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Kluge A, Schaeffer E, Bunk J, Sommerauer M, Röttgen S, Schulte C, Roeben B, von Thaler AK, Welzel J, Lucius R, Heinzel S, Xiang W, Eschweiler GW, Maetzler W, Suenkel U, Berg D. Detecting Misfolded α-Synuclein in Blood Years before the Diagnosis of Parkinson's Disease. Mov Disord 2024. [PMID: 38651526 DOI: 10.1002/mds.29766] [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: 07/25/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Identifying individuals with Parkinson's disease (PD) already in the prodromal phase of the disease has become a priority objective for opening a window for early disease-modifying therapies. OBJECTIVE The aim was to evaluate a blood-based α-synuclein seed amplification assay (α-syn SAA) as a novel biomarker for diagnosing PD in the prodromal phase. METHODS In the TREND study (University of Tuebingen) biennial blood samples of n = 1201 individuals with/without increased risk for PD were taken prospectively over 4 to 10 years. We retrospectively analyzed blood samples of 12 participants later diagnosed with PD during the study to detect and amplify pathological α-syn conformers derived from neuronal extracellular vesicles using (1) immunoblot analyses with an antibody against these conformers and (2) an α-syn-SAA. Additionally, blood samples of n = 13 healthy individuals from the TREND cohort and n = 20 individuals with isolated rapid eye movement sleep behavior disorder (iRBD) from the University Hospital Cologne were analyzed. RESULTS All individuals with PD showed positive immunoblots and a positive α-syn SAA at the time of diagnosis. Moreover, all PD patients showed a positive α-syn SAA 1 to 10 years before clinical diagnosis. In the iRBD cohort, 30% showed a positive α-syn SAA. All healthy controls had a negative SAA. CONCLUSIONS We here demonstrate the possibility to detect and amplify pathological α-syn conformers in peripheral blood up to 10 years before the clinical diagnosis of PD in individuals with and without iRBD. The findings of this study indicate that this blood-based α-syn SAA assay has the potential to serve as a diagnostic biomarker for prodromal PD. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Annika Kluge
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Josina Bunk
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Michael Sommerauer
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Sinah Röttgen
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Ralph Lucius
- Institute of Anatomy, Kiel University, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Wei Xiang
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Gerhard W Eschweiler
- Geriatric Center, University Hospital Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Ulrike Suenkel
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Partner Site Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
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Bang C, Heinzel S. [Relationships between microbiome and neurodegeneration]. Nervenarzt 2023; 94:885-891. [PMID: 37672084 DOI: 10.1007/s00115-023-01537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Neurodegenerative diseases are often associated with changes in the (gut) microbiome. OBJECTIVE Based on studies in Parkinson's disease (PD) and Alzheimer's disease (AD), an overview of the current evidence of microbial changes and their possible role in the development of these diseases is given. METHODS Analysis, summary, and evaluation of the current literature on (gut) microbiome and neurodegeneration. RESULTS Numerous studies have shown dysbiotic changes in the gut microbiome of PD and AD patients compared to healthy individuals, some of which might occur even in the prodromal phase. Specifically, these patients show a reduction in bacteria involved in the synthesis of short-chain fatty acids. These microbial alterations have been associated with systemic inflammation and a compromised integrity of the intestinal barrier and blood-brain barrier. Bacterial molecules such as lipopolysaccharides may play an important role in these changes. Additionally, the bacterial protein curli, found on the surface of e.g., Escherichia coli, has been shown in vitro and in animal models to promote the misfolding of α-synuclein, thus suggesting a crucial pathomechanism. Moreover, certain oral bacteria appear to be more prevalent in AD patients and may contribute to the pathogenesis of AD. CONCLUSION Neurodegenerative diseases are associated with dysbiosis of the (gut) microbiome, which can have diverse systemic effects; however, it remains unclear whether this dysbiosis is a cause or a consequence of the diseases. Further investigation of this (prodromal) microbial imbalance could reveal new approaches for targeted therapeutic manipulation of the microbiome to modify and prevent these diseases.
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Affiliation(s)
- Corinna Bang
- Institut für Klinische Molekularbiologie (IKMB), Universitätsklinikum Schleswig-Holstein (UKSH), Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
| | - Sebastian Heinzel
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein (UKSH), Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
- Institut für Medizinische Informatik und Statistik (IMIS), Universitätsklinikum Schleswig-Holstein (UKSH), Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
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Kastner L, Suenkel U, Eschweiler GW, Dankowski T, von Thaler AK, Mychajliw C, Brockmann K, Maetzler W, Berg D, Fallgatter AJ, Heinzel S, Thiel A. Older adults' coping strategies during the COVID-19 pandemic - a longitudinal mixed-methods study. Front Psychol 2023; 14:1209021. [PMID: 37744579 PMCID: PMC10512280 DOI: 10.3389/fpsyg.2023.1209021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Older age is a main risk factor for severe COVID-19. In 2020, a broad political debate was initiated as to what extent older adults need special protection and isolation to minimize their risk for SARS-CoV-2 infection. However, isolation might also have indirect negative psychological (e.g., loneliness, stress, fear, anxiety, depression) or physical (e.g., lack of exercise, missing medical visits) consequences depending on individual strategies and personality traits to cope longitudinally with this crisis. Methods To examine the impact of individuals' coping with the pandemic on mental health, a large sample of 880 older adults of the prospective longitudinal cohort TREND study were surveyed six times about their individual coping strategies in the COVID-19 pandemic between May 2020 (05/2020: Mage = 72.1, SDage = 6.4, Range: 58-91 years) and November 2022 in an open response format. The relevant survey question was: "What was helpful for you to get through the last months despite the COVID-19 pandemic? E.g., phone calls, going for a walk, or others." Results and Discussion In total, we obtained 4,561 records containing 20,578 text passages that were coded and assigned to 427 distinct categories on seven levels based on qualitative content analysis using MAXQDA. The results allow new insights into the impact of personal prerequisites (e.g., value beliefs, living conditions), the general evaluation of the pandemic (e.g., positive, irrelevant, stressful) as well as the applied coping strategies (e.g., cognitive, emotional- or problem-focused) to deal with the COVID-19 pandemic by using an adapted Lazarus stress model. Throughout the pandemic emotional-focused as well as problem-focused strategies were the main coping strategies, whereas general beliefs, general living conditions and the evaluation were mentioned less frequently.
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Affiliation(s)
- Lydia Kastner
- Institute for Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Ulrike Suenkel
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- German Center for Mental Health (DZPG), Partner Site Tübingen, Tübingen, Germany
| | - Gerhard W. Eschweiler
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Geriatric Center, Tübingen University Hospital, Tübingen, Germany
| | - Theresa Dankowski
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Anna-Katharina von Thaler
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christian Mychajliw
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Geriatric Center, Tübingen University Hospital, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Andreas J. Fallgatter
- Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- German Center for Mental Health (DZPG), Partner Site Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Medical Centre Schleswig-Holstein and Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Ansgar Thiel
- Institute for Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Lead Graduate School and Research Network, Eberhard Karls University of Tübingen, Tübingen, Germany
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Schwefel MK, Kaufmann C, Gutmann G, Henze R, Fydrich T, Rapp MA, Ströhle A, Heissel A, Heinzel S. Physical fitness is associated with neural activity during working memory performance in major depressive disorder. Neuroimage Clin 2023; 38:103401. [PMID: 37060626 PMCID: PMC10133876 DOI: 10.1016/j.nicl.2023.103401] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/17/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Deficits in cognition like working memory (WM) are highly prevalent symptoms related to major depressive disorder (MDD). Neuroimaging studies have described frontoparietal abnormalities in patients with MDD as a basis for these deficits. Based on research in healthy adults, it is hypothesized that increased physical fitness might be a protective factor for these deficits in MDD. However, the relationship between physical fitness and WM-related neural activity and performance has not been tested in MDD, to date. Understanding these associations could inform the development of physical exercise interventions in MDD. METHODS Within a larger project, 111 (53female) MDD outpatients and 56 (34female) healthy controls performed an n-back task (0-, 1-, 2-, 3-back) during functional Magnetic Resonance Imaging. Physical fitness from a graded exercise test on a cycle ergometer was performed by 106 MDD patients. RESULTS Patients showed reduced performance particularly at high loads of the n-back WM task and prolonged reaction times at all n-back loads. A whole-brain interaction analysis of group by WM load revealed reduced neural activity in six frontoparietal clusters at medium and high WM loads in MDD patients compared to healthy controls. Analysis of covariance within the MDD sample showed that physical fitness was associated with neural activity in right and left superior parietal lobules. Externally defined Regions of Interest confirmed this analysis. CONCLUSIONS Results indicate frontoparietal hypoactivity in MDD at high demands, arguing for decreased WM capacity. We demonstrate a parietal fitness correlate which could be used to guide future research on effects of exercise on cognitive functioning in MDD.
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Affiliation(s)
- M K Schwefel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - C Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - G Gutmann
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - R Henze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - T Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M A Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - A Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - A Heissel
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - S Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Dankowski T, Kastner L, Suenkel U, von Thaler AK, Mychajliw C, Krawczak M, Maetzler W, Berg D, Brockmann K, Thiel A, Eschweiler GW, Heinzel S. Longitudinal dynamics of depression in risk groups of older individuals during the COVID-19 pandemic. Front Epidemiol 2023; 3:1093780. [PMID: 38455897 PMCID: PMC10911044 DOI: 10.3389/fepid.2023.1093780] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/25/2023] [Indexed: 03/09/2024]
Abstract
Background Older individuals are most at risk of severe COVID-19 and particularly require protection causing (self)restriction of psychosocial interaction in daily living. So far, the impact of psychosocial withdrawal on mental health seems less pronounced in community-dwelling older individuals compared to younger individuals. However, dynamics and adverse long-term effects of the pandemic, such as increases in depression, are still mostly unclear, especially for vulnerable subgroups. Methods Pre-pandemic and 3-, 8-, 14-, 20-month peri-pandemic data were analyzed in 877 older participants (age at 3-month peri-pandemic: mean ± SD: 72.3 ± 6.3, range: 58-91 years) of the observational prospective TREND study in Germany. Severity of depression (Beck's Depression Inventory-II scores) and key factors of (mental) health were investigated for cross-sectional associations using path modeling. Risk groups defined by resilience, loneliness, history of depression, stress, health status and fear of COVID-19 were investigated for differences in depression between timepoints. Findings The early pandemic (3-month) severity of depression was most strongly associated with history of depression, stress and resilience. Overall increases in clinically relevant depression (mild-severe) from pre- to 3-month peri-pandemic were small (% with depression at pre-/3-month peri-pandemic: 8.3%/11.5%). Changes were most pronounced in risk groups with low resilience (27.2%/41.8%), loneliness (19.0%/28.9%), fear of COVID-19 (17.6%/31.4%), high stress (24.4%/34.2%), a history of depression (27.7%/36.9%), and low health status (21.8%/31.4%). Changes in depression were largely observed from pre- to 3-month and were sustained to the 20-month peri-pandemic timepoint, overall and in stratified risk groups defined by single and cumulative risk factors. Changes between timepoints were heterogenous as indicated by alluvial diagrams. Conclusion Only specific risk groups of older individuals showed a large increase in depression during the COVID-19 pandemic. Since these increases occurred early in the pandemic and were sustained over 20 months, these vulnerable risk groups need to be prioritized for counselling and risk mitigation of depression.
