous or metachronous aneurysms. While most are asymptomatic at presentation, there is concern for aneurysm thrombosis, embolization, or rupture, which can lead to acute limb ischemia or even limb loss. These complications require early intervention with either open or endovascular surgery, oftentimes staged due to complexity. METHOD We describe a case of a 65-year-old male presenting with a symptomatic common femoral artery aneurysm with a simultaneous infrarenal abdominal aortic aneurysm, requiring a hybrid endovascular and open approach for operative repair due to the size and characteristics of his aneurysms. DISCUSSION As the consensus for the management of synchronous/metachronous aneurysms is to stage the procedures, it is important to report scenarios where a single hybrid operation was technically feasible and resulted in good patient outcomes. CONCLUSION This report supports the role of utilizing multiple hybrid operative techniques to best repair the respective aneurysm in a single operation, with favorable patient outcomes.
Collapse
Affiliation(s)
- Raymond E Kennedy
- Division of Vascular Surgery and Endovascular Therapy, 12287Rutgers Robert Wood Johnson, Medical School, New Brunswick, NJ, USA
| | - C A Hamilton
- Division of Vascular Surgery and Endovascular Therapy, 12287Rutgers Robert Wood Johnson, Medical School, New Brunswick, NJ, USA
| | - S A Rahimi
- Division of Vascular Surgery and Endovascular Therapy, 12287Rutgers Robert Wood Johnson, Medical School, New Brunswick, NJ, USA
| | - J W Ady
- Division of Vascular Surgery and Endovascular Therapy, 12287Rutgers Robert Wood Johnson, Medical School, New Brunswick, NJ, USA
| |
Collapse
|
9
|
Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett N, Firbank M, Roberts G, Taylor J, Allan LM, O’Brien J, Yarnall AJ, Thomas AJ. Blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre in mild cognitive impairment with Lewy bodies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5709. [PMID: 35388536 PMCID: PMC9321690 DOI: 10.1002/gps.5709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Orthostatic hypotension is a common feature of normal ageing, and age-related neurodegenerative diseases, in particular the synucleinopathies including dementia with Lewy bodies. Orthostatic hypotension and other abnormal cardiovascular responses may be early markers of Lewy body disease. We aimed to assess whether abnormal blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre would be more common in mild cognitive impairment with Lewy bodies (MCI-LB) than MCI due to Alzheimer's disease (MCI-AD). METHODS MCI patients (n = 89) underwent longitudinal clinical assessment with differential classification of probable MCI-LB, possible MCI-LB, or MCI-AD, with objective autonomic function testing at baseline. Blood pressure and heart rate responses to active stand and Valsalva manoeuvre were calculated from beat-to-beat cardiovascular data, with abnormalities defined by current criteria, and age-adjusted group differences estimated with logistic models. RESULTS Orthostatic hypotension and abnormal heart rate response to orthostatic challenge were not more common in probable MCI-LB than MCI-AD. Heart rate abnormalities were likewise not more common in response to Valsalva manoeuvre in probable MCI-LB. An abnormal blood pressure response to Valsalva (delayed return to baseline/absence of overshoot after release of strain) was more common in probable MCI-LB than MCI-AD. In secondary analyses, magnitude of blood pressure drop after active stand and 10-s after release of Valsalva strain were weakly correlated with cardiac sympathetic denervation. CONCLUSIONS Probable MCI-LB may feature abnormal blood pressure response to Valsalva, but orthostatic hypotension is not a clear distinguishing feature from MCI-AD.
Collapse
Affiliation(s)
- Calum A. Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - James Frith
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Paul C. Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sally A. H. Barker
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Louise M. Allan
- College of Medicine and Health, St Luke's CampusExeter UniversityExeterUK
| | - John O’Brien
- Department of PsychiatryUniversity of Cambridge, Level E4, Addenbrooke's HospitalCambridgeUK
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
10
|
Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett N, Firbank M, Roberts G, Taylor J, Allan LM, O’Brien J, Yarnall AJ, Thomas AJ. Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5703. [PMID: 35302677 PMCID: PMC9311677 DOI: 10.1002/gps.5703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI-LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI-AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI-LB from MCI-AD. METHODS Ninety-three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31-item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI-AD or MCI-LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub-scales were assessed, controlling for age. RESULTS Age-adjusted severity of overall autonomic symptomatology was greater in MCI-LB (Ratio = 2.01, 95% CI: 1.37-2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI-AD did not have significantly higher autonomic symptom severity than controls overall. A cut-off of 4/5 on the COMPASS was sensitive to MCI-LB (92%) but not specific to this (42% specificity vs. MCI-AD and 52% vs. healthy controls). CONCLUSIONS Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI-AD, but such autonomic symptoms are not a specific finding. The COMPASS-31 may therefore have value as a sensitive screening test for early-stage Lewy body disease.
Collapse
Affiliation(s)
- Calum A. Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James Frith
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sally A. H. Barker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Rory Durcan
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sarah Lawley
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Nicola Barnett
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Michael Firbank
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Gemma Roberts
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - John O’Brien
- Department of PsychiatryUniversity of CambridgeAddenbrooke's HospitalCambridgeUK
| | - Alison J. Yarnall
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
11
|
Donaghy PC, Ciafone J, Durcan R, Hamilton CA, Barker S, Lloyd J, Firbank M, Allan LM, O'Brien JT, Taylor JP, Thomas AJ. Mild cognitive impairment with Lewy bodies: neuropsychiatric supportive symptoms and cognitive profile. Psychol Med 2022; 52:1147-1155. [PMID: 32840196 DOI: 10.1017/s0033291720002901] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort. METHODS Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis. RESULTS Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD. CONCLUSIONS MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.
Collapse
Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- College of Medicine and Health, Exeter University, Exeter, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
12
|
Thomas AJ, Hamilton CA, Heslegrave A, Barker S, Durcan R, Lawley S, Barnett N, Lett D, Firbank M, Roberts G, Taylor JP, Donaghy PC, Zetterberg H, O'Brien J. A Longitudinal Study of Plasma pTau181 in Mild Cognitive Impairment with Lewy Bodies and Alzheimer's Disease. Mov Disord 2022; 37:1495-1504. [PMID: 35318733 PMCID: PMC9540809 DOI: 10.1002/mds.28994] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) co-pathology is common in dementia with Lewy bodies and is associated with increased decline. Plasma pTau181 is a blood-based biomarker that can detect AD co-pathology. OBJECTIVES We investigated whether pTau181 was associated with cognitive decline in mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with AD (MCI-AD). METHODS We assessed plasma pTau181 using a single-molecule array (Simoa) immunoassay at baseline and follow-up in a longitudinal cohort of MCI-LB, MCI-AD, and controls. RESULTS One hundred forty-six subjects (56 probable MCI-LB, 22 possible MCI-LB, 44 MCI-AD, and 24 controls) were reviewed for up to 5.7 years. Probable MCI-LB had significantly higher pTau181 (22.2% mean increase) compared with controls and significantly lower (24.4% mean decrease) levels compared with MCI-AD. Receiver operating characteristic analyses of pTau181 in discriminating probable MCI-LB from controls showed an area under the curve (AUC) of 0.68 (83% specificity, 57% sensitivity); for discriminating MCI-AD from healthy controls, AUC was 0.8 (83.3% specificity, 72.7% sensitivity). pTau181 concentration was less useful in discriminating between probable MCI-LB and MCI-AD: AUC of 0.64 (71.4% specificity, 52.3% sensitivity). There was an association between pTau181 and cognitive decline in MCI-AD but not in MCI-LB. In a subset with repeat samples there was a nonsignificant 3% increase per follow-up year in plasma pTau181. The rate of change in pTau181 was not significantly different in different diagnostic subgroups. CONCLUSIONS pTau181 was not associated with an increased decline assessed using either baseline or repeat pTau181. pTau181 partially discriminated probable MCI-LB from controls and MCI-AD from controls but was not useful in distinguishing probable MCI-LB from MCI-AD.
