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Ouellette J, Lacoste B. From Neurodevelopmental to Neurodegenerative Disorders: The Vascular Continuum. Front Aging Neurosci 2021; 13:749026. [PMID: 34744690 PMCID: PMC8570842 DOI: 10.3389/fnagi.2021.749026] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
Structural and functional integrity of the cerebral vasculature ensures proper brain development and function, as well as healthy aging. The inability of the brain to store energy makes it exceptionally dependent on an adequate supply of oxygen and nutrients from the blood stream for matching colossal demands of neural and glial cells. Key vascular features including a dense vasculature, a tightly controlled environment, and the regulation of cerebral blood flow (CBF) all take part in brain health throughout life. As such, healthy brain development and aging are both ensured by the anatomical and functional interaction between the vascular and nervous systems that are established during brain development and maintained throughout the lifespan. During critical periods of brain development, vascular networks remodel until they can actively respond to increases in neural activity through neurovascular coupling, which makes the brain particularly vulnerable to neurovascular alterations. The brain vasculature has been strongly associated with the onset and/or progression of conditions associated with aging, and more recently with neurodevelopmental disorders. Our understanding of cerebrovascular contributions to neurological disorders is rapidly evolving, and increasing evidence shows that deficits in angiogenesis, CBF and the blood-brain barrier (BBB) are causally linked to cognitive impairment. Moreover, it is of utmost curiosity that although neurodevelopmental and neurodegenerative disorders express different clinical features at different stages of life, they share similar vascular abnormalities. In this review, we present an overview of vascular dysfunctions associated with neurodevelopmental (autism spectrum disorders, schizophrenia, Down Syndrome) and neurodegenerative (multiple sclerosis, Huntington's, Parkinson's, and Alzheimer's diseases) disorders, with a focus on impairments in angiogenesis, CBF and the BBB. Finally, we discuss the impact of early vascular impairments on the expression of neurodegenerative diseases.
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Affiliation(s)
- Julie Ouellette
- Ottawa Hospital Research Institute, Neuroscience Program, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Baptiste Lacoste
- Ottawa Hospital Research Institute, Neuroscience Program, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
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Heim B, Krismer F, Poewe W, Seppi K. Imaging markers of disease progression in multiple system atrophy. FUTURE NEUROLOGY 2019. [DOI: 10.2217/fnl-2018-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Different neuroimaging modalities hold potential as surrogate markers of underlying neurodegeneration in multiple system atrophy (MSA) and may reflect cell loss, altered glucose metabolism, microglial proliferation, astroglial activation, and nigrostriatal denervation. Multiple studies have demonstrated that serial structural and functional imaging studies are capable of demonstrating neurodegeneration in MSA patients quantitatively, which allows sample size estimates based on rates of progression of these neuroimaging markers. This review summarizes recent research findings as a tool to assess longitudinal changes of serial neuroimaging-derived parameters in MSA.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, 6020 Innsbruck, Austria
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Guevara C, de Grazia J, Baabor P, Soruco W. Self-reported urinary impairment identifies 'fast progressors' in terms of neuronal loss in multiple system atrophy. Auton Neurosci 2019; 217:1-6. [PMID: 30704970 DOI: 10.1016/j.autneu.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/11/2018] [Accepted: 12/13/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION MSA is an adult-onset, sporadic, progressive parkinsonian syndrome characterised by the presence of akinesia, cerebellar dysfunction, autonomic failure and pyramidal signs. Annualized-whole-brain atrophy rate (a-WBAR) is an informative way to quantify disease progression. In this longitudinal work we investigate the correlations of a-WBAR with clinical scales for motor impairment, autonomic disability and cognitive decline in MSA and explore how atrophy progresses within the brain. METHOD Fourty-one MSA patients were studied using Structural Imaging Evaluation with Normalization of Atrophy (SIENA). SIENA is an MRI-based algorithm that quantifies brain tissue volume. Clinical parameters were explored using the 18-item Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr Scale, the Frontal Assessment Battery and the Natural History and Neuroprotection in Parkinson Plus Syndromes scale (sub-items for orthostatic and urinary functions). RESULTS The mean (±SD) age was 60.4 years ± 7.7 and a-WBAR was 1.65% ± 0.9. Demographics and clinical ratings at the time of the first scan were non-significantly associated with a-WBAR. The only exception was the baseline urinary score with a weak but significant association (R2 = 0.15, p = 0.04). Progression of grey matter atrophy was detected in the left superior temporal gyrus, right middle frontal gyrus, right frontopolar region and midbrain. CONCLUSION Urinary impairment at baseline may help to identify 'fast progressors' in terms of neuronal loss, particularly in the frontal and temporal lobes. Thus, urinary impairment should be recognized as a key target for disease modifying therapeutic interventions in MSA.
