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Watanabe Y, Miyazaki Y, Hata M, Fukuma R, Aoki Y, Kazui H, Araki T, Taomoto D, Satake Y, Suehiro T, Sato S, Kanemoto H, Yoshiyama K, Ishii R, Harada T, Kishima H, Ikeda M, Yanagisawa T. A deep learning model for the detection of various dementia and MCI pathologies based on resting-state electroencephalography data: A retrospective multicentre study. Neural Netw 2024; 171:242-250. [PMID: 38101292 DOI: 10.1016/j.neunet.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 11/12/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Dementia and mild cognitive impairment (MCI) represent significant health challenges in an aging population. As the search for noninvasive, precise and accessible diagnostic methods continues, the efficacy of electroencephalography (EEG) combined with deep convolutional neural networks (DCNNs) in varied clinical settings remains unverified, particularly for pathologies underlying MCI such as Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and idiopathic normal-pressure hydrocephalus (iNPH). Addressing this gap, our study evaluates the generalizability of a DCNN trained on EEG data from a single hospital (Hospital #1). For data from Hospital #1, the DCNN achieved a balanced accuracy (bACC) of 0.927 in classifying individuals as healthy (n = 69) or as having AD, DLB, or iNPH (n = 188). The model demonstrated robustness across institutions, maintaining bACCs of 0.805 for data from Hospital #2 (n = 73) and 0.920 at Hospital #3 (n = 139). Additionally, the model could differentiate AD, DLB, and iNPH cases with bACCs of 0.572 for data from Hospital #1 (n = 188), 0.619 for Hospital #2 (n = 70), and 0.508 for Hospital #3 (n = 139). Notably, it also identified MCI pathologies with a bACC of 0.715 for Hospital #1 (n = 83), despite being trained on overt dementia cases instead of MCI cases. These outcomes confirm the DCNN's adaptability and scalability, representing a significant stride toward its clinical application. Additionally, our findings suggest a potential for identifying shared EEG signatures between MCI and dementia, contributing to the field's understanding of their common pathophysiological mechanisms.
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Affiliation(s)
- Yusuke Watanabe
- Institute for Advanced Co-creation Studies, Osaka University, Osaka, Japan
| | - Yuki Miyazaki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Hata
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryohei Fukuma
- Institute for Advanced Co-creation Studies, Osaka University, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasunori Aoki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Psychiatry, Nippon Life Hospital, Osaka, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toshihiko Araki
- Department of Medical Technology, Osaka University Hospital, Osaka, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryouhei Ishii
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Tatsuya Harada
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan; RIKEN, Tokyo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takufumi Yanagisawa
- Institute for Advanced Co-creation Studies, Osaka University, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Anjum MF, Espinoza AI, Cole RC, Singh A, May P, Uc EY, Dasgupta S, Narayanan NS. Resting-state EEG measures cognitive impairment in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:6. [PMID: 38172519 PMCID: PMC10764756 DOI: 10.1038/s41531-023-00602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Cognitive dysfunction is common in Parkinson's disease (PD). We developed and evaluated an EEG-based biomarker to index cognitive functions in PD from a few minutes of resting-state EEG. We hypothesized that synchronous changes in EEG across the power spectrum can measure cognition. We optimized a data-driven algorithm to efficiently capture these changes and index cognitive function in 100 PD and 49 control participants. We compared our EEG-based cognitive index with the Montreal cognitive assessment (MoCA) and cognitive tests across different domains from National Institutes of Health (NIH) Toolbox using cross-validations, regression models, and randomization tests. Finally, we externally validated our approach on 32 PD participants. We observed cognition-related changes in EEG over multiple spectral rhythms. Utilizing only 8 best-performing electrodes, our proposed index strongly correlated with cognition (MoCA: rho = 0.68, p value < 0.001; NIH-Toolbox cognitive tests: rho ≥ 0.56, p value < 0.001) outperforming traditional spectral markers (rho = -0.30-0.37). The index showed a strong fit in regression models (R2 = 0.46) with MoCA, yielded 80% accuracy in detecting cognitive impairment, and was effective in both PD and control participants. Notably, our approach was equally effective (rho = 0.68, p value < 0.001; MoCA) in out-of-sample testing. In summary, we introduced a computationally efficient data-driven approach for cross-domain cognition indexing using fewer than 10 EEG electrodes, potentially compatible with dynamic therapies like closed-loop neurostimulation. These results will inform next-generation neurophysiological biomarkers for monitoring cognition in PD and other neurological diseases.
