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Fiondella L, Gami-Patel P, Blok CA, Rozemuller AJM, Hoozemans JJM, Pijnenburg YAL, Scarioni M, Dijkstra AA. Movement disorders are linked to TDP-43 burden in the substantia nigra of FTLD-TDP brain donors. Acta Neuropathol Commun 2023; 11:63. [PMID: 37046309 PMCID: PMC10091586 DOI: 10.1186/s40478-023-01560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
Movement disorders (MD) have been linked to degeneration of the substantia nigra (SN) in Parkinson's disease and include bradykinesia, rigidity, and tremor. They are also present in frontotemporal dementia (FTD), where MD have been linked to frontotemporal lobar degeneration with tau pathology (FTLD-tau). Although MD can also occur in FTLD with TDP-43 pathology (FTLD-TDP), the local pathology in the SN of FTLD-TDP patients with MD is currently unexplored. The aims of this study are to characterize the frequency and the nature of MD in a cohort of FTLD-TDP brain donors and to investigate the relationship between the presence of MD, the nigral neuronal loss, and the TDP-43 burden in the SN. From our cohort of FTLD-TDP patients (n = 53), we included 13 donors who presented with MD (FTLD-MD+), and nine age-sex matched donors without MD (FTLD-MD-) for whom the SN was available. In these donors, the TDP-43 burden and the neuronal density in the SN were assessed with ImageJ and Qupath software. The results were compared between the two groups using T-test. We found that the TDP-43 burden in the SN was higher in FTLD-MD+ (mean 3,43%, SD ± 2,7) compared to FTLD-MD- (mean 1,21%, SD ± 0,67) (p = 0,04), while no significant difference in nigral neuronal density was found between the groups (p = 0,09). 17% of FTLD-TDP patients developed MD, which present as symmetric akinetic-rigid parkinsonism or CBS. Given the absence of a significant nigral neuronal cell loss, TDP-43 induced neuronal dysfunction could be sufficient to cause MD.
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Affiliation(s)
- Luigi Fiondella
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Priya Gami-Patel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Christian A Blok
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Marta Scarioni
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Anke A Dijkstra
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
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Kim J, Jang H, Park YH, Youn J, Seo SW, Kim HJ, Na DL. Motor Symptoms in Early- versus Late-Onset Alzheimer's Disease. J Alzheimers Dis 2023; 91:345-354. [PMID: 36404549 DOI: 10.3233/jad-220745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age at onset was suggested as one possible risk factor for motor dysfunction in Alzheimer's disease (AD). OBJECTIVE We investigated the association of motor symptoms with cognition or neurodegeneration in patients with AD, and whether this association differs by the age at onset. METHODS We included 113 amyloid positive AD patients and divided them into early-onset AD (EOAD) and late-onset AD (LOAD), who underwent the Unified Parkinson's Disease Rating Scale (UPDRS)-Part III (=UPDRS) scoring, Mini-Mental State Examination (MMSE)/Clinical Deterioration Rating Sum-of-Boxes (CDR-SOB), and magnetic resonance image (MRI). Multiple linear regression was used to evaluate the association of UPDRS and MMSE/CDR-SOB or MRI neurodegeneration measures, and whether the association differs according to the group. RESULTS The prevalence of motor symptoms and their severity did not differ between the groups. Lower MMSE (β= -1.1, p < 0.001) and higher CDR-SOB (β= 2.0, p < 0.001) were significantly associated with higher UPDRS. There was no interaction effect between MMSE/CDR-SOB and AD group on UPDRS. Global or all regional cortical thickness and putaminal volume were negatively associated with UPDRS score, but the interaction effect of neurodegeneration and AD group on UPDRS score was significant only in parietal lobe (p for interaction = 0.035), which showed EOAD to have a more pronounced association between parietal thinning and motor symptoms. CONCLUSION Our study suggested that the severity of motor deterioration in AD is related to the severity of cognitive impairment itself rather than age at onset, and motor symptoms might occur through multiple mechanisms including cortical and subcortical atrophy.
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Affiliation(s)
- Jinhee Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimers Convergence Research Center, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Yu-Hyun Park
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimers Convergence Research Center, Samsung Medical Center, Seoul, Korea
| | - Jinyoung Youn
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimers Convergence Research Center, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimers Convergence Research Center, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University, Seoul, Korea
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Functional Correlates of Striatal Dopamine Transporter Cerebrospinal Fluid Levels in Alzheimer's Disease: A Preliminary 18F-FDG PET/CT Study. Int J Mol Sci 2023; 24:ijms24010751. [PMID: 36614193 PMCID: PMC9820963 DOI: 10.3390/ijms24010751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
The aim of our study was to investigate regional glucose metabolism with 18F-FDG positron emission tomography/computed tomography in a population of patients with Alzheimer's disease (AD) in relation to cerebrospinal (CSF) levels of striatal dopamine transporter (DAT). All patients underwent lumbar puncture and received a biomarker-based diagnosis of AD. Differences in regional brain glucose metabolism were assessed by Statistical Parametric Mapping version 12 with the use of age, gender, and MMSE as covariates in the analysis. A positive correlation between CSF DAT levels and glucose metabolism at the level of two brain areas involved in the pathophysiological process of Alzheimer's disease, the substantia nigra and the posterior cingulate gyrus, has been highlighted. Results indicate that patients with higher CSF DAT levels have a better metabolic pattern in two key zones, suggesting less advanced disease status in patients with more conserved dopaminergic systems.
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Rainwater Charitable Foundation criteria for the neuropathologic diagnosis of progressive supranuclear palsy. Acta Neuropathol 2022; 144:603-614. [PMID: 35947184 PMCID: PMC9468104 DOI: 10.1007/s00401-022-02479-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 01/28/2023]
Abstract
Neuropathologic criteria for progressive supranuclear palsy (PSP) proposed by a National Institute of Neurological Disorders and Stroke (NINDS) working group were published in 1994 and based on the presence of neurofibrillary tangles in basal ganglia and brainstem. These criteria did not stipulate detection methods or incorporate glial tau pathology. In this study, a group of 14 expert neuropathologists scored digital slides from 10 brain regions stained with hematoxylin and eosin (H&E) and phosphorylated tau (AT8) immunohistochemistry. The cases included 15 typical and atypical PSP cases and 10 other tauopathies. Blinded to clinical and neuropathological information, raters provided a categorical diagnosis (PSP or not-PSP) based upon provisional criteria that required neurofibrillary tangles or pretangles in two of three regions (substantia nigra, subthalamic nucleus, globus pallidus) and tufted astrocytes in one of two regions (peri-Rolandic cortices, putamen). The criteria showed high sensitivity (0.97) and specificity (0.91), as well as almost perfect inter-rater reliability for diagnosing PSP and differentiating it from other tauopathies (Fleiss kappa 0.826). Most cases (17/25) had 100% agreement across all 14 raters. The Rainwater Charitable Foundation criteria for the neuropathologic diagnosis of PSP feature a simplified diagnostic algorithm based on phosphorylated tau immunohistochemistry and incorporate tufted astrocytes as an essential diagnostic feature.
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Kawakatsu S, Kobayashi R, Hayashi H, Morioka D, Utsunomiya A, Kabasawa T, Ohe R, Otani K. Clinicopathological heterogeneity of Alzheimer's disease with pure Alzheimer's disease pathology: Cases associated with dementia with Lewy bodies, very early-onset dementia, and primary progressive aphasia. Neuropathology 2021; 41:427-449. [PMID: 34816507 DOI: 10.1111/neup.12765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/05/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
We report four cases depicting the heterogeneity of Alzheimer's disease (AD) associated with pure AD pathology. Case 1 was a 77-year-old man with a false positive diagnosis of dementia with Lewy bodies with reduced dopamine transporter uptake activity of the striatum but no Lewy body pathology. There were tau deposits in the large neurons in the putamen, which may be related to the development of parkinsonism. Case 2 was an AD patient in his early 30s who presented with a psychotic episode and a cognitive decline, and later developed myoclonus and seizures. He demonstrated considerable amyloid-beta deposits in the cerebral cortex, including cotton wool plaques, basal ganglia, and cerebellum. Tau deposits were also abundant in the cerebral neocortex, hippocampus, basal ganglia, and brain stem. Case 3 was a 60-year-old woman who exhibited typical symptoms characteristic of the logopenic variant of primary progressive aphasia (lvPPA). Case 4 was a 68-year-old man who exhibited the semantic variant of primary progressive aphasia (svPPA) plus repetition impairment, a rare case associated with AD pathology. In addition to tau pathology, astrocytic pathology was prominent in the white matter and cortical layers of the left temporoparietal cortices. While the main AD lesion in case 4 was evaluated by tau accumulation and astrogliosis in the left temporal lobe, that in case 3 in was evaluated by the same points in the left parietal lobe. Within the spectrum of lvPPA, case 4 may be regarded as a temporal variant of lvPPA presenting svPPA. The pathology of PPA associated with AD may have broader clinical manifestations than that in previously described cases. Case 4 also showed pathological features characteristic of cerebral amyloid angiopathy throughout the cerebral cortex. The distribution of tau and astrocytic pathologies in the cerebral cortex, basal ganglia, brain stem, and cerebellum may explain the various symptoms of atypical pure AD patients.