Collapse
Affiliation(s)
- Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Debbie Lett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| |
Collapse
|
13
|
Hamilton CA, Matthews FE, Erskine D, Attems J, Thomas AJ. Neurodegenerative brain changes are associated with area deprivation in the United Kingdom: findings from the Brains for Dementia Research study. Acta Neuropathol Commun 2021; 9:198. [PMID: 34924033 PMCID: PMC8684681 DOI: 10.1186/s40478-021-01301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022] Open
Abstract
Socioeconomic disadvantage is associated with greater risk of dementia. This has been theorised to reflect inequalities in cognitive reserve, healthcare access, lifestyle, and other health factors which may contribute to the clinical manifestation of dementia. We aimed to assess whether area deprivation in the United Kingdom was associated with greater risk or severity of the specific neurodegenerative diseases which lead to dementia in a multi-centre cohort with autopsy assessment. Participants underwent clinical assessment prior to brain tissue donation post-mortem. Each then underwent detailed, standardised neuropathological assessment. National area deprivation statistics were derived for each participant’s neighbourhood, for use as a predictor in binary and ordinal logistic models assessing the respective presence and severity of staging of key neuropathological changes, adjusting for theorised confounders. Individuals from among the 20% most deprived neighbourhoods in the United Kingdom had significantly higher neurofibrillary tangle and neuritic plaque staging, and increased risk of cerebral amyloid angiopathy. These findings were not explained by a greater risk of diabetes or hypertension, APOE genotype, alcohol misuse or tobacco smoking, sex, or age differences. A sensitivity analysis conditioning on baseline cognitive impairment did not meaningfully change the observed association. Socioeconomic disadvantage may contribute to dementia incidence through a greater severity of specific neuropathological changes (neurofibrillary tangles, neuritic plaques, and cerebral amyloid angiopathy), independent of other indirect influences. Mechanisms through which deprivation is associated with these require further exploration.
Collapse
|
14
|
Hamilton CA, Schumacher J, Matthews F, Taylor JP, Allan L, Barnett N, Cromarty RA, Donaghy PC, Durcan R, Firbank M, Lawley S, O'Brien JT, Roberts G, Thomas AJ. Slowing on quantitative EEG is associated with transition to dementia in mild cognitive impairment. Int Psychogeriatr 2021; 33:1321-1325. [PMID: 34551831 DOI: 10.1017/s1041610221001083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer's disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01-3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Schumacher
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allan
- Institute of Health Research, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, Herschel Smith Building, University of Cambridge, Cambridge, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
15
|
Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, McKeith IG, Thomas AJ. Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease. Psychol Med 2021; 51:2590-2598. [PMID: 32366348 DOI: 10.1017/s0033291720001130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD). METHODS A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function. RESULTS Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline. CONCLUSIONS These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms - particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, Level E4, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SZ, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
16
|
Schumacher J, Ray NJ, Hamilton CA, Donaghy PC, Firbank M, Roberts G, Allan L, Durcan R, Barnett N, O'Brien JT, Taylor JP, Thomas AJ. Cholinergic white matter pathways in dementia with Lewy bodies and Alzheimer's disease. Brain 2021; 145:1773-1784. [PMID: 34605858 PMCID: PMC9166545 DOI: 10.1093/brain/awab372] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Patients who have dementia with Lewy bodies and Alzheimer’s disease show early degeneration of the cholinergic nucleus basalis of Meynert. However, how white matter projections between the nucleus basalis of Meynert and the cortex are altered in neurodegenerative disease is unknown. Tractography of white matter pathways originating from the nucleus basalis of Meynert was performed using diffusion-weighted imaging in 46 patients with Alzheimer’s disease dementia, 48 with dementia with Lewy bodies, 35 with mild cognitive impairment with Alzheimer’s disease, 38 with mild cognitive impairment with Lewy bodies and 71 control participants. Mean diffusivity of the resulting pathways was compared between groups and related to cognition, attention, functional EEG changes and dementia conversion in the mild cognitive impairment groups. We successfully tracked a medial and a lateral pathway from the nucleus basalis of Meynert. Mean diffusivity of the lateral pathway was higher in both dementia and mild cognitive impairment groups than controls (all P < 0.03). In the patient groups, increased mean diffusivity of this pathway was related to more impaired global cognition (β = −0.22, P = 0.06) and worse performance on an attention task (β = 0.30, P = 0.03). In patients with mild cognitive impairment, loss of integrity of both nucleus basalis of Meynert pathways was associated with increased risk of dementia progression [hazard ratio (95% confidence interval), medial pathway: 2.51 (1.24–5.09); lateral pathway: 2.54 (1.24–5.19)]. Nucleus basalis of Meynert volume was reduced in all clinical groups compared to controls (all P < 0.001), but contributed less strongly to cognitive impairment and was not associated with attention or dementia conversion. EEG slowing in the patient groups as assessed by a decrease in dominant frequency was associated with smaller nucleus basalis of Meynert volumes (β = 0.22, P = 0.02) and increased mean diffusivity of the lateral pathway (β = −0.47, P = 0.003). We show that degeneration of the cholinergic nucleus basalis of Meynert in Alzheimer’s disease and dementia with Lewy bodies is accompanied by an early reduction in integrity of white matter projections that originate from this structure. This is more strongly associated with cognition and attention than the volume of the nucleus basalis of Meynert itself and might be an early indicator of increased risk of dementia conversion in people with mild cognitive impairment.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola J Ray
- Health, Psychology and Communities Research Centre, Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
17
|
Hamilton CA, Matthews FE, Allan LM, Barker S, Ciafone J, Donaghy PC, Durcan R, Firbank MJ, Lawley S, O'Brien JT, Roberts G, Taylor JP, Thomas AJ. Utility of the pareidolia test in mild cognitive impairment with Lewy bodies and Alzheimer's disease. Int J Geriatr Psychiatry 2021; 36:1407-1414. [PMID: 33772864 DOI: 10.1002/gps.5546] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Previous research has identified that dementia with Lewy bodies (DLB) has abnormal pareidolic responses which are associated with severity of visual hallucinations (VH), and the pareidolia test accurately classifies DLB with VH. We aimed to assess whether these findings would also be evident at the earlier stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) in comparison to MCI due to AD (MCI-AD) and cognitively healthy comparators. METHODS One-hundred and thirty-seven subjects were assessed prospectively in a longitudinal study with a mean follow-up of 1.2 years (max = 3.7): 63 MCI-LB (22% with VH) and 40 MCI-AD according to current research diagnostic criteria, and 34 healthy comparators. The pareidolia test was administered annually as a repeated measure. RESULTS Probable MCI-LB had an estimated pareidolia rate 1.2-6.7 times higher than MCI-AD. Pareidolia rates were not associated with concurrent VH, but had a weak association with total score on the North East Visual Hallucinations Inventory. The pareidolia test was not an accurate classifier of either MCI-LB (Area under curve (AUC) = 0.61), or VH (AUC = 0.56). There was poor sensitivity when differentiating MCI-LB from controls (41%) or MCI-AD (27%), though specificity was better (91% and 89%, respectively). CONCLUSIONS Whilst pareidolic responses are specifically more frequent in MCI-LB than MCI-AD, sensitivity of the pareidolia test is poorer than in DLB, with fewer patients manifesting VH at the earlier MCI stage. However, the high specificity and ease of use may make it useful in specialist clinics where imaging biomarkers are not available.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- College of Medicine and Health, Exeter University, Exeter, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
18
|
Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Durcan R, Roberts G, Ciafone J, Barker SAH, Firbank M, McKeith IG, Thomas AJ. Progression to Dementia in Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease. Neurology 2021; 96:e2685-e2693. [PMID: 33875556 PMCID: PMC8205466 DOI: 10.1212/wnl.0000000000012024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/02/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To determine whether mild cognitive impairment with Lewy bodies or mild cognitive impairment with Alzheimer disease differ in their rates of clinical progression to dementia, we undertook longitudinal observation of mild cognitive impairment cases with detailed clinical assessment of Lewy body diagnostic characteristics. METHODS Two prospective longitudinal cohorts including 111 individuals ≥60 years of age with mild cognitive impairment were assessed annually to track cognitive and clinical progression, including the presence or absence of core clinical features and proposed biomarkers of dementia with Lewy bodies. Multistate modeling was used to assess the associations of diagnostic characteristics of dementia with Lewy bodies with clinical progression from mild cognitive impairment to dementia, with death as a competing outcome. RESULTS After a mean follow-up of 2.2 years (range 1-6.7 years), 38 of the 111 (34%) participants progressed to dementia: 10 with AD, 3 with possible dementia with Lewy bodies, and 25 with probable dementia with Lewy bodies. The presence of any Lewy body disease characteristic was associated with an increased hazard of transition to dementia; this risk further increased as more diagnostic characteristics were observed (hazard ratio 1.33 per characteristic, 95% confidence interval [CI] 1.11-1.60) and was especially high for those experiencing complex visual hallucinations (hazard ratio 1.98, 95% CI 0.92-4.29) or cognitive fluctuations (hazard ratio 3.99, 95% CI 2.03-7.84). CONCLUSIONS Diagnostic characteristics of Lewy body disease are associated with an increased risk of transition from mild cognitive impairment to dementia.