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Affiliation(s)
- Theresa Dankowski
- Department of Neurology, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Lydia Kastner
- Institute of Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Lead Graduate School and Research Network, University of Tübingen, Tübingen, Germany
| | - Ulrike Suenkel
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Department of Neurology, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christian Mychajliw
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Ansgar Thiel
- Institute of Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Gerhard W. Eschweiler
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Geriatric Center, Tübingen University Hospital, Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurology, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
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Zacharias HU, Kaleta C, Cossais F, Schaeffer E, Berndt H, Best L, Dost T, Glüsing S, Groussin M, Poyet M, Heinzel S, Bang C, Siebert L, Demetrowitsch T, Leypoldt F, Adelung R, Bartsch T, Bosy-Westphal A, Schwarz K, Berg D. Microbiome and Metabolome Insights into the Role of the Gastrointestinal-Brain Axis in Parkinson's and Alzheimer's Disease: Unveiling Potential Therapeutic Targets. Metabolites 2022; 12:metabo12121222. [PMID: 36557259 PMCID: PMC9786685 DOI: 10.3390/metabo12121222] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Neurodegenerative diseases such as Parkinson's (PD) and Alzheimer's disease (AD), the prevalence of which is rapidly rising due to an aging world population and westernization of lifestyles, are expected to put a strong socioeconomic burden on health systems worldwide. Clinical trials of therapies against PD and AD have only shown limited success so far. Therefore, research has extended its scope to a systems medicine point of view, with a particular focus on the gastrointestinal-brain axis as a potential main actor in disease development and progression. Microbiome and metabolome studies have already revealed important insights into disease mechanisms. Both the microbiome and metabolome can be easily manipulated by dietary and lifestyle interventions, and might thus offer novel, readily available therapeutic options to prevent the onset as well as the progression of PD and AD. This review summarizes our current knowledge on the interplay between microbiota, metabolites, and neurodegeneration along the gastrointestinal-brain axis. We further illustrate state-of-the art methods of microbiome and metabolome research as well as metabolic modeling that facilitate the identification of disease pathomechanisms. We conclude with therapeutic options to modulate microbiome composition to prevent or delay neurodegeneration and illustrate potential future research directions to fight PD and AD.
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Affiliation(s)
- Helena U. Zacharias
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, 30625 Hannover, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
- Correspondence: (H.U.Z.); (C.K.)
| | - Christoph Kaleta
- Research Group Medical Systems Biology, Institute for Experimental Medicine, Kiel University, 24105 Kiel, Germany
- Kiel Nano, Surface and Interface Science—KiNSIS, Kiel University, 24118 Kiel, Germany
- Correspondence: (H.U.Z.); (C.K.)
| | | | - Eva Schaeffer
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Henry Berndt
- Research Group Comparative Immunobiology, Zoological Institute, Kiel University, 24118 Kiel, Germany
| | - Lena Best
- Research Group Medical Systems Biology, Institute for Experimental Medicine, Kiel University, 24105 Kiel, Germany
| | - Thomas Dost
- Research Group Medical Systems Biology, Institute for Experimental Medicine, Kiel University, 24105 Kiel, Germany
| | - Svea Glüsing
- Institute of Human Nutrition and Food Science, Food Technology, Kiel University, 24118 Kiel, Germany
| | - Mathieu Groussin
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Mathilde Poyet
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sebastian Heinzel
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
- Institute of Medical Informatics and Statistics, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Leonard Siebert
- Kiel Nano, Surface and Interface Science—KiNSIS, Kiel University, 24118 Kiel, Germany
- Functional Nanomaterials, Department of Materials Science, Kiel University, 24143 Kiel, Germany
| | - Tobias Demetrowitsch
- Institute of Human Nutrition and Food Science, Food Technology, Kiel University, 24118 Kiel, Germany
- Kiel Network of Analytical Spectroscopy and Mass Spectrometry, Kiel University, 24118 Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
- Neuroimmunology, Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Rainer Adelung
- Kiel Nano, Surface and Interface Science—KiNSIS, Kiel University, 24118 Kiel, Germany
- Functional Nanomaterials, Department of Materials Science, Kiel University, 24143 Kiel, Germany
| | - Thorsten Bartsch
- Kiel Nano, Surface and Interface Science—KiNSIS, Kiel University, 24118 Kiel, Germany
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Anja Bosy-Westphal
- Institute of Human Nutrition and Food Science, Kiel University, 24107 Kiel, Germany
| | - Karin Schwarz
- Kiel Nano, Surface and Interface Science—KiNSIS, Kiel University, 24118 Kiel, Germany
- Institute of Human Nutrition and Food Science, Food Technology, Kiel University, 24118 Kiel, Germany
- Kiel Network of Analytical Spectroscopy and Mass Spectrometry, Kiel University, 24118 Kiel, Germany
| | - Daniela Berg
- Kiel Nano, Surface and Interface Science—KiNSIS, Kiel University, 24118 Kiel, Germany
- Department of Neurology, Kiel University and University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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Heinzel S, Mascalzoni D, Bäumer T, Berg D, Kasten M, Brüggemann N. Clinical relevance and translational impact of reduced penetrance in genetic movement disorders. MED GENET-BERLIN 2022. [DOI: 10.1515/medgen-2022-2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Reduced penetrance is an important but underreported aspect in monogenic diseases. It refers to the phenomenon that carriers of pathogenic variants do not manifest with an overt disease. Clinical expressivity, on the other hand, describes the degree to which certain disease characteristics are present. In this article, we discuss the implications of reduced penetrance on genetic testing and counseling, outline how penetrance can be estimated in rare diseases using large cohorts and review the ethical, legal and social implications of studying non-manifesting carriers of pathogenic mutations. We highlight the interplay between reduced penetrance and the prodromal phase of a neurodegenerative disorder through the example of monogenic Parkinson’s disease and discuss the therapeutic implications.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology , Christian-Albrechts University of Kiel , Kiel , Germany
| | - Deborah Mascalzoni
- Institute for Biomedicine , Eurac Research , Affiliated Institute of the University of Lübeck , Bolzano , Italy
- Center for Research Ethics and Bioethics , Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
| | - Tobias Bäumer
- Institute of Systems Motor Science , University of Lübeck , Lübeck , Germany
| | - Daniela Berg
- Department of Neurology , Christian-Albrechts University of Kiel , Kiel , Germany
| | - Meike Kasten
- Department of Psychiatry and Psychotherapy , University of Lübeck , Lübeck , Germany
- Institute of Neurogenetics , University of Lübeck , Lübeck , Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics , University of Lübeck , Lübeck , Germany
- Department of Neurology, Center for Brain, Behavior and Metabolism , University of Lübeck , Lübeck , Germany
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8
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Bianchini E, Warmerdam E, Romijnders R, Stürner KH, Baron R, Heinzel S, Pontieri FE, Hansen C, Maetzler W. Turning when using a smartphone in persons with and without neurologic conditions: an observational study (Preprint). J Med Internet Res 2022; 25:e41082. [PMID: 36995756 PMCID: PMC10131647 DOI: 10.2196/41082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. OBJECTIVE This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. METHODS Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. RESULTS In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. CONCLUSIONS Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. TRIAL REGISTRATION German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neurology, Kiel University, Kiel, Germany
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Elke Warmerdam
- Department of Neurology, Kiel University, Kiel, Germany
- Division of Surgery, Saarland University, Homburg, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Kiel, Germany
- Faculty of Engineering, Kiel University, Kiel, Germany
| | | | - Ralf Baron
- Department of Neurology, Kiel University, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Francesco Ernesto Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Santa Lucia Foundation, Rome, Italy
| | - Clint Hansen
- Department of Neurology, Kiel University, Kiel, Germany
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9
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Elshehabi M, Del Din S, Hobert MA, Warmerdam E, Sünkel U, Schmitz-Hübsch T, Behncke LM, Heinzel S, Brockmann K, Metzger FG, Schlenstedt C, Rochester L, Hansen C, Berg D, Maetzler W. Walking parameters of older adults from a lower back inertial measurement unit, a 6-year longitudinal observational study. Front Aging Neurosci 2022; 14:789220. [PMID: 36172482 PMCID: PMC9511986 DOI: 10.3389/fnagi.2022.789220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Gait changes during aging and differs between sexes. Inertial measurement units (IMUs) enable accurate quantitative evaluations of gait in ambulatory environments and in large populations. This study aims to provide IMU-based gait parameters' values derived from a large longitudinal cohort study in older adults. We measured gait parameters, such as velocity, step length, time, variability, and asymmetry, from straight, self-paced 20-m walks in older adults (four visits: 715/1102/1017/957 participants) every second year over 6 years using an IMU at the lower back. Moreover, we calculated the associations of gait parameters with sex and age. Women showed lower gait speed, step length, step time, stride time, swing time, and stance time, compared to men. Longitudinal analyses suggest that these parameters are at least partly deteriorating within the assessment period of 2 years, especially in men and at an older age. Variability and asymmetry parameters show a less clear sex- and age-associated pattern. Altogether, our large longitudinal dataset provides the first sex-specific information on which parameters are particularly promising for the detection of age-related gait changes that can be extracted from an IMU on the lower back. This information may be helpful for future observational and treatment studies investigating sex and age-related effects on gait, as well as for studies investigating age-related diseases.
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Affiliation(s)
- Morad Elshehabi
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Markus A Hobert
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Elke Warmerdam
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Ulrike Sünkel
- German Center for Neurodegenerative Diseases DZNE, Tübingen, Germany.,Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Kathrin Brockmann
- German Center for Neurodegenerative Diseases DZNE, Tübingen, Germany.,Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Geriatric Center, University of Tübingen, Tübingen, Germany
| | | | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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10
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Heinzel S, Aho VTE, Suenkel U, von Thaler AK, Schulte C, Deuschle C, Paulin L, Hantunen S, Brockmann K, Eschweiler GW, Maetzler W, Berg D, Auvinen P, Scheperjans F. Gut Microbiome Signatures of Risk and Prodromal Markers of Parkinson Disease. Ann Neurol 2021; 90:E1-E12. [PMID: 34021620 DOI: 10.1002/ana.26128] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Alterations of the gut microbiome in Parkinson disease (PD) have been repeatedly demonstrated. However, little is known about whether such alterations precede disease onset and how they relate to risk and prodromal markers of PD. We investigated associations of these features with gut microbiome composition. METHODS Established risk and prodromal markers of PD as well as factors related to diet/lifestyle, bowel function, and medication were studied in relation to bacterial α-/β-diversity, enterotypes, and differential abundance in stool samples of 666 elderly TREND (Tübingen Evaluation of Risk Factors for Early Detection of Neurodegeneration) study participants. RESULTS Among risk and prodromal markers, physical inactivity, occupational solvent exposure, and constipation showed associations with α-diversity. Physical inactivity, sex, constipation, possible rapid eye movement sleep behavior disorder (RBD), and smoking were associated with β-diversity. Subthreshold parkinsonism and physical inactivity showed an interaction effect. Among other factors, age and urate-lowering medication were associated with α- and β-diversity. Constipation was highest in individuals with the Firmicutes-enriched enterotype, and physical inactivity was most frequent in the Bacteroides-enriched enterotype. Constipation was lowest and subthreshold parkinsonism least frequent in individuals with the Prevotella-enriched enterotype. Differentially abundant taxa were linked to constipation, physical inactivity, possible RBD, smoking, and subthreshold parkinsonism. Substantia nigra hyperechogenicity, olfactory loss, depression, orthostatic hypotension, urinary/erectile dysfunction, PD family history, and the prodromal PD probability showed no significant microbiome associations. INTERPRETATION Several risk and prodromal markers of PD are associated with gut microbiome composition. However, the impact of the gut microbiome on PD risk and potential microbiome-dependent subtypes in the prodrome of PD need further investigation based on prospective clinical and (multi)omics data in incident PD cases. ANN NEUROL 2021;90:E1-E12.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Velma T E Aho
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Christian Deuschle
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Lars Paulin
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, Geriatric Center, Tübingen University Hospital, Tübingen, Germany
- Geriatric Center, Tübingen University Hospital, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Petri Auvinen
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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11
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Yilmaz R, Suenkel U, Postuma RB, Heinzel S, Berg D. Comparing the Two Prodromal Parkinson's Disease Research Criteria-Lessons for Future Studies. Mov Disord 2021; 36:1731-1732. [PMID: 33929050 DOI: 10.1002/mds.28637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rezzak Yilmaz
- Department of Neurology, University of Ankara School of Medicine, Ankara, Turkey
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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12
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Cossais F, Schaeffer E, Heinzel S, Zimmermann J, Niesler B, Röth R, Rappold G, Scharf A, Zorenkov D, Lange C, Barrenschee M, Margraf NG, Ellrichmann M, Berg D, Böttner M, Wedel T. Expression Profiling of Rectal Biopsies Suggests Altered Enteric Neuropathological Traits in Parkinson's Disease Patients. J Parkinsons Dis 2020; 11:171-176. [PMID: 33337386 DOI: 10.3233/jpd-202258] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Still little is known about the nature of the gastrointestinal pathological alterations occurring in Parkinson's disease (PD). Here, we used multiplexed mRNA profiling to measure the expression of a panel of 770 genes related to neuropathological processes in deep submucosal rectal biopsies of PD patients and healthy controls. Altered enteric neuropathological traits based on the expression of 22 genes related to neuroglial and mitochondrial functions, vesicle trafficking and inflammation was observed in 9 out of 12 PD patients in comparison to healthy controls. These results provide new evidences that intestinal neuropathological alterations may occur in a large proportion of PD patients.