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Affiliation(s)
- Shinobu Kawakatsu
- Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ryota Kobayashi
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Hiroshi Hayashi
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Daichi Morioka
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
| | - Aya Utsunomiya
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanobu Kabasawa
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
| | - Rintaro Ohe
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
| | - Koichi Otani
- Department of Psychiatry, Yamagata University School of Medicine, Yamagata, Japan
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Spencer PS. Parkinsonism and motor neuron disorders: Lessons from Western Pacific ALS/PDC. J Neurol Sci 2021; 433:120021. [PMID: 34635325 DOI: 10.1016/j.jns.2021.120021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 01/16/2023]
Abstract
Recognized worldwide as an unusual "overlap" syndrome, Parkinsonism and motor neuron disease, with or without dementia, is best exemplified by the former high-incidence clusters of Amyotrophic Lateral Sclerosis and Parkinsonism-Dementia Complex (ALS/PDC) in Guam, USA, in the Kii Peninsula of Honshu Island, Japan, and in Papua, Indonesia, on the western side of New Guinea. Western Pacific ALS/PDC is a disappearing neurodegenerative disorder with multiple and sometime overlapping phenotypes (ALS, atypical parkinsonism, dementia) that appear to constitute a single disease of environmental origin, in particular from exposure to genotoxins/neurotoxins in seed of cycad plants (Cycas spp.) formerly used as a traditional source of food (Guam) and/or medicine (Guam, Kii-Japan, Papua-Indonesia). Seed compounds include the principal cycad toxin cycasin, its active metabolite methylazoxymethanol (MAM) and a non-protein amino acid β-N-methylamino-L-alanine (L-BMAA); each reproduces components of ALS/PDC neuropathology when individually administered to laboratory species in single doses perinatally (MAM, L-BMAA) or repeatedly for prolonged periods to young adult animals (L-BMAA). Human exposure to MAM, a potent DNA-alkylating mutagen, also has potential relevance to the high incidence of diverse mutations found among Guamanians with/without ALS/PDC. In sum, seven decades of intensive study of ALS/PDC has revealed field and laboratory approaches leading to discovery of disease etiology that are now being applied to sporadic neurodegenerative disorders such as ALS beyond the Western Pacific region. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Peter S Spencer
- Department of Neurology, School of Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA.
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Simonet C, Noyce A. Mild parkinsonian signs: the interface between aging and Parkinson’s disease. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2021. [DOI: 10.47795/khgp5988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mild Parkinsonian Signs (MPS) describe a spectrum that exists between the expected motor decline of normal aging and a more serious motor deterioration resulting from Parkinson’s disease (PD) and neurodegeneration. Although MPS are a feature of the prodromal stage of PD, their formal definition is unclear and still relies somewhat on conventional clinical criteria for PD. This review will summarise the early motor features of PD and methods of assessment, from conventional clinical scales to advances in quantitative measures. Finally, the boundaries of motor decline as part of normal aging and pathological neurodegeneration will be discussed.
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8
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Winkel I, Ermann N, Żelwetro A, Sambor B, Mroczko B, Kornhuber J, Paradowski B, Lewczuk P. Cerebrospinal fluid α synuclein concentrations in patients with positive AD biomarkers and extrapyramidal symptoms. J Neural Transm (Vienna) 2021; 128:817-825. [PMID: 34036433 PMCID: PMC8205875 DOI: 10.1007/s00702-021-02351-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022]
Abstract
Extrapyramidal symptoms (EP) are not uncommon in Alzheimer's Disease (AD); when present, they negatively influence the course of the disorder. A large proportion of AD patients shows concomitant Lewy bodies' pathology post mortem. Total α Synuclein (αSyn) concentrations are frequently increased in the cerebrospinal fluid (CSF) of AD patients, but are decreased in Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB). αSyn CSF concentrations in AD patients with EP (EP+) have not been reported so far. αSyn and the four Neurochemical Dementia Diagnostics (NDD) CSF biomarkers, (Aβ1-42, Aβ42/40, Tau, and pTau181), interpreted according to the Erlangen Score algorithm, were measured in patients with positive NDD results and presence of extrapyramidal symptoms (NDD + / EP+; n = 26), in patients with positive NDD results and absence of extrapyramidal symptoms (NDD+ / EP-; n = 54), and in subjects with negative NDD results (NDD-; n = 34). Compared to the NDD- controls (379.8 ± 125.2 pg/mL), NDD+ patients showed, on average, highly significantly increased CSF αSyn (519 ± 141.3 pg/mL, p < 0.01), but without differences between NDD+ / EP+ and NDD+ / EP- subgroups (p = 0. 38). Moderate but highly significant association was observed between concentrations of αSyn and Tau (r = 0.47, p < 0.01) and pTau181 (r = 0.65, p < 0.01). Adjusted for diagnoses, age, and sex, subjects with more advanced neurodegeneration on neuroimaging showed significantly lower αSyn concentrations (p < 0.02). In the setting AD versus controls, the area under the receiver operating characteristic (ROC) curve was 0.804 [0.712; 0.896] with the sensitivity and the specificity of 0.863 and 0.618, respectively. αSyn in AD patients does not differentiate between subjects with- and without EP. Its increased average concentration reflects probably neurodegenerative process, and is not specific for any pathophysiologic mechanisms. Further studies are necessary to explain the role of CSF αSyn as a potential biomarker.
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Affiliation(s)
- Izabela Winkel
- Dementia Disorders Center of the Medical University of Wrocław, Ścinawa, Poland.,Department and Clinic of Geriatrics, Medical University of Wrocław, Wrocław, Poland
| | - Natalia Ermann
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Agnieszka Żelwetro
- Interdyscyplinarne Studia Doktoranckie Uniwersytetu SWPS, II Wydział Psychologii, Wrocław, Poland
| | | | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany. .,Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland. .,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland. .,Department of Psychiatry and Psychotherapy, Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Schwabachanlage 6, 91054, Erlangen, Germany.
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Kociolek AJ, Fernandez KK, Jin Z, Cosentino S, Zhu CW, Gu Y, Stern Y. Extrapyramidal signs and Alzheimer's disease prognosis in a multiethnic, community-based sample of demented elders. Alzheimers Dement 2021; 17:1465-1473. [PMID: 33710771 DOI: 10.1002/alz.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Extrapyramidal signs (EPS) are a common feature of Alzheimer's disease associated with worse outcomes in observational studies of dementia. Less research has been conducted on ethnic minority and non-clinic-based populations. METHODS One hundred and forty-two multiethnic community-dwelling participants with dementia were selected. Adjusted Cox models were fitted for mortality, cognitive (Mini Mental State Examination ≤10), functional (Blessed Dementia Rating Scale ≥10), and dependency (needs full-time care) endpoints with baseline EPS as predictor. RESULTS Thirty-seven participants (26.06%) had EPS at baseline. EPS predicted more rapid time to death (hazard ratio [HR] = 2.76, 95% confidence interval [CI] = 1.49, 5.42), and functional endpoint (HR = 3.88, 95% CI = 1.75, 8.62) but not cognitive and dependency endpoints. No evidence of interaction by ethnicity, age, sex, education, or apolipoprotein E ε4 polymorphism was found. DISCUSSION Our results partially confirm previous studies on predominantly White, clinic-based samples. Further research is needed to better understand the etiological role of EPS in AD.
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Affiliation(s)
- Anton J Kociolek
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kayri K Fernandez
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Epidemiology, Columbia University, New York, New York, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Chung SJ, Lee S, Yoo HS, Baik K, Lee HS, Jung JH, Choi Y, Hong JM, Kim YJ, Ye BS, Sohn YH, Yun M, Lee PH. Different patterns of β-amyloid deposition in patients with Alzheimer's disease according to the presence of mild parkinsonism. Neurobiol Aging 2021; 101:199-206. [PMID: 33631471 DOI: 10.1016/j.neurobiolaging.2021.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to compare the patterns of β-amyloid deposition between patients with early-stage Alzheimer's disease (AD) with mild parkinsonism and those without parkinsonism. Sixty-one patients with early-stage AD (Clinical Dementia Rating [CDR], 0.5 or 1) who underwent 18F-florbetaben (18F-FBB) PET scans were enrolled. We performed comparative analyses of regional FBB uptake in the frontal, parietal, lateral temporal, medial temporal, occipital, anterior cingulate, and posterior cingulate cortices and in the precuneus, striatum, and thalamus between AD patients with mild parkinsonism (AD-p+; n = 23) and those without parkinsonism (AD-p-; n = 38). There was no significant difference in age, sex, years of education, Mini-Mental State Examination score, and white matter hyperintensity severity between groups. The AD-p+ group had lower composite scores in frontal/executive function domain than the AD-p- group. The AD-p+ group had a higher FBB uptake in the occipital cortex, but not in other cortical regions, than the AD-p- group. Our findings suggest that additional β-amyloid deposition in the occipital region is associated with mild parkinsonism in early-stage AD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Sangwon Lee
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yonghoon Choi
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Man Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Miller-Patterson C, Han J, Yaffe K, Rosso AL, Launer LJ, Kritchevsky SB, Boudreau RM, Rosano C. Clinical and neuroimaging correlates of progression of mild parkinsonian signs in community-dwelling older adults. Parkinsonism Relat Disord 2020; 75:85-90. [PMID: 32505084 DOI: 10.1016/j.parkreldis.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mild parkinsonian signs (MPS) are associated with morbidity. Identification of MPS progression markers may be vital for preventive management, yet has not been pursued. This study aimed to ascertain clinical/neuroimaging features predictive of MPS progression. METHODS 205 participants in the Health ABC Study were included. MPS was defined using published guidelines. MPS progression was evaluated by determining UPDRS-III change between baseline and follow-up ≥2 years later. Standard brain MRI and DTI were obtained at baseline. Correlation coefficients between demographics, vascular risk factors, imaging markers, and UPDRS-III change were adjusted for follow-up time. Linear regression was used to adjust for possible confounders in the relationship between imaging markers and MPS progression. RESULTS 30% of participants had baseline MPS. Demographics and risk factors did not differ significantly between participants with MPS (MPS+) and without MPS (MPS-). Mean follow-up time was 3.8±0.8 years. Older age, male gender, diabetes were associated with faster rate of UPDRS-III change in MPS- but not MPS+ participants. Among MPS- participants, the only imaging marker associated with faster UPDRS-III progression was higher gray matter mean diffusivity (MD), widespread in various cortico-subcortical bihemispheric regions, independent of age, gender, diabetes. No imaging features were associated with UPDRS-III change among MPS+ participants. CONCLUSIONS Lower gray matter integrity predicted MPS progression in those who did not have baseline MPS. Microstructural imaging may capture early changes related to MPS development, prior to macrostructural change. Any future management promoting gray matter preservation may inhibit MPS development.