Collapse
Affiliation(s)
- Calum A Hamilton
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK.
| | - Fiona E Matthews
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - John T O'Brien
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Nicola Barnett
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Kirsty Olsen
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Rory Durcan
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Gemma Roberts
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sally A H Barker
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Michael Firbank
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Ian G McKeith
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (C.A.H., P.C.D., J.-P.T., N.B., K.O., R.D., G.R., J.C., S.A.H.B., M.F., I.G.M., A.J.T.) and Population Health Sciences Institute (F.E.M.), Newcastle University; and Department of Psychiatry (J.T.O.), University of Cambridge School of Clinical Medicine, UK
| |
Collapse
|
19
|
Roberts G, Donaghy PC, Lloyd J, Durcan R, Petrides G, Colloby SJ, Lawley S, Ciafone J, Hamilton CA, Firbank M, Allan L, Barnett N, Barker S, Olsen K, Howe K, Ali T, Taylor JP, O'Brien J, Thomas AJ. Accuracy of dopaminergic imaging as a biomarker for mild cognitive impairment with Lewy bodies. Br J Psychiatry 2021; 218:276-282. [PMID: 33355065 DOI: 10.1192/bjp.2020.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain. AIMS To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies. METHOD We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard. RESULTS At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52-77%), specificity 88% (76-95%) and accuracy 76% (68-84%), with positive likelihood ratio 5.3. CONCLUSIONS It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
Collapse
Affiliation(s)
- Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; and Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Jim Lloyd
- Translational and Clinical Research Institute, Newcastle University, UK; and Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kim Howe
- Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Tamir Ali
- Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| |
Collapse
|
20
|
Schumacher J, Taylor JP, Hamilton CA, Firbank M, Donaghy PC, Roberts G, Allan L, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Functional connectivity in mild cognitive impairment with Lewy bodies. J Neurol 2021; 268:4707-4720. [PMID: 33928432 PMCID: PMC8563567 DOI: 10.1007/s00415-021-10580-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/13/2022]
Abstract
Previous resting-state fMRI studies in dementia with Lewy bodies have described changes in functional connectivity in networks related to cognition, motor function, and attention as well as alterations in connectivity dynamics. However, whether these changes occur early in the course of the disease and are already evident at the stage of mild cognitive impairment is not clear. We studied resting-state fMRI data from 31 patients with mild cognitive impairment with Lewy bodies compared to 28 patients with mild cognitive impairment due to Alzheimer’s disease and 24 age-matched controls. We compared the groups with respect to within- and between-network functional connectivity. Additionally, we applied two different approaches to study dynamic functional connectivity (sliding-window analysis and leading eigenvector dynamic analysis). We did not find any significant changes in the mild cognitive impairment groups compared to controls and no differences between the two mild cognitive impairment groups, using static as well as dynamic connectivity measures. While patients with mild cognitive impairment with Lewy bodies already show clear functional abnormalities on EEG measures, the fMRI analyses presented here do not appear to be sensitive enough to detect such early and subtle changes in brain function in these patients.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
21
|
Roberts G, Durcan R, Donaghy PC, Lawley S, Ciafone J, Hamilton CA, Colloby SJ, Firbank MJ, Allan L, Barnett N, Barker S, Howe K, Ali T, Petrides GS, Lloyd J, Taylor JP, O'Brien J, Thomas AJ. Accuracy of Cardiac Innervation Scintigraphy for Mild Cognitive Impairment With Lewy Bodies. Neurology 2021; 96:e2801-e2811. [PMID: 33883238 PMCID: PMC8205462 DOI: 10.1212/wnl.0000000000012060] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To provide evidence that cardiac I-123-metaiodobenzylguanidine sympathetic innervation imaging (MIBG) scintigraphy differentiates probable mild cognitive impairment with Lewy bodies (MCI-LB) from mild cognitive impairment due to Alzheimer disease (MCI-AD), we scanned patients with MCI and obtained consensus clinical diagnoses of their MCI subtype. We also performed baseline FP-CIT scans to compare the accuracy of MIBG and FP-CIT. Methods We conducted a prospective cohort study into the accuracy of cardiac MIBG scintigraphy in the diagnosis of MCI-LB. Follow-up clinical assessment was used to diagnose MCI-AD (no core features of MCI-LB and normal FP-CIT), probable MCI-LB (2 or more core features, or 1 core feature with abnormal FP-CIT), or possible MCI-LB (1 core feature or abnormal FP-CIT). For the comparison between MIBG and FP-CIT, only core clinical features were used for diagnosis. Results We recruited 95 people with mild cognitive impairment. Cardiac MIBG was abnormal in 22/37 probable and 2/15 possible MCI-LB cases and normal in 38/43 MCI-AD cases. The sensitivity in probable MCI-LB was 59% (95% confidence interval [CI], 42%–75%), specificity 88% (75%–96%), and accuracy 75% (64%–84%). The positive likelihood ratio was 5.1 and negative likelihood ratio 0.46. With symptom-only diagnoses, the accuracies were 79% for MIBG (95% CI, 68%–87%) and 76% for FP-CIT (95% CI, 65%–85%). Conclusions Cardiac MIBG appears useful in early disease, with an abnormal scan highly suggestive of MCI-LB. Validation in a multicenter setting is justified. Classification of Evidence This study provides Class I evidence that cardiac MIBG distinguishes MCI-LB from MCI-AD.
Collapse
Affiliation(s)
- Gemma Roberts
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK.
| | - Rory Durcan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sarah Lawley
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Calum A Hamilton
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sean J Colloby
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Michael J Firbank
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Louise Allan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Nicola Barnett
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sally Barker
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Kim Howe
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Tamir Ali
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - George S Petrides
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Jim Lloyd
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John O'Brien
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| |
Collapse
|
22
|
Firbank MJ, Durcan R, O'Brien JT, Allan LM, Barker S, Ciafone J, Donaghy PC, Hamilton CA, Lawley S, Roberts G, Taylor JP, Thomas AJ. Hippocampal and insula volume in mild cognitive impairment with Lewy bodies. Parkinsonism Relat Disord 2021; 86:27-33. [PMID: 33823470 DOI: 10.1016/j.parkreldis.2021.03.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Diagnostic criteria for prodromal dementia with Lewy bodies have recently been published. These include the use of imaging biomarkers to distinguish mild cognitive impairment with Lewy bodies (MCI-LB) from MCI due to other causes. Two potential biomarkers listed, though not formally included in the diagnostic criteria, due to insufficient evidence, are relatively preserved hippocampi, and atrophy of the insula cortex on structural brain imaging. METHODS In this report, we sought to investigate these imaging biomarkers in 105 research subjects, including well characterised groups of patients with MCI-LB (n = 38), MCI with no core features of Lewy body disease (MCI-AD; n = 36) and healthy controls (N = 31). Hippocampal and insula volumes were determined from T1 weighted structural MRI scans, using grey matter segmentation performed with SPM software. RESULTS Adjusting for age, sex and intracranial volume, there were no differences in hippocampal or insula volume between MCI-AD and MCI-LB, although in both conditions volumes were significantly reduced relative to controls. CONCLUSION Our results do not support the use of either hippocampal or insula volume to identify prodromal dementia with Lewy bodies.
Collapse
Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, UK.
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | | | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| |
Collapse
|
23
|
Abstract
Leading theory hypothesizes that age deficits in decision making may rise as the complexity of decision-related information increases. This suggests that older adults would benefit relative to young adults from simplification of information used to inform decision making. Participants indicated political, nutritional and medical preferences and then chose between politicians, foods and medicines. The amount of information presented was systematically varied but age differences were largely similar for simple and complex trials. Paradoxically, the data showed that decisions based on simpler information could be less aligned with participant's preferences than decisions based on more complex information. Further analyses suggested that participants may have been responding purely on the basis of their most valued preferences and that when information about those preferences was not presented, decision making became poorer. Contrary to our expectations, simplification of information by exclusion may therefore hinder decision making and may not particularly help older adults.
Collapse
Affiliation(s)
- Stephen P Badham
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Calum A Hamilton
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| |
Collapse
|
24
|
Schumacher J, Taylor JP, Hamilton CA, Firbank M, Cromarty RA, Donaghy PC, Roberts G, Allan L, Lloyd J, Durcan R, Barnett N, O'Brien JT, Thomas AJ. In vivo nucleus basalis of Meynert degeneration in mild cognitive impairment with Lewy bodies. Neuroimage Clin 2021; 30:102604. [PMID: 33711623 PMCID: PMC7972982 DOI: 10.1016/j.nicl.2021.102604] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/05/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
Nucleus basalis of Meynert (NBM) degeneration occurs early in Lewy body dementia. NBM degeneration is related to cognitive impairment in MCI with Lewy bodies. EEG slowing in MCI patients is related to the severity of NBM degeneration.