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Affiliation(s)
- François Cossais
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jessica Zimmermann
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Ralph Röth
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gudrun Rappold
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Amelie Scharf
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Dmitri Zorenkov
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christina Lange
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Martina Böttner
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
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13
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Moscovich M, Heinzel S, Postuma RB, Reilmann R, Klockgether T, Jacobi H, Höglinger G, Berg D. How specific are non-motor symptoms in the prodrome of Parkinson's disease compared to other movement disorders? Parkinsonism Relat Disord 2020; 81:213-218. [PMID: 33039276 DOI: 10.1016/j.parkreldis.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 01/03/2023]
Abstract
The clinical diagnosis of Parkinson's disease (PD) based on motor signs is often preceded by several non-motor symptoms that can indicate early prodromal neurodegenerative processes. Such prodromal symptoms can aid the early detection of PD, but their specificity for prodromal PD in comparison to prodromes of other movement disorders is still largely unclear. We here aim to give a first insight into the published evidence of prodromal non-motor symptoms in PD, dementia with Lewy bodies (DLB), multiple system atrophy (MSA), Huntington's disease (HD), progressive supranuclear palsy (PSP) and spinocerebellar ataxia (SCA). REM-sleep behavior disorder (RBD) and autonomic dysfunction have been observed in the prodromes of PD, MSA, DLB and SCA. Depression and cognitive decline have been reported for prodromal PD, DLB, HD, SCA, and PSP. Olfactory loss has only been described in prodromal PD/DLB. However, estimating the specificity of prodromal non-motor symptoms in PD is so far complicated by scarce prospective evidence and study limitations. Information on marker specificity is a prerequisite for an accurate early (differential) diagnosis of prodromal diseases, as well as specific recruitment for targeted neuroprotective interventions. We here would like to raise awareness of these issues and encourage further prospective research of prodromal non-motor symptoms in neurodegenerative movement disorders and other diseases.
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Affiliation(s)
- Mariana Moscovich
- Department of Neurology, Christian-Albrechts University, Kiel, Germany.
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal, Quebec, Canada
| | - Ralf Reilmann
- George-Huntington-Institute, Technology-Park Muenster, Muenster, Germany; Department of Clinical Radiology, University of Muenster, Muenster, Germany; Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Thomas Klockgether
- Department of Neurology, University of Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Heike Jacobi
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Günter Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
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14
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Bey K, Weinhold L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Lennertz L, Schmid M, Ramirez A, Kathmann N, Wagner M. The polygenic risk for obsessive-compulsive disorder is associated with the personality trait harm avoidance. Acta Psychiatr Scand 2020; 142:326-336. [PMID: 32786038 DOI: 10.1111/acps.13226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Accepted: 08/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a complex psychiatric disorder with a substantial genetic contribution. While the specific variants underlying OCD's heritability are still unknown, findings from genome-wide association studies (GWAS) corroborate the importance of common SNPs explaining the phenotypic variance in OCD. Investigating associations between the genetic liability for OCD, as reflected by a polygenic risk score (PRS), and potential endophenotypes of the disorder, such as the personality trait harm avoidance, may aid the understanding of functional pathways from genes to diagnostic phenotypes. METHODS We derived PRS for OCD at several P-value thresholds based on the latest Psychiatric Genomics Consortium OCD GWAS (2688 cases, 7037 controls) in an independent sample of OCD patients (n = 180), their unaffected first-degree relatives (n = 108) and healthy controls (n = 200). Using linear regression, we tested whether these PRS are associated with the personality trait harm avoidance. RESULTS Results showed that OCD PRS significantly predicted OCD status, with patients having the highest scores and relatives having intermediate scores. Furthermore, the genetic risk for OCD was associated with harm avoidance across the entire sample, and among OCD patients. As indicated by mediation analyses, harm avoidance mediated the association between the OCD PRS and OCD caseness. These results were observed at multiple P-value thresholds and persisted after the exclusion of patients with a current comorbid major depressive or anxiety disorder. CONCLUSION Our findings support the polygenic nature of OCD and further validate harm avoidance as a candidate endophenotype and diathesis of OCD.
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Affiliation(s)
- K Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - L Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - R Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - S Heinzel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - C Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychology, University of Hamburg, Hamburg, Germany
| | - L Lennertz
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - M Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - A Ramirez
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - N Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
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15
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Mack DJ, Heinzel S, Pilotto A, Stetz L, Lachenmaier S, Gugolz L, Srulijes K, Eschweiler GW, Sünkel U, Berg D, Ilg UJ. The effect of age and gender on anti-saccade performance: Results from a large cohort of healthy aging individuals. Eur J Neurosci 2020; 52:4165-4184. [PMID: 32575168 DOI: 10.1111/ejn.14878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/23/2019] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 01/21/2023]
Abstract
By 2050, the global population of people aged 65 years or older will triple. While this is accompanied with an increasing burden of age-associated diseases, it also emphasizes the need to understand the effects of healthy aging on cognitive processes. One such effect is a general slowing of processing speed, which is well documented in many domains. The execution of anti-saccades depends on a well-established brain-wide network ranging from various cortical areas and basal ganglia through the superior colliculus down to the brainstem saccade generators. To clarify the consequences of healthy aging as well as gender on the execution of reflexive and voluntary saccades, we measured a large sample of healthy, non-demented individuals (n = 731, aged 51-84 years) in the anti-saccade task. Age affected various aspects of saccade performance: The number of valid trials decreased with age. Error rate, saccadic reaction times (SRTs), and variability in saccade accuracy increased with age, whereas anti-saccade costs, accuracy, and peak velocity of anti-saccades and direction errors were not affected by age. Gender affected SRTs independent of age and saccade type with male participants having overall shorter SRTs. Our rigid and solid statistical testing using linear mixed-effect models provide evidence for a uniform slowing of processing speed independent of the actually performed eye movement. Our data do not support the assumption of a specific deterioration of frontal lobe functions with aging.
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Affiliation(s)
- David J Mack
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Lena Stetz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sandra Lachenmaier
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Leonie Gugolz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Karin Srulijes
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Geriatric Center, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Sünkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Uwe J Ilg
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
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Heinzel S, Aho VTE, Suenkel U, von Thaler AK, Schulte C, Deuschle C, Paulin L, Hantunen S, Brockmann K, Eschweiler GW, Maetzler W, Berg D, Auvinen P, Scheperjans F. Gut Microbiome Signatures of Risk and Prodromal Markers of Parkinson Disease. Ann Neurol 2020; 88:320-331. [PMID: 32441370 DOI: 10.1002/ana.25788] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Alterations of the gut microbiome in Parkinson disease (PD) have been repeatedly demonstrated. However, little is known about whether such alterations precede disease onset and how they relate to risk and prodromal markers of PD. We investigated associations of these features with gut microbiome composition. METHODS Established risk and prodromal markers of PD as well as factors related to diet/lifestyle, bowel function, and medication were studied in relation to bacterial α-/β-diversity, enterotypes, and differential abundance in stool samples of 666 elderly TREND (Tübingen Evaluation of Risk Factors for Early Detection of Neurodegeneration) study participants. RESULTS Among risk and prodromal markers, physical activity, occupational solvent exposure, and constipation showed associations with α-diversity. Physical activity, sex, constipation, possible rapid eye movement sleep behavior disorder (RBD), and smoking were associated with β-diversity. Subthreshold parkinsonism and physical activity showed an interaction effect. Among other factors, age and urate-lowering medication were associated with α- and β-diversity. Physical inactivity and constipation were highest in individuals with the Firmicutes-enriched enterotype. Constipation was lowest and subthreshold parkinsonism least frequent in individuals with the Prevotella-enriched enterotype. Differentially abundant taxa were linked to constipation, physical activity, possible RBD, smoking, and subthreshold parkinsonism. Substantia nigra hyperechogenicity, olfactory loss, depression, orthostatic hypotension, urinary/erectile dysfunction, PD family history, and the prodromal PD probability showed no significant microbiome associations. INTERPRETATION Several risk and prodromal markers of PD are associated with gut microbiome composition. However, the impact of the gut microbiome on PD risk and potential microbiome-dependent subtypes in the prodrome of PD need further investigation based on prospective clinical and (multi)omics data in incident PD cases. ANN NEUROL 2020;88:320-331.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Velma T E Aho
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland.,Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Christian Deuschle
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Lars Paulin
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Geriatric Center at the University Hospital Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Petri Auvinen
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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17
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Geritz J, Maetzold S, Steffen M, Pilotto A, Corrà MF, Moscovich M, Rizzetti MC, Borroni B, Padovani A, Alpes A, Bang C, Barcellos I, Baron R, Bartsch T, Becktepe JS, Berg D, Bergeest LM, Bergmann P, Bouça-Machado R, Drey M, Elshehabi M, Farahmandi S, Ferreira JJ, Franke A, Friederich A, Geisler C, Hüllemann P, Gierthmühlen J, Granert O, Heinzel S, Heller MK, Hobert MA, Hofmann M, Jemlich B, Kerkmann L, Knüpfer S, Krause K, Kress M, Krupp S, Kudelka J, Kuhlenbäumer G, Kurth R, Leypoldt F, Maetzler C, Maia LF, Moewius A, Neumann P, Niemann K, Ortlieb CT, Paschen S, Pham MH, Puehler T, Radloff F, Riedel C, Rogalski M, Sablowsky S, Schanz EM, Schebesta L, Schicketmüller A, Studt S, Thieves M, Tönges L, Ullrich S, Urban PP, Vila-Chã N, Wiegard A, Warmerdam E, Warnecke T, Weiss M, Welzel J, Hansen C, Maetzler W. Motor, cognitive and mobility deficits in 1000 geriatric patients: protocol of a quantitative observational study before and after routine clinical geriatric treatment - the ComOn-study. BMC Geriatr 2020; 20:45. [PMID: 32028945 PMCID: PMC7006407 DOI: 10.1186/s12877-020-1445-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany). METHODS This is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week's inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters. DISCUSSION This study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sara Maetzold
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Maren Steffen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Marta F. Corrà
- Neurology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Mariana Moscovich
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Maria C. Rizzetti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Annekathrin Alpes
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Igor Barcellos
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ralf Baron
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jos S. Becktepe
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Lu M. Bergeest
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular, Lisbon, Portugal. CNS-Campus Neurológico Sénior, Torres Vedras, Portugal. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Michael Drey
- Medical Clinic and Policlinic IV, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Morad Elshehabi
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Susan Farahmandi
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal. CNS-Campus Neurológico Sénior, Torres Vedras, Portugal. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja Friederich
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Institute of Human nutrition, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philipp Hüllemann
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Janne Gierthmühlen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Maren K. Heller