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Affiliation(s)
- Cameron Miller-Patterson
- University of Pittsburgh School of Medicine, Department of Neurology, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
| | - Jennifer Han
- University of Pittsburgh School of Medicine, Department of Neurology, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Kristine Yaffe
- University of California San Francisco School of Medicine, Department of Psychiatry, 533 Parnassus Ave, San Francisco, CA, 94143, USA; University of California San Francisco School of Medicine, Department of Neurology, 533 Parnassus Ave, San Francisco, CA, 94143, USA; University of California San Francisco School of Medicine, Department of Epidemiology, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Andrea L Rosso
- University of Pittsburgh School of Public Health, Department of Epidemiology, 130 De Soto St, Pittsburgh, PA, 15213, USA
| | - Lenore J Launer
- National Institutes of Health, 251 Bayview Blvd, Bethesda, MD, 21224, USA; National Institute on Aging, 251 Bayview Blvd, Bethesda, MD, 21224, USA
| | - Stephen B Kritchevsky
- Wake Forest University School of Medicine, Stricht Center for Healthy Aging and Alzheimer's Prevention, Winston-Salem, NC, USA
| | - Robert M Boudreau
- University of Pittsburgh School of Public Health, Department of Epidemiology, 130 De Soto St, Pittsburgh, PA, 15213, USA
| | - Caterina Rosano
- University of Pittsburgh School of Public Health, Department of Epidemiology, 130 De Soto St, Pittsburgh, PA, 15213, USA
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12
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Clinical features of Lewy body dementia: insights into diagnosis and pathophysiology. J Neurol 2019; 267:380-389. [DOI: 10.1007/s00415-019-09583-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/18/2022]
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13
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Jang H, Jang YK, Park S, Kim SE, Kim SJ, Cho SH, Youn J, Seo SW, Kim HJ, Na DL. Presynaptic dopaminergic function in early-onset Alzheimer's disease: an FP-CIT image study. Neurobiol Aging 2019; 86:75-80. [PMID: 31843258 DOI: 10.1016/j.neurobiolaging.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
We aimed to investigate whether amyloid-β (Aβ) positive early-onset Alzheimer's disease (EOAD) patients have presynaptic dopaminergic deficits on in vivo 18F-FP-CIT PET imaging. We enrolled 34 EOAD patients and 9 cognitively normal controls (NC), all of whom underwent 18F-florbetaben and 18F-FP-CIT PET at Samsung Medical Center. We assessed motor symptoms using Unified Parkinson's Disease Rating Scale (UPDRS) and divided the EOAD patients into 2 groups using a UPDRS cutoff of 10. We compared regional florbetaben and FP-CIT uptake across the NC and the 2 EOAD groups with lower and higher UPDRS and investigated the associations between regional florbetaben or FP-CIT uptake and UPDRS in EOAD patients. Among the 30 EOAD patients who were Aβ positive on florbetaben PET, the higher UPDRS (>10) group (n = 9) had a longer disease duration (7.2 ± 3.3 vs. 4.1 ± 1.8, p = 0.002), and had a tendency to have lower Mini-Mental State Examination (9.6 ± 7.9 vs. 15.0 ± 6.0, p = 0.052) than the lower UPDRS (≤10) group (n = 21). Across the NC and the 2 EOAD groups, there were no significant differences in FP-CIT uptake in caudate (p = 0.122) and putamen (p = 0.685) or florbetaben uptake in midbrain (p = 0.890). Finally, regression analyses showed that UPDRS was not associated with FP-CIT uptake in caudate (p = 0.913) or putamen (p = 0.407), or with florbetaben PET uptake in caudate (p = 0.553), putamen (p = 0.617), midbrain (p = 0.843), or global cortex (p = 0.658). This study showed that parkinsonian signs in EOAD patients may be related with mechanisms other than presynaptic dopaminergic deficit. Our finding is clinically important because it suggests that L-dopa treatment in EOAD with parkinsonian signs may not improve motor symptoms.
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Affiliation(s)
- Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea
| | - Young Kyoung Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Seongbeom Park
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Si Eun Kim
- Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea
| | - Seung Joo Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Soo Hyun Cho
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jinyoung Youn
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea
| | - Duk L Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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14
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Jo H, Kim M, Park S, Park JE, Cho SH, Kim SJ, Jang H, Jung YH, Kim J, Na DL, Seo SW, Cho JW, Kim HJ. Dopa Responsive Parkinsonism in an Early Onset Alzheimer's Disease Patient with a Presenilin 1 Mutation (A434T). J Alzheimers Dis 2019; 71:7-13. [PMID: 31322578 DOI: 10.3233/jad-190469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease patients with presenilin 1 (PSEN1) mutations commonly show parkinsonism in addition to dementia. Yet, whether these patients show dopaminergic deficit and response to L-dopa is largely unknown. We report a 43-year-old woman with a PSEN1 mutation (A434T) who showed right side dominant parkinsonism. As disease progressed, she developed bilateral parkinsonism which was markedly relieved by L-dopa. Amyloid (Florbetaben) positron-emission tomography (PET) showed cortical florbetaben uptake, relatively sparing the striatum. Initial dopamine transporter (FP-CIT) PET showed asymmetrically decreased FP-CIT uptake in the left striatum. We suggest that in Alzheimer's disease patients with PSEN1 mutation, parkinsonism may be relieved by L-dopa when it is associated with presynaptic dopaminergic deficit.
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Affiliation(s)
- Hyunjin Jo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Seongbeom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jong Eun Park
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Soo Hyun Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea.,Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Joo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea.,Department of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Yong Hee Jung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Junpyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, Korea
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15
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Chung SJ, Lee YH, Yoo HS, Sohn YH, Ye BS, Cha J, Lee PH. Distinct FP-CIT PET patterns of Alzheimer's disease with parkinsonism and dementia with Lewy bodies. Eur J Nucl Med Mol Imaging 2019; 46:1652-1660. [PMID: 30980099 DOI: 10.1007/s00259-019-04315-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Little is known regarding the clinical relevance or neurobiology of subtle motor disturbance in Alzheimer's disease (AD). This study aims to investigate the patterns of striatal 18F-FP-CIT uptake in patients with AD-related cognitive impairment (ADCI) with mild parkinsonism. METHODS We recruited 29 consecutive patients with ADCI with mild parkinsonism. All patients underwent 18F-FP-CIT PET scans and dopamine transporter (DAT) availability in striatal subregions (anterior/posterior caudate, anterior/posterior putamen, ventral putamen, ventral striatum) was quantified. Additionally, 32 patients with dementia with Lewy bodies (DLB) and 21 healthy controls were included to perform inter-group comparative analyses of the striatal DAT availability. The discriminatory power of striatal DAT availability to differentiate ADCI from DLB was assessed using receiver operating characteristics (ROC) analyses. The Spearman's correlation coefficient was calculated to assess the relationship between motor severity and DAT availability in striatal subregions. RESULTS Patients with ADCI with mild parkinsonism exhibited decreased DAT availability in the caudate that was intermediate between healthy controls and patients with DLB. The DAT availability in other striatal subregions, including the posterior putamen, did not differ between the ADCI with parkinsonism and healthy control groups. The ROC analysis showed that DAT availability of all striatal subregions, especially the whole striatum, had a fair discriminatory power. Parkinsonian motor severity did not correlate with the striatal DAT availability in ADCI with parkinsonism. CONCLUSIONS The present study demonstrated that patients with ADCI with mild parkinsonism had distinct DAT scan patterns and suggests that parkinsonism is associated with the extranigral source of pathology.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 30722, South Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 30722, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 30722, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 30722, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 30722, South Korea
| | - Jungho Cha
- Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 30722, South Korea. .,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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16
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Ferrari C, Lombardi G, Polito C, Lucidi G, Bagnoli S, Piaceri I, Nacmias B, Berti V, Rizzuto D, Fratiglioni L, Sorbi S. Alzheimer's Disease Progression: Factors Influencing Cognitive Decline. J Alzheimers Dis 2019; 61:785-791. [PMID: 29226870 DOI: 10.3233/jad-170665] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) patients present high variability in the rate of cognitive decline. Despite the wide knowledge on factors influencing dementia risk, little is known on what accounts for AD progression. Previous studies on this topic have mainly analyzed each factor separately without taking into account the interaction between genetic and non-genetic factors. OBJECTIVE The aim of the present study is to evaluate the role of demographic, clinical, therapeutic, and genetic factors and their interaction on cognitive decline among newly diagnosed AD patients. METHODS We retrospectively selected 160 AD patients diagnosed at the Neurology Unit of Careggi University Hospital of Florence. We evaluated the occurrence of rapid cognitive changes defined as the worsening of more than four points at the Mini-Mental State Examination after 2-year follow up period. RESULTS Among the 160 AD patients, 50% presented rapid disease progression. Extrapyramidal signs at disease onset were predictors of worse outcome (OR 2.2), especially among Apolipoprotein E (APOE) ɛ4 allele carriers, while the presence of family history for dementia decreased the risk of rapid progression by about 50%. Higher educated ɛ4-carriers showed a slower AD progression. We identified the chronic use of aspirin as potential secondary preventative strategy for the non ɛ4-carriers. CONCLUSION At dementia onset, some clinical and demographic data can be predictors of future progression. The outcomes of the present study support the already hypothesized interaction between genetic and non-genetic factors during disease course and suggest genetic-based approaches.