Objectives To investigate in vivo degeneration of the cholinergic system in mild cognitive impairment with Lewy bodies (MCI-LB), we studied nucleus basalis of Meynert (NBM) volumes from structural MR images and its relation to EEG slowing and cognitive impairment. Methods We studied the NBM using structural MR images in 37 patients with MCI-LB, 34 patients with MCI with Alzheimer’s disease (MCI-AD), and 31 healthy control participants. We also tested correlations between NBM volumes and measures of overall cognition and measures of EEG slowing in the MCI groups. Results Overall NBM volume was reduced in MCI-LB compared to controls with no significant difference between MCI-AD and controls or between the two MCI groups. The voxel-wise analysis revealed bilateral clusters of reduced NBM volume in MCI-LB compared to controls and smaller clusters in MCI-AD compared to controls. There was a significant association between overall NBM volume and measures of overall cognition in MCI-LB, but not in MCI-AD. In both MCI groups, reduced NBM volume was correlated with more severe EEG slowing. Conclusions This study provides in vivo evidence that early cholinergic degeneration in DLB occurs at the MCI stage and is related to the severity of cognitive impairment. Furthermore, the results suggest that early EEG slowing in MCI-LB might be in part cholinergically driven. Importantly, these findings suggest an early cholinergic deficit in MCI-LB that may motivate further testing of the effectiveness of cholinesterase inhibitors in this group.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom; Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NFS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge CB2 0SP, United Kingdom
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| |
Collapse
|
25
|
Hamilton CA, Matthews FE, Donaghy PC, Taylor JP, O'Brien JT, Barnett N, Olsen K, Lloyd J, Petrides G, McKeith IG, Thomas AJ. Cognitive Decline in Mild Cognitive Impairment With Lewy Bodies or Alzheimer Disease: A Prospective Cohort Study. Am J Geriatr Psychiatry 2021; 29:272-284. [PMID: 32863138 DOI: 10.1016/j.jagp.2020.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We explored whether the mild cognitive impairment (MCI) stages of dementia with Lewy bodies (DLB) and Alzheimer disease (AD) differ in their cognitive profiles, and longitudinal progression. DESIGN A prospective, longitudinal design was utilized with annual follow-up (Max 5 years, Mean 1.9, standard deviation 1.1) after diagnosis. Participants underwent repeated cognitive testing, and review of their clinical diagnosis and symptoms, including evaluation of core features of DLB. SETTING This was an observational study of independently living individuals, recruited from local healthcare trusts in North East England, UK. PARTICIPANTS An MCI cohort (n = 76) aged ≥60 years was utilized, differentially diagnosed with MCI due to AD (MCI-AD), or possible/probable MCI with Lewy bodies (MCI-LB). MEASUREMENTS A comprehensive clinical and neuropsychological testing battery was administered, including ACE-R, trailmaking tests, FAS verbal fluency, and computerized battery of attention and perception tasks. RESULTS Probable MCI-LB presented with less impaired recognition memory than MCI-AD, greater initial impairments in verbal fluency and perception of line orientation, and thereafter demonstrated an expedited decline in visuo-constructional functions in the ACE-R compared to MCI-AD. No clear diagnostic group differences were found in deterioration speeds for global cognition, language, overall memory, attention or other executive functions. CONCLUSION These findings provide further evidence for differences in severity and decline of visuospatial dysfunctions in DLB compared with AD; further exploration is required to clarify when and how differences in attention, executive, and memory functions emerge, as well as speed of decline to dementia.
Collapse
Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom.
| | - Fiona E Matthews
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University (FEM), Newcastle upon Tyne, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, Level E4, University of Cambridge School of Clinical Medicine (JTO), Cambridge, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - Jim Lloyd
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust (JL, GP), Newcastle upon Tyne, United Kingdom
| | - George Petrides
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust (JL, GP), Newcastle upon Tyne, United Kingdom
| | - Ian G McKeith
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| | - Alan J Thomas
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University (CAH, PCD, J-PT, NB, KO, IGM, AJT), Newcastle upon Tyne, United Kingdom
| |
Collapse
|
26
|
Firbank MJ, O'Brien JT, Durcan R, Allan LM, Barker S, Ciafone J, Donaghy PC, Hamilton CA, Lawley S, Lloyd J, Roberts G, Taylor JP, Thomas AJ. Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling. J Neurol 2020; 268:1284-1294. [PMID: 33084940 PMCID: PMC7990749 DOI: 10.1007/s00415-020-10271-1] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
Objective To use arterial spin labelling to investigate differences in perfusion in mild cognitive impairment with Lewy bodies (MCI-LB) compared to Alzheimer type MCI (MCI-AD) and healthy controls. Methods We obtained perfusion images on 32 MCI-LB, 30 MCI-AD and 28 healthy subjects of similar age. Perfusion relative to cerebellum was calculated, and we aimed to examine differences in relative perfusion between MCI-LB and the other groups. This included whole brain voxelwise comparisons, as well as using predefined region-of-interest ratios of medial occipital to medial temporal, and posterior cingulate to precuneus. Differences in occipital perfusion in eyes open vs eyes closed conditions were also examined. Results Compared to controls, the MCI-LB showed reduced perfusion in the precuneus, parietal, occipital and fusiform gyrus regions. In our predefined regions, the ratio of perfusion in occipital/medial temporal was significantly lower, and the posterior cingulate/precuneus ratio was significantly higher in MCI-LB compared to controls. Overall, the occipital perfusion was greater in the eyes open vs closed condition, but this did not differ between groups. Conclusion We found patterns of altered perfusion in MCI-LB which are similar to those seen in dementia with Lewy bodies, with reduction in posterior parietal and occipital regions, but relatively preserved posterior cingulate.
Collapse
Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- College of Medicine and Health, Exeter University, Exeter, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
27
|
Thomas AJ, Hamilton CA, Donaghy PC, Martin-Ruiz C, Morris CM, Barnett N, Olsen K, Taylor JP, O'Brien JT. Prospective longitudinal evaluation of cytokines in mild cognitive impairment due to AD and Lewy body disease. Int J Geriatr Psychiatry 2020; 35:1250-1259. [PMID: 32557792 DOI: 10.1002/gps.5365] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We conducted a prospective longitudinal study of plasma cytokines during the Mild Cognitive Impairment (MCI) stage of Lewy body disease and Alzheimer's disease, hypothesizing that cytokine levels would decrease over time and that this would be correlated with decline in cognition. METHODS Older (≥60) people with MCI were recruited from memory services in healthcare trusts in North East England, UK. MCI was diagnosed as due to Alzheimer's disease (MCI-AD) or Lewy body disease (MCI-LB). Baseline and repeat annual clinical and cognitive assessments were undertaken and plasma samples were obtained at the same time. Cytokine assays were performed on all samples using the Meso Scale Discovery V-Plex Plus Proinflammatory Panel 1, which included IFNγ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13 and TNFα. RESULTS Fifty-six patients (21 MCI-AD, 35 MCI-LB) completed prospective evaluations and provided samples up to 3 years after baseline. Six cytokines (IFNγ, IL-1β, IL-2, IL-4, IL-6 and IL-10) showed highly significant (P < .002) decreases over time. AD and LB did not differ in rate of decrease nor were there any effects related to age or general morbidity. Decrease in five of these cytokines (IFNγ, IL-1β, IL-2, IL-4, and IL-10) was highly correlated with decrease in cognition (P < .003). CONCLUSIONS Peripheral inflammation decreased in both disease groups during MCI suggesting this may be a therapeutic window for future anti-inflammatory agents.