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Björn Jemlich
- Third Medical Clinic for Gastroenterology/Rheumatology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Laura Kerkmann
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Stephanie Knüpfer
- Department of Urology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Katharina Krause
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Maximilian Kress
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sonja Krupp
- Research Group Geriatrics Lübeck, Red Cross Hospital Geriatric Centre, Lübeck, Germany
| | - Jennifer Kudelka
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Roland Kurth
- Department of Psychiatry and Psychotherapy, ZIP, Centre for Integrative Psychiatry, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Luis F. Maia
- Neurology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Andreas Moewius
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Patricia Neumann
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Katharina Niemann
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Steffen Paschen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Minh H. Pham
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Digital Signal Processing and System Theory, Faculty of Engineering, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Franziska Radloff
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christian Riedel
- Department of Radiology and Neuroradiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Marten Rogalski
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Simone Sablowsky
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Elena M. Schanz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Linda Schebesta
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | | | - Simone Studt
- Department of Psychiatry and Psychotherapy, ZIP, Centre for Integrative Psychiatry, Kiel, Germany
| | - Martina Thieves
- Geriatric Clinic, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Lars Tönges
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Sebastian Ullrich
- Third Medical Clinic for Gastroenterology/Rheumatology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Peter P. Urban
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Nuno Vila-Chã
- Neurology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Anna Wiegard
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Elke Warmerdam
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Digital Signal Processing and System Theory, Faculty of Engineering, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Michael Weiss
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
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Heinzel S, Berg D, Gasser T, Chen H, Yao C, Postuma RB. Update of the MDS research criteria for prodromal Parkinson's disease. Mov Disord 2019; 34:1464-1470. [DOI: 10.1002/mds.27802] [Citation(s) in RCA: 248] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/19/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Daniela Berg
- Department of Neurology Christian‐Albrechts‐University Kiel Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research University of Tuebingen Tuebingen Germany
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research University of Tuebingen Tuebingen Germany
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human Medicine Michigan State University East Lansing Michigan USA
| | - Chun Yao
- Department of Neurology Montreal General Hospital Montreal Quebec Canada
| | - Ronald B. Postuma
- Department of Neurology Montreal General Hospital Montreal Quebec Canada
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Micó-Amigo ME, Kingma I, Heinzel S, Nussbaum S, Heger T, van Lummel RC, Berg D, Maetzler W, van Dieën JH. Dual vs. Single Tasking During Circular Walking: What Better Reflects Progression in Parkinson's Disease? Front Neurol 2019; 10:372. [PMID: 31139130 PMCID: PMC6527841 DOI: 10.3389/fneur.2019.00372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 03/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background and Aim: Reliable, valid and sensitive measures of dual-task-associated impairments in patients with Parkinson's disease (PD) may reveal progressive deficits unnoticed under single-task walking. The aim of this study was to quantitatively identify markers of progressive gait deficits in idiopathic PD while walking over a circular trajectory condition in single-task walking and in different dual-task conditions: (1) circular walking while checking boxes on a paper sheet as fast as possible and (2) circular walking while performing subtraction of 7 as fast as possible. In addition, we aimed to study the added value of dual-tasking assessment over single (circular) walking task assessment in the study of PD progression. Methods: The assessments were performed every 6 months over a (up to) 5 years period for 22 patients in early-stage PD, 27 patients in middle-stage PD and 25 healthy controls (HC). Longitudinal changes of 27 gait features extracted from accelerometry were compared between PD groups and HCs using generalized estimating equations analysis, accounting for gait speed, age, and levodopa medication state confounders when required. In addition, dual-task-interference with gait and cognitive performance was assessed, as well as their combination. Results: The results support the validity and robustness of some of the gait features already identified in our previous work as progression markers of the disease in single-task circular walking. However, fewer gait features from dual-task than from single-task assessments were identified as markers of progression in PD. Moreover, we did not clearly identify progressive worsening of dual-task-interference in patients with PD, although some group differences between early and middle stages of PD vs. the control group were observed for dual-task interference with the gait task and with the concurrent tasks. Conclusions: Overall, the results showed that dual-tasking did not have added value in the study of PD progression from circular gait assessments. Our analyses suggest that, while single-task walking might be sensitive enough, dual-tasking may introduce additional (error) variance to the data and may represent complex composite measures of cognitive and motor performance.
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Affiliation(s)
- M Encarna Micó-Amigo
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | | | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Paschen S, Forstenpointner J, Becktepe J, Heinzel S, Hellriegel H, Witt K, Helmers AK, Deuschl G. Long-term efficacy of deep brain stimulation for essential tremor: An observer-blinded study. Neurology 2019; 92:e1378-e1386. [PMID: 30787161 DOI: 10.1212/wnl.0000000000007134] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/13/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (Vim) is established for medically refractory severe essential tremor (ET), but long-term efficacy is controversial. METHODS Twenty patients with ET with DBS had standardized video-documented examinations at baseline, in the stimulation-on condition at short term (13.1 ± 1.9 months since surgery, mean ± SEM), and in the stimulator switched on and off (stim-ON/OFF) at long term; all assessments were done between 32 and 120 months (71.9 ± 6.9 months) after implantation. The primary outcome was the Tremor Rating Scale (TRS) blindly assessed by 2 trained movement disorder neurologists. Secondary outcomes were TRS subscores A, B, and C; Archimedes spiral score; and activities of daily living score. At long-term follow-up, tremor was additionally recorded with accelerometry. The rebound effect after switching the stimulator off was assessed for 1 hour in a subgroup. RESULTS Tremor severity worsened considerably over time in both in the nonstimulated and stimulated conditions. Vim-DBS improved the TRS in the short term and long term significantly. The spiral score and functional measures showed similar improvements. All changes were highly significant. However, the stimulation effect was negatively correlated with time since surgery (ρ = -0.78, p < 0.001). This was also true for the secondary outcomes. Only one-third of the patients had a rebound effect terminated 60 minutes after the stimulator was switched off. Long-term worsening of the TRS was more profound during stim-ON than in the stim-OFF condition, indicating habituation to stimulation. CONCLUSION Vim-DBS loses efficacy over the long term. Efforts are needed to improve the long-term efficacy of Vim-DBS. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with medically refractory severe ET, the efficacy of Vim-DBS severely decreases over 10 years.
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Affiliation(s)
- Steffen Paschen
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Julia Forstenpointner
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Jos Becktepe
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Sebastian Heinzel
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Helge Hellriegel
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Karsten Witt
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Ann-Kristin Helmers
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Günther Deuschl
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany.
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21
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Micó-Amigo ME, Kingma I, Heinzel S, Rispens SM, Heger T, Nussbaum S, van Lummel RC, Berg D, Maetzler W, van Dieën JH. Potential Markers of Progression in Idiopathic Parkinson's Disease Derived From Assessment of Circular Gait With a Single Body-Fixed-Sensor: A 5 Year Longitudinal Study. Front Hum Neurosci 2019; 13:59. [PMID: 30837857 PMCID: PMC6389786 DOI: 10.3389/fnhum.2019.00059] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/04/2018] [Accepted: 02/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background and Aim: Development of objective, reliable and easy-to-use methods to obtain progression markers of Parkinson's disease (PD) is required to evaluate interventions and to advance research in PD. This study aimed to provide quantitative markers of progression in idiopathic PD from the assessment of circular gait (walking in circles) with a single body-fixed inertial sensor placed on the lower back. Methods: The assessments were performed every 6 months over a (up to) 5 years period for 22 patients in early-stage PD, 27 patients in middle-stage PD and 25 healthy controls (HC). Longitudinal changes of 24 gait features extracted from accelerometry were compared between PD groups and HCs with generalized estimating equations (GEE) analysis, accounting for gait speed, age and levodopa medication state confounders when required. Results: Five gait features indicated progressive worsening in early stages of PD: number of steps, total duration and harmonic ratios calculated from vertical (VT), medio-lateral (ML), and anterior-posterior (AP) accelerations. For middle stages of PD, three gait features were identified as potential progression markers: stride time variability, and stride regularity from VT and AP acceleration. Conclusion: Faster progressive worsening of gait features in early and middle stages of PD relative to healthy controls over 5 years confirmed the potential of accelerometry-based assessments as quantitative progression markers in early and middle stages of the disease. The difference in significant parameters between both PD groups suggests that distinct domains of gait deteriorate in these PD stages. We conclude that instrumented circular walking assessment is a practical and useful tool in the assessment of PD progression that may have relevant potential to be implemented in clinical trials and even clinical routine, particularly in a developing digital era.
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Affiliation(s)
- M. Encarna Micó-Amigo
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Sietse M. Rispens
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Personal Health Department, Philips Research Europe, Eindhoven, Netherlands
| | - Tanja Heger
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | | | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
- Personal Health Department, Philips Research Europe, Eindhoven, Netherlands
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
- Personal Health Department, Philips Research Europe, Eindhoven, Netherlands
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jaap H. van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
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22
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Hobert MA, Nussbaum S, Heger T, Berg D, Maetzler W, Heinzel S. Progressive Gait Deficits in Parkinson's Disease: A Wearable-Based Biannual 5-Year Prospective Study. Front Aging Neurosci 2019; 11:22. [PMID: 30814947 PMCID: PMC6381067 DOI: 10.3389/fnagi.2019.00022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 10/29/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Gait changes occur during all Parkinson’s disease (PD) stages and wearable sensor-derived gait parameters may quantify PD progression. However, key aspects that may qualify quantitative gait parameters as progression markers in PD remain elusive. Objectives: Longitudinal changes in gait parameters from a lower-back sensor under convenient and challenging walking conditions in early- and mid-stage PD patients (E-PD, M-PD) compared to controls were investigated. Methods: Normal- and fast-pace parameters (step: number, time, velocity, variability) were assessed every 6 months for up to 5 years in 22 E-PD (<4 years baseline disease duration), 18 M-PD (>5 years) and 24 controls. Parameter trajectories and associations with MDS-UPDRS-III were tested using generalized estimating equations. Results: Normal-pace step number (annual change in E-PD: 2.1%, Time∗Group: p = 0.001) and step time variability (8.5%, p < 0.05) longitudinally increased in E-PD compared to controls (0.7%, -12%). For fast pace, no significant progression differences between groups were observed. Longitudinal changes in M-PD did not differ significantly from controls. MDS-UPDRS-III was largely associated with normal-pace parameters in M-PD. Conclusion: Wearables can quantify progressive gait deficits indicated by increasing step number and step time variability in E-PD. In M-PD, and for fast-pace, gait parameters possess limited potential as PD progression markers.
