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Martinez-Horta S, Perez-Perez J, Perez-Gonzalez R, Sampedro F, Horta-Barba A, Campolongo A, Rivas-Asensio E, Puig-Davi A, Pagonabarraga J, Kulisevsky J. Cognitive phenotype and neurodegeneration associated with Tau in Huntington's disease. Ann Clin Transl Neurol 2024; 11:1160-1171. [PMID: 38544341 DOI: 10.1002/acn3.52031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 05/15/2024] Open
Abstract
OBJECTIVE The clinical phenotype of Huntington's disease (HD) can be very heterogeneous between patients, even when they share equivalent CAG repeat length, age, or disease burden. This heterogeneity is especially evident in terms of the cognitive profile and related brain changes. To shed light on the mechanisms participating in this heterogeneity, the present study delves into the association between Tau pathology and more severe cognitive phenotypes and brain damage in HD. METHODS We used a comprehensive neuropsychological examination to characterize the cognitive phenotype of a sample of 30 participants with early-to-middle HD for which we also obtained 3 T structural magnetic resonance image (MRI) and cerebrospinal fluid (CSF). We quantified CSF levels of neurofilament light chain (NfL), total Tau (tTau), and phosphorylated Tau-231 (pTau-231). Thanks to the cognitive characterization carried out, we subsequently explored the relationship between different levels of biomarkers, the cognitive phenotype, and brain integrity. RESULTS The results confirmed that more severe forms of cognitive deterioration in HD extend beyond executive dysfunction and affect processes with clear posterior-cortical dependence. This phenotype was in turn associated with higher CSF levels of tTau and pTau-231 and to a more pronounced pattern of posterior-cortical atrophy in specific brain regions closely linked to the cognitive processes affected by Tau. INTERPRETATION Our findings reinforce the association between Tau pathology, cognition, and neurodegeneration in HD, emphasizing the need to explore the role of Tau in the cognitive heterogeneity of the disease.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- European Huntington's Disease Network (EHDN)
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- European Huntington's Disease Network (EHDN)
| | - Rocío Perez-Gonzalez
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) and Instituto de Neurociencias UMH-CSIC, Alicante, Spain
| | - Frederic Sampedro
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Neuroradiology unit, Radiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- European Huntington's Disease Network (EHDN)
| | - Antonia Campolongo
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Elisa Rivas-Asensio
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Arnau Puig-Davi
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- European Huntington's Disease Network (EHDN)
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- European Huntington's Disease Network (EHDN)
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- European Huntington's Disease Network (EHDN)
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Migliore S, Bianco SD, Scocchia M, Maffi S, Busi LC, Ceccarelli C, Curcio G, Mazza T, Squitieri F. Prodromal Cognitive Changes as a Prognostic Indicator of Forthcoming Huntington's Disease Severity: A Retrospective Longitudinal Study. Mov Disord Clin Pract 2024; 11:363-372. [PMID: 38264920 PMCID: PMC10982604 DOI: 10.1002/mdc3.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cognitive changes in Huntington's disease (HD) precede motor manifestations. ENROLL-HD platform includes four cognitive measures of information processing speed (IPS). Our group is eager to seek clinical markers in the life stage that is as close as possible to the age of onset (ie, the so called prodromal HD phase) because this is the best time for therapeutic interventions. OBJECTIVES Our study aimed to test whether cognitive scores in prodromal ENROLL-HD mutation carriers show the potential to predict the severity of motor and behavioral changes once HD became fully manifested. METHODS From the global ENROLL-HD cohort of 21,343 participants, we first selected a premanifest Cohort#1 (ie, subjects with Total Motor Score (TMS) <10 and Diagnostic Confidence Level (DCL) <4, N = 1.222). From this cohort, we then focused on a prodromal Cohort#2 of subjects who were ascertained to phenoconvert into manifest HD at follow-up visits (ie, subjects from 6 ≤ TMS≤9 and DCL <4 to TMS≥10 and DCL = 4, n = 206). RESULTS The main results of our study showed that low IPS before phenoconversion in Cohort#2 predicted the severity of motor and behavioral manifestations. By combining the four IPS cognitive measures (eg, the Categorical Verbal Fluency Test; Stroop Color Naming Test; Stroop Word Reading; Symbol Digit Modalities Test), we generated a Composite Cognition Score (CCS). The lower the CCS score the higher the TMS and the apathy scores in the same longitudinally followed-up patients after phenoconversion. CONCLUSIONS CCS might represent a clinical instrument to predict the prognosis of mutation carriers who are close to manifesting HD.