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Affiliation(s)
- Md Fahim Anjum
- Department of Neurology, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Arturo I Espinoza
- Department of Neurology, The University of Iowa, Iowa city, IA, 52240, USA
| | - Rachel C Cole
- Department of Neurology, The University of Iowa, Iowa city, IA, 52240, USA
| | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, South Dakota, SD, 57069, USA
| | - Patrick May
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa city, IA, 52240, USA
| | - Ergun Y Uc
- Department of Neurology, The University of Iowa, Iowa city, IA, 52240, USA
- Neurology Service, Iowa City VA Medical Center, Iowa city, IA, 52240, USA
| | - Soura Dasgupta
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa city, IA, 52240, USA
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Kucikova L, Kalabizadeh H, Motsi KG, Rashid S, O'Brien JT, Taylor JP, Su L. A systematic literature review of fMRI and EEG resting-state functional connectivity in Dementia with Lewy Bodies: Underlying mechanisms, clinical manifestation, and methodological considerations. Ageing Res Rev 2024; 93:102159. [PMID: 38056505 DOI: 10.1016/j.arr.2023.102159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/14/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
Previous studies suggest that there may be important links between functional connectivity, disease mechanisms underpinning the Dementia with Lewy Body (DLB) and the key clinical symptoms, but the exact relationship remains unclear. We performed a systematic literature review to address this gap by summarising the research findings while critically considering the impact of methodological differences on findings. The main methodological choices of fMRI articles included data-driven, seed-based or regions of interest approaches, or their combinations. Most studies focused on examining large-scale resting-state networks, which revealed a consistent decrease in connectivity and some associations with non-cognitive symptoms. Although the inter-network connectivity showed mixed results, the main finding is consistent with theories positing disconnection between visual and attentional areas of the brain implicated in the aetiology of psychotic symptoms in the DLB. The primary methodological choice of EEG studies was implementing the phase lag index and using graph theory. The EEG studies revealed a consistent decrease in connectivity on alpha and beta frequency bands. While the overall trend of findings showed decreased connectivity, more subtle changes in the directionality of connectivity were observed when using a hypothesis-driven approach. Problems with cognition were also linked with greater functional connectivity disturbances. In summary, connectivity measures can capture brain disturbances in the DLB and remain crucial in uncovering the causal relationship between the networks' disorganisation and underlying mechanisms resulting in psychotic, motor, and cognitive symptoms of the DLB.
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Affiliation(s)
- Ludmila Kucikova
- Neuroscience Institute, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Hoda Kalabizadeh
- Oxford Machine Learning in NeuroImaging Lab, OMNI, Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | | | - Sidrah Rashid
- Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Li Su
- Neuroscience Institute, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom; Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
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Liu J, Li Q, Peng T, Zhou Q, He B, Zhu B. Assessment of Four Serum Biochemical Markers in Elderly Patients with Vascular Dementia after Cerebral Infarction and Their Response to Donepezil and Idebenone. J Neurol Surg B Skull Base 2023; 84:629-636. [PMID: 37854539 PMCID: PMC10581822 DOI: 10.1055/s-0042-1756500] [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: 03/02/2022] [Accepted: 08/03/2022] [Indexed: 10/20/2023] Open
Abstract
Objective Our study aimed to explore four serum levels of biochemical markers, including brain-derived neurotrophic factor (BDNF), homocysteine (Hcy), nitric oxide (NO), and γ-interferon (IFN-γ), in elderly patients with vascular dementia (VD) after the cerebral infarction and to elucidate possible connections between them. Method The elderly patients with VD after cerebral infarction admitted in our hospital, and the elderly persons for physical examination from November 2020 to December 2021 were included in this study. The serum levels of BDNF, Hcy, NO, and IFN-γ were compared between the study group and the control group. Results In the study group, the serum levels of Hcy and IFN-γ were significantly higher than that in the control group, whereas significantly lower serum levels of BDNF and NO were found in the study group compared with the control group. After receiving the intervention of donepezil and/or idebenone, the serum levels of Hcy and IFN-γ in group B were significantly lower than that in group A, while the serum levels of BDNF and NO in group B were significantly higher than that in Group A. Conclusion The results of our study showed abnormally expressed serum levels of