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Affiliation(s)
- Markus A Hobert
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany.,Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Tanja Heger
- Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany.,Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany.,Department of Neurodegenerative, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University zu Kiel, Kiel, Germany
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23
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Yilmaz R, Strafella AP, Bernard A, Schulte C, van den Heuvel L, Schneiderhan-Marra N, Knorpp T, Joos TO, Leypoldt F, Geritz J, Hansen C, Heinzel S, Apel A, Gasser T, Lang AE, Berg D, Maetzler W, Marras C. Serum Inflammatory Profile for the Discrimination of Clinical Subtypes in Parkinson's Disease. Front Neurol 2018; 9:1123. [PMID: 30622507 PMCID: PMC6308160 DOI: 10.3389/fneur.2018.01123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Blood levels of immune markers have been proposed to discriminate patients with Parkinson's disease (PD) from controls. However, differences between clinical PD subgroups regarding these markers still need to be identified. Objective: To investigate whether clinical phenotypes can be predicted by the assessment of immune marker profiles in the serum of PD patients. Methods: Phenotypes of clinical PD from Tübingen, Germany (n = 145) and Toronto, Canada (n = 90) were defined regarding clinical subtype, disease onset, severity, and progression as well as presence of cognitive and/or autonomic dysfunction. A panel of serum immune markers was assessed using principal component analysis (PCA) and regression models to define the marker(s) that were associated with clinical phenotypes after adjusting for potential confounders. Findings of both centers were compared for validation. Further, a [18F] FEPPA-PET was performed in a group of patients with high and low values of candidate markers for the assessment of in vivo brain microglial activation. Results: Overall, serum immune markers did not cluster to define a pro/anti-inflammatory profile in PCA. Out of 25 markers only IL-12p40 showed a trend to discriminate between PD subgroups in both cohorts which could not be replicated by [18F] FEPPA-PET. Conclusions: Assessment of cytokines in serum does not reliably differentiate clinical PD subtypes. Accompanying subtype-irrelevant inflammation in PD, dual activity, and lack of specificity of the immune markers, the complex function of microglia, probable effects of treatment, disease stage, and progression on inflammation as well as current technical limitations may limit the usefulness of serum immune markers for the differentiation of subtypes.
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Affiliation(s)
- Rezzak Yilmaz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Antonio P Strafella
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute, University Hospital Network, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Alice Bernard
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Lieneke van den Heuvel
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Thomas Knorpp
- Natural and Medical Sciences Institute (NMI) at the University of Tübingen, Reutlingen, Germany
| | - Thomas O Joos
- Natural and Medical Sciences Institute (NMI) at the University of Tübingen, Reutlingen, Germany
| | - Frank Leypoldt
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja Apel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Anthony E Lang
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, University Health Network, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Connie Marras
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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24
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Friederich A, Flinspach A, Suenkel U, Eschweiler GW, Greulich K, Maetzler W, Berg D, Heinzel S. Prodromal features of Parkinson's disease: Self‐reported symptoms versus clinically assessed signs. Mov Disord 2018; 34:144-146. [DOI: 10.1002/mds.27539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/16/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anja Friederich
- Department of Neurology Christian‐Albrechts‐University Kiel Germany
| | - Aminah Flinspach
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration University of Tübingen Tübingen Germany
| | - Ulrike Suenkel
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration University of Tübingen Tübingen Germany
| | - Gerhard W. Eschweiler
- Department of Psychiatry and Psychotherapy, Geriatric Center Tübingen University Hospital Tübingen Germany
- Geriatric Center at the University Hospital Tübingen Tübingen Germany
| | - Katharina Greulich
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration University of Tübingen Tübingen Germany
| | - Walter Maetzler
- Department of Neurology Christian‐Albrechts‐University Kiel Germany
| | - Daniela Berg
- Department of Neurology Christian‐Albrechts‐University Kiel Germany
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration University of Tübingen Tübingen Germany
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25
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Heinzel S, Berg D, Binder S, Ebersbach G, Hickstein L, Herbst H, Lorrain M, Wellach I, Maetzler W, Petersen G, Schmedt N, Volkmann J, Woitalla D, Amelung V. Do We Need to Rethink the Epidemiology and Healthcare Utilization of Parkinson's Disease in Germany? Front Neurol 2018; 9:500. [PMID: 30008693 PMCID: PMC6033992 DOI: 10.3389/fneur.2018.00500] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/07/2018] [Indexed: 12/22/2022] Open
Abstract
Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Sebastian Binder
- inav - Institute for Applied Health Services Research GmbH, Berlin, Germany
| | | | - Lennart Hickstein
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany.,Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Ingmar Wellach
- Office for Neurology/Ev. Amalie Sieveking Hospital, Hamburg, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Niklas Schmedt
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
| | - Dirk Woitalla
- Department of Neurology, Sankt Josef Hospital, Bochum, Germany
| | - Volker Amelung
- inav - Institute for Applied Health Services Research GmbH, Berlin, Germany
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26
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Abstract
BACKGROUND Parkinson's disease (PD) is characterized by heterogeneity and multifactorial longitudinal changes. To identify PD subtypes and factors influencing the disease course, multiple cohort studies have been designed globally. Knowledge about existing cohorts is pivotal to foster collaboration, which may help to advance the understanding of PD. OBJECTIVE To raise the awareness about PD cohorts and potential global collaboration opportunities. METHODS Observational cohort studies in clinical PD were identified by a European working group (JPND BioLoC-PD) and through literature search. Using a structured survey investigators of 44 cohorts provided basic information on cohorts and assessments performed. RESULTS For the 44 cohorts (32% on early/de-novo PD), 14.666 participants (cohorts' median: 138; range: 23-3.090), a median 1.5-year follow-up interval (0.5-4 years) and a median (planned) observational period of 5 years (1-20 years) were indicated. All studies have assessed motor functions often using rating scales (UPDRS-III; 93% of studies) and less frequently quantitative gait/balance (25%) or fine motor assessments (27%). Cognitive (100%), neuropsychiatric (91%), daily living (78%), sleep (70%), sensory (63%), and gastrointestinal/autonomic (55%) assessments were common and often comparable. Neuroimaging data (82%) and biomaterial (69%) have been collected in many studies. Surprisingly, possible disease modifiers, such as sport/physical activity (11%), have rarely been assessed. CONCLUSIONS Existing data of PD cohorts provide vast collaboration opportunities. We propose to establish a comprehensive, up-to-date, open-access internet platform with easy-to-use search tools of PD cohort descriptions and potentially available data. Bringing researchers together to enable collaborative joint, meta- and replication analyses is timely and necessary to advance PD research ultimately required for an understanding of PD that can be translated into more effective therapies.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Stefanie Lerche
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
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27
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Heinzel S, Kasten M, Behnke S, Vollstedt EJ, Klein C, Hagenah J, Pausch C, Heilmann R, Brockmann K, Suenkel U, Yilmaz R, Liepelt-Scarfone I, Walter U, Berg D. Age- and sex-related heterogeneity in prodromal Parkinson's disease. Mov Disord 2018; 33:1025-1027. [PMID: 29570852 DOI: 10.1002/mds.27349] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Meike Kasten
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Stefanie Behnke
- Department of Neurology, Saarland University Hospital, Homburg, Germany
| | - Eva-Juliane Vollstedt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Johann Hagenah
- Department of Neurology, Westküstenklinikum Heide, Heide, Germany
| | - Christoph Pausch
- Department of Neurology, Saarland University Hospital, Homburg, Germany
| | - Robert Heilmann
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Kathrin Brockmann
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Department of Neurodegeneration, Tübingen, Tübingen, Germany
| | - Ulrike Suenkel
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Rezzak Yilmaz
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Department of Neurodegeneration, Tübingen, Tübingen, Germany
| | - Uwe Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Hertie Institute for Clinical Brain Research (HIH), Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
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28
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Sartor J, Bettecken K, Bernhard FP, Hofmann M, Gladow T, Lindig T, Ciliz M, Ten Kate M, Geritz J, Heinzel S, Benedictus M, Scheltens P, Hobert MA, Maetzler W. Corrigendum: White Matter Changes-Related Gait and Executive Function Deficits: Associations with Age and Parkinson's Disease. Front Aging Neurosci 2017; 9:342. [PMID: 29056907 PMCID: PMC5651038 DOI: 10.3389/fnagi.2017.00342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | | | | | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tuebingen, Germany
| | - Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Mara Ten Kate
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Marije Benedictus
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Markus A Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
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29
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Heinzel S, Bernhard FP, Roeben B, Nussbaum S, Heger T, Martus P, Hobert MA, Maetzler W, Berg D. Progression markers of motor deficits in Parkinson's disease: A biannual 4-year prospective study. Mov Disord 2017; 32:1254-1256. [PMID: 28681985 DOI: 10.1002/mds.27062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/18/2017] [Accepted: 05/01/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Clinic of Tuebingen, Tuebingen, Germany
| | - Markus A Hobert
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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Sartor J, Bettecken K, Bernhard FP, Hofmann M, Gladow T, Lindig T, Ciliz M, Ten Kate M, Geritz J, Heinzel S, Benedictus M, Scheltens P, Hobert MA, Maetzler W. White Matter Changes-Related Gait and Executive Function Deficits: Associations with Age and Parkinson's Disease. Front Aging Neurosci 2017; 9:213. [PMID: 28713264 PMCID: PMC5491602 DOI: 10.3389/fnagi.2017.00213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 01/22/2023] Open
Abstract
Background: White matter changes (WMC) are a common finding among older adults and patients with Parkinson's disease (PD), and have been associated with, e.g., gait deficits and executive dysfunction. How the factors age and PD influence WMC-related deficits is, to our best knowledge, not investigated to date. We hypothesized that advanced age and presence of PD leads to WMC-related symptoms while practicing tasks with a low complexity level, and low age and absence of PD leads to WMC-related symptoms while practicing tasks with a high complexity level. Methods: Hundred and thirty-eight participants [65 young persons without PD (50–69 years, yPn), 22 young PD patients (50–69 years, yPD), 36 old persons without PD (70–89 years, oPn) and 15 old PD patients (70–89 years, oPD)] were included. Presence and severity of WMC were determined with the modified Fazekas score. Velocity of walking under single and dual tasking conditions and the Trail Making Test (TMT) were used as gait and executive function parameters. Correlations between presence and severity of WMC, and gait and executive function parameters were tested in yPn, yPD, oPn, and oPD using Spearman's rank correlation, and significance between groups was evaluated with Fisher's z-transformed correlation coefficient. Results: yPn and yPD, as well as oPn and oPD did not differ regarding demographic and clinical parameters. Severity of WMC was not significantly different between groups. yPn and yPD displayed significant correlations of WMC with executive function parameters at low levels of task complexity, oPn at intermediate, and oPD at high complexity levels. Conclusion: This study argues for a relevant association of age and PD-related brain pathology with WMC-related gait and executive function deficits.
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Affiliation(s)
- Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | | | | | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of TuebingenTuebingen, Germany
| | - Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Mara Ten Kate
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Marije Benedictus
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Markus A Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
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31
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Yilmaz R, Pilotto A, Roeben B, Preische O, Suenkel U, Heinzel S, Metzger FG, Laske C, Maetzler W, Berg D. Erratum: Structural Ultrasound of the Medial Temporal Lobe in Alzheimer's Disease. Ultraschall Med 2017; 38:e16. [PMID: 27459251 DOI: 10.1055/s-0035-1567111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- R Yilmaz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - A Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - B Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - O Preische
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - U Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - S Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - F G Metzger
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
| | - C Laske
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
- Section for Dementia Research, University of Tuebingen, Tuebingen, Germany
| | - W Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - D Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
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32
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Yilmaz R, Pilotto A, Roeben B, Preische O, Suenkel U, Heinzel S, Metzger FG, Laske C, Maetzler W, Berg D. Structural Ultrasound of the Medial Temporal Lobe in Alzheimer's Disease. Ultraschall Med 2017; 38:294-300. [PMID: 27273178 DOI: 10.1055/s-0042-107150] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose One of the anatomical hallmarks of Alzheimer's disease (AD) is the atrophy of the medial temporal lobe (MTL), yet cost-effective and broadly available methodological alternatives to the current imaging tools for screening of this brain area are not currently available. Materials and Methods Using structural transcranial ultrasound (TCS), we attempted to visualize and measure the MTL, and compared the results of 32 AD patients and 84 healthy controls (HC). The MTL and the surrounding space were defined in the coronal plane on TCS. A ratio of the height of the MTL/height of the choroidal fissure (M/F) was calculated in order to obtain a regional proportion. Results An insufficient temporal bone window was identified in 22 % of the AD patients and 12 % of the HCs. The results showed that the ratio of M/F was significantly smaller in the AD group on both sides (p = 0.004 right, p = 0.007 left side). Furthermore, the M/F ratio made it possible to discriminate AD patients from HCs with a sensitivity of 83 % (right)/73 % (left) and a specificity of 76 % (right)/72 % (left) which is basically comparable to results published for magnetic resonance imaging. The measurements showed substantial intra/interrater reliability (ICC:0.79/0.69). Conclusion These results suggest that utilization of structural TCS may possibly constitute a cheap and easy-to-use supplement to other techniques for the diagnosis of AD. It may be especially useful as a screening tool in the large population of individuals with cognitive decline. Further studies are needed to validate this novel method.