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Affiliation(s)
- Carlos Guevara
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile.
| | - José de Grazia
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile
| | - Pablo Baabor
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile
| | - Wendy Soruco
- Facultad de Medicina, Universidad de Chile, Santos Dummont 999, Santiago, Chile
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Abstract
Qualitative and quantitative structural magnetic resonance imaging offer objective measures of the underlying neurodegeneration in atypical parkinsonism. Regional changes in tissue volume, signal changes and increased deposition of iron as assessed with different structural MRI techniques are surrogate markers of underlying neurodegeneration and may reflect cell loss, microglial proliferation and astroglial activation. Structural MRI has been explored as a tool to enhance diagnostic accuracy in differentiating atypical parkinsonian disorders (APDs). Moreover, the longitudinal assessment of serial structural MRI-derived parameters offers the opportunity for robust inferences regarding the progression of APDs. This review summarizes recent research findings as (1) a diagnostic tool for APDs as well as (2) as a tool to assess longitudinal changes of serial MRI-derived parameters in the different APDs.
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Kim HJ, Jeon B, Fung VSC. Role of Magnetic Resonance Imaging in the Diagnosis of Multiple System Atrophy. Mov Disord Clin Pract 2016; 4:12-20. [PMID: 30363358 DOI: 10.1002/mdc3.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022] Open
Abstract
Background Multiple system atrophy (MSA) is a rapidly progressing neurodegenerative disorder without effective disease-modifying therapies. Because of a lack of reliable diagnostic biomarkers, there has been increasing interest in using magnetic resonance imaging (MRI) to improve the diagnostic accuracy of MSA. Methods This review summarizes recent literatures on the role of MRI in the diagnosis of MSA. Results Several MRI abnormalities on conventional MRI already are included in the current diagnostic criteria for MSA. Other features on conventional MRI are also used to make a diagnosis of MSA or to rule out alternative diagnoses. On the other hand, some of the MRI findings that were previously considered suggestive of a diagnosis of MSA are now being challenged, because it turned out that they were not as specific to MSA as previously thought. More advanced MRI modalities, including susceptibility-weighted imaging, diffusion-weighted imaging, diffusion tensor imaging, voxel-based morphometry, and cortical thickness analysis, are now used to study the changes in the brains of patients with MSA. Furthermore, studies have produced promising results demonstrating the use of MRI as a tool for monitoring and assessing disease progression in MSA. Conclusions MRI is useful and indispensable in the diagnosis of MSA and also possibly for monitoring disease progression. In this regard, well-designed, long-term, prospective studies on large numbers of patients are needed.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Victor S C Fung
- Movement Disorders Unit Department of Neurology Westmead Hospital and Sydney Medical School Sydney Australia
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Whole-Brain Atrophy Rate in Idiopathic Parkinson's Disease, Multiple System Atrophy, and Progressive Supranuclear Palsy. PARKINSONS DISEASE 2016; 2016:9631041. [PMID: 27190673 PMCID: PMC4848442 DOI: 10.1155/2016/9631041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/16/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022]
Abstract
In multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), the absence of surrogate endpoints makes clinical trials long and expensive. We aim to determine annualized whole-brain atrophy rates (a-WBAR) in idiopathic Parkinson's disease (IPD), MSA, and PSP. Ten healthy controls, 20 IPD, 12 PSP, and 8 MSA patients were studied using a volumetric MRI technique (SIENA). In controls, the a-WBAR was 0.37% ± 0.28 (CI 95% 0.17–0.57), while in IPD a-WBAR was 0.54% ± 0.38 (CI 95% 0.32–0.68). The IPD patients did not differ from the controls. In PSP, the a-WBAR was 1.26% ± 0.51 (CI 95%: 0.95–1.58). In MSA, a-WBAR was 1.65% ± 1.12 (CI 95%: 0.71–2.59). MSA did not differ from PSP. The a-WBAR in PSP and MSA were significantly higher than in the IPD group (p = 0.004 and p < 0.001, resp.). In PSP, the use of a-WBAR required one-half of the patients needed for clinical scales to detect a 50% reduction in their progression. In MSA, one-quarter of the patients would be needed to detect the same effect. a-WBAR is a reasonable candidate to consider as a surrogate endpoint in short clinical trials using smaller sample sizes. The confidence intervals for a-WBAR may add a potential retrospective application for a-WBAR to improve the diagnostic accuracy of MSA and PSP versus IPD.
