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Cámara A, Compta Y, Baixauli M, Maragall L, Pérez-Soriano A, Montagut N, Ahuir M, Ludeña E, Peri L, Fernández N, Villote S, Lopez de Los Reyes JC, Navarro-Otano J, Zaro I, Muñoz E, Buongiorno M, Caballol N, Pont-Sunyer C, Puente V, Giraldo D, Valldeoriola F, Lombraña M, Martí MJ. Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study. Parkinsonism Relat Disord 2024; 124:106993. [PMID: 38735163 DOI: 10.1016/j.parkreldis.2024.106993] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers. METHODS In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants. RESULTS At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations. CONCLUSIONS The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.
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Affiliation(s)
- A Cámara
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain.
| | - Y Compta
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain.
| | - M Baixauli
- Urology Service. Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Maragall
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - A Pérez-Soriano
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - N Montagut
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M Ahuir
- Psychology Unit Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Ludeña
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - L Peri
- Psychology Unit Hospital Clinic de Barcelona, Barcelona, Spain
| | - N Fernández
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - S Villote
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - J C Lopez de Los Reyes
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - J Navarro-Otano
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - I Zaro
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - E Muñoz
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | | | - N Caballol
- Hospital Moisès Broggi, Sant Joan Despí, Spain
| | | | - V Puente
- Hospital del Mar, Barcelona, Spain
| | - D Giraldo
- Hospital Comarcal Sant Jaume de Calella, Spain
| | - F Valldeoriola
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M Lombraña
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - M J Martí
- Parkinson's Disease & Movement Disorders Unit and Hospital de Dia de Malalties Neurodegeneratives (HDMND), Neurology Service, Hospital Clínic / IDIBAPS / CIBERNED / European Reference Network for Rare Neurological Diseases (ERN-RND / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
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Falgàs N, Sacchi L, Carandini T, Montagut N, Conte G, Triulzi F, Galimberti D, Arighi A, Sanchez-Valle R, Fumagalli GG. Utility of visual rating scales in primary progressive aphasia. Alzheimers Res Ther 2024; 16:73. [PMID: 38582927 PMCID: PMC10998321 DOI: 10.1186/s13195-024-01442-7] [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: 11/13/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Differential diagnosis among subjects with Primary Progressive Aphasia (PPA) can be challenging. Structural MRI can support the clinical profile. Visual rating scales are a simple and reliable tool to assess brain atrophy in the clinical setting. The aims of the study were to establish to what extent the visual rating scales could be useful in the differential diagnosis of PPA, to compare the clinical diagnostic impressions derived from routine MRI interpretations with those obtained using the visual rating scale and to correlate results of the scales in a voxel-based morphometry (VBM) analysis. METHOD Patients diagnosed with primary progressive aphasia (PPA) according to current criteria from two centers-Ospedale Maggiore Policlinico of Milan and Hospital Clínic de Barcelona-were included in the study. Two blinded clinicians evaluated the subjects MRIs for cortical atrophy and white matter hyperintensities using two protocols: routine readings and the visual rating scale. The diagnostic accuracy between patients and controls and within PPA subgroups were compared between the two protocols. RESULTS One hundred fifty Subjects were studied. All the scales showed a good to excellent intra and inter-rater agreement. The left anterior temporal scale could differentiate between semantic PPA and all other variants. The rater impression after the protocol can increase the accuracy just for the logopenic PPA. In the VBM analysis, the scores of visual rating scales correlate with the corresponding area of brain atrophy. CONCLUSION The Left anterior temporal rating scale can distinguish semantic PPA from other variants. The rater impression after structured view improved the diagnostic accuracy of logopenic PPA compared to normal readings. The unstructured view of the MRI was reliable for identifying semantic PPA and controls. Neither the structured nor the unstructured view could identify the nonfluent and undetermined variants.
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Affiliation(s)
- Neus Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, FRCB Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Luca Sacchi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tiziana Carandini
- Neurodegenerative Diseases Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Nuria Montagut
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, FRCB Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Giorgio Conte
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabio Triulzi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Neurodegenerative Diseases Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Diseases Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Raquel Sanchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, FRCB Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Giorgio Giulio Fumagalli
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Corso Bettini 31, Rovereto, 38068, Italy.
