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Jellinger KA. Pathomechanisms of cognitive and behavioral impairment in corticobasal degeneration. J Neural Transm (Vienna) 2023; 130:1509-1522. [PMID: 37659990 DOI: 10.1007/s00702-023-02691-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Corticobasal degeneration (CBD) is a rare, sporadic, late-onset progressive neurodegenerative disorder of unknown etiology, clinically characterized by an akinetic-rigid syndrome, behavior and personality disorders, language problems (aphasias), apraxia, executive and cognitive abnormalities and limb dystonia. The syndrome is not specific, as clinical features of pathologically proven CBD include several phenotypes. This 4-repeat (4R) tauopathy is morphologically featured by often asymmetric frontoparietal atrophy, ballooned/achromatic neurons containing filamentous 4R-tau aggregates in cortex and striatum, thread-like processes that are more widespread than in progressive supranuclear palsy (PSP), pathognomonic "astroglial plaques", and numerous inclusions in both astrocytes and oligodendroglia ("coiled bodies") in the white matter. Cognitive deficits in CBD are frequent initial presentations before onset of motor symptoms, depending on the phenotypic variant. They predominantly include executive and visuospatial dysfunction, sleep disorders and language deficits with usually preserved memory domains. Neuroimaging studies showed heterogenous locations of brain atrophy, particularly contralateral to the dominant symptoms, with disruption of striatal connections to prefrontal cortex and basal ganglia circuitry. Asymmetric hypometabolism, mainly involving frontal and parietal regions, is associated with brain cholinergic deficits, and dopaminergic nigrostriatal degeneration. Widespread alteration of cortical and subcortical structures causing heterogenous changes in various brain functional networks support the concept that CBD, similar to PSP, is a brain network disruption disorder. Putative pathogenic factors are hyperphosphorylated tau-pathology, neuroinflammation and oxidative injury, but the basic mechanisms of cognitive impairment in CBD, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for early diagnosis and adequate treatment of this fatal disorder.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Corticobasal degeneration and corticobasal syndrome: A review. Clin Park Relat Disord 2019; 1:66-71. [PMID: 34316603 PMCID: PMC8288513 DOI: 10.1016/j.prdoa.2019.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
Corticobasal degeneration (CBD) is a rare neurodegenerative disorder. The most common presentation of CBD is the corticobasal syndrome (CBS), which is a constellation of cortical and extrapyramidal symptoms and signs. Clinical-pathological studies have illustrated that CBD can present with diverse clinical phenotypes, including a non-fluent, agrammatic primary progressive aphasia syndrome, a behavioral, dysexecutive and visuospatial syndrome, as well as a progressive supranuclear palsy-like syndrome. Conversely, multiple pathologies, such as CBD, Alzheimer's disease and progressive supranuclear palsy may underlie a patient with CBS. This clinical-pathological overlap emphasizes the need for biomarkers that will assist in the accurate diagnosis of patients with CBS. This review presents an overview of the pathological, genetic, clinical and therapeutic characteristics of CBD, with an emphasis on the imaging (structural and functional) and biochemical (cerebrospinal fluid) biomarkers of CBD.
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Abbate C, Trimarchi PD, Manzoni L, Quarenghi AM, Salvi GP, Inglese S, Giunco F, Bagarolo R, Mari D, Arosio B. A posterior variant of corticobasal syndrome: Evidence from a longitudinal study of cognitive and functional status in a single case. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1452868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
| | - Pietro Davide Trimarchi
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Laura Manzoni
- Istituto Clinico Quarenghi, via San Carlo 70, 24016 San Pellegrino Terme, Italy
| | | | - Gian Pietro Salvi
- Istituto Clinico Quarenghi, via San Carlo 70, 24016 San Pellegrino Terme, Italy
| | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
| | - Fabrizio Giunco
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Renzo Bagarolo
- Alzheimer’s Assessment Unit, S. Maria Nascente, Fondazione IRCCS Don Carlo Gnocchi, via Alfonso Capecelatro 66, 20148 Milan, Italy
| | - Daniela Mari
- Department of Medical Sciences and Community Health, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122 Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy
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Constantinides VC, Paraskevas GP, Potagas C, Stefanis L, Kapaki E. Quantifying apraxia and ophthalmokinetic abnormalities in patients with atypical Parkinsonism: A new way to differential diagnosis? Parkinsonism Relat Disord 2018; 61:39-44. [PMID: 30563744 DOI: 10.1016/j.parkreldis.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Vasilios C Constantinides
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, 72-74 Vas. Sophias Ave, 11528, Athens, Greece.
| | - George P Paraskevas
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, 72-74 Vas. Sophias Ave, 11528, Athens, Greece.
| | - Constantinos Potagas
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, 72-74 Vas. Sophias Ave, 11528, Athens, Greece.
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, 72-74 Vas. Sophias Ave, 11528, Athens, Greece.
| | - Elisabeth Kapaki
- 1st Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, 72-74 Vas. Sophias Ave, 11528, Athens, Greece.