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Affiliation(s)
| | - Gemma Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Cristina Polito
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Italy
| | - Giulia Lucidi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Irene Piaceri
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Italy
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Centrum, Stockholm, Sweden
| | - Sandro Sorbi
- IRCCS Don Gnocchi, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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17
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Chang YP, Chou MC, Lai CL, Chien I, Yang YH. Apolipoprotein E e4 allele is associated with extrapyramidal symptoms in Alzheimer's disease. Neuropsychiatr Dis Treat 2019; 15:1915-1919. [PMID: 31371964 PMCID: PMC6628598 DOI: 10.2147/ndt.s207050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Extrapyramidal symptoms (EPS) are not uncommon in Alzheimer's disease (AD). As apolipoprotein E(APOE) e4 allele is a major risk factor for late-onset AD, we intend to examine the association between APOE genotype and the development of EPS in AD. METHOD This study describes two hundred and fifty-five clinically diagnosed AD patients aged 72 to 80 years from 2010 to 2014. We reviewed the medical charts to determine the development of EPS. APOE genotypes were also confirmed. RESULTS APOE e4 allele was detected in 74 patients (29%) and rigidity was among the most common EPS (61%). After adjusting the age, gender, baseline clinical dementia rating, we found AD patients carrying APOE e4 allele are more likely to develop EPS (OR: 4.515, p=0.033). CONCLUSION This study demonstrates the higher coexistence of EPS in AD patients with APOE e4 allele. Furthermore, the identification of APOE e4 allele in the development of EPS in AD patients supports the hypothesis that EPS may be partially attributed to AD pathology.
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Affiliation(s)
- Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Chou
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chiou-Lian Lai
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I Chien
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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High prevalence of parkinsonism in patients with MCI or mild Alzheimer's disease. Alzheimers Dement 2018; 14:1615-1622. [PMID: 30222946 DOI: 10.1016/j.jalz.2018.06.3054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/19/2018] [Accepted: 06/15/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The objective of this study was to examine the prevalence of the coexistence of parkinsonism in patients with mild cognitive impairment (MCI) or mild Alzheimer's disease (AD). METHODS Outpatients were evaluated with Mini-Mental State Examination, Clinical Dementia Rating Scale, NIA-AA criteria, MRI, and 123I-IMP SPECT (3D-SSP). Parkinsonism in patients diagnosed with MCI (Mini-Mental State Examination ≥24, n = 63) or mild AD (Mini-Mental State Examination 20-23, n = 43) was examined using the Unified Parkinson's Disease Rating Scale-III and 123I-FP-CIT dopamine transporter SPECT. RESULTS One hundred six patients (60-97 years) were enrolled. Fifty-six patients (52.8%) were diagnosed as having concomitant parkinsonism with rigidity and resting tremor and dopamine transporter reduction in the basal ganglia. The mean (SD) age (n = 56) was 80.6 (6.1) years, significantly older than patients without parkinsonism [77.6 (7.0) years, n = 50] (P < .05). The mean (SD) UPDRS-III score was 5.8 (2.4). CONCLUSION The prevalence rate of the coexistence of mild parkinsonism in MCI or mild AD may be higher than previously recognized.
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19
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Schirinzi T, Di Lorenzo F, Sancesario GM, Di Lazzaro G, Ponzo V, Pisani A, Mercuri NB, Koch G, Martorana A. Amyloid-Mediated Cholinergic Dysfunction in Motor Impairment Related to Alzheimer’s Disease. J Alzheimers Dis 2018; 64:525-532. [DOI: 10.3233/jad-171166] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | | | - Giulia Maria Sancesario
- Department of Experimental Medicine and Surgery, University of Roma Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giulia Di Lazzaro
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | | | - Antonio Pisani
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
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20
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Added Value of Combined Semi-Quantitative and Visual [123I]FP-CIT SPECT Analyses for the Diagnosis of Dementia With Lewy Bodies. Clin Nucl Med 2017; 42:e96-e102. [DOI: 10.1097/rlu.0000000000001477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Stern Y, Gu Y, Cosentino S, Azar M, Lawless S, Tatarina O. The Predictors study: Development and baseline characteristics of the Predictors 3 cohort. Alzheimers Dement 2017; 13:20-27. [PMID: 27219818 PMCID: PMC5118195 DOI: 10.1016/j.jalz.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/18/2016] [Accepted: 04/09/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Predictors study was designed to predict the length of time to major disease outcomes in Alzheimer's disease (AD) patients. Here, we describe the development of a new, Predictors 3, cohort. METHODS Patients with prevalent or incident AD and individuals at-risk for developing AD were selected from the North Manhattan community and followed annually with instruments comparable to those used in the original two Predictors cohorts. RESULTS The original Predictors cohorts were clinic based and racially/ethnically homogenous (94% white, 6% black; 3% Hispanic). In contrast, the 274 elders in this cohort are community-based and ethnically diverse (39% white, 40% black, 21% other; 78% Hispanic). Confirming previous observations, psychotic features were associated with poorer function and mental status and extrapyramidal signs with poorer function. DISCUSSION This new cohort will allow us to test observations made in our original clinic-based cohorts in patients that may be more representative of the general community.
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Affiliation(s)
- Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Siobhan Lawless
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Oksana Tatarina
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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22
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Guerram M, Zhang LY, Jiang ZZ. G-protein coupled receptors as therapeutic targets for neurodegenerative and cerebrovascular diseases. Neurochem Int 2016; 101:1-14. [PMID: 27620813 DOI: 10.1016/j.neuint.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 12/24/2022]
Abstract
Neurodegenerative and cerebrovascular diseases are frequent in elderly populations and comprise primarily of dementia (mainly Alzheimer's disease) Parkinson's disease and stroke. These neurological disorders (NDs) occur as a result of neurodegenerative processes and represent one of the most frequent causes of death and disability worldwide with a significant clinical and socio-economic impact. Although NDs have been characterized for many years, the exact molecular mechanisms that govern these pathologies or why they target specific individuals and specific neuronal populations remain unclear. As research progresses, many similarities appear which relate these diseases to one another on a subcellular level. Discovering these similarities offers hope for therapeutic advances that could ameliorate the conditions of many diseases simultaneously. G-protein coupled receptors (GPCRs) are the most abundant receptor type in the central nervous system and are linked to complex downstream pathways, manipulation of which may have therapeutic application in many NDs. This review will highlight the potential use of neurotransmitter GPCRs as emerging therapeutic targets for neurodegenerative and cerebrovascular diseases.
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Affiliation(s)
- Mounia Guerram
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; Faculty of Exact Sciences and Nature and Life Sciences, Department of Biology, Larbi Ben M'hidi University, Oum El Bouaghi 04000, Algeria
| | - Lu-Yong Zhang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Zhen-Zhou Jiang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing 210009, China.
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Lamotte G, Morello R, Lebasnier A, Agostini D, Bouvard G, De La Sayette V, Defer GL. Influence of education on cognitive performance and dopamine transporter binding in dementia with Lewy bodies. Clin Neurol Neurosurg 2016; 146:138-43. [DOI: 10.1016/j.clineuro.2016.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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Theofilas P, Dunlop S, Heinsen H, Grinberg LT. Turning on the Light Within: Subcortical Nuclei of the Isodentritic Core and their Role in Alzheimer's Disease Pathogenesis. J Alzheimers Dis 2016; 46:17-34. [PMID: 25720408 DOI: 10.3233/jad-142682] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pharmacological interventions in Alzheimer's disease (AD) are likely to be more efficacious if administered early in the course of the disease, foregoing the spread of irreversible changes in the brain. Research findings underline an early vulnerability of the isodendritic core (IC) network to AD neurofibrillary lesions. The IC constitutes a phylogenetically conserved subcortical system including the locus coeruleus in pons, dorsal raphe nucleus, and substantia nigra in the midbrain, and nucleus basalis of Meynert in basal forebrain. Through their ascending projections to the cortex, the IC neurons regulate homeostasis and behavior by synthesizing aminergic and cholinergic neurotransmitters. Here we reviewed the evidence demonstrating that neurons of the IC system show neurofibrillary tangles in the earliest stages of AD, prior to cortical pathology, and how this involvement may explain pre-amnestic symptoms, including depression, agitation, and sleep disturbances in AD patients. In fact, clinical and animal studies show a significant reduction of AD cognitive and behavioral symptoms following replenishment of neurotransmitters associated with the IC network. Therefore, the IC network represents a unique candidate for viable therapeutic intervention and should become a high priority for research in AD.
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Affiliation(s)
- Panos Theofilas
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Dunlop
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Helmut Heinsen
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Psychiatrics, University of Wuerzburg, Germany
| | - Lea Tenenholz Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.,Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Eisenmenger LB, Huo EJ, Hoffman JM, Minoshima S, Matesan MC, Lewis DH, Lopresti BJ, Mathis CA, Okonkwo DO, Mountz JM. Advances in PET Imaging of Degenerative, Cerebrovascular, and Traumatic Causes of Dementia. Semin Nucl Med 2016; 46:57-87. [DOI: 10.1053/j.semnuclmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tosto G, Monsell SE, Hawes SE, Bruno G, Mayeux R. Progression of Extrapyramidal Signs in Alzheimer’s Disease: Clinical and Neuropathological Correlates. J Alzheimers Dis 2015; 49:1085-93. [DOI: 10.3233/jad-150244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Giuseppe Tosto
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Sergievsky Center, College of Physiciansand Surgeons, Columbia University New York, NY, USA
| | - Sarah E. Monsell
- National Alzheimer’s Coordinating Center, University of Washington, WA, USA
| | - Stephen E. Hawes
- National Alzheimer’s Coordinating Center, University of Washington, WA, USA
- Department of Epidemiology, University of Washington, WA, USA
| | - Giuseppe Bruno
- Department of Neurology and Psychiatry, University “Sapienza”, Rome, Italy
| | - Richard Mayeux
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Sergievsky Center, College of Physiciansand Surgeons, Columbia University New York, NY, USA
- Department of Neurology, College of Physiciansand Surgeons, Columbia University and the New York, Presbyterian Hospital, New York, NY, USA
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Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer's disease. Eur J Nucl Med Mol Imaging 2015; 43:184-192. [PMID: 26233438 PMCID: PMC4679785 DOI: 10.1007/s00259-015-3146-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/14/2015] [Indexed: 11/28/2022]
Abstract
Purpose 123I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT SPECT) and 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy can be used to assist in the diagnosis of patients with dementia with Lewy bodies (DLB). We compared the diagnostic value of these two methods in differentiating DLB from Alzheimer’s disease (AD). Furthermore, we evaluated whether a combination of DAT SPECT and MIBG myocardial scintigraphy would provide a more useful means of differentiating between DLB and AD. Methods Patients with AD (n = 57) and patients with DLB (n = 76) who underwent both DAT SPECT and MIBG myocardial scintigraphy were enrolled. The sensitivity, specificity, and accuracy of both methods as well as their combination for differentiating DLB from AD were calculated. Moreover, we examined whether symptoms of the patients with DLB were associated with the patterns of the abnormalities displayed on DAT SPECT and MIBG myocardial scintigraphy. Results The sensitivity and specificity of differentiating DLB from AD were 72.4 and 94.4 % by the heart to mediastinum ratio of MIBG uptake, 88.2 and 88.9 % by the specific binding ratio on DAT SPECT, and 96.1 and 90.7 % by their combination, respectively. The combined use of DAT SPECT and MIBG myocardial scintigraphy enabled more accurate differentiation between DLB and AD compared with either DAT SPECT or MIBG myocardial scintigraphy alone. There was a significantly higher frequency of parkinsonism in the abnormal DAT SPECT group than the normal DAT SPECT group. On the other hand, there was a higher frequency of the appearance of rapid eye movement (REM) sleep behavior disorder in the abnormal MIBG uptake group than the normal MIBG uptake group. Conclusion These results suggested that using a combination of these scintigraphic methods is a useful and practical approach to differentiate DLB from AD.