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Borrego-Écija S, Montagut N, Martín-Trias P, Vaqué-Alcázar L, Illán-Gala I, Balasa M, Lladó A, Casanova-Mollà J, Bargalló N, Valls-Solé J, Lleó A, Bartrés-Faz D, Sánchez-Valle R. Multifocal Transcranial Direct Current Stimulation in Primary Progressive Aphasia Does Not Provide a Clinical Benefit Over Speech Therapy. J Alzheimers Dis 2023:JAD230069. [PMID: 37182884 DOI: 10.3233/jad-230069] [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: 05/16/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a group of neurodegenerative disorders including Alzheimer's disease and frontotemporal dementia characterized by language deterioration. Transcranial direct current stimulation (tDCS) is a non-invasive intervention for brain dysfunction. OBJECTIVE To evaluate the tolerability and efficacy of tDCS combined with speech therapy in the three variants of PPA. We evaluate changes in fMRI activity in a subset of patients. METHODS Double-blinded, randomized, cross-over, and sham-controlled tDCS study. 15 patients with PPA were included. Each patient underwent two interventions: a) speech therapy + active tDCS and b) speech therapy + sham tDCS stimulation. A multifocal strategy with anodes placed in the left frontal and parietal regions was used to stimulate the entire language network. Efficacy was evaluated by comparing the results of two independent sets of neuropsychological assessments administered at baseline, immediately after the intervention, and at 1 month and 3 months after the intervention. In a subsample, fMRI scanning was performed before and after each intervention. RESULTS The interventions were well tolerated. Participants in both arms showed clinical improvement, but no differences were found between active and sham tDCS interventions in any of the evaluations. There were trends toward better outcomes in the active tDCS group for semantic association and reading skills. fMRI identified an activity increase in the right frontal medial cortex and the bilateral paracingulate gyrus after the active tDCS intervention. CONCLUSION We did not find differences between active and sham tDCS stimulation in clinical scores of language function in PPA patients.
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Affiliation(s)
- Sergi Borrego-Écija
- Alzheimer's disease and other cognitive disorders Unit. Neurology Service, Hospital Clinic de Barcelona, Institutd'Investigació Biomèdica August Pi i Sunyer, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Nuria Montagut
- Alzheimer's disease and other cognitive disorders Unit. Neurology Service, Hospital Clinic de Barcelona, Institutd'Investigació Biomèdica August Pi i Sunyer, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Pablo Martín-Trias
- Medical Psychology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Insitute of Neurosciences, University of Barcelona; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Lídia Vaqué-Alcázar
- Medical Psychology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Insitute of Neurosciences, University of Barcelona; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Ignacio Illán-Gala
- Memory Unit, Service of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Centro de Investigación en Red en enfermedadesneurogenerativas (CIBERNED), Madrid, Spain
| | - Mircea Balasa
- Alzheimer's disease and other cognitive disorders Unit. Neurology Service, Hospital Clinic de Barcelona, Institutd'Investigació Biomèdica August Pi i Sunyer, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Albert Lladó
- Alzheimer's disease and other cognitive disorders Unit. Neurology Service, Hospital Clinic de Barcelona, Institutd'Investigació Biomèdica August Pi i Sunyer, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Jordi Casanova-Mollà
- Clinical Neurophysiology Unit, Institutd'Investigació Biomèdica August Pi i Sunyer, NeurologyService, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Nuria Bargalló
- Radiology Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Valls-Solé
- Clinical Neurophysiology Unit, Institutd'Investigació Biomèdica August Pi i Sunyer, NeurologyService, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alberto Lleó
- Memory Unit, Service of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Centro de Investigación en Red en enfermedadesneurogenerativas (CIBERNED), Madrid, Spain
| | - David Bartrés-Faz
- Medical Psychology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Insitute of Neurosciences, University of Barcelona; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's disease and other cognitive disorders Unit. Neurology Service, Hospital Clinic de Barcelona, Institutd'Investigació Biomèdica August Pi i Sunyer, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