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Affiliation(s)
- Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza HospitalSan Giovanni RotondoItaly
| | | | - Marta Scocchia
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
| | - Sabrina Maffi
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza HospitalSan Giovanni RotondoItaly
| | - Ludovica Camilla Busi
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
| | - Consuelo Ceccarelli
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'AquilaL'AquilaItaly
| | - Tommaso Mazza
- Bioinformatics Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza"San Giovanni RotondoItaly
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza HospitalSan Giovanni RotondoItaly
- Rare Neurological Diseases Centre (CMNR)Fondazione Italian League for Research on Huntington (LIRH)RomeItaly
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Benedict RHB, Vo P, Adlard N, Grennan O, Enstone A, Bridge D, Wyn R, Cohan SL. Disutility of Cognitive Processing Speed (CPS) Impairment in the Context of Multiple Sclerosis: A Time Trade-Off (TTO) Elicitation Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:55-67. [PMID: 38348373 PMCID: PMC10860390 DOI: 10.2147/ceor.s433294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Cognitive impairment, especially relating to cognitive processing speed, is a major cause of disability in people with multiple sclerosis (MS). Utility values are quantitative estimates of the quality of life experienced in specific health states and are a key component of cost-effectiveness modelling. However, existing health state utility values in MS typically focus on physical ability and are generally derived using generic (not disease-specific) measures of quality of life. The objective of the current study was to generate health state utility values for levels of cognitive impairment. We used a direct utility elicitation approach called the time trade-off (TTO) methodology. Materials and Methods Health state descriptions were created following interviews with healthcare professionals, patients, and caregivers in the United States (n=35), and with healthcare professionals in the UK (n=5). Three health states (mild, moderate, and severe impairment) were defined based upon a well-established and validated test for cognitive dysfunction called the Symbol Digit Modalities Test (SDMT) and described using qualitative interview findings. Next, interviews with members of the general public in the UK were conducted to estimate utility values for each health state using the TTO methodology. The procedure was based on the established Measurement and Valuation of Health (MVH) protocol, which generates values on a scale from 0.0 to 1.0. Results Mean health state utility values were 0.77 ± 0.24 in "mild impairment" (SDMT 43-40), 0.57 ± 0.26 in "moderate impairment" (SDMT 39-32), and 0.34 ± 0.28 in "severe impairment" (SDMT ≤ 31). Discussion Results indicate that the public perceives that health states of cognitive slowing (as observed in MS) are associated with a substantial reduction in affected individuals' health-related quality of life, quantified using the TTO methodology. Future economic modeling should consider how utility impacts of both cognitive and physical disability can be appropriately incorporated.
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Affiliation(s)
- Ralph H B Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Pamela Vo
- Novartis Pharma AG, Basel, Switzerland
| | | | | | | | | | - Robin Wyn
- Adelphi Values PROVE, Bollington, UK
| | - Stanley L Cohan
- Providence Brain and Spine Institute, Providence St. Joseph Health, Portland, OR, USA
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Plasma TDP-43 Reflects Cortical Neurodegeneration and Correlates with Neuropsychiatric Symptoms in Huntington's Disease. Clin Neuroradiol 2022; 32:1077-1085. [PMID: 35238950 DOI: 10.1007/s00062-022-01150-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Huntington's disease (HD) is a monogenic neurodegenerative disease with no effective treatment currently available. The pathological hallmark of HD is the aggregation of mutant huntingtin in the medium spiny neurons of the striatum, leading to severe subcortical atrophy. Cortical degeneration also occurs in HD from its very early stages, although its biological origin is poorly understood. Among the possible pathological mechanisms that could promote cortical damage in HD, the in vivo study of TDP-43 pathology remains to be explored, which was the main objective of this work. METHODS We investigated the clinical and structural brain correlates of plasma TDP-43 levels in a sample of 36 HD patients. Neuroimaging alterations were assessed both at the macrostructural (cortical thickness) and microstructural (intracortical diffusivity) levels. Importantly, we controlled for mutant huntingtin and tau biomarkers in order to assess the independent role of TDP-43 in HD neurodegeneration. RESULTS Plasma TDP-43 levels in HD specifically correlated with the presence and severity of apathy (p = 0.003). The TDP-43 levels also reflected cortical thinning and microstructural degeneration, especially in frontal and anterior-temporal regions (p < 0.05 corrected). These TDP-43-related brain alterations correlated, in turn, with the severity of cognitive, motor and behavioral symptoms. CONCLUSION Our results suggest that the presence of TDP-43 pathology in HD has an independent contribution to the severity of neuropsychiatric symptoms and frontotemporal degeneration. These findings point out the importance of TDP-43 as an additional pathological process to be taken into consideration in this devastating disorder.