Collapse
Affiliation(s)
- Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Carmen Martin-Ruiz
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris M Morris
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
28
|
Schumacher J, Taylor JP, Hamilton CA, Firbank M, Cromarty RA, Donaghy PC, Roberts G, Allan L, Lloyd J, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Quantitative EEG as a biomarker in mild cognitive impairment with Lewy bodies. Alzheimers Res Ther 2020; 12:82. [PMID: 32641111 PMCID: PMC7346501 DOI: 10.1186/s13195-020-00650-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
Objectives To investigate using quantitative EEG the (1) differences between patients with mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with Alzheimer’s disease (MCI-AD) and (2) its utility as a potential biomarker for early differential diagnosis. Methods We analyzed eyes-closed, resting-state, high-density EEG data from highly phenotyped participants (39 MCI-LB, 36 MCI-AD, and 31 healthy controls). EEG measures included spectral power in different frequency bands (delta, theta, pre-alpha, alpha, and beta), theta/alpha ratio, dominant frequency, and dominant frequency variability. Receiver operating characteristic (ROC) analyses were performed to assess diagnostic accuracy. Results There was a shift in power from beta and alpha frequency bands towards slower frequencies in the pre-alpha and theta range in MCI-LB compared to healthy controls. Additionally, the dominant frequency was slower in MCI-LB compared to controls. We found significantly increased pre-alpha power, decreased beta power, and slower dominant frequency in MCI-LB compared to MCI-AD. EEG abnormalities were more apparent in MCI-LB cases with more diagnostic features. There were no significant differences between MCI-AD and controls. In the ROC analysis to distinguish MCI-LB from MCI-AD, beta power and dominant frequency showed the highest area under the curve values of 0.71 and 0.70, respectively. While specificity was high for some measures (up to 0.97 for alpha power and 0.94 for theta/alpha ratio), sensitivity was generally much lower. Conclusions Early EEG slowing is a specific feature of MCI-LB compared to MCI-AD. However, there is an overlap between the two MCI groups which makes it difficult to distinguish between them based on EEG alone.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
29
|
Schumacher J, Thomas AJ, Peraza LR, Firbank M, Cromarty R, Hamilton CA, Donaghy PC, O'Brien JT, Taylor JP. EEG alpha reactivity and cholinergic system integrity in Lewy body dementia and Alzheimer's disease. Alzheimers Res Ther 2020; 12:46. [PMID: 32321573 PMCID: PMC7178985 DOI: 10.1186/s13195-020-00613-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/02/2020] [Indexed: 11/14/2023]
Abstract
BACKGROUND Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is characterised by marked deficits within the cholinergic system which are more severe than in Alzheimer's disease (AD) and are mainly caused by degeneration of the nucleus basalis of Meynert (NBM) whose widespread cholinergic projections provide the main source of cortical cholinergic innervation. EEG alpha reactivity, which refers to the reduction in alpha power over occipital electrodes upon opening the eyes, has been suggested as a potential marker of cholinergic system integrity. METHODS Eyes-open and eyes-closed resting state EEG data were recorded from 41 LBD patients (including 24 patients with DLB and 17 with PDD), 21 patients with AD, and 40 age-matched healthy controls. Alpha reactivity was calculated as the relative reduction in alpha power over occipital electrodes when opening the eyes. Structural MRI data were used to assess volumetric changes within the NBM using a probabilistic anatomical map. RESULTS Alpha reactivity was reduced in AD and LBD patients compared to controls with a significantly greater reduction in LBD compared to AD. Reduced alpha reactivity was associated with smaller volumes of the NBM across all groups (ρ = 0.42, pFDR = 0.0001) and in the PDD group specifically (ρ = 0.66, pFDR = 0.01). CONCLUSIONS We demonstrate that LBD patients show an impairment in alpha reactivity upon opening the eyes which distinguishes this form of dementia from AD. Furthermore, our results suggest that reduced alpha reactivity might be related to a loss of cholinergic drive from the NBM, specifically in PDD.
Collapse
Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK.
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | | | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - Ruth Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, School of Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
30
|
Hamilton CA, St Laurent RA, Dexter K, Kitching IJ, Breinholt JW, Zwick A, Timmermans MJTN, Barber JR, Kawahara AY. Phylogenomics resolves major relationships and reveals significant diversification rate shifts in the evolution of silk moths and relatives. BMC Evol Biol 2019; 19:182. [PMID: 31533606 PMCID: PMC6751749 DOI: 10.1186/s12862-019-1505-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Silkmoths and their relatives constitute the ecologically and taxonomically diverse superfamily Bombycoidea, which includes some of the most charismatic species of Lepidoptera. Despite displaying spectacular forms and diverse ecological traits, relatively little attention has been given to understanding their evolution and drivers of their diversity. To begin to address this problem, we created a new Bombycoidea-specific Anchored Hybrid Enrichment (AHE) probe set and sampled up to 571 loci for 117 taxa across all major lineages of the Bombycoidea, with a newly developed DNA extraction protocol that allows Lepidoptera specimens to be readily sequenced from pinned natural history collections. RESULTS The well-supported tree was overall consistent with prior morphological and molecular studies, although some taxa were misplaced. The bombycid Arotros Schaus was formally transferred to Apatelodidae. We identified important evolutionary patterns (e.g., morphology, biogeography, and differences in speciation and extinction), and our analysis of diversification rates highlights the stark increases that exist within the Sphingidae (hawkmoths) and Saturniidae (wild silkmoths). CONCLUSIONS Our study establishes a backbone for future evolutionary, comparative, and taxonomic studies of Bombycoidea. We postulate that the rate shifts identified are due to the well-documented bat-moth "arms race". Our research highlights the flexibility of AHE to generate genomic data from a wide range of museum specimens, both age and preservation method, and will allow researchers to tap into the wealth of biological data residing in natural history collections around the globe.
Collapse
Affiliation(s)
- C A Hamilton
- Florida Museum of Natural History, University of Florida, Gainesville, FL, 32611, USA.
- Department of Entomology, Plant Pathology & Nematology, University of Idaho, Moscow, ID, 83844, USA.
| | - R A St Laurent
- Florida Museum of Natural History, University of Florida, Gainesville, FL, 32611, USA
| | - K Dexter
- Florida Museum of Natural History, University of Florida, Gainesville, FL, 32611, USA
| | - I J Kitching
- Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
| | - J W Breinholt
- Florida Museum of Natural History, University of Florida, Gainesville, FL, 32611, USA
- RAPiD Genomics, 747 SW 2nd Avenue #314, Gainesville, FL, 32601, USA
| | - A Zwick
- Australian National Insect Collection, CSIRO, Clunies Ross St, Acton, ACT, Canberra, 2601, Australia
| | - M J T N Timmermans
- Department of Natural Sciences, Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - J R Barber
- Department of Biological Sciences, Boise State University, Boise, ID, 83725, USA
| | - A Y Kawahara
- Florida Museum of Natural History, University of Florida, Gainesville, FL, 32611, USA.
| |
Collapse
|
31
|
Abstract
SummaryPaired blood samples were obtained from mothers (venous) and babies (cord venous blood) at the time of delivery by caesarean section under epidural anaesthetic. Fetal platelets failed to aggregate in response to adrenaline in vitro although adrenaline could potentiate the threshold response to adenosine diphosphate (1 μM). Fetal platelet responses to collagen and 8 Arg vasopressin did not differ significantly from maternal responses. Maternal and fetal platelets also showed similar inhibition of aggregation after activation of adenylate cyclase (PGE1 and parathormone), in contrast to the inhibition of adenylate cyclase by adrenaline.Alpha2 adrenoceptors were investigated using [3H] yohimbine binding receptor number and were reduced modestly but significantly on fetal compared to maternal platelets. The failure of fetal platelet aggregation in response to adrenaline appears to be related to a failure of receptor coupling and may represent a delayed maturation of fetal platelet alpha receptors or a response- to increased circulating catecholamines during birth.
Collapse
Affiliation(s)
- C R Jones
- The University Department of Materia Medica, Stobhill General Hospital, Glasgow, UK
| | - R McCabe
- The University Department of Materia Medica, Stobhill General Hospital, Glasgow, UK
| | - C A Hamilton
- The University Department of Materia Medica, Stobhill General Hospital, Glasgow, UK
| | - J L Reid
- The University Department of Materia Medica, Stobhill General Hospital, Glasgow, UK
| |
Collapse
|
32
|
Hamilton CA, Miller A, Casablanca Y, Horowitz NS, Rungruang B, Krivak TC, Richard SD, Rodriguez N, Birrer MJ, Backes FJ, Geller MA, Quinn M, Goodheart MJ, Mutch DG, Kavanagh JJ, Maxwell GL, Bookman MA. Clinicopathologic characteristics associated with long-term survival in advanced epithelial ovarian cancer: an NRG Oncology/Gynecologic Oncology Group ancillary data study. Gynecol Oncol 2017; 148:275-280. [PMID: 29195926 DOI: 10.1016/j.ygyno.2017.11.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 09/13/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To identify clinicopathologic factors associated with 10-year overall survival in epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC), and to develop a predictive model identifying long-term survivors. METHODS Demographic, surgical, and clinicopathologic data were abstracted from GOG 182 records. The association between clinical variables and long-term survival (LTS) (>10years) was assessed using multivariable regression analysis. Bootstrap methods were used to develop predictive models from known prognostic clinical factors and predictive accuracy was quantified using optimism-adjusted area under the receiver operating characteristic curve (AUC). RESULTS The analysis dataset included 3010 evaluable patients, of whom 195 survived greater than ten years. These patients were more likely to have better performance status, endometrioid histology, stage III (rather than stage IV) disease, absence of ascites, less extensive preoperative disease distribution, microscopic disease residual following cyoreduction (R0), and decreased complexity of surgery (p<0.01). Multivariable regression analysis revealed that lower CA-125 levels, absence of ascites, stage, and R0 were significant independent predictors of LTS. A predictive model created using these variables had an AUC=0.729, which outperformed any of the individual predictors. CONCLUSIONS The absence of ascites, a low CA-125, stage, and R0 at the time of cytoreduction are factors associated with LTS when controlling for other confounders. An extensively annotated clinicopathologic prediction model for LTS fell short of clinical utility suggesting that prognostic molecular profiles are needed to better predict which patients are likely to be long-term survivors.