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Zhang P, Xie MQ, Ding YQ, Liao M, Qi SS, Chen SX, Gu QQ, Zhou P, Sun CY. Allopregnanolone enhances the neurogenesis of midbrain dopaminergic neurons in APPswe/PSEN1 mice. Neuroscience 2015; 290:214-26. [PMID: 25637494 DOI: 10.1016/j.neuroscience.2015.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/16/2015] [Accepted: 01/18/2015] [Indexed: 12/12/2022]
Abstract
An earlier study has demonstrated that exogenous allopregnanolone (APα) can reverse the reduction of tyrosine hydroxylase (TH)-positive neurons in the substantia nigra pars compacta (SNpc) of 3-month-old male triple transgenic Alzheimer's disease mouse (3xTgAD). This paper is focused on further clarifying the origin of these new-born TH-positive neurons induced by exogenous APα treatment. We performed a deeper research in another AD mouse model, 4-month-old male APPswe/PSEN1 double transgenic AD mouse (2xTgAD) by measuring APα concentration and counting immunopositive neurons using enzyme-linked immunosorbent assay (ELISA) and unbiased stereology. It was found that endogenous APα level and the number of TH-positive neurons were reduced in the 2xTgAD mice, and these reductions were present prior to the appearance of β-amyloid (Aβ)-positive plaques. Furthermore, a single 20mg/kg of exogenous APα treatment prevented the decline of total neurons, TH-positive neurons and TH/bromodeoxyuridine (BrdU) double-positive neurons in the SNpc of 2xTgAD mice although the decreased intensity of TH-positive fibers was not rescued in the striatum. It was also noted that exogenous APα administration had an apparent increase in the doublecortin (DCX)-positive neurons and DCX/BrdU double-positive neurons of subventricular zone (SVZ), as well as in the percentage of neuronal nuclear antigen (NeuN)/BrdU double-positive neurons of the SNpc in the 2xTgAD mice. These findings indicate that a lower level of endogenous APα is implicated in the loss of midbrain dopaminergic neurons in the 2xTgAD mice, and exogenous APα-induced a significant increase in the new-born dopaminergic neurons might be derived from the proliferating and differentiation of neural stem niche of SVZ.
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Affiliation(s)
- P Zhang
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China; Institute of Neuroscience, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - M Q Xie
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China; Institute of Neuroscience, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - Y-Q Ding
- Institute of Neuroscience, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - M Liao
- Institute of Neuroscience, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China; Department of Histology and Embryology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - S S Qi
- Department of Pharmacy, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
| | - S X Chen
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - Q Q Gu
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China; Institute of Neuroscience, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - P Zhou
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China
| | - C Y Sun
- Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China; Institute of Neuroscience, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, China.
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Jellinger KA. Pathogenesis of mild parkinsonian signs in aging. J Neurol 2015; 262:213. [DOI: 10.1007/s00415-014-7546-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022]
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At the interface of sensory and motor dysfunctions and Alzheimer's disease. Alzheimers Dement 2015; 11:70-98. [PMID: 25022540 PMCID: PMC4287457 DOI: 10.1016/j.jalz.2014.04.514] [Citation(s) in RCA: 360] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/13/2014] [Accepted: 04/09/2014] [Indexed: 11/21/2022]
Abstract
Recent evidence indicates that sensory and motor changes may precede the cognitive symptoms of Alzheimer's disease (AD) by several years and may signify increased risk of developing AD. Traditionally, sensory and motor dysfunctions in aging and AD have been studied separately. To ascertain the evidence supporting the relationship between age-related changes in sensory and motor systems and the development of AD and to facilitate communication between several disciplines, the National Institute on Aging held an exploratory workshop titled "Sensory and Motor Dysfunctions in Aging and AD." The scientific sessions of the workshop focused on age-related and neuropathologic changes in the olfactory, visual, auditory, and motor systems, followed by extensive discussion and hypothesis generation related to the possible links among sensory, cognitive, and motor domains in aging and AD. Based on the data presented and discussed at this workshop, it is clear that sensory and motor regions of the central nervous system are affected by AD pathology and that interventions targeting amelioration of sensory-motor deficits in AD may enhance patient function as AD progresses.
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Liepelt-Scarfone I, Lerche S, Behnke S, Godau J, Gaenslen A, Pausch C, Fassbender K, Brockmann K, Srulijes K, Huber H, Wurster I, Berg D. Clinical characteristics related to worsening of motor function assessed by the Unified Parkinson's Disease Rating Scale in the elderly population. J Neurol 2014; 262:451-8. [PMID: 25451854 DOI: 10.1007/s00415-014-7584-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
There is evidence that nigrostriatal pathology may at least partly underlie mild Parkinsonian signs. We evaluated whether an increase in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) could be predicted by the presence of risk and prodromal markers for neurodegenerative diseases in elderly individuals without those diseases. Therefore, we analyzed the UPDRS-III score and various risk and prodromal markers known to antecede neurodegenerative diseases in a population-based cohort comprising 807 individuals free of neurodegenerative diseases at baseline. After 5 years, eight persons (1.0 %) were diagnosed with Parkinson's Disease (PD). Of those, seven (87.5 %) had motor worsening ≥3 points on the UPDRS-III from baseline to follow-up, one had two points increase. Of the 788 people without PD, 568 (72.1 %) showed no increase in the UPDRS-III scale, 220 (27.9 %) had ≥1 point increase and out of these 104 (13.2 %) had an increase of ≥3 points in the UPDRS-III score after 5 years. We identified an age >60 years (relative risk, RR = 1.7; confidence interval, CI 1.3-2.1) and the occurrence of ≥2 risk factors (RR = 1.5; CI 1.2-1.9) as possible predictors of motor progression. After 5 years, individuals with an increase in the UPDRS-III score had more often a one-sided reduced arm swing (p < 0.001) and identified less odors in the Sniffin' sticks test (p < 0.041) than persons with stable motor performance. Our data support the assumption that progression of Parkinsonian signs assessed by the UPDRS-III parallels the development of prodromal markers for neurodegenerative diseases in the elderly population.
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Affiliation(s)
- Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany,
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Shulman JM, Yu L, Buchman AS, Evans DA, Schneider JA, Bennett DA, De Jager PL. Association of Parkinson disease risk loci with mild parkinsonian signs in older persons. JAMA Neurol 2014; 71:429-35. [PMID: 24514572 PMCID: PMC4039209 DOI: 10.1001/jamaneurol.2013.6222] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Parkinsonian motor signs are common in the aging population and are associated with adverse health outcomes. Compared with Parkinson disease (PD), potential genetic risk factors for mild parkinsonian signs have been largely unexplored. OBJECTIVE To determine whether PD susceptibility loci are associated with parkinsonism or substantia nigra pathology in a large community-based cohort of older persons. DESIGN, SETTING, AND PARTICIPANTS Eighteen candidate single-nucleotide polymorphisms from PD genome-wide association studies were evaluated in a joint clinicopathologic cohort. Participants included 1698 individuals and a nested autopsy collection of 821 brains from the Religious Orders Study and the Rush Memory and Aging Project, 2 prospective community-based studies. MAIN OUTCOMES AND MEASURES The primary outcomes were a quantitative measure of global parkinsonism or component measures of bradykinesia, rigidity, tremor, and gait impairment that were based on the motor Unified Parkinson's Disease Rating Scale. In secondary analyses, we examined associations with additional quantitative motor traits and postmortem indices, including substantia nigra Lewy bodies and neuronal loss. RESULTS Parkinson disease risk alleles in the MAPT (rs2942168; P = .0006) and CCDC62 (rs12817488; P = .004) loci were associated with global parkinsonism, and these associations remained after exclusion of patients with a PD diagnosis. Based on motor Unified Parkinson's Disease Rating Scale subscores, MAPT (P = .0002) and CCDC62 (P = .003) were predominantly associated with bradykinesia, and we further discovered associations between SREBF1 (rs11868035; P = .005) and gait impairment, SNCA (rs356220; P = .04) and rigidity, and GAK (rs1564282; P = .03) and tremor. In the autopsy cohort, only NMD3 (rs34016896; P = .03) was related to nigral neuronal loss, and no associations were detected with Lewy bodies. CONCLUSIONS AND RELEVANCE In addition to the established link to PD susceptibility, our results support a broader role for several loci in the development of parkinsonian motor signs and nigral pathology in older persons.