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Affiliation(s)
- Rezzak Yilmaz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Oliver Preische
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
| | - Christoph Laske
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center at the University Hospital, University of Tuebingen, Tuebingen, Germany
- Section for Dementia Research, University of Tuebingen, Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Neurology, German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
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Pilotto A, Heinzel S, Suenkel U, Lerche S, Brockmann K, Roeben B, Schaeffer E, Wurster I, Yilmaz R, Liepelt-Scarfone I, von Thaler AK, Metzger FG, Eschweiler GW, Postuma RB, Maetzler W, Berg D. Application of the movement disorder society prodromal Parkinson's disease research criteria in 2 independent prospective cohorts. Mov Disord 2017; 32:1025-1034. [DOI: 10.1002/mds.27035] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Neurology Unit, Department of Clinical and Experimental Sciences; University of Brescia, Brescia, Italy and Parkinson's Disease Rehabilitation Centre, FERB ONLUS S.Isidoro Hospital, Trescore Balneario (BG); Italy
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Stefanie Lerche
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Eva Schaeffer
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Isabel Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Rezzak Yilmaz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - Anna-Katharina von Thaler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Florian G. Metzger
- Department of Psychiatry and Psychotherapy, Geriatric Center; Tuebingen University Hospital; Tuebingen Germany
| | - Gerhard W. Eschweiler
- Department of Psychiatry and Psychotherapy, Geriatric Center; Tuebingen University Hospital; Tuebingen Germany
| | - Ron B. Postuma
- Department of Neurology; Montreal General Hospital; Montreal Quebec Canada
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
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Bey K, Lennertz L, Riesel A, Klawohn J, Kaufmann C, Heinzel S, Grützmann R, Kathmann N, Wagner M. Harm avoidance and childhood adversities in patients with obsessive-compulsive disorder and their unaffected first-degree relatives. Acta Psychiatr Scand 2017; 135:328-338. [PMID: 28160276 DOI: 10.1111/acps.12707] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Accepted: 01/16/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The etiology of obsessive-compulsive disorder (OCD) is assumed to involve interactions between genetically determined vulnerability factors and significant environmental features. Here, we aim to investigate how the personality trait harm avoidance and the experience of childhood adversities contribute to OCD. METHOD A total of 169 patients with OCD, 157 healthy comparison subjects, and 57 unaffected first-degree relatives of patients with OCD participated in the study. Harm avoidance was assessed using the Temperament and Character Inventory, and the severity of childhood adversities was measured with the Childhood Trauma Questionnaire. RESULTS Both patients with OCD and relatives showed elevated levels of harm avoidance compared to controls. Furthermore, patients exhibited significantly higher scores than relatives. This linear pattern was observed throughout all subscales of harm avoidance, and remained stable after controlling for the severity of depressive and obsessive-compulsive symptoms. With regard to childhood adversities, patients with OCD reported higher levels than relatives and controls. CONCLUSION Our results provide further evidence for a diathesis-stress model of OCD. While patients and unaffected relatives share elevated levels of harm avoidance, supporting the role of harm avoidance as an endophenotype of OCD, a heightened severity of childhood adversity was only observed in patients. The assumed biological underpinnings of these findings are discussed.
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Affiliation(s)
- K Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - L Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - A Riesel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - J Klawohn
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - C Kaufmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - S Heinzel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - R Grützmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - N Kathmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Roeben B, Maetzler W, Vanmechelen E, Schulte C, Heinzel S, Stellos K, Godau J, Huber H, Brockmann K, Wurster I, Gaenslen A, Grüner E, Niebler R, Eschweiler GW, Berg D. Association of Plasma Aβ40 Peptides, But Not Aβ42, with Coronary Artery Disease and Diabetes Mellitus. J Alzheimers Dis 2017; 52:161-9. [PMID: 27003209 DOI: 10.3233/jad-150575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVE Plasma levels of amyloid-beta (Aβ) 1-40 peptide have been proposed to be associated with cardiovascular mortality in patients with coronary artery disease (CAD). Therefore, we aimed to investigate the association of plasma Aβ levels with CAD, cardiovascular risk factors (CVRF), and APOE genotype in non-demented elderly individuals. METHODS Plasma Aβ1 - 40 and Aβ1 - 42 levels of 526 individuals (mean age of 63.0±7.3 years) were quantified with the INNO-BIA plasma Aβ forms assay based on multiplextrademark technique. APOE genotype was determined with an established protocol. Presence of CAD and CVRFs were ascertained using a questionnaire and/or medical records. RESULTS Plasma Aβ1 - 40 levels were significantly higher in individuals with CAD (p = 0.043) and, independently, in individuals with diabetes mellitus (DM) type 2 (p = 0.001) while accounting for age- and gender-effects. Plasma Aβ1 - 42 levels were higher in APOEɛ4 carriers (p = 0.004), but were neither relevantly associated with CAD nor with any CVRF. Plasma Aβ1 - 40 showed no association with APOE genotype. DISCUSSION Our findings argue for an association of circulating plasma Aβ1 - 40 peptides with incident CAD and DM. Further investigations are needed to entangle the role of Aβ1 - 40 role in the pathophysiology of cardiovascular disease independent of its known role in Alzheimer's disease.
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Affiliation(s)
- Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Geriatric Center, University of Tübingen, Tübingen, Germany
| | - Eugeen Vanmechelen
- Key4AD, Eke, Belgium.,Innogenetics N.V. (now Fujirebio Europe N.V.), Ghent, Belgium
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Konstantinos Stellos
- Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany.,German Center of Cardiovascular Research (DZHK), Frankfurt, Germany
| | - Jana Godau
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Heiko Huber
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Isabel Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Alexandra Gaenslen
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Eva Grüner
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany
| | - Raphael Niebler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Geriatric Center, University of Tübingen, Tübingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Geriatric Center, University of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Marchingo JM, Prevedello G, Kan A, Heinzel S, Hodgkin PD, Duffy KR. T-cell stimuli independently sum to regulate an inherited clonal division fate. Nat Commun 2016; 7:13540. [PMID: 27869196 PMCID: PMC5121331 DOI: 10.1038/ncomms13540] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 04/07/2016] [Accepted: 10/07/2016] [Indexed: 12/31/2022] Open
Abstract
In the presence of antigen and costimulation, T cells undergo a characteristic response of expansion, cessation and contraction. Previous studies have revealed that population-level reproducibility is a consequence of multiple clones exhibiting considerable disparity in burst size, highlighting the requirement for single-cell information in understanding T-cell fate regulation. Here we show that individual T-cell clones resulting from controlled stimulation in vitro are strongly lineage imprinted with highly correlated expansion fates. Progeny from clonal families cease dividing in the same or adjacent generations, with inter-clonal variation producing burst-size diversity. The effects of costimulatory signals on individual clones sum together with stochastic independence; therefore, the net effect across multiple clones produces consistent, but heterogeneous population responses. These data demonstrate that substantial clonal heterogeneity arises through differences in experience of clonal progenitors, either through stochastic antigen interaction or by differences in initial receptor sensitivities. Why do populations of highly similar T cells have heterogeneous division destinies in response to antigenic stimulus? Here the authors develop a multiplex-dye assay and a mathematical framework to test clonal heterogeneity and show distinction in division destiny is a result of inter-clonal variability as lineage imprinting ensures clones share similar proliferation fates.
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Affiliation(s)
- J M Marchingo
- Division of Immunology, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - G Prevedello
- Hamilton Institute, Maynooth University, Maynooth, Co Kildare W23 WK26, Ireland
| | - A Kan
- Division of Immunology, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - S Heinzel
- Division of Immunology, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - P D Hodgkin
- Division of Immunology, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - K R Duffy
- Hamilton Institute, Maynooth University, Maynooth, Co Kildare W23 WK26, Ireland
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Yilmaz R, Gräber S, Roeben B, Suenkel U, von Thaler AK, Heinzel S, Metzger FG, Eschweiler GW, Maetzler W, Berg D, Liepelt-Scarfone I. Cognitive Performance Patterns in Healthy Individuals with Substantia Nigra Hyperechogenicity and Early Parkinson's Disease. Front Aging Neurosci 2016; 8:271. [PMID: 27895578 PMCID: PMC5108760 DOI: 10.3389/fnagi.2016.00271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/28/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction: Hyperechogenicity of the substantia nigra (SN+) is a risk marker for Parkinson’s disease (PD) which can be detected before the diagnosis. In healthy individuals, SN+ has been associated with slight deficits in specific cognitive functions, suggesting cognitive impairment as a possible pre-diagnostic marker for PD. However, the pattern of cognitive deficits associated with SN+ has not yet been compared with those present in PD. Methods: Data of 262 healthy individuals with normal echogenicity (SN-) and 48 healthy individuals with SN+ were compared with 82 early stage PD patients using the “Consortium to Establish a Registry for Alzheimer’s disease” test battery. First, the test clusters (factors) were identified using a principal component analysis (PCA). Mean group performance of cognitive tests belonging to distinct factors, according to the PCA, and single subtest performances were compared using analyses of variance. Second, the number of individuals with abnormal cognitive performances (z-score < -1.0) were compared between groups. Results: Verbal memory, semantic and executive function, and praxis were identified as components of cognitive performances. The SN+ group performed significantly worse than the SN- group in tests assessing semantic and executive function, with a non-significant decrease in verbal memory. On the subtest level, individuals of the SN+ group scored significantly lower than the SN- group on the Boston Naming Test (BNT; p = 0.008). In all subtests, the percentages of PD patients with values below the cut-off for abnormal performance were higher than in the SN- group. Moreover, more individuals from the SN+ group scored below the cut-off in the BNT (SN- = 8.4%, SN+ = 20.8%, p = 0.01) and TMT-B (SN- = 6.9%, SN+ = 16.7%, p = 0.02), compared to the SN- group. Conclusion: This study confirms poorer performance of healthy individuals with SN+ compared to SN- in specific cognitive domains. However, against the SN- group, the cognitive profile of the SN+ group was not fully consistent with the profile of early PD patients. Our data argues that cognitive impairment associated with SN+ might differ slightly from that seen in early PD. Compensational mechanisms in the early phases of neurodegeneration, and the fact that only a subgroup of SN+ will develop PD, may partly explain these differences.