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Montagut N, Borrego-Écija S, Herrero J, Lladó A, Balasa M, Muñoz E, Valldeoriola F, Sánchez-Valle R. Escala Barcelona para la apraxia bucofonatoria: instrumento de evaluación cuantitativo. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Montagut N, Borrego-Écija S, Herrero J, Lladó A, Balasa M, Muñoz E, Valldeoriola F, Sánchez-Valle R. Barcelona scale for buccophonatory apraxia: Quantitative assessment tool. Neurologia 2022:S2173-5808(22)00140-7. [PMID: 36272532 DOI: 10.1016/j.nrleng.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Currently there is no tool to quantify buccophonatory apraxia to stratify, compare and monitor patients longitudinally in an objective manner. Our aim in this study is to create a quantitative scale for buccophonatory apraxia and evaluate it in patients with the non-fluent/grammatical variant of primary progressive aphasia (nfvPPA) and other neurodegenerative diseases that occur with speech and/or language problems. METHODS The scale was designed based on useful elements in the assessment of buccophonatory apraxia and the total was quantified in seconds. The scale was administered to 64 participants with diagnoses of: nfvPPA, semantic variant of primary progressive aphasia (svPPA), logopenic variant of primary progressive aphasia (lvPPA), Huntington's disease, Parkinson's disease, as well as a group of healthy controls. RESULTS Patients showed a significantly higher score compared to controls. The nfvPPA group had the highest mean score on the scale (429 seconds ± 278). The scale was useful to differentiate vnfPPA from svPPA and Parkinson's disease (area under curve [AUC] of 0.956 and 0.989, respectively), but less to differentiate it from Huntington's disease (AUC = 0.67) and lvPPA. There was a statistically significant relationship between total score and disease severity in nfvPPA (P < .029). CONCLUSIONS The Barcelona scale for buccophonatory apraxia could be useful to quantitatively evaluate buccophonatory apraxia in different neurodegenerative diseases, and compare patients, especially in nfvPPA.
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Affiliation(s)
- N Montagut
- Unidad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Unidad de Parkinson y Trastornos del Movimiento, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - S Borrego-Écija
- Unidad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Herrero
- Unidad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Unidad de Parkinson y Trastornos del Movimiento, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Lladó
- Unidad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigació Biomédica August Pi i Sunyer, Barcelona, Spain
| | - M Balasa
- Unidad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigació Biomédica August Pi i Sunyer, Barcelona, Spain
| | - E Muñoz
- Unidad de Parkinson y Trastornos del Movimiento, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigació Biomédica August Pi i Sunyer, Barcelona, Spain
| | - F Valldeoriola
- Unidad de Parkinson y Trastornos del Movimiento, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigació Biomédica August Pi i Sunyer, Barcelona, Spain
| | - R Sánchez-Valle
- Unidad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain.
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Cámara A, Compta Y, Pérez-Soriano A, Montagut N, Ahuir M, Ludeña E, Baixauli M, Peri-Cusi L, Fernández N, Villote S, Caballol N, Buongiorno M, Pont-Sunyer C, Puente V, Giraldo D, Garrido A, Painous C, Sánchez A, Muñoz E, Valldeoriola F, Lombraña M, Martí M. Healthcare education program in multiple system atrophy - preliminary results of satisfaction from a national registry based longitudinal study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gil-Navarro S, Gelpi E, Lomeña F, Montagut N, Lladó A, Molinuevo JL, Sánchez-Valle R. In vivo decreased dopamine transporter uptake in corticobasal degeneration presenting with primary progressive aphasia without parkinsonism. Eur J Neurol 2014; 21:e56-7. [PMID: 24919427 DOI: 10.1111/ene.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/12/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S Gil-Navarro
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Barcelona, Spain