Collapse
Affiliation(s)
- C A Hamilton
- Gynecologic Cancer Center of Excellence, John P. Murtha Cancer Center, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
| | - A Miller
- NRG Oncology Statistics and Data Management Center/Gynecologic Oncology Group, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Y Casablanca
- Gynecologic Cancer Center of Excellence, John P. Murtha Cancer Center, Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - N S Horowitz
- Division of Gynecologic Oncology, Brigham & Women's Hospital, Boston, MA, United States
| | - B Rungruang
- Division of Gynecologic Oncology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - T C Krivak
- Division of Gynecologic Oncology, Western Pennsylvania Hospital, Pittsburgh, PA, United States
| | - S D Richard
- Division of Gynecologic Oncology, Hahnemann University Hospital/Drexel University College of Medicine, Philadelphia, PA, United States
| | - N Rodriguez
- Division of Gynecologic Oncology, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - M J Birrer
- Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - F J Backes
- Division of Gynecologic Oncology, Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, United States
| | - M A Geller
- Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - M Quinn
- Gynaecological Oncology, ANZGOG, Royal Women's Hospital and University of Melbourne, Australia
| | - M J Goodheart
- Gynecologic Oncology, University of Iowa, Iowa City, IA, United States
| | - D G Mutch
- Gynecologic Oncology, Washington University, St. Louis, MO, United States
| | - J J Kavanagh
- MD Anderson Cancer Center, Houston, TX, United States
| | - G L Maxwell
- Inova Fairfax Hospital Department of Obstetrics and Gynecology, Inova Schar Cancer Institute, Falls Church, VA, United States
| | - M A Bookman
- US Oncology Research and Arizona Oncology, Tucson, AZ, United States
| |
Collapse
|
33
|
Mackenzie RM, Hamilton CA, Miller WH, Salt IP, Murphy MP, Delles C, Dominiczak AF. 022 MitoQ10 decreases AMPK activation in endothelial cells from patients with coronary artery disease and diabetes. Heart 2010. [DOI: 10.1136/hrt.2010.195941.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
34
|
McLachlan J, Hamilton CA, Beattie E, Murphy MP, Dominiczak AF, Nicklin SA, Graham D. 021 Therapeutic effects of MitoQ10 on hypertension and cardiac hypertrophy. Heart 2010. [DOI: 10.1136/hrt.2010.195941.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
35
|
Hamilton CA, Cheung MK, Osann K, Chen L, Teng NN, Longacre TA, Powell MA, Hendrickson MR, Kapp DS, Chan JK. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer 2006; 94:642-6. [PMID: 16495918 PMCID: PMC2361201 DOI: 10.1038/sj.bjc.6603012] [Citation(s) in RCA: 450] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
To compare the survival of women with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC) to those with grade 3 endometrioid uterine carcinoma (G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan–Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older (median age: 70 years and 68 vs 66 years, respectively; P<0.0001) and more likely to be black compared to G3EC (15 and 12% vs 7%; P<0.0001). A higher proportion of UPSC and CC patients had stage III–IV disease compared to G3EC patients (52 and 36% vs 29%; P<0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5-year disease-specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively (P<0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I–II (74, 82, and 86%; P<0.0001) and stage III–IV disease (33, 40, and 54; P<0.0001). On multivariate analysis, more favourable histology (G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high-risk patients.
Collapse
Affiliation(s)
- C A Hamilton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, San Francisco Comprehensive Cancer Center, 1600 Divisidero, San Francisco, CA 94115, USA
| | - M K Cheung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
| | - K Osann
- Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine – Medical Center, 101 The City Drive, Orange, CA 92868, USA
| | - L Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, San Francisco Comprehensive Cancer Center, 1600 Divisidero, San Francisco, CA 94115, USA
| | - N N Teng
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
| | - T A Longacre
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Department of Pathology, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - M A Powell
- Divison of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes Hospital Plaza, St Louis, MI 63110, USA
| | - M R Hendrickson
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Department of Pathology, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - D S Kapp
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Department of Radiation Oncology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
| | - J K Chan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA. E-mail:
| |
Collapse
|
36
|
Hamilton CA, Link KM, Salido TB, Epstein FH, Hundley WG. Is imaging at intermediate doses necessary during dobutamine stress magnetic resonance imaging? J Cardiovasc Magn Reson 2002; 3:297-302. [PMID: 11777220 DOI: 10.1081/jcmr-100108582] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To determine if visualization of left ventricular contraction throughout the course of a pharmacologic stress test performed with magnetic resonance imaging (MRI) (rather than solely at baseline and peak stress) is necessary, we retrospectively reviewed dobutamine MRI results in 469 consecutively referred patients for diagnosis of inducible ischemia. At each stage of pharmacologic stress, six image planes of the heart were viewed and left ventricular wall motion was scored as normal, hypokinetic, akinetic, or dyskinetic. Inducible ischemia was identified in 102 patients; in 39 patients (38%), evidence of ischemia occurred before receiving high doses of dobutamine. During testing, 103 patients developed chest discomfort consistent with angina, but only 26 of the 103 patients (25%) developed new wall motion abnormalities indicative of ischemia. Continuous image acquisition and review during dobutamine MRI pharmacologic stress testing provides a mechanism to detect ischemia and avoid premature test termination during the early stages of the procedure. Compared with protocols that image only at baseline and at peak stress, continuous acquisition and review may enhance the safety and improve the diagnostic accuracy of pharmacologic stress testing during dobutamine MRI.
Collapse
Affiliation(s)
- C A Hamilton
- Department of Medical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | | |
Collapse
|
37
|
Hamilton CA, O'Dowd G, McIntosh L, Berg G, Butler J, Pathi V, Williams R, Reid JL, Dominiczak AF. Vasorelaxant properties of isolated human radial arteries: comparison with internal mammary arteries. Atherosclerosis 2002; 160:345-53. [PMID: 11849657 DOI: 10.1016/s0021-9150(01)00605-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Radial arteries, used in revascularisation surgery, are prone to spasm. We have examined the ability of nitrovasodilators, calcium channel blockers, and K(ATP) channel openers to cause vasodilation, and to attenuate contractions due to depolarisation and receptor activation in radial and mammary arteries used in coronary artery bypass graft surgery. Two to three millimetre rings of artery obtained from patients at surgery were studied in organ baths in vitro. Constriction to KC1 and phenylephrine was examined before and again after treatment of the rings with drug or vehicle. Calcium channel blockers were the only compounds to inhibit contractions to both KC1 and phenylephrine. Sodium nitroprusside attenuated constriction to phenylephrine but not KC1 in both vessels. K(ATP) channel openers similarly attenuated constriction to phenylephrine in radial arteries but were much less effective in mammary arteries. These studies support the continued use of calcium blockers after revascularisation with radial artery but suggest that other classes of drug may be as effective at minimising spasm due to receptor mediated constriction.
Collapse
Affiliation(s)
- C A Hamilton
- Departments of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Fennell JP, Brosnan MJ, Frater AJ, Hamilton CA, Alexander MY, Nicklin SA, Heistad DD, Baker AH, Dominiczak AF. Adenovirus-mediated overexpression of extracellular superoxide dismutase improves endothelial dysfunction in a rat model of hypertension. Gene Ther 2002; 9:110-7. [PMID: 11857069 DOI: 10.1038/sj.gt.3301633] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2001] [Accepted: 11/30/2001] [Indexed: 11/09/2022]
Abstract
Gene transfer may be appropriate for therapeutic protocols targeted at the vascular endothelium. Endothelial dysfunction is the principal phenotype associated with atherosclerosis and hypertension. Oxidative stress has been implicated in the development of endothelial dysfunction. We have explored the ability of overexpressing anti-oxidant genes (superoxide dismutases; SODs) in vitro and in vivo to assess their potential for reversing endothelial dysfunction in a rat model, the stroke-prone spontaneously hypertensive rat (SHRSP). Western blotting and immunofluorescence assays in vitro showed efficient overexpression of MnSOD and ECSOD with respect to localisation to the mitochondria and extracellular surface, respectively. Transgene functional activity was quantified with SOD activity assays. MnSOD and ECSOD overexpression in intact SHRSP vessels in vivo led to endothelial and adventitial overexpression. Pharmacological assessment of transduced vessels following in vivo delivery by basal NO availability quantification demonstrated that the "null" adenovirus and MnSOD adenovirus did not significantly increase NO availability. However, AdECSOD-treated carotid arteries showed a significant increase in NO availability (1.91 +/- 0.04 versus 0.75 +/- 0.08 g/g, n = 6, P = 0.029). In summary, efficient overexpression of ECSOD, but not MnSOD in vivo, results in improved endothelial function in a rat model of hypertension and has important implications for the development of endothelial-based vascular gene therapy.