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Affiliation(s)
- Joshua M Shulman
- Department of Neurology, Baylor College of Medicine, Houston, Texas2Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Philip L De Jager
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts7Harvard Medical School, Boston, Massachusetts8Program in Medical and Population Genetics, Broad Institute, Cam
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Extrapyramidal signs by dementia severity in Alzheimer disease and dementia with Lewy bodies. Alzheimer Dis Assoc Disord 2014; 27:226-32. [PMID: 23023095 DOI: 10.1097/wad.0b013e31826f040d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alzheimer disease (AD) and dementia with Lewy bodies (DLB) are common etiologies of dementia with overlapping clinical features. Our objective was to determine which extrapyramidal signs (EPSs) are most helpful in identifying DLB. We analyzed data from the National Alzheimer's Coordinating Center, including demographics, Unified Parkinson's Disease Rating Scale (UPDRS) scores, Mini-Mental State Examination (MMSE) scores, and clinical diagnosis. The subjects were divided into 3 groups: AD, DLB, or Lewy body variant (LBV). The UPDRS motor scores were totaled and analyzed within and across the MMSE strata using regression techniques. Further, we divided UPDRS subscores into 9 EPSs, dichotomized as either present or absent. Logistic regression analysis was used to compare each of the EPS in the AD and Lewy body (DLB+LBV) groups. DLB subjects (n=130) were more likely to be male individuals, younger, and have higher MMSE scores (P<0.001) compared with that in AD (n=1826) or LBV (n=105) subjects. Differences were found for total UPDRS score and number of EPSs (P<0.001), after controlling for age, sex, and MMSE. Logistic regression models demonstrated that masked facies best differentiated AD from Lewy body (odds ratio=6.5, P<0.001, 95% confidence interval, 3.8-11.1). If these findings are neuropathologically validated, then the presence of specific EPS may help clinicians better differentiate AD and DLB.
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Uemura Y, Wada-Isoe K, Nakashita S, Nakashima K. Depression and cognitive impairment in patients with mild parkinsonian signs. Acta Neurol Scand 2013; 128:153-9. [PMID: 23397887 DOI: 10.1111/ane.12089] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mild parkinsonian signs (MPS) are reported to be associated with increased risk of dementia, Parkinson's disease, parkinsonism, and vascular lesions of white matter and are also a significant predictor of mortality. Although more than 20% of subjects aged 60 years and older suffer from MPS in Japan, it is often unrecognized and underestimated by patients and medical physicians. We used neuropsychological methods to examine cognitive function and depressive symptoms in subjects with MPS. METHODS We performed a population-based study in Ama-cho, a rural island town in western Japan. Participants included 951 subjects aged 65 years and older, 613 of whom completed all questionnaires, neurological examinations, and neuropsychological assessments and were included in the data analysis. Subjects were assessed for depression and subjective cognitive impairment using the Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and modified Unified Parkinson's Disease Rating Scale (mUPDRS). RESULTS Of the 613 participants, 143 were diagnosed with MPS. GDS scores were significantly higher in the MPS group compared with the motor control group, while MMSE scores were significantly lower. CONCLUSIONS We demonstrated that MPS correlate with both depressive symptoms and cognitive impairment.
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Affiliation(s)
- Y. Uemura
- Department of Neurology; Matsue Seikyo General Hospital; Matsue; Japan
| | - K. Wada-Isoe
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago; Japan
| | - S. Nakashita
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago; Japan
| | - K. Nakashima
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago; Japan
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Choi SH, Olabarrieta M, Lopez OL, Maruca V, Dekosky ST, Hamilton RL, Becker JT. Gray matter atrophy associated with extrapyramidal signs in the Lewy body variant of Alzheimer's disease. J Alzheimers Dis 2013; 32:1043-9. [PMID: 22886020 DOI: 10.3233/jad-2012-121108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Up to 60% of the patients with Alzheimer's disease (AD) can have cortical or brainstem Lewy bodies (LB), and extrapyramidal signs (EPS) have been found to be associated with LB in AD patients. However, the relationship between EPS and brain volumes has not been studied in the LB variant of AD using structural magnetic resonance imaging (MRI). The purpose of this study was to determine the relationship between patterns of brain atrophy and clinical EPS in patients with pathologically confirmed AD. We compared gray matter structure using voxel-based morphometry in 29 Definite AD cases, 16 (55%) of whom also had LBs identified with α-synuclein immunohistochemistry. Multivariate models analyzed brain volume at a voxel level accounting for subject group, Mini-Mental State Examination (MMSE), EPS, total brain volume, and the time from MRI scan to death. There was no significant difference in gray matter volume in the Definite AD patients as a function of LB. There was a significant association between gray matter volumes and the MMSE in AD patients, both with and without LBs. There was a significant correlation between gray matter volume and EPS only in the group of AD patients with LBs, and not in those with pure AD. These findings suggest that that the etiology of EPS in patients with the LB variant of AD is associated with neuronal loss in the nigrostriatal tracts. By contrast, the source of the EPS in AD alone appears to be less well localized.
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Affiliation(s)
- Seong Hye Choi
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Ziebell M, Andersen BB, Pinborg LH, Knudsen GM, Stokholm J, Thomsen G, Karlsborg M, Høgh P, Mørk ML, Hasselbalch SG. Striatal dopamine transporter binding does not correlate with clinical severity in dementia with Lewy bodies. J Nucl Med 2013; 54:1072-6. [PMID: 23637201 DOI: 10.2967/jnumed.112.114025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Patients who have dementia with Lewy bodies (DLB) show both clinical and histopathologic overlap with Alzheimer disease patients and Parkinson disease patients. In this study, we correlated the core features of DLB (dementia, parkinsonism, hallucinations, and fluctuations) with striatal dopamine transporter (DAT) availability as assessed with SPECT and (123)I-N-(3-iodoprop-2E-enyl)-2-β-carbomethoxy-3β-(4-methylphenyl) nortropane ((123)I-PE2I) in patients with newly diagnosed DLB. METHODS Two hundred eighty-eight patients were consecutively included in the study as they were referred for diagnostic SPECT scanning of DAT with (123)I-PE2I. Of those patients, 51 had, on the basis of clinical guideline criteria, a probable-DLB diagnosis at follow-up 16 ± 11.6 mo later. Before or on the day of the SPECT scan, DLB patients had a routine neurologic examination including Hoehn and Yahr grading and were cognitively evaluated with the Mini Mental State Examination. RESULTS There was no correlation between Mini Mental State Examination, Hoehn and Yahr score, fluctuations or hallucinations, and striatal DAT availability as measured with (123)I-PE2I and SPECT. CONCLUSION In patients with newly diagnosed DLB, symptoms are not associated with a reduction in striatal DAT despite its firm involvement in DLB pathology.
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Affiliation(s)
- Morten Ziebell
- Neurobiology Research Unit and Cimbi, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
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Bennett DA, Schneider JA, Arvanitakis Z, Wilson RS. Overview and findings from the religious orders study. Curr Alzheimer Res 2012; 9:628-45. [PMID: 22471860 PMCID: PMC3409291 DOI: 10.2174/156720512801322573] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 12/27/2011] [Accepted: 01/12/2012] [Indexed: 12/22/2022]
Abstract
UNLABELLED The Religious Orders Study is a longitudinal clinical-pathologic cohort study of aging and Alzheimer's disease (AD). In this manuscript, we summarize the study methods including the study design and describe the clinical evaluation, assessment of risk factors, collection of ante-mortem biological specimens, brain autopsy and collection of selected postmortem data. THE RESULTS (1) review the relation of neuropathologic indices to clinical diagnoses and cognition proximate to death; (2) examine the relation of risk factors to clinical outcomes; (3) examine the relation of risk factors to measures of neuropathology; and (4) summarize additional study findings. We then discuss and contextualize the study findings.
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Affiliation(s)
- David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina, Suite 1028, Chicago, IL 60612, USA.
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Jellinger KA. Interaction between pathogenic proteins in neurodegenerative disorders. J Cell Mol Med 2012; 16:1166-83. [PMID: 22176890 PMCID: PMC3823071 DOI: 10.1111/j.1582-4934.2011.01507.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/16/2011] [Indexed: 12/21/2022] Open
Abstract
The misfolding and progressive aggregation of specific proteins in selective regions of the nervous system is a seminal occurrence in many neurodegenerative disorders, and the interaction between pathological/toxic proteins to cause neurodegeneration is a hot topic of current neuroscience research. Despite clinical, genetic and experimental differences, increasing evidence indicates considerable overlap between synucleinopathies, tauopathies and other protein-misfolding diseases. Inclusions, often characteristic hallmarks of these disorders, suggest interactions of pathological proteins enganging common downstream pathways. Novel findings that have shifted our understanding in the role of pathologic proteins in the pathogenesis of Alzheimer, Parkinson, Huntington and prion diseases, have confirmed correlations/overlaps between these and other neurodegenerative disorders. Emerging evidence, in addition to synergistic effects of tau protein, amyloid-β, α-synuclein and other pathologic proteins, suggests that prion-like induction and spreading, involving secreted proteins, are major pathogenic mechanisms in various neurodegenerative diseases, depending on genetic backgrounds and environmental factors. The elucidation of the basic molecular mechanisms underlying the interaction and spreading of pathogenic proteins, suggesting a dualism or triad of neurodegeneration in protein-misfolding disorders, is a major challenge for modern neuroscience, to provide a deeper insight into their pathogenesis as a basis of effective diagnosis and treatment.
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Jellinger KA. Interaction between α-synuclein and other proteins in neurodegenerative disorders. ScientificWorldJournal 2011; 11:1893-907. [PMID: 22125446 PMCID: PMC3217595 DOI: 10.1100/2011/371893] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/10/2011] [Indexed: 02/06/2023] Open
Abstract
Protein aggregation is a common characteristic of many neurodegenerative disorders, and the interaction between pathological/toxic proteins to cause neurodegeneration is a hot topic of current neuroscience research. Despite clinical, genetic, and experimental differences, evidence increasingly indicates considerable overlap between synucleinopathies and tauopathies or other protein-misfolding diseases. Inclusions, characteristics of these disorders, also occurring in other neurodegenerative diseases, suggest interactions of pathological proteins engaging common downstream pathways. Novel findings that have shifted our understanding in the role of pathologic proteins in the pathogenesis of Parkinson and Alzheimer diseases have confirmed correlations/overlaps between these and other neurodegenerative disorders. The synergistic effects of α-synuclein, hyperphosphorylated tau, amyloid-β, and other pathologic proteins, and the underlying molecular pathogenic mechanisms, including induction and spread of protein aggregates, are critically reviewed, suggesting a dualism or triad of neurodegeneration in protein-misfolding disorders, although the etiology of most of these processes is still mysterious.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, A-1070 Vienna, Austria.