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Cordato NJ, Halliday GM. The differentiation of progressive supranuclear palsy. Neurodegener Dis Manag 2015; 5:385-8. [PMID: 26510162 DOI: 10.2217/nmt.15.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nicholas J Cordato
- St George & Calvary Hospitals, 3 Chapel Street, Kogarah NSW 2217, Sydney, Australia.,Neuroscience Research Australia & University of New South Wales, Sydney, Australia
| | - Glenda M Halliday
- Neuroscience Research Australia & University of New South Wales, Sydney, Australia
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Krismer F, Jellinger KA, Scholz SW, Seppi K, Stefanova N, Antonini A, Poewe W, Wenning GK. Multiple system atrophy as emerging template for accelerated drug discovery in α-synucleinopathies. Parkinsonism Relat Disord 2014; 20:793-9. [PMID: 24894118 PMCID: PMC4141743 DOI: 10.1016/j.parkreldis.2014.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/27/2014] [Accepted: 05/07/2014] [Indexed: 12/21/2022]
Abstract
There is evidence that the α-synucleinopathies Parkinson's disease (PD) and the Parkinson variant of multiple system atrophy (MSA-P) overlap at multiple levels. Both disorders are characterized by deposition of abnormally phosphorylated fibrillar α-synuclein within the central nervous system suggesting shared pathophysiological mechanisms. Despite the considerable clinical overlap in the early disease stages, MSA-P, in contrast to PD, is fatal and rapidly progressive. Moreover recent clinical studies have shown that surrogate markers of disease progression can be quantified easily and may reliably depict the rapid course of MSA. We therefore posit that, MSA-P may be exploited as a filter barrier in the development of disease-modifying therapeutic strategies targeting common pathophysiological mechanisms of α-synucleinopathies. This approach might reduce the number of negative phase III clinical trials, and, in turn, shift the available resources to earlier development stages, thereby increasing the number of candidate compounds validated. α-synucleinopathies overlap at multiple levels. α-synucleinopathies are characterized by an abnormal deposition of α-synuclein. Validated surrogate markers in MSA reliably monitor disease progression. MSA may serve as a template disease for other α-synucleinopathies.
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Affiliation(s)
- Florian Krismer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | | | - Sonja W Scholz
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | - Nadia Stefanova
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | - Angelo Antonini
- Department of Parkinson's Disease and Movement Disorders, IRCCS San Camillo, Venice, Italy.
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Haas BR, Stewart TH, Zhang J. Premotor biomarkers for Parkinson's disease - a promising direction of research. Transl Neurodegener 2012; 1:11. [PMID: 23211054 PMCID: PMC3514104 DOI: 10.1186/2047-9158-1-11] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/31/2012] [Indexed: 12/25/2022] Open
Abstract
The second most serious neurodegenerative disease is Parkinson’s disease (PD). Over the past several decades, a strong body of evidence suggests that PD can begin years before the hallmark clinical motor symptoms appear. Biomarkers for PD are urgently needed to differentiate between neurodegenerative disorders, screen novel therapeutics, and predict eventual clinical PD before the onset of symptoms. Some clinical evaluations and neuroimaging techniques have been developed in the last several years with some success in this area. Moreover, other strategies have been utilized to identify biochemical and genetic markers associated with PD leading to the examination of PD progression and pathogenesis in cerebrospinal fluid, blood, or saliva. Finally, interesting results are surfacing from preliminary studies using known PD-associated genetic mutations to assess potential premotor PD biomarkers. The current review highlights recent advances and underscores areas of potential advancement.
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Affiliation(s)
- Brian R Haas
- Department of Pathology, University of Washington School of Medicine, HMC Box 359635, 325 9th Avenue, Seattle, WA, 98104, USA.