Collapse
Affiliation(s)
- J P Fennell
- BHF Blood Pressure Group, Department of Medicine and Therapeutics, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Hamilton CA, Good AG, Taylor GJ. Vacuolar H+-ATPase, but not mitochondrial F1F0-ATPase, is required for aluminum resistance in Saccharomyces cerevisiae. FEMS Microbiol Lett 2001; 205:231-6. [PMID: 11750808 DOI: 10.1111/j.1574-6968.2001.tb10953.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
It was recently shown that vacuolar ATPase and mitochondrial F1F0-ATPase activities are induced by aluminum (Al) in an Al-resistant cultivar of wheat, suggesting that induction of these enzymes could be an adaptive trait involved in Al resistance. To test this hypothesis, we used the Saccharomyces cerevisiae model system. In yeast, unlike wheat, the activity, transcript and protein levels of mitochondrial F1F0-ATPase, but not vacuolar ATPase, are induced by Al, while plasma membrane P-ATPase activity is inhibited. However, yeast vacuolar ATPase mutant strains are hypersensitive to Al, while F1F0-ATPase mutant strains exhibit wild-type growth. These data suggest that vacuolar ATPase activity is involved in Al resistance, with ATP required for this activity supplied by mitochondrial F1F0-ATPase or fermentation.
Collapse
Affiliation(s)
- C A Hamilton
- Department of Biological Sciences, University of Alberta, T6G 2E9, Edmonton, AB, Canada.
| | | | | |
Collapse
|
40
|
Alexander MR, Kitzman DW, Khaliq S, Darty SN, Hamilton CA, Herrington DM, Link KM, Hundley WG. Determination of femoral artery endothelial function by phase contrast magnetic resonance imaging. Am J Cardiol 2001; 88:1070-4. [PMID: 11704017 DOI: 10.1016/s0002-9149(01)01998-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M R Alexander
- Department of Internal Medicine (Cardiology Section), The Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Rerkpattanapipat P, Link KM, Hamilton CA, Hundley WG. Detecting left ventricular myocardial ischemia during intravenous dobutamine with cardiovascular magnetic resonance imaging (MRI). J Cardiovasc Magn Reson 2001; 3:21-5. [PMID: 11545136 DOI: 10.1081/jcmr-100000144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Advances in computer software, scanner hardware, and hemodynamic monitoring equipment have permitted the development of cardiovascular stress testing protocols for use during intravenous Dobutamine infusions within magnetic resonance imaging (MRI) scanners. Recent studies have documented that the safety profile and clinical utility of Dobutamine/Atropine cardiac stress testing during MRI compares favorably with other noninvasive stress imaging modalities and is particularly useful in patients not well suited for stress echocardiograms.
Collapse
Affiliation(s)
- P Rerkpattanapipat
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA
| | | | | | | |
Collapse
|
42
|
Hundley WG, Kitzman DW, Morgan TM, Hamilton CA, Darty SN, Stewart KP, Herrington DM, Link KM, Little WC. Cardiac cycle-dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance. J Am Coll Cardiol 2001; 38:796-802. [PMID: 11527636 DOI: 10.1016/s0735-1097(01)01447-4] [Citation(s) in RCA: 288] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The goal of this study was to determine if cardiac cycle-dependent changes in proximal thoracic aortic area and distensibility are associated with exercise intolerance in elderly patients with diastolic heart failure (DHF). BACKGROUND Aortic compliance declines substantially with age. We hypothesized that a reduction in cardiac cycle-dependent changes in thoracic aortic area and distensibility (above that which occurs with aging) could be associated with the exercise intolerance that is prominent in elderly diastolic heart failure patients. METHODS Thirty subjects (20 healthy individuals [10 < 30 years of age and 10 > 60 years of age] and 10 individuals > the age of 60 years with DHF) underwent a magnetic resonance imaging (MRI) study of the heart and proximal thoracic aorta followed within 48 h by maximal exercise ergometry with expired gas analysis. RESULTS The patients with DHF had higher resting brachial pulse and systolic blood pressure, left ventricular mass, aortic wall thickness and mean aortic flow velocity, and, compared with healthy older subjects, they had a significant reduction in MRI-assessed cardiac cycle-dependent change in aortic area and distensibility (p < 0.0001) that correlated with diminished peak exercise oxygen consumption (r = 0.79). After controlling for age and gender in a multivariate analysis, thoracic aortic distensibility was a significant predictor of peak exercise oxygen consumption (p < 0.04). CONCLUSIONS Older patients with isolated DHF have reduced cardiac cycle-dependent changes in proximal thoracic aortic area and distensibility (beyond that which occurs with normal aging), and this correlates with and may contribute to their severe exercise intolerance.
Collapse
Affiliation(s)
- W G Hundley
- Department of Internal Medicine, Cardiology Section, the Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
In human radial arteries, a nitric oxide/prostanoid-independent mechanism that has the pharmacological characteristics of an EDHF contributes to endothelium-dependent relaxation. H2O2 can act as an EDHF in some vascular beds. We examined the hypothesis that endogenously produced H2O2 mediated the nitric oxide/prostanoid-independent relaxation to carbachol in radial arteries obtained from patients undergoing coronary artery bypass surgery. Superoxide levels, measured by chemiluminescence, were similar in radial and internal mammary arteries, but immunohistochemical staining for Cu/Zn superoxide dismutase (SOD) was lower in endothelium from radial arteries. In organ chamber studies, neither addition of catalase nor addition of SOD to the bathing fluid modified nitric oxide/prostanoid-independent relaxations to carbachol in radial arteries. However, nitric oxide-dependent vasorelaxation was enhanced in the presence of SOD. Thus the nitric oxide/prostanoid-independent relaxation to carbachol is not due to H2O2 and, unlike nitric oxide-mediated vasorelaxation, is not attenuated by superoxide. Blood vessels showing EDHF-mediated relaxations resistant to oxidative stress may provide favorable outcomes in revascularization surgery.
Collapse
Affiliation(s)
- C A Hamilton
- Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, United Kingdom.
| | | | | | | | | |
Collapse
|
44
|
MacKay AJ, Hamilton CA, McArthur K, Berg G, Tropeano AI, Boutouyrie P, Reid JL, Dominiczak AF. Radial artery hypertrophy occurs in coronary atherosclerosis and is independent of blood pressure. Clin Sci (Lond) 2001; 100:509-16. [PMID: 11294691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Endothelial dysfunction, believed to underlie the structural changes of atherosclerosis, is a systemic phenomenon. Despite this, the radial artery has been considered as devoid of atherosclerosis and is commonly used as a conduit in coronary artery bypass grafting (CABG). Recently, histological study has shown intimal hyperplasia and other structural changes consistent with early atherosclerosis in the radial artery. The objective of the present study was to determine if structural changes in the radial artery could be detected in vivo in patients with coronary atherosclerosis. Using high resolution echo-tracking, measurements of radial artery internal diameter, wall thickness and wall cross-sectional area were made in 25 patients awaiting CABG and in 20 controls. Digital and brachial blood pressures were also recorded. Mean arterial pressures did not differ between the patient and control groups. All measures of wall thickness were greater in the patient than the control group. Neither current arterial pressures nor past history of hypertension correlated with wall thickness. Using a model of analysis of covariance, coronary artery disease was the best single predictor of intima-media thickness, R(2)=48%, n=44, P<0.0005. We concluded that increased radial artery wall thickness can be demonstrated in vivo in patients with coronary atherosclerosis. This is a novel observation which seems to be independent of blood pressure, and is consistent both with the hypothesis of systemic endothelial dysfunction leading to systemic structural changes and also to the recent histological evidence for atherosclerotic changes in this vessel.
Collapse
Affiliation(s)
- A J MacKay
- Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, Scotland, UK.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Hamilton CA, Good AG, Taylor GJ. Induction of vacuolar ATPase and mitochondrial ATP synthase by aluminum in an aluminum-resistant cultivar of wheat. Plant Physiol 2001; 125:2068-77. [PMID: 11299386 PMCID: PMC88862 DOI: 10.1104/pp.125.4.2068] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2000] [Revised: 11/12/2000] [Accepted: 01/03/2001] [Indexed: 05/18/2023]
Abstract
Two 51-kD aluminum (Al)-induced proteins (RMP51, root membrane proteins of 51 kD) were recently discovered in an aluminum-resistant cultivar of wheat (Triticum aestivum) cv PT741 (Basu et al., 1994a). These proteins segregate with the aluminum resistance phenotype in a segregating population arising from a cross between Al-resistant cv PT741 and Al-sensitive cv Katepwa (Taylor et al., 1997). The proteins have been purified by continuous elution electrophoresis and analyzed by peptide microsequencing. Sequence analysis of the purified peptides revealed that they are homologous to the B subunit of the vacuolar H+-ATPase (V-ATPase) and the alpha- and beta-subunits of the mitochondrial ATP synthase (F1F0-ATPase). To confirm that these ATPases are induced by Al, ATPase activity and transcript levels were analyzed under Al stress. Both V-ATPase and F1F0-ATPase activities were induced by Al and responded in a dose-dependent manner to 0 to 150 microM Al. In contrast, plasma membrane H+-ATPase (P-ATPase) activity decreased to 0.5x control levels, even when plants were exposed to 25 microM Al. Northern analysis showed that the transcript encoding the B subunit of V-ATPase increased by 2.2x in a dose-dependent manner, whereas levels of the transcript encoding the alpha-subunit of F1F0-ATPase remained constant. The effect of Al on ATPase activity in other cultivars was also examined. The Al-resistant cultivar, cv PT741, was the only cultivar to show induction of V- and F1F0-ATPases. These results suggest that the V-ATPase in cv PT741 is responding specifically to Al stress with the ATP required for its activity supplied by ATP synthase to maintain energy balance within the cell.