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Affiliation(s)
- Rezzak Yilmaz
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen Tuebingen, Germany
| | - Susanne Gräber
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative DiseasesTuebingen, Germany
| | - Benjamin Roeben
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative DiseasesTuebingen, Germany
| | - Ulrike Suenkel
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen Tuebingen, Germany
| | - Anna-Katharina von Thaler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen Tuebingen, Germany
| | - Sebastian Heinzel
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University of TuebingenTuebingen, Germany; Geriatric Center at the University Hospital of TuebingenTuebingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of TuebingenTuebingen, Germany; Geriatric Center at the University Hospital of TuebingenTuebingen, Germany
| | - Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany; Geriatric Center at the University Hospital of TuebingenTuebingen, Germany
| | - Daniela Berg
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative DiseasesTuebingen, Germany
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Heinzel S, Roeben B, Ben-Shlomo Y, Lerche S, Alves G, Barone P, Behnke S, Berendse HW, Bloem BR, Burn D, Dodel R, Grosset DG, Hu M, Kasten M, Krüger R, Moccia M, Mollenhauer B, Oertel W, Suenkel U, Walter U, Wirdefeldt K, Liepelt-Scarfone I, Maetzler W, Berg D. Prodromal Markers in Parkinson's Disease: Limitations in Longitudinal Studies and Lessons Learned. Front Aging Neurosci 2016; 8:147. [PMID: 27445791 PMCID: PMC4916171 DOI: 10.3389/fnagi.2016.00147] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/07/2016] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence supports a prodromal neurodegenerative process preceding the clinical onset of Parkinson's disease (PD). Studies have identified several different prodromal markers that may have the potential to predict the conversion from healthy to clinical PD but use considerably different approaches. We systematically reviewed 35 longitudinal studies reporting prodromal PD features and evaluated the methodological quality across 10 different predefined domains. We found limitations in the following domains: PD diagnosis (57% of studies), prodromal marker assessments (51%), temporal information on prodromal markers or PD diagnosis (34%), generalizability of results (17%), statistical methods (accounting for at least age as confounder; 17%), study design (14%), and sample size (9%). However, no limitations regarding drop-out (or bias investigation), or report of inclusion/exclusion criteria or prodromal marker associations were revealed. Lessons learned from these limitations and additional aspects of current prodromal marker studies in PD are discussed to provide a basis for the evaluation of findings and the improvement of future research in prodromal PD. The observed heterogeneity of studies, limitations and analyses might be addressed in future longitudinal studies using a, yet to be established, modular minimal set of assessments improving comparability of findings and enabling data sharing and combined analyses across studies.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol Bristol, UK
| | - Stefanie Lerche
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Guido Alves
- Norwegian Centre for Movement Disorders and Department of Neurology, Stavanger University Hospital Stavanger, Norway
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno Salerno, Italy
| | - Stefanie Behnke
- Department of Neurology, University of Homburg Homburg, Germany
| | - Henk W Berendse
- Department of Neurology and Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology Nijmegen, Netherlands
| | - David Burn
- Institute of Neuroscience, Newcastle University Newcastle Upon Tyne, UK
| | - Richard Dodel
- Department of Neurology, Philipps-University Marburg Marburg, Germany
| | - Donald G Grosset
- Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, UK
| | - Michele Hu
- Oxford Parkinson's Disease Centre and Nuffield Department of Clinical Neurosciences, University of Oxford Oxford, UK
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck Lübeck, Germany
| | - Rejko Krüger
- Clinical and Experimental Neuroscience, Luxembourg Center for Systems Biomedicine Belva, Luxembourg
| | - Marcello Moccia
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno Salerno, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-KlinikKassel, Germany; Department of Neuropathology, University Medical CenterGöttingen, Germany
| | - Wolfgang Oertel
- Department of Neurology, Philipps-University Marburg Marburg, Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Uwe Walter
- Department of Neurology, University of Rostock Rostock, Germany
| | - Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics and Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of TübingenTübingen, Germany; German Center for Neurodegenerative Diseases, University of TübingenTübingen, Germany; Department of Neurology, Christian-Albrechts-UniversityKiel, Germany
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Lerche S, Heinzel S, Alves GW, Barone P, Behnke S, Ben-Shlomo Y, Berendse H, Bloem BR, Burn D, Dodel R, Grosset DG, Hipp G, Hu MT, Kasten M, Krüger R, Liepelt-Scarfone I, Maetzler W, Moccia M, Mollenhauer B, Oertel W, Roeben B, Walter U, Wirdefeldt K, Berg D. Aiming for Study Comparability in Parkinson's Disease: Proposal for a Modular Set of Biomarker Assessments to be Used in Longitudinal Studies. Front Aging Neurosci 2016; 8:121. [PMID: 27303289 PMCID: PMC4882324 DOI: 10.3389/fnagi.2016.00121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/12/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefanie Lerche
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative Diseases, University of TuebingenTuebingen, Germany
| | - Sebastian Heinzel
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative Diseases, University of TuebingenTuebingen, Germany
| | - Guido W Alves
- Norwegian Centre for Movement Disorders, Stavanger University Hospital Stavanger, Norway
| | - Paolo Barone
- Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno Salerno, Italy
| | - Stefanie Behnke
- Department of Neurology, Saarland University Hospital Homburg, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol Bristol, UK
| | - Henk Berendse
- Department of Neurology and Neuroscience Campus Amsterdam, VU University Hospital Amsterdam, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior Nijmegen, Netherlands
| | - David Burn
- Institute of Neuroscience, Newcastle University Newcastle, UK
| | - Richard Dodel
- Department of Neurology, Philipps-Universität Marburg Marburg, Germany
| | - Donald G Grosset
- Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, UK
| | - Geraldine Hipp
- Clinical and Experimental Neuroscience, Luxembourg Centre for Systems Biomedicine, University of LuxembourgBelval, Luxembourg; Centre Hospitalier LuxembourgLuxembourg, Luxembourg
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson's Disease Centre, University of Oxford Oxford, UK
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck Lübeck, Germany
| | - Rejko Krüger
- Clinical and Experimental Neuroscience, Luxembourg Centre for Systems Biomedicine, University of LuxembourgBelval, Luxembourg; Centre Hospitalier LuxembourgLuxembourg, Luxembourg
| | - Inga Liepelt-Scarfone
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative Diseases, University of TuebingenTuebingen, Germany
| | - Walter Maetzler
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative Diseases, University of TuebingenTuebingen, Germany
| | - Marcello Moccia
- Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno Salerno, Italy
| | - Brit Mollenhauer
- Paracelsus-Elena-KlinikKassel, Germany; University Medical Center, Georg-August-Universität GöttingenGöttingen, Germany
| | - Wolfgang Oertel
- Department of Neurology, Philipps-Universität Marburg Marburg, Germany
| | - Benjamin Roeben
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative Diseases, University of TuebingenTuebingen, Germany
| | - Uwe Walter
- Department of Neurology, University of Rostock Rostock, Germany
| | - Karin Wirdefeldt
- Department of Epidemiology and Biostatistics, Karolinska InstitutetStockholm, Sweden; Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden
| | - Daniela Berg
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany; German Center for Neurodegenerative Diseases, University of TuebingenTuebingen, Germany; Department of Neurology, Christian-Albrechts UniversityKiel, Germany
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Heinzel S, Maechtel M, Hasmann SE, Hobert MA, Heger T, Berg D, Maetzler W. Motor dual-tasking deficits predict falls in Parkinson's disease: A prospective study. Parkinsonism Relat Disord 2016; 26:73-7. [PMID: 26997654 DOI: 10.1016/j.parkreldis.2016.03.007] [Citation(s) in RCA: 68] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/16/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Falls severely affect lives of Parkinson's disease (PD) patients. Cognitive impairment including dual-tasking deficits contribute to fall risk in PD. However, types of dual-tasking deficits preceding falls in PD are still unclear. METHODS Walking velocities during box-checking and subtracting serial 7s were assessed twice a year in 40 PD patients over 2.8 ± 1.0 years. Fourteen patients reported a fall within this period (4 excluded fallers already reported falls at baseline). Their dual-task costs (DTC; mean ± standard deviation) 4.2 ± 2.2 months before the first fall were compared with 22 patients never reporting falls. ROC analyses and logistic regressions accounting for DTC, UPDRS-III and disease duration were used for faller classification and prediction. RESULTS Only walking/box-checking predicted fallers. Fallers showed higher DTC for walking while box-checking, p = 0.029, but not for box-checking while walking, p = 0.178 (combined motor DTC, p = 0.022), than non-fallers. Combined motor DTC classified fallers and non-fallers (area under curve: 0.75; 95% confidence interval, CI: 0.60-0.91) with 71.4% sensitivity (95%CI: 41.9%-91.6%) and 77.3% specificity (54.6%-92.2%), and significantly predicted future fallers (p = 0.023). Here, 20.4%-points higher combined motor DTC (i.e. the mean difference between fallers and non-fallers) was associated with a 2.6 (1.1-6.0) times higher odds to be a future faller. CONCLUSION Motor dual-tasking is a potentially valuable predictor of falls in PD, suggesting that avoiding dual task situations as well as specific motor dual-task training might help to prevent falls in PD. These findings and their therapeutic relevance need to be further validated in PD patients without fall history, in early PD stages, and with various motor-motor dual-task challenges.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Mirjam Maechtel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sandra E Hasmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Markus A Hobert
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
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Bernhard FP, Heinzel S, Binder G, Weber K, Apel A, Roeben B, Deuschle C, Maechtel M, Heger T, Nussbaum S, Gasser T, Maetzler W, Berg D. Insulin-Like Growth Factor 1 (IGF-1) in Parkinson's Disease: Potential as Trait-, Progression- and Prediction Marker and Confounding Factors. PLoS One 2016; 11:e0150552. [PMID: 26967642 PMCID: PMC4788352 DOI: 10.1371/journal.pone.0150552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/15/2016] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Biomarkers indicating trait, progression and prediction of pathology and symptoms in Parkinson's disease (PD) often lack specificity or reliability. Investigating biomarker variance between individuals and over time and the effect of confounding factors is essential for the evaluation of biomarkers in PD, such as insulin-like growth factor 1 (IGF-1). MATERIALS AND METHODS IGF-1 serum levels were investigated in up to 8 biannual visits in 37 PD patients and 22 healthy controls (HC) in the longitudinal MODEP study. IGF-1 baseline levels and annual changes in IGF-1 were compared between PD patients and HC while accounting for baseline disease duration (19 early stage: ≤3.5 years; 18 moderate stage: >4 years), age, sex, body mass index (BMI) and common medical factors putatively modulating IGF-1. In addition, associations of baseline IGF-1 with annual changes of motor, cognitive and depressive symptoms and medication dose were investigated. RESULTS PD patients in moderate (130±26 ng/mL; p = .004), but not early stages (115±19, p>.1), showed significantly increased baseline IGF-1 levels compared with HC (106±24 ng/mL; p = .017). Age had a significant negative correlation with IGF-1 levels in HC (r = -.47, p = .028) and no correlation in PD patients (r = -.06, p>.1). BMI was negatively correlated in the overall group (r = -.28, p = .034). The annual changes in IGF-1 did not differ significantly between groups and were not correlated with disease duration. Baseline IGF-1 levels were not associated with annual changes of clinical parameters. DISCUSSION Elevated IGF-1 in serum might differentiate between patients in moderate PD stages and HC. However, the value of serum IGF-1 as a trait-, progression- and prediction marker in PD is limited as IGF-1 showed large inter- and intraindividual variability and may be modulated by several confounders.