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Rosano C, Bennett DA, Newman AB, Venkatraman V, Yaffe K, Harris T, Kritchevsky S, Aizenstein HJ. Patterns of focal gray matter atrophy are associated with bradykinesia and gait disturbances in older adults. J Gerontol A Biol Sci Med Sci 2012; 67:957-62. [PMID: 22367436 DOI: 10.1093/gerona/glr262] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Identify the neuroimaging correlates of parkinsonian signs in older adults living in the community. METHODS Magnetic resonance imaging was obtained in 307 adults (82.9 years, 55% women, 39% blacks) concurrently with the Unified Parkinson Disease Rating scale-motor part. Magnetic resonance imaging measures included volume of whole-brain white matter hyperintensities and of gray matter for primary sensorimotor, supplementary motor, medial temporal areas, cerebellum, prefronto-parietal cortex, and basal ganglia. RESULTS About 25% of the participants had bradykinesia, 26% had gait disturbances, and 12% had tremor. Compared with those without, adults with any one of these signs were older, walked more slowly, had worse scores on tests of cognition, mood and processing speed, and higher white matter hyperintensities volume (all p ≤ .002). Gray matter volume of primary sensorimotor area was associated with bradykinesia (standardized odds ratio [95% confidence interval]: 0.46 [0.31, 0.68], p < .0001), and gray matter volume of medial temporal area was associated with gait disturbances (0.56 [0.42, 0.83], p < .0001), independent of white matter hyperintensities volume and age. Further adjustment for measures of muscle strength, cardiovascular health factors, cognition, processing speed, and mood or for gait speed did not substantially change these results. CONCLUSIONS Atrophy within primary sensorimotor and medial temporal areas might be important for development of bradykinesia and of gait disturbances in community-dwelling elderly adults. The pathways underlying these associations may not include changes in white matter hyperintensities volume, cognition, information processing speed, mood, or gait speed.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, 130 North Bellefield Street, Room 512, Pittsburgh, PA 15213, USA.
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Metzler-Baddeley C, O'Sullivan MJ, Bells S, Pasternak O, Jones DK. How and how not to correct for CSF-contamination in diffusion MRI. Neuroimage 2012; 59:1394-403. [PMID: 21924365 DOI: 10.1016/j.neuroimage.2011.08.043] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/25/2011] [Accepted: 08/16/2011] [Indexed: 01/09/2023] Open
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Galvin JE, Price JL, Yan Z, Morris JC, Sheline YI. Resting bold fMRI differentiates dementia with Lewy bodies vs Alzheimer disease. Neurology 2011; 76:1797-803. [PMID: 21525427 DOI: 10.1212/wnl.0b013e31821ccc83] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Clinicopathologic phenotypes of dementia with Lewy bodies (DLB) and Alzheimer disease (AD) often overlap, making discrimination difficult. We performed resting state blood oxygen level-dependent (BOLD) functional connectivity MRI (fcMRI) to determine whether there were differences between AD and DLB. METHODS Participants (n = 88) enrolled in a longitudinal study of memory and aging underwent 3-T fcMRI. Clinical diagnoses of probable DLB (n = 15) were made according to published criteria. Cognitively normal control participants (n = 38) were selected for the absence of cerebral amyloid burden as imaged with Pittsburgh compound B (PiB). Probable AD cases (n = 35) met published criteria and had appreciable amyloid deposits with PiB imaging. Functional images were collected using a gradient spin-echo sequence sensitive to BOLD contrast (T2* weighting). Correlation maps selected a seed region in the combined bilateral precuneus. RESULTS Participants with DLB had a functional connectivity pattern for the precuneus seed region that was distinct from AD; both the DLB and AD groups had functional connectivity patterns that differed from the cognitively normal group. In the DLB group, we found increased connectivity between the precuneus and regions in the dorsal attention network and the putamen. In contrast, we found decreased connectivity between the precuneus and other task-negative default regions and visual cortices. There was also a reversal of connectivity in the right hippocampus. CONCLUSIONS Changes in functional connectivity in DLB indicate patterns of activation that are distinct from those seen in AD and may improve discrimination of DLB from AD and cognitively normal individuals. Since patterns of connectivity differ between AD and DLB groups, measurements of BOLD functional connectivity can shed further light on neuroanatomic connections that distinguish DLB from AD.
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Affiliation(s)
- J E Galvin
- Center of Excellence on Brain Aging, New York University Langone School of Medicine, 145 East 32nd St, Second Floor, New York, NY 10016, USA.