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Gil-Navarro S, Lladó A, Rami L, Castellví M, Bosch B, Bargalló N, Lomeña F, Reñé R, Montagut N, Antonell A, Molinuevo JL, Sánchez-Valle R. Neuroimaging and biochemical markers in the three variants of primary progressive aphasia. Dement Geriatr Cogn Disord 2013; 35:106-17. [PMID: 23392204 DOI: 10.1159/000346289] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIM To investigate in variants of primary progressive aphasia (PPA) the association between current clinical and neuroimaging criteria and biochemical/genetic markers at the individual level. METHODS Thirty-two PPA patients were classified as non-fluent/agrammatic (nfvPPA), semantic (svPPA), or logopenic variant (lvPPA) or as unclassifiable (uPPA). In all patients, we evaluated the neuroimaging criteria (magnetic resonance imaging and/or single photon emission computed tomography/positron emission tomography) of each variant and studied serum progranulin levels, APOE genotype and Alzheimer's disease (AD)-cerebrospinal fluid (CSF) biomarkers. Cases with a first-degree family history of early-onset dementia were genetically tested. RESULTS Ten of 15 (66%) nfvPPA, 5/5 (100%) svPPA and 7/7 (100%) lvPPA patients showed at least one positive neuroimaging-supported diagnostic criterion. All lvPPA and 3/5 (60%) uPPA patients presented AD-CSF biomarkers, which were absent in nfvPPA and svPPA cases. Four (27%) nfvPPA patients had dementia-causing mutations: 2 carried a GRN mutation and 2 the C9ORF72 hexanucleotide expansion. CONCLUSIONS There was an excellent association between clinical criteria and neuroimaging-supported biomarkers in svPPA and lvPPA, as well as with AD-CSF biochemical markers in the lvPPA. Neuroimaging, biochemical and genetic findings in nfvPPA were heterogeneous. Incorporating biochemical/genetic markers into the PPA clinical diagnosis would allow clinicians to improve their predictions of PPA neuropathology, especially in nfvPPA and uPPA cases.
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Affiliation(s)
- S Gil-Navarro
- Alzheimer's Disease and Other Cognitive Disorders Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
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Gil-Navarro S, Lomeña F, Cot A, Lladó A, Montagut N, Castellví M, Bosch B, Rami L, Antonell A, Balasa M, Pavia J, Iranzo A, Molinuevo JL, Sánchez-Valle R. Decreased striatal dopamine transporter uptake in the non-fluent/agrammatic variant of primary progressive aphasia. Eur J Neurol 2013; 20:1459-e126. [PMID: 23679075 DOI: 10.1111/ene.12196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Patients with the non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) may develop atypical parkinsonian syndromes. However, there is no current biomarker to assess which patients are at high risk of developing parkinsonism. 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (123I-FP-CIT)-SPECT detects striatal dopamine dysfunction in vivo. The objective of the present study was to study whether non-fluent/agrammatic patients without parkinsonism at baseline present decreased striatal 123I-FP-CIT uptake. METHODS Visual and semi-quantitative assessments of the striatal 123I-FP-CIT uptake ratio were carried out in 15 patients with nfvPPA, eight patients with the logopenic variant of PPA (lvPPA) and 18 controls. To rule out progranulin mutations or underlying Alzheimer's disease (AD), serum progranulin levels and cerebrospinal fluid (CSF) biomarkers of AD (Aβ42 , total-tau, phosphorylated-tau181 ) were determined. A second 123I-FP-CIT-SPECT analysis in the biomarker-enriched groups was also carried out. RESULTS Patients with nfvPPA presented reduced striatal 123I-FP-CIT binding, especially in the left hemisphere (P = 0.002), compared with controls. All lvPPA patients had normal striatal 123I-FP-CIT uptake. 123I-FP-CIT striatal binding in nfvPPA patients with normal progranulin and CSF biomarker levels (nfvPPA/bio-) was also significantly reduced (P < 0.05) compared with lvPPA patients with positive AD biomarkers. Sixty-four per cent (9/14) of nfvPPA patients and 80% of nfvPPA/bio- patients (8/10) showed a diminished individual left striatal 123I-FP-CIT uptake ratio. On follow-up, seven nfvPPA/bio- patients developed parkinsonism (median 1.9 years; range 1.2-2.9), six of them with baseline reduced 123I-FP-CIT uptake. CONCLUSIONS Reduced striatal tracer uptake in nfvPPA patients prior to clinical parkinsonism can be detected by 123I-FP-CIT-SPECT, especially in those with nfvPPA/bio-, suggesting subclinical nigrostriatal degeneration. Decreased striatal 123I-FP-CIT binding might identify PPA patients at increased risk of developing atypical parkinsonian syndromes, probably related to tau-pathology.
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Affiliation(s)
- S Gil-Navarro
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Department, Hospital Clínic, Barcelona, Spain
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