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Tabrizi SJ, Schobel S, Gantman EC, Mansbach A, Borowsky B, Konstantinova P, Mestre TA, Panagoulias J, Ross CA, Zauderer M, Mullin AP, Romero K, Sivakumaran S, Turner EC, Long JD, Sampaio C. A biological classification of Huntington's disease: the Integrated Staging System. Lancet Neurol 2022; 21:632-644. [PMID: 35716693 DOI: 10.1016/s1474-4422(22)00120-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 12/24/2022]
Abstract
The current research paradigm for Huntington's disease is based on participants with overt clinical phenotypes and does not address its pathophysiology nor the biomarker changes that can precede by decades the functional decline. We have generated a new research framework to standardise clinical research and enable interventional studies earlier in the disease course. The Huntington's Disease Integrated Staging System (HD-ISS) comprises a biological research definition and evidence-based staging centred on biological, clinical, and functional assessments. We used a formal consensus method that involved representatives from academia, industry, and non-profit organisations. The HD-ISS characterises individuals for research purposes from birth, starting at Stage 0 (ie, individuals with the Huntington's disease genetic mutation without any detectable pathological change) by using a genetic definition of Huntington's disease. Huntington's disease progression is then marked by measurable indicators of underlying pathophysiology (Stage 1), a detectable clinical phenotype (Stage 2), and then decline in function (Stage 3). Individuals can be precisely classified into stages based on thresholds of stage-specific landmark assessments. We also demonstrated the internal validity of this system. The adoption of the HD-ISS could facilitate the design of clinical trials targeting populations before clinical motor diagnosis and enable data standardisation across ongoing and future studies.
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Affiliation(s)
- Sarah J Tabrizi
- UCL Huntington's Disease Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, UK Dementia Research Institute, University College London, UK.
| | - Scott Schobel
- Product Development Neuroscience, F Hoffmann-La Roche, Basel, Switzerland
| | | | | | | | | | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | | | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Departments of Neurology, Neuroscience, and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Klaus Romero
- Critical Path Institute, Tucson, Arizona 85718, USA
| | | | | | - Jeffrey D Long
- Department of Psychiatry, Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, NJ, USA; Clinical Pharmacology Laboratory, Faculdade de Medicina de Lisboa, University of Lisbon, Lisbon, Portugal.
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Lee JM, Huang Y, Orth M, Gillis T, Siciliano J, Hong E, Mysore JS, Lucente D, Wheeler VC, Seong IS, McLean ZL, Mills JA, McAllister B, Lobanov SV, Massey TH, Ciosi M, Landwehrmeyer GB, Paulsen JS, Dorsey ER, Shoulson I, Sampaio C, Monckton DG, Kwak S, Holmans P, Jones L, MacDonald ME, Long JD, Gusella JF. Genetic modifiers of Huntington disease differentially influence motor and cognitive domains. Am J Hum Genet 2022; 109:885-899. [PMID: 35325614 DOI: 10.1016/j.ajhg.2022.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/01/2022] [Indexed: 12/12/2022] Open
Abstract
Genome-wide association studies (GWASs) of Huntington disease (HD) have identified six DNA maintenance gene loci (among others) as modifiers and implicated a two step-mechanism of pathogenesis: somatic instability of the causative HTT CAG repeat with subsequent triggering of neuronal damage. The largest studies have been limited to HD individuals with a rater-estimated age at motor onset. To capitalize on the wealth of phenotypic data in several large HD natural history studies, we have performed algorithmic prediction by using common motor and cognitive measures to predict age at other disease landmarks as additional phenotypes for GWASs. Combined with imputation with the Trans-Omics for Precision Medicine reference panel, predictions using integrated measures provided objective landmark phenotypes with greater power to detect most modifier loci. Importantly, substantial differences in the relative modifier signal across loci, highlighted by comparing common modifiers at MSH3 and FAN1, revealed that individual modifier effects can act preferentially in the motor or cognitive domains. Individual components of the DNA maintenance modifier mechanisms may therefore act differentially on the neuronal circuits underlying the corresponding clinical measures. In addition, we identified additional modifier effects at the PMS1 and PMS2 loci and implicated a potential second locus on chromosome 7. These findings indicate that broadened discovery and characterization of HD genetic modifiers based on additional quantitative or qualitative phenotypes offers not only the promise of in-human validated therapeutic targets but also a route to dissecting the mechanisms and cell types involved in both the somatic instability and toxicity components of HD pathogenesis.