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Park M, Shah RC, Fogg LF, Wyatt JK. Daytime sleepiness in mild Alzheimer's disease with and without parkinsonian features. Sleep Med 2011; 12:397-402. [PMID: 21388877 DOI: 10.1016/j.sleep.2010.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) and nocturnal sleep disruption are common in Alzheimer's disease (AD). However, little is known regarding risk factors for developing EDS and sleep disruption in AD. In AD, EDS is associated with parkinsonian motor features (PF), which are associated with faster cognitive decline. The primary aim of this exploratory study was to evaluate whether differences in EDS and nocturnal sleep disruption exist between AD participants with versus without PF. METHODS Thirty-six participants with mild AD were evaluated for PF using the modified motor UPDRS (mmUPDRS) scoring system and classified according to absence (AD-PF, n=19) or presence (AD+PF, n=17) of PF. EDS was assessed using questionnaires and a multiple sleep latency test (MSLT) performed the day after nocturnal polysomnogram. Participants were considered "Sleepy" or "Not Sleepy" according to mean MSLT scores (cutoff score=10.4 min). RESULTS Results showed that the AD+PF group were sleepier than the AD-PF group by subjective and objective measures, despite similarities in nocturnal sleep. The AD+PF group had higher scores on the Epworth Sleepiness Scale (8.5 versus 3.9, p=.001). The AD+PF group also had higher percentage of participants that had "Sleepy" MSLT scores compared to the AD-PF group (75% versus 31.6%, respectively; χ(2)=6.56, p=.01). CONCLUSIONS The presence of parkinsonian features may be an independent risk factor for sleepiness in mild AD.
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Affiliation(s)
- Margaret Park
- Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612-3833, USA.
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Israeli-Korn SD, Massarwa M, Schechtman E, Strugatsky R, Avni S, Farrer LA, Friedland RP, Inzelberg R. Mild cognitive impairment is associated with mild parkinsonian signs in a door-to-door study. J Alzheimers Dis 2011; 22:1005-13. [PMID: 20930290 DOI: 10.3233/jad-2010-101230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mild cognitive impairment (MCI) and healthy aging have been shown to be associated with mild parkinsonian signs (MPS). We performed a door-to-door observational and follow-up study amongst consenting residents of Wadi Ara Arab villages in northern Israel aged ≥65 years (n=687) to examine whether MPS represent a risk factor for MCI and/or conversion from MCI to Alzheimer's disease (AD). In Phase 1, 223 cognitively normal (CN) and 173 MCI subjects were assessed by interview for medical history, neurological examination, motor part of the Unified Parkinson Disease Rating Scale (mUPDRS) (divided into item-clusters: axial, limb bradykinesia, tremor and rigidity) and cognitive tests. MCI subjects (n=111) were re-evaluated in Phase 2 for conversion to AD at least one year after initial assessment. MCI subjects had a higher frequency of axial dysfunction (8.7% vs. 1.3%) and limb bradykinesia (10.4% vs. 1.3%) than CN subjects (p<0.001, both). Stepwise logistic regression analysis estimating the probability of MCI vs. CN revealed higher mUPDRS (OR =1.19, 95% CI, 1.05 to 1.35, p=0.006) and higher limb bradykinesia scores (OR=1.75, 95% CI, 1.2 to 2.56, p=0.003) and not age as explanatory variables. Presence of MPS did not predict conversion to AD after adjustment for age and time-interval. These results suggest that axial and bradykinetic parkinsonian signs represent risk factors for MCI but MPS may not predict conversion from MCI to AD.
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Affiliation(s)
- Simon D Israeli-Korn
- The Joseph Sagol Neuroscience Center and Neurology Department, Sheba Medical Center, Tel Hashomer, Israel
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Cilia R, Rossi C, Frosini D, Volterrani D, Siri C, Pagni C, Benti R, Pezzoli G, Bonuccelli U, Antonini A, Ceravolo R. Dopamine Transporter SPECT Imaging in Corticobasal Syndrome. PLoS One 2011; 6:e18301. [PMID: 21559307 PMCID: PMC3085517 DOI: 10.1371/journal.pone.0018301] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 03/02/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate dopaminergic function in a large cohort of patients with corticobasal syndrome (CBS) and describe its relationship with clinical features in comparison to Parkinson's disease and healthy control subjects. In addition, we assessed prevalence and features of individuals with CBS and in vivo evidence of preserved nigral neuronal density. BACKGROUND Substantia nigra pars compacta (SNc) neuronal degeneration is a mandatory pathological criterion for definite corticobasal degeneration, though sporadic autopsy-proven cases with ante-mortem imaging evidence of preserved nigral terminals have been recently described. METHODS In this multicenter study, we investigated presynaptic nigrostriatal function in 36 outpatients fulfilling clinical criteria for "probable corticobasal degeneration" (age 71±7.3 years; disease duration 3.9±1.6 years), 37 PD and 24 healthy control subjects using FP-CIT single photon emission computed tomography. Clinical, neuropsychological, and magnetic resonance imaging assessment was performed to characterize CBS patients. Linear discriminant analysis was used to categorize normal vs. pathological scans. RESULTS FP-CIT binding reduction in patients with CBS was characterized by larger variability, more uniform reduction throughout the striatum and greater hemispheric asymmetry compared to PD. Moreover, there was no significant correlation between tracer uptake values and clinical features such as disease duration and severity. Despite all CBS subjects showed obvious bilateral extrapyramidal signs, FP-CIT uptake was found to be normal bilaterally in four CBS patients and only unilaterally in other four cases. Extensive clinical, neuropsychological and imaging assessment did not reveal remarkable differences between CBS subjects with normal vs. pathological FP-CIT uptake. CONCLUSIONS Our findings support the hypothesis that extrapyramidal motor symptoms in CBS are not invariably associated with SNc neuronal degeneration and that supranigral factors may play a major role in several cases. CBS individuals with normal FP-CIT uptake do not show any clinical or cognitive feature suggesting a different pathology than CBD.
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Affiliation(s)
- Roberto Cilia
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
| | - Carlo Rossi
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | - Daniela Frosini
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | | | - Chiara Siri
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
| | - Cristina Pagni
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | | | - Gianni Pezzoli
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
| | - Ubaldo Bonuccelli
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
- Neurological Unit, Viareggio, Italy
| | - Angelo Antonini
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy
- Institute of Neurology, IRCCS San Camillo, Venice, Italy
- University of Padua, Padua, Italy
| | - Roberto Ceravolo
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
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Uemura Y, Wada-Isoe K, Nakashita S, Nakashima K. Mild parkinsonian signs in a community-dwelling elderly population sample in Japan. J Neurol Sci 2011; 304:61-6. [PMID: 21377694 DOI: 10.1016/j.jns.2011.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/24/2010] [Accepted: 02/11/2011] [Indexed: 12/21/2022]
Abstract
Mild parkinsonian signs (MPS) may represent the mild end of a disease spectrum that spans from normal aging to neurodegenerative diseases. We conducted a population-based study in a rural island town in western Japan, Ama-cho. Participants included 1129 subjects, aged 60 years and older, residing in the town. Participants were classified according to a modified Unified Parkinson's Disease Rating Scale (mUPDRS) score. MPS was determined to be present if any of the following conditions were met: (1) two or more mUPDRS ratings=1 [MPS-mild]; (2) one mUPDRS rating≥2; or (3) mUPDRS rest tremor rating≥1; [(2) and (3): MPS-severe]. Subjects wore a uniaxial accelerometer (Actiwatch), resulting in the measurement of actigraphic activity counts (AC). Of the 804 participants with complete data, 178 subjects (22.1%) were classified as demonstrating MPS. AC was significantly lower in the MPS-severe group compared with both the CTL and the MPS-mild groups. Diagnostic sensitivity for MPS-severe became 100% when we adopted a cutoff point of low physical activity, as measured by actigraphy, combined with the presence of subjective depression. We established the prevalence of MPS in a community-dwelling elderly population sample in Japan. Actigraphy may be a useful objective tool for screening MPS-severe.
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Affiliation(s)
- Yusuke Uemura
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
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Interaction between α-synuclein and tau in Parkinson's disease comment on Wills et al.: elevated tauopathy and α-synuclein pathology in postmortem Parkinson's disease brains with and without dementia. Exp Neurol 2010; 225: 210-218. Exp Neurol 2010; 227:13-8. [PMID: 20965169 DOI: 10.1016/j.expneurol.2010.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/12/2010] [Indexed: 11/23/2022]
Abstract
Recent neurochemical studies in postmortem brains of patients with Parkinson's disease (PD), PD with dementia (PDD) and age-matched controls revealed significant decrease of tyrosine hydroxylase (TH) and dopamine transporter (DAT) in striatum, confirming previous studies indicating substantial loss of dopaminergic neurons and terminals. Insoluble α-synuclein (αSyn) was significantly increased in both striata and inferior frontal gyrus (IFG), more severe in PDD, probably related to Lewy body (LB) burden discussed as one cause of dementia in PD. Parkin levels frequently related to recessive and young-onset PD were unchanged, suggesting no link to sporadic PD. Novel and most interesting data showed elevated tauopathy in striata of both PD and PDD, associated with increased levels of phosphorylated GSK-3β and reduced 20S proteasomal subunits but - despite increased cortical αSyn - unchanged pTau in IFG, related to increased pGSK-3β and decreased 19S proteasome subunits. These data, recently confirmed in PDGF-αSyn transgenic mice (Haggerty et al., submitted) suggest tauopathy in PD and PDD restricted to the dopaminergic nigrostriatal system and in various animal models of PD show topographic differences from a global tauopathy in Alzheimer's disease (AD) (and other tauopathies). Although some of these data are at variance to current neuropathologic findings in PD and PDD, they confirm frequently discussed correlations/overlaps between AD and PD/PDD and synergistic effects of αSyn, pTau, β-amyloid, and other pathologic proteins, suggesting a dualism or triad of neurodegeneration, the basic molecular pathogenesis remains to be elucidated.