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Park JE. Apraxia: Review and Update. J Clin Neurol 2017; 13:317-324. [PMID: 29057628 PMCID: PMC5653618 DOI: 10.3988/jcn.2017.13.4.317] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
Praxis, the ability to perform skilled or learned movements is essential for daily living. Inability to perform such praxis movements is defined as apraxia. Apraxia can be further classified into subtypes such as ideomotor, ideational and limb-kinetic apraxia. Relevant brain regions have been found to include the motor, premotor, temporal and parietal cortices. Apraxia is found in a variety of highly prevalent neurological disorders including dementia, stroke and Parkinsonism. Furthermore, apraxia has been shown to negatively affect quality of life. Therefore, recognition and treatment of this disorder is critical. This article provides an overview of apraxia and highlights studies dealing with the neurophysiology of this disorder, opening up novel perspectives for the use of motor training and noninvasive brain stimulation as treatment.
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Affiliation(s)
- Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
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Mäki-Marttunen V, Villarreal M, Leiguarda RC. Lateralization of brain activity during motor planning of proximal and distal gestures. Behav Brain Res 2014; 272:226-37. [DOI: 10.1016/j.bbr.2014.06.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 11/27/2022]
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Stamenova V, Roy EA, Black SE. Limb apraxia in corticobasal syndrome. Cortex 2011; 47:460-72. [DOI: 10.1016/j.cortex.2010.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 03/31/2010] [Accepted: 04/29/2010] [Indexed: 11/26/2022]
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Tabaki NE, Vikelis M, Besmertis L, Vemmos K, Stathis P, Mitsikostas DD. Apraxia related with subcortical lesions due to cerebrovascular disease. Acta Neurol Scand 2010; 122:9-14. [PMID: 20028344 DOI: 10.1111/j.1600-0404.2009.01224.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine whether ideomotor apraxia exists in patients with subcortical ischemic lesions. PATIENTS AND METHODS A matched-control, prospective and multi-centered research design was used. Ideomotor apraxia, anxiety and depression were assessed by the Movement Imitation Test and the Hamilton scales, respectively. RESULTS Forty two consecutive patients with subcortical ischemic stroke and an equal number of healthy participants, matched in age and sex were included. Paired-sample t-tests showed that patients had significantly more apractic elements in their movements (t = 5.03, P < 0.01), higher anxiety (t = -2.55, P = 0.0014) and depression levels (t = -2.61, P = 0.012) than their healthy matched participants. Participants with higher anxiety and depression scores performed worse on the Movement Imitation Test. CONCLUSIONS Ischemic damage of subcortical modular systems may affect praxis.
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Stamenova V, Roy EA, Black SE. A Model-Based Approach to Understanding Apraxia in Corticobasal Syndrome. Neuropsychol Rev 2008; 19:47-63. [DOI: 10.1007/s11065-008-9079-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
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Liepelt I, Maetzler W, Blaicher HP, Gasser T, Berg D. Treatment of dementia in parkinsonian syndromes with cholinesterase inhibitors. Dement Geriatr Cogn Disord 2007; 23:351-67. [PMID: 17389795 DOI: 10.1159/000101337] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2006] [Indexed: 12/13/2022] Open
Abstract
In Parkinsonian syndromes behavioural symptoms and dementia can be even more debilitating than motor symptoms and are an important predictor for nursing home placement and mortality. Neuropathologically, dementia seems to be primarily related to cortical changes rather than to subcortical alterations. Concerning neurotransmitter systems, the cholinergic system has been proposed to play a key role in cognitive disturbances. Based on studies with patients with Alzheimer disease, the application of cholinesterase inhibitors is vividly discussed also for dementia associated with parkinsonian syndromes. This review focuses on the specific symptoms of dementia in different parkinsonian syndromes and critically questions the effect of cholinergic treatment on cognitive functions in patients with extrapyramidal syndromes and dementia. There is evidence that medication with some cholinesterase inhibitors can enhance cognition as well as activities of daily living in dementia with Parkinson's disease and seems to reduce behavioural disturbances in both dementia with Parkinson's disease and dementia with Lewy bodies. The effect of treatment with cholinesterase inhibitors in progressive supranuclear palsy and corticobasal degeneration warrants carefully designed studies including a sufficient number of patients and symptom-adopted dementia scales.
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Affiliation(s)
- Inga Liepelt
- Hertie Institute for Clinical Brain Research, University of Tubingen, Tubingen, Germany.
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Abstract
Limb apraxia occurs in progressive supranuclear palsy (PSP); however, its characteristics and relation to dementia are unclear. We compared 25 probable PSP patients on cognitive and ideomotor apraxia tests with 19 healthy controls. Eleven PSP patients were demented (D-PSP) and 14 not (ND-PSP). D-PSP patients did worse than controls and ND-PSP patients in all cognitive tests; and ND-PSP patients did worse than controls in all except the memory test. In the apraxia test, PSP patients committed mainly sequence errors and executed complex gestures badly. Apraxia correlated strongly with dementia. In PSP, limb apraxia seems mainly due to frontal deafferentation and lesions, but only when these are severe enough to cause dementia.
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Affiliation(s)
- Paola Soliveri
- Department of Neurology, Istituto Nazionale Neurologico "C. Besta", Milano, Italy.
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