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Zhu JJ, Chen YJ, Chen LL, Zhao LJ, Zhou P. Factors that contribute to the cognitive impairment in elderly dialysis patients. Ther Apher Dial 2021; 26:632-639. [PMID: 34550646 DOI: 10.1111/1744-9987.13740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/11/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the cognitive function in dialysis patients over 60 years old and identify the contributing factors. METHODS A group of elderly dialysis patients in the Department of Nephrology, Pan'an People's Hospital between March 2015 and June 2018 were chosen as the subjects for this study. Patients were divided into two groups, those with cognitive impairment and those with normal cognitive function. Results of their Montreal Cognitive Assessment (MoCA) scores, Controlled Oral Word Association Test (COWAT), Wechsler Adult Intelligence Scale Digit Span subtest (WDMS), and Stanford Diagnostic Math Test (SDMT) were reviewed and analyzed. RESULTS Among the 110 elderly dialysis patients, 75 patients (68.18%) showed different levels of damage to their cognitive function. Their assessment scores on MoCA (total), MoCA subtests: visuospatial/executive, naming, attention, language, delayed recall, abstraction and orientation, COWAT (total), COWAT1, COWAT2, COWAT3, WMDS-Backward, and SDMT are significantly lower than patients with normal cognitive abilities (p < 0.05). Further analysis showed that the highest percentage (72.00%) of patients had impairment with visuospatial/executive function; and, of the 75 cognitive impaired patients, 37.33% showed cognitive damage in two MoCA subtests simultaneously. Patients with and without cognitive impairment showed a significant (p < 0.05) difference on factors including age, education level, employment status, financial situation, dialysis vintage, serum albumin, and hemoglobin. CONCLUSION Elderly patients on dialysis have a higher risk of becoming cognitive impaired. The cognitive impairment in elderly dialysis patients was significantly associated with age, dialysis vintage, and levels of serum albumin and hemoglobin.
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Affiliation(s)
- Jun-Jie Zhu
- Department of Nephrology, Pan'an People's Hospital, Jinhua, China
| | - Yang-Jin Chen
- Department of Nephrology, Pan'an People's Hospital, Jinhua, China
| | - Ling-Ling Chen
- Department of Nephrology, Pan'an People's Hospital, Jinhua, China
| | - Li-Jun Zhao
- Department of Nuclear Medicine, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ping Zhou
- Department of Nephrology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
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Martinez-Horta S, Sampedro F, Horta-Barba A, Perez-Perez J, Pagonabarraga J, Gomez-Anson B, Kulisevsky J. Structural brain correlates of dementia in Huntington's disease. NEUROIMAGE-CLINICAL 2020; 28:102415. [PMID: 32979842 PMCID: PMC7519361 DOI: 10.1016/j.nicl.2020.102415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023]
Abstract
Dementia may occur in the early stages of HD and with independence of disease burden. More severe posterior-cortical atrophy is associated with dementia in HD. Neuropsychological alterations of dementia in HD extends beyond executive dysfunction. CAG-independent neuropathological mechanisms may contribute to dementia in HD.