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Louis ED, Tang MX, Schupf N. Mild parkinsonian signs are associated with increased risk of dementia in a prospective, population-based study of elders. Mov Disord 2010; 25:172-8. [PMID: 20077482 DOI: 10.1002/mds.22943] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There is some evidence that mild parkinsonian signs (MPSs) are associated with increased risk of dementia, suggesting that MPS could be an early biomarker for dementia. Our aims, in a new cohort, were to determine whether (1) baseline MPS are a predictor of incident dementia and (2) there is an interaction between MPS and other baseline risk factors for dementia (i.e., the presence of both together greatly elevates the risk of dementia) was the objective. In a prospective, longitudinal study of community-dwelling elders in northern Manhattan, NY, Parkinsonian signs were rated with an abbreviated Unified Parkinson's Disease Rating Scale. Risk of incident dementia was assessed using Cox proportional hazards models. There were 1,851 participants (mean follow-up = 3.7 years). Participants with baseline MPS were twice as likely to develop dementia as participants without MPS: 16.3% versus 7.7%, unadjusted hazards ratio (HR) = 2.24 (P< 0.001), adjusted HR = 1.98 (P < 0.001). MPS were divided into three subtypes: adjusted HR(axial dysfunction) = 2.45 (P < 0.001), adjusted HR(tremor) = 2.38 (P = 0.006), and adjusted HR(rigidity) = 1.16 (P = 0.58). When MPS were treated as a continuous variable, the adjusted HR = 1.15 (P = 0.001). There were no interactions between MPS and other baseline risk factors for dementia, including gender, education, race, family history of dementia, stroke, and apolipoprotein E-e4. Baseline MPS seems to be a predictor of incident dementia. These motor signs might, therefore, serve as a useful biomarker for emerging dementia.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Portet F, Scarmeas N, Cosentino S, Helzner EP, Stern Y. Extrapyramidal signs before and after diagnosis of incident Alzheimer disease in a prospective population study. ACTA ACUST UNITED AC 2009; 66:1120-6. [PMID: 19752301 DOI: 10.1001/archneurol.2009.196] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Extrapyramidal signs (EPSs) are commonly accepted as a feature of Alzheimer disease (AD) and may influence both the profile of impairment and prognosis. OBJECTIVE To examine rates of occurrence and risk factors for all types of EPSs and to describe the impact of EPSs over time on the clinical course of AD. DESIGN Longitudinal study. SETTING The Washington Heights Hamilton Heights Inwood Columbia Aging Project. Patients A total of 388 patients with incident AD (mean age, 79 years; 71.4% female). MAIN OUTCOME MEASURES Extrapyramidal signs rated by means of a standardized portion of the Unified Parkinson's Disease Rating Scale; prevalence and incidence rates and cumulative risk for non-drug-induced EPSs; and rates of change in EPSs over time, taking into account potential covariates. RESULTS Extrapyramidal signs were detected in 12.3% of patients at first evaluation and 22.6% at last evaluation. In a multivariate-adjusted generalized estimating equation model of change, total EPS score increased at an annual rate of 1.3%. Women (relative risk [RR], 1.57; P = .03), older patients (RR, 1.03; P = .02), and those with EPSs at baseline (RR, 2.07; P = .001) had greater rates of cognitive decline. CONCLUSIONS Extrapyramidal signs occur frequently and progress significantly in AD. Patients with incident AD and concomitant EPSs have a greater rate of cognitive decline than do patients with incident AD but without EPSs.
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Affiliation(s)
- Florence Portet
- Memory Research Resource Center for Alzheimer's Disease, Neurology Department, U 888 Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Montpellier, France.
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Classification and basic pathology of Alzheimer disease. Acta Neuropathol 2009; 118:5-36. [PMID: 19381658 DOI: 10.1007/s00401-009-0532-1] [Citation(s) in RCA: 654] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 03/30/2009] [Accepted: 03/30/2009] [Indexed: 11/26/2022]
Abstract
The lesions of Alzheimer disease include accumulation of proteins, losses of neurons and synapses, and alterations related to reactive processes. Extracellular Abeta accumulation occurs in the parenchyma as diffuse, focal or stellate deposits. It may involve the vessel walls of arteries, veins and capillaries. The cases in which the capillary vessel walls are affected have a higher probability of having one or two apoepsilon 4 alleles. Parenchymal as well as vascular Abeta deposition follows a stepwise progression. Tau accumulation, probably the best histopathological correlate of the clinical symptoms, takes three aspects: in the cell body of the neuron as neurofibrillary tangle, in the dendrites as neuropil threads, and in the axons forming the senile plaque neuritic corona. The progression of tau pathology is stepwise and stereotyped from the entorhinal cortex, through the hippocampus, to the isocortex. The neuronal loss is heterogeneous and area-specific. Its mechanism is still discussed. The timing of the synaptic loss, probably linked to Abeta peptide itself, maybe as oligomers, is also controversial. Various clinico-pathological types of Alzheimer disease have been described, according to the type of the lesions (plaque only and tangle predominant), the type of onset (focal onset), the cause (genetic or sporadic) and the associated lesions (Lewy bodies, vascular lesions, hippocampal sclerosis, TDP-43 inclusions and argyrophilic grain disease).
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Fleischman DA, Buchman AS, Bienias JL, Bennett DA. Visuoperceptual repetition priming and progression of parkinsonian signs in aging. Neurobiol Aging 2009; 30:441-9. [PMID: 17709154 PMCID: PMC2666281 DOI: 10.1016/j.neurobiolaging.2007.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Revised: 06/19/2007] [Accepted: 07/07/2007] [Indexed: 10/22/2022]
Abstract
Parkinsonian signs in older persons are associated with numerous adverse health outcomes, however there is limited information about factors which predict progression of these signs. Using generalized linear models, we examined the association between efficiency in visuoperceptual and conceptual processing, measured by repetition priming, and rate of change in parkinsonian signs in a large sample of older persons without cognitive impairment or Parkinson's disease. Subjects with better visuoperceptual priming, measured by threshold word-identification and word-stem completion, at study baseline, progressed more slowly during follow-up of up to 11 years. Conceptual priming was not associated with change in parkinsonian signs. The findings demonstrate that individual differences in visuoperceptual processing efficiency, measured by repetition priming, occur in older persons without cognitive impairment and predict important changes in motor function. Reduced visuoperceptual priming in aging may be an early signal of vulnerability in a corticostrial circuit that contributes to sensorimotor integration.
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Affiliation(s)
- Debra A Fleischman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
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Huang X, Abbott RD, Petrovitch H, Mailman RB, Ross GW. Low LDL cholesterol and increased risk of Parkinson's disease: prospective results from Honolulu-Asia Aging Study. Mov Disord 2008; 23:1013-1018. [PMID: 18381649 DOI: 10.1002/mds.22013] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Low-density lipoprotein cholesterol (LDL-C) levels are suggested to be associated inversely with Parkinson's disease (PD). To test the hypothesis that LDL-C levels may increase PD risk, we studied a prospective cohort of 3,233 men (Honolulu-Asia Aging Study) for whom the LDL-C from fasting lipid profiles was obtained during 1991 to 1993. The cohort was followed longitudinally until 2001 for incident Parkinson's cases. During follow-up, 41 men developed PD (18.4/10,000 person-years). Although the incidence of PD increased with decreasing LDL-C in a dose-dependent manner, the association was only significant for men aged 71 to 75 years. In the latter group, risk of PD declined from 38.5/10,000 person-years in men with LDL-C levels <80 mg/dl to less than 9/10,000 person-years for concentrations that were > or =140 mg/dl. After adjustment for age, smoking, coffee intake, and other factors, the relative odds of PD for men at the 80th versus the 20th percentile of LDL-C (135 vs. 85 mg/dl) was 0.4 (95% confidence interval: 0.2, 0.9). This prospective study supports the hypothesis that low LDL-C is associated with an increased risk of PD. Although confirmation is required, the underlying mechanisms may be useful in understanding key aspects of PD.
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Affiliation(s)
- Xuemei Huang
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert D Abbott
- Division of Biostatistics and Epidemiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Department of Health Science, Shiga University of Medical Science, Otsu, Shiga, Japan.,The Pacific Health Research Institute and the Kuakini Medical Center, Honolulu, Hawaii, USA
| | - Helen Petrovitch
- The Pacific Health Research Institute and the Kuakini Medical Center, Honolulu, Hawaii, USA.,Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii, USA.,Department of Geriatric Medicine, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA.,Department of Medicine, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Richard B Mailman
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - G Webster Ross
- The Pacific Health Research Institute and the Kuakini Medical Center, Honolulu, Hawaii, USA.,Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii, USA.,Department of Geriatric Medicine, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA.,Department of Medicine, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
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Wilson RS, Arnold SE, Buchman AS, Tang Y, Bennett DA. Odor identification and progression of parkinsonian signs in older persons. Exp Aging Res 2008; 34:173-87. [PMID: 18568978 DOI: 10.1080/03610730802070001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The authors tested the hypothesis that difficulty in identifying odors, a common finding in Parkinson's disease, is associated with more rapid progression of parkinsonian signs in 743 community-dwelling older people without dementia or Parkinson's disease at study onset. Odor identification ability was assessed at baseline with the 12-item Brief Smell Identification Test (mean = 9.0 correct, SD = 2.1), and parkinsonism was assessed annually for up to 5 years with a modified version of the Unified Parkinson's Disease Rating Scale. In an analysis adjusted for age, sex, and education, lower odor identification score was related to higher level of global parkinsonism at baseline (p < .001) and more rapid progression of global parkinsonism on follow-up (p = .002). This result mainly reflected an association of odor identification with worsening parkinsonian gait. The results suggest that impaired odor identification is associated with more rapid progression of parkinsonism in old age, particularly parkinsonian gait disturbance.
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Affiliation(s)
- Robert S Wilson
- Rush Alzheimer's Disease Center and Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA.
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