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Rigotti DJ, Kirov II, Djavadi B, Perry N, Babb JS, Gonen O. Longitudinal whole-brain N-acetylaspartate concentration in healthy adults. AJNR Am J Neuroradiol 2011; 32:1011-5. [PMID: 21511862 DOI: 10.3174/ajnr.a2452] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although NAA is often used as a marker of neural integrity and health in different neurologic disorders, the temporal behavior of WBNAA is not well characterized. Our goal therefore was to establish its normal variations in a cohort of healthy adults over typical clinical trial periods. MATERIALS AND METHODS Baseline amount of brain NAA, Q(NAA), was obtained with nonlocalizing proton MR spectroscopy from 9 subjects (7 women, 2 men; 31.2 ± 5.6 years old). Q(NAA) was converted into absolute millimole amount by using phantom-replacement. The WBNAA concentration was derived by dividing Q(NAA) with the brain parenchyma volume, V(B), segmented from MR imaging. Temporal variations were determined with 4 annual scans of each participant. RESULTS The distribution of WBNAA levels was not different among time points with respect to the mean, 12.1 ± 1.5 mmol/L (P > .6), nor was its intrasubject change (coefficient of variation = 8.6%) significant between any 2 scans (P > .5). There was a small (0.2 mL) but significant (P = .05) annual V(B) decline. CONCLUSIONS WBNAA is stable over a 3-year period in healthy adults. It qualifies therefore as a biomarker for global neuronal loss and dysfunction in diffuse neurologic disorders that may be well worth considering as a secondary outcome measure candidate for clinical trials.
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Affiliation(s)
- D J Rigotti
- Department of Radiology, New York University School of Medicine, New York, 10016, USA
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Caviness JN, Lue L, Adler CH, Walker DG. Parkinson's disease dementia and potential therapeutic strategies. CNS Neurosci Ther 2011; 17:32-44. [PMID: 21199444 PMCID: PMC6493795 DOI: 10.1111/j.1755-5949.2010.00216.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Dementia in Parkinson's disease (PD-D) has only been acknowledged in the recent three decades, but research in this field has accelerated. The purpose of this review was to discuss advances in PD-D regarding biomarker correlates and potential therapeutic targets. Attention and executive dysfunction, memory deficits that improve with cueing, and visual hallucinations are characteristic in PD-D. PD-D dramatically increases the disability and misery of the disease. Current treatment for PD-D is symptomatic, modest, and only transiently effective. There is wide agreement that more effective treatment is needed, but this will require more knowledge about PD-D pathophysiology. Advances in the pathogenesis of PD have focused on the substantia nigra, which is the location from where the pathophysiology of motor symptoms primarily arises in initial stages. In contradistinction, pathology studies have suggested that cognitive decline correlates with cortical and subcortical-cortical projection pathway abnormalities. There is evidence that substantia nigra mechanisms, including protein aggregation of α-synuclein (e.g., Lewy bodies) may also play a role in cortical neuron degeneration. Other different mechanisms, such as Alzheimer's disease pathology (e.g., Aβ aggregation) may be operant for PD-D. Biomarkers of various types are being proposed for the study of PD-D as well as for objective measures of PD-D prediction and progression. Therapeutic targets are currently derived mostly from general PD neurodegeneration research rather than cortical PD neurodegeneration per se. Protein aggregation, genes that are associated with PD, oxidative stress, inflammation, and trophic factors constitute the major classes of therapeutic targets for PD-D. More research is needed on the specific aspects of cortical dysfunction and degeneration that create PD-D.
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Abstract
Brain imaging enables the investigation of brain morphology and function in patients with Parkinson's disease (PD). Innovative magnetic resonance imaging (MRI) techniques have recently been established as a new research tool in PD. They are based on the investigation of neuronal tissue properties (MR relaxometry, SWI, DWI, DTI, VBM) and of cerebral perfusion and neuronal activity (ASL, fcMRI). Besides a better understanding of the pathophysiology of PD, these innovative MR techniques might be suitable for measuring progression of PD and the effect of therapeutic interventions on brain functioning. In the clinical setting, they could help to advance the differential diagnosis of parkinsonian disorders.
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Tambasco N, Belcastro V, Sarchielli P, Floridi P, Pierguidi L, Menichetti C, Castrioto A, Chiarini P, Parnetti L, Eusebi P, Calabresi P, Rossi A. A magnetization transfer study of mild and advanced Parkinson’s disease. Eur J Neurol 2010; 18:471-7. [PMID: 20722713 DOI: 10.1111/j.1468-1331.2010.03184.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- N Tambasco
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia, Italy.
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