Background Huntington’s disease (HD) is a fatal genetic neurodegenerative disorder with no effective treatment currently available. Progressive basal ganglia and whole-brain atrophy and concurrent cognitive deterioration are prototypical aspects of HD. However, the specific patterns of brain atrophy underlying cognitive impairment of different severity in HD are poorly understood. The aim of this study was to investigate the specific structural brain correlates of major cognitive deficits in HD and to explore its association with neuropsychological indicators. Participants Thirty-five symptomatic early-to-mild HD patients and 15 healthy controls (HC) with available T1-MRI imaging were included in this study. Methods In this cross-sectional study, HD patients were classified as patients with (HD-Dem) and without (HD-ND) major cognitive impairment in the range of dementia. This classification was based on previously validated PD-CRS cutoff scores for HD. Differences in brain atrophy across groups were studied by means of grey-matter volume voxel-based morphometry (GMV-VBM) and cortical thickness (Cth). Voxelwise and vertexwise general linear models were used to assess the group comparisons, controlling for the effects of age, sex, education, CAG repeat length and severity of motor symptoms. Clusters surviving p < 0.05 and family-wise error (FWE) correction were considered statistically significant. In order to characterize the impact on cognitive performance of the observed brain differences across groups, GMV and Cth values in the set of significant regions were computed and correlated with specific neuropsychological tests. Results All groups had similar sociodemographic profiles, and the HD groups did not significantly differ in terms of CAG repeat length. Compared to HC, both HD groups exhibited significant atrophy in multiple subcortical and parietal brain regions. However, compared to HC and HD-ND groups, HD-Dem patients showed a more prominent pattern of reduced GMV and cortical thinning. Importantly, this thinning was restricted to regions of the parietal-temporal and occipital cortices. Furthermore, these brain alterations were further associated with poorer cognitive performance in tasks assessing frontal-executive and attention domains as well as memory, language and constructional abilities. Conclusions Major cognitive impairment in the range of dementia in HD is associated with brain and cognitive alterations exceeding the prototypical frontal-executive deficits commonly recognized in HD. The observed posterior-cortical damage identified by MRI and its association with memory, language, and visuoconstructive dysfunction suggest a strong involvement of extra-striatal atrophy in the onset of severe cognitive dysfunction in HD patients. Critically, major cognitive impairment in this sample was not associated with CAG repeat length, age or education. This finding could support a possible involvement of additional neuropathological mechanisms aggravating cognitive deterioration in HD.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; European Huntington's Disease Network (EHDN), Spain
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Beatriz Gomez-Anson
- Neuroradiology, Radiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain.
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Mills JA, Long JD, Mohan A, Ware JJ, Sampaio C. Cognitive and Motor Norms for Huntington’s Disease. Arch Clin Neuropsychol 2020; 35:671-682. [DOI: 10.1093/arclin/acaa026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/21/2020] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The progression of Huntington’s disease (HD) for gene-expanded carriers is well-studied. Natural aging effects, however, are not often considered in the evaluation of HD progression.
Objective
To examine the effects of natural aging for healthy controls and to develop normative curves by age, sex, and education from the distribution of observed scores for the Symbol Digit Modalities Test, Stroop Word Reading Test, Stroop Color Naming Test, Stroop Interference Test, Total Motor Score, and Total Functional Capacity (TFC) from the Unified Huntington’s Disease Rating Scale (UHDRS) along with a composite score.
Methods
After combining longitudinal REGISTRY and Enroll-HD data, we used quantile regression and natural cubic splines for age to fit models for healthy controls (N = 3,394; N observations = 8,619). Normative curves were estimated for the 0.05, 0.25, 0.50, 0.75, and 0.95 quantiles. Two types of reference curves were considered: unconditional curves were dependent on age alone, whereas conditional curves were dependent on age and other covariates, namely sex and education.
Results
Conditioning on education was necessary for the Symbol Digit, Stroop Word, Stroop Color, Stroop Interference, and composite UHDRS. Unconditional curves were sufficient for the Total Motor Score. TFC was unique in that the curve was constant over age with its intercept at the maximum score (TFC = 13). For all measures, sex effects were minimal, so conditioning on sex was unwarranted.
Conclusions
Extreme quantile estimates for each measure can be considered as boundaries for natural aging and scores falling beyond these thresholds are likely the result of disease progression. Normative curves and tables are developed and can serve as references for clinical characterization in HD.
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Affiliation(s)
- James A Mills
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
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Eizaguirre MB, Vanotti SI, Aguayo Arelis A, Rabago Barajas B, Cores EV, Macías MA, Benedict RHB, Cáceres F. Symbol Digit Modalities Test-Oral Version: An Analysis of Culture Influence on a Processing Speed Test in Argentina, Mexico, and the USA. Dev Neuropsychol 2020; 45:129-138. [DOI: 10.1080/87565641.2020.1737699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- María Bárbara Eizaguirre
- Research Institute of Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina
| | - Sandra Ines Vanotti
- Research Institute of Psychology, School of Psychology, Buenos Aires University, Buenos Aires, Argentina
- MS Clinic, Buenos Aires Institute of Neurosciences (INEBA), Buenos Aires, Argentina
| | | | | | - Evangelina Valeria Cores
- Argentinean Science and Technology Research Council (CONICET), General Hospital of Acute Diseases Eva Perón - CONICET
| | | | - Ralph H. B. Benedict
- Department of Neurology, School of Medicine, Department of Neurology, University at Buffalo, Buffalo, NY, USA
| | - Fernando Cáceres
- MS Clinic, Buenos Aires Institute of Neurosciences (INEBA), Buenos Aires, Argentina
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