Collapse
Affiliation(s)
- C A Hamilton
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta T6G 2E9, Canada.
| | | | | |
Collapse
|
46
|
Robinson WR, Hamilton CA, Michaels SH, Kissinger P. Effect of excisional therapy and highly active antiretroviral therapy on cervical intraepithelial neoplasia in women infected with human immunodeficiency virus. Am J Obstet Gynecol 2001; 184:538-43. [PMID: 11262450 DOI: 10.1067/mob.2001.111103] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to determine the rates of recurrence, persistence, and progression of cervical intraepithelial neoplasia in women who were seropositive for human immunodeficiency virus after excisional therapy with and without highly active antiretroviral therapy. STUDY DESIGN The records of 118 women with cervical intraepithelial neoplasia, 56 of whom were infected with human immunodeficiency virus and 62 of whom were not infected, were examined to compare outcomes. Demographic, behavioral, and clinical indices were analyzed. RESULTS Of 54 women infected with human immunodeficiency virus, 31 (57.4%) had persistent or recurrent cervical intraepithelial neoplasia, in comparison with 10 (16.7%) of 60 noninfected women (P <.01). Progression occurred in 4 (16.7%) of 54 in the infected group and in 3 (5.0%) of 60 in the noninfected group (P <.05). In 21 (60.0%) of 35 infected women, in comparison with 8 (32%) of 25 noninfected women, disease persisted 6 months after diagnosis if treatment was not given (P <.05). Of 19 infected women, 10 (52.6%) had recurrent disease after treatment, compared with 2 (5.7%) of 35 noninfected women (P <.01). Risk factors for recurrence in women who were seropositive for human immunodeficiency virus included margin involvement of specimens obtained by loop electrosurgical excision (87.5% vs 20.0%l; P <.05). Exposure to highly active antiretroviral therapy, including therapy with protease inhibitors, was associated with a lower recurrence or persistence rate (17.6% vs. 70.3%; P <.05) and a lower progression rate (0% vs. 24%; P <.05). CONCLUSION Women infected with human immunodeficiency virus had high rates of recurrent and persistent cervical intraepithelial neoplasia despite standard therapy. Low CD4(+) levels and margin involvement of specimens obtained by loop electrosurgical excision are risk factors for recurrence. The use of highly active antiretroviral therapy is associated with a lower risk of recurrence, persistence, and progression of cervical intraepithelial neoplasia.
Collapse
Affiliation(s)
- W R Robinson
- Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | | | | |
Collapse
|
47
|
Abstract
Oxidative stress, a state of excessive reactive oxidative species activity, is associated with vascular disease states such as hypertension. In this review, we discuss the recent advances in the field of reactive oxidative species-mediated vascular damage in hypertension. These include the identification of redox-sensitive tyrosine kinases, the characterization of enzymatic sources of superoxide production in human blood vessels, and their relationship with vascular damage in atherosclerosis and hypertension. Finally, recent developments in the search for strategies to attenuate vascular oxidative stress are reviewed.
Collapse
Affiliation(s)
- C Berry
- The British Heart Foundation Blood Pressure Group, Department of Medicine and Therapeutics, University of Glasgow, Glasgow, UK
| | | | | | | | | |
Collapse
|
48
|
Hamilton CA, Brosnan MJ, McIntyre M, Graham D, Dominiczak AF. Superoxide excess in hypertension and aging: a common cause of endothelial dysfunction. Hypertension 2001; 37:529-34. [PMID: 11230330 DOI: 10.1161/01.hyp.37.2.529] [Citation(s) in RCA: 325] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is evidence in humans that hypertension and aging similarly impair endothelial function, although the mechanism remains unclear. Superoxide anion (O(2)(-)) is a major determinant of nitric oxide (NO) bioavailability and thus endothelial function. We sought to determine the relationship between endothelial function, O(2)(-), and age in normotensive Wistar-Kyoto (WKY) and stroke-prone spontaneously hypertensive rats (SHRSP). Aortic rings were removed from female WKY and SHRSP at 3 to 4 months (young) and 9 to 12 months (old). O(2)(-) generation by aortic rings was measured before and after removal of the endothelium or incubation with N(G) nitro-L-arginine methyl ester, diphenyleneiodonium, or apocynin. Levels of p22phox were studied with immunohistochemistry and used as a marker of NAD(P)H oxidase expression. NO bioavailability was significantly lower in old WKY compared with young WKY (P=0.0009) and in old SHRSP compared with young SHRSP (P=0.005). O(2)(-) generation was significantly greater in old WKY compared with young WKY (P=0.0001). Removal of the endothelium and N(G) nitro-L-arginine methyl ester treatment resulted in a significant reduction in O(2)(-) generation in old SHRSP (P=0.009 and 0.001, respectively). Diphenyleneiodonium significantly reduced O(2)(-) generation in 12-month WKY (P=0.008) and 12-month SHRSP (P=0.009). Apocynin attenuated O(2)(-) generation by older WKY (P=0.038) and SHRSP (P=0.028). p22phox was increased in older animals compared with young. We conclude that NO bioavailability decreases with age in female WKY and SHRSP. O(2)(-) generation increases with age in WKY and is higher in SHRSP and may contribute to the reduced NO by scavenging. NAD(P)H oxidase may contribute to the age-related increase in O(2)(-).
Collapse
Affiliation(s)
- C A Hamilton
- Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
| | | | | | | | | |
Collapse
|
49
|
Rerkpattanapipat P, Link KM, Hamilton CA, Hundley WG. Clinical utility of assessments of left ventricular systolic function and coronary arterial blood flow during pharmacological stress with magnetic resonance imaging. Top Magn Reson Imaging 2000; 11:399-405. [PMID: 11153706 DOI: 10.1097/00002142-200012000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Rerkpattanapipat
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA
| | | | | | | |
Collapse
|
50
|
Alexander MY, Brosnan MJ, Hamilton CA, Fennell JP, Beattie EC, Jardine E, Heistad DD, Dominiczak AF. Gene transfer of endothelial nitric oxide synthase but not Cu/Zn superoxide dismutase restores nitric oxide availability in the SHRSP. Cardiovasc Res 2000; 47:609-17. [PMID: 10963734 DOI: 10.1016/s0008-6363(00)00079-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Previous studies from our group have shown a deficit in nitric oxide (NO) bioavailability and an excess production of the superoxide anion (O(2)(-)) in the stroke prone spontaneously hypertensive rat (SHRSP) compared to the normotensive Wistar Kyoto (WKY) strain. This present study has investigated whether adenoviral-mediated gene transfer of human eNOS or Cu/ZnSOD can alter the NO/O(2)(-) balance, thereby improving endothelial function. METHODS A recombinant adenovirus, Ad/Hu/eNOS, containing the human eNOS cDNA fragment was generated by homologous recombination in 293 cells. Ad/Hu/eNOS or Ad/Cu/ZnSOD was delivered into SHRSP carotid arteries in vivo, using a titre of 2x10(9)-2x10(10) plaque forming units (pfu)/ml, and the effect on gene expression was observed 24 h later. RESULTS Western blotting confirmed increased enzyme levels of eNOS and Cu/ZnSOD in the viral-infused vessels. Ex vivo, the pressor response to phenylephrine (PE) in the presence of L-NAME was increased in the eNOS-infused arteries relative to the contralateral controls, indicating restoration of basal NO availability to that observed in untreated control WKY rats. Infusion of the SOD virus produced a statistically insignificant increase in NO bioavailability. CONCLUSIONS Our results support our previous findings obtained using a bovine eNOS recombinant adenovirus, that recombinant adenoviral gene transfer of human eNOS has a significant effect on NO bioavailability. In contrast, AdCu/ZnSOD gene transfer does not elicit an effect in our model. These results indicate that short-term overexpression of a recombinant eNOS, but not Cu/ZnSOD gene, in carotid arteries of the SHRSP is an effective means of locally increasing NO bioavailability to improve endothelial function.
Collapse
Affiliation(s)
- M Y Alexander
- Department of Medicine and Therapeutics, University of Glasgow, Western Infirmary, Church St., G11 6NT, Scotland, Glasgow, UK.
| | | | | | | | | | | | | | | |
Collapse
|