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Affiliation(s)
- Felix P. Bernhard
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Gerhard Binder
- Department of Pediatric Endocrinology, University Children`s Hospital Tuebingen, Tuebingen, Germany
| | - Karin Weber
- Department of Pediatric Endocrinology, University Children`s Hospital Tuebingen, Tuebingen, Germany
| | - Anja Apel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Christian Deuschle
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Mirjam Maechtel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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Rosenbaum D, Hagen K, Deppermann S, Kroczek AM, Haeussinger FB, Heinzel S, Berg D, Fallgatter AJ, Metzger FG, Ehlis AC. State-dependent altered connectivity in late-life depression: a functional near-infrared spectroscopy study. Neurobiol Aging 2016; 39:57-68. [DOI: 10.1016/j.neurobiolaging.2015.11.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/04/2015] [Accepted: 11/27/2015] [Indexed: 01/08/2023]
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Yilmaz R, Behnke S, Liepelt-Scarfone I, Roeben B, Pausch C, Runkel A, Heinzel S, Niebler R, Suenkel U, Eschweiler GW, Maetzler W, Berg D. Substantia nigra hyperechogenicity is related to decline in verbal memory in healthy elderly adults. Eur J Neurol 2016; 23:973-8. [DOI: 10.1111/ene.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- R. Yilmaz
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - S. Behnke
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - I. Liepelt-Scarfone
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - B. Roeben
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - C. Pausch
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - A. Runkel
- Department of Neurology; University of Homburg/Saar; Homburg Germany
| | - S. Heinzel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - R. Niebler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - U. Suenkel
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
| | - G. W. Eschweiler
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
- Geriatric Center at the University Hospital Tübingen; Tübingen Germany
| | - W. Maetzler
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - D. Berg
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tübingen; Tübingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
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Lerche S, Liepelt-Scarfone I, Alves G, Barone P, Behnke S, Ben-Shlomo Y, Berendse H, Burn D, Dodel R, Grosset D, Heinzel S, Hu M, Kasten M, Krüger R, Maetzler W, Moccia M, Mollenhauer B, Oertel W, Roeben B, Sünkel U, Walter U, Wirdefeldt K, Berg D. Methods in Neuroepidemiology Characterization of European Longitudinal Cohort Studies in Parkinson's Disease - Report of the JPND Working Group BioLoC-PD. Neuroepidemiology 2015; 45:282-97. [DOI: 10.1159/000439221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Enormous effort is being put into the identification and characterization of symptoms that may be used as predictive and progression markers in Parkinson's disease (PD). An impressive number of PD patients and individuals at risk for or in the prodromal stage of PD are currently followed in longitudinal studies; however, there does not exist an overview on the kind of markers evaluated and the assessments used. Methods: Information on the design, sample size, evaluated markers and assessments of 21 studies of the Joint Programme - Neurodegenerative Disease Research BioLoC-PD working group were collected by questionnaire. The studies were classified into at risk/prodromal or clinical PD cohorts. The assessments were grouped into quantitative assessments, investigator-rated assessments, investigator interviews, patient-rated questionnaires and caregiver-rated questionnaires. Results: Compilation of these data revealed an interesting consensus on evaluated markers, but there was an enormous variability of assessments. Furthermore, there is a remarkable similarity in the markers assessed and evaluation methods applied in the risk/prodromal and clinical PD cohorts. Conclusions: The inventory of the longitudinal cohorts that are part of the BioLoC-PD consortium reveals that there is a growing consensus on the markers that should be assessed in longitudinal cohort studies in PD. However, controversy still exists on the specific type of assessment. To allow comparison of data and common analyses it will be essential to harmonize scales and assessment outcomes.
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Heinzel S, Metzger FG, Ehlis AC, Korell R, Alboji A, Haeussinger FB, Wurster I, Brockmann K, Suenkel U, Eschweiler GW, Maetzler W, Berg D, Fallgatter AJ. Age and Vascular Burden Determinants of Cortical Hemodynamics Underlying Verbal Fluency. PLoS One 2015; 10:e0138863. [PMID: 26394050 PMCID: PMC4578891 DOI: 10.1371/journal.pone.0138863] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Aging processes and several vascular burden factors have been shown to increase the risk of dementia including Alzheimer's disease. While pathological alterations in dementia precede diagnosis by many years, reorganization of brain processing might temporarily delay cognitive decline. We hypothesized that in healthy elderly individuals both age-related neural and vascular factors known to be related to the development of dementia impact functional cortical hemodynamics during increased cognitive demands. METHODS Vascular burden factors and cortical functional hemodynamics during verbal fluency were assessed in 1052 non-demented elderly individuals (51 to 83 years; cross-sectional data of the longitudinal TREND study) using functional near-infrared spectroscopy (fNIRS). The prediction of functional hemodynamic responses by age in multiple regressions and the impact of single and cumulative vascular burden factors including hypertension, diabetes, obesity, smoking and atherosclerosis were investigated. RESULTS Replicating and extending previous findings we could show that increasing age predicted functional hemodynamics to be increased in right prefrontal and bilateral parietal cortex, and decreased in bilateral inferior frontal junction during phonological fluency. Cumulative vascular burden factors, with hypertension in particular, decreased left inferior frontal junction hemodynamic responses during phonological fluency. However, age and vascular burden factors showed no statistical interaction on functional hemodynamics. CONCLUSION Based on these findings, one might hypothesize that increased fronto-parietal processing may represent age-related compensatory reorganization during increased cognitive demands. Vascular burden factors, such as hypertension, may contribute to regional cerebral hypoperfusion. These neural and vascular hemodynamic determinants should be investigated longitudinally and combined with other markers to advance the prediction of future cognitive decline and dementia.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- * E-mail:
| | - Florian G. Metzger
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center, University Hospital Tübingen, Tübingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Robert Korell
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Ahmed Alboji
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | | | - Isabel Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
| | - Gerhard W. Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Geriatric Center, University Hospital Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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Heinzel S, Hasmann S, Hobert M, Heger T, Berg D, Maetzler W. P167. Dual tasking deficits in motor tasks predict falls in Parkinson’s disease. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.266] [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: 11/26/2022]
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Heinzel S, Liepelt-Scarfone I, Roeben B, Nasi-Kordhishti I, Suenkel U, Wurster I, Brockmann K, Fritsche A, Niebler R, Metzger FG, Eschweiler GW, Fallgatter AJ, Maetzler W, Berg D. A neurodegenerative vascular burden index and the impact on cognition. Front Aging Neurosci 2014; 6:161. [PMID: 25071568 PMCID: PMC4088338 DOI: 10.3389/fnagi.2014.00161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 03/14/2014] [Accepted: 06/20/2014] [Indexed: 12/21/2022] Open
Abstract
A wide range of vascular burden factors has been identified to impact vascular function and structure as indicated by carotid intima–media thickness (IMT). On the basis of their impact on IMT, vascular factors may be selected and clustered in a vascular burden index (VBI). Since many vascular factors increase the risk of Alzheimer’s disease (AD), a multifactorial neurodegenerative VBI may be related to early pathological processes in AD and cognitive decline in its preclinical stages. We investigated an elderly cohort at risk for neurodegeneration (TREND study, n = 1102) for the multifactorial influence of vascular burden factors on IMT measured by ultrasound. To create a VBI for this cohort, vascular factors and their definitions (considering medical history, medication, and/or blood marker data) were selected based on their statistical effects on IMT in multiple regressions including age and sex. The impact of the VBI on cognitive performance was assessed using the Trail-Making Test (TMT) and the consortium to establish a registry for Alzheimer’s disease (CERAD) neuropsychological battery. IMT was significantly predicted by age (standardized β = 0.26), sex (0.09; males > females) and the factors included in the VBI: obesity (0.18), hypertension (0.14), smoking (0.08), diabetes (0.07), and atherosclerosis (0.05), whereas other cardiovascular diseases or hypercholesterolemia were not significant. Individuals with 2 or more VBI factors compared to individuals without had an odds ratio of 3.17 regarding overly increased IMT ( ≥ 1.0 mm). The VBI showed an impact on executive control [log(TMT B−A), p = 0.047] and a trend toward decreased global cognitive function (CERAD total score, p = 0.057) independent of age, sex, and education. A VBI established on the basis of IMT may help to identify individuals with overly increased vascular burden linked to decreased cognitive function indicating neurodegenerative processes. The longitudinal study of this risk cohort will reveal the value of the VBI as prodromal marker for cognitive decline and AD.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany ; German Center for Neurodegenerative Diseases (DZNE) , Tübingen , Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Isabella Nasi-Kordhishti
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Isabel Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Andreas Fritsche
- Department of Internal Medicine IV, University of Tübingen , Tübingen , Germany
| | - Raphael Niebler
- Department of Psychiatry and Psychotherapy, University of Tübingen , Tübingen , Germany ; Geriatric Center, University Hospital Tübingen , Tübingen , Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University of Tübingen , Tübingen , Germany ; Geriatric Center, University Hospital Tübingen , Tübingen , Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University of Tübingen , Tübingen , Germany ; Geriatric Center, University Hospital Tübingen , Tübingen , Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen , Tübingen , Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tübingen , Tübingen , Germany ; German Center for Neurodegenerative Diseases (DZNE) , Tübingen , Germany
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Karch S, Tominschek I, Heinzel S, Aigner M, Windischberger C, Moser E, Pogarell O, Schiepek G. EPA-0997 – Neurobiological aspects of psychotherapy in OCD. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78295-1] [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: 11/16/2022] Open
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Hagen K, Ehlis AC, Haeussinger FB, Heinzel S, Dresler T, Mueller LD, Herrmann MJ, Fallgatter AJ, Metzger FG. Activation during the Trail Making Test measured with functional near-infrared spectroscopy in healthy elderly subjects. Neuroimage 2014; 85 Pt 1:583-91. [DOI: 10.1016/j.neuroimage.2013.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 07/01/2013] [Accepted: 09/07/2013] [Indexed: 11/16/2022] Open
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Hahn T, Heinzel S, Notebaert K, Dresler T, Reif A, Lesch KP, Jakob PM, Windmann S, Fallgatter AJ. The tricks of the trait: neural implementation of personality varies with genotype-dependent serotonin levels. Neuroimage 2013; 81:393-399. [PMID: 23684859 DOI: 10.1016/j.neuroimage.2013.05.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 03/08/2013] [Revised: 04/23/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022] Open
Abstract
Gray's Reinforcement Sensitivity Theory (RST) has developed into one of the most prominent personality theories of the last decades. The RST postulates a Behavioral Inhibition System (BIS) modulating the reaction to stimuli indicating aversive events. A number of psychiatric disorders including depression, anxiety disorders, and psychosomatic illnesses have been associated with extreme BIS responsiveness. In recent years, neuroimaging studies have implicated the amygdala-septo-hippocampal circuit as an important neural substrate of the BIS. However, the neurogenetic basis of the regulation of this behaviorally and clinically essential system remains unclear. Investigating the effects of two functional genetic polymorphisms (tryptophan hydroxylase-2, G-703T, and serotonin transporter, serotonin transporter gene-linked polymorphic region) in 89 human participants, we find significantly different patterns of associations between BIS scores and amygdala-hippocampus connectivity during loss anticipation for genotype groups regarding both polymorphisms. Specifically, the correlation between amygdala-hippocampus connectivity and Gray's trait anxiety scores is positive in individuals homozygous for the TPH2 G-allele, while carriers of at least one T-allele show a negative association. Likewise, individuals homozygous for the 5-HTTLPR L(A) variant display a positive association while carriers of the S/L(G) allele show a trend towards a negative association. Thus, we show converging evidence of different neural implementation of the BIS depending on genotype-dependent levels of serotonin. We provide evidence suggesting that genotype-dependent serotonin levels and thus putative changes in the efficiency of serotonergic neurotransmission might not only alter brain activation levels directly, but also more fundamentally impact the neural implementation of personality traits. We outline the direct clinical implications arising from this finding and discuss the complex interplay of neural responses, genes and personality traits in this context.
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Affiliation(s)
- Tim Hahn
- Department of Cognitive Psychology II, Johann Wolfgang Goethe University Frankfurt/Main, Germany.
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Karolien Notebaert
- Department of Cognitive Psychology II, Johann Wolfgang Goethe University Frankfurt/Main, Germany; Research Center of Marketing and Consumer Science, Katholieke Universiteit Leuven, Belgium
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany; LEAD Graduate School, University of Tübingen, Tübingen, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Klaus-Peter Lesch
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Peter M Jakob
- Research Center Magnetic Resonance Bavaria, Würzburg, Germany; Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
| | - Sabine Windmann
- Department of Cognitive Psychology II, Johann Wolfgang Goethe University Frankfurt/Main, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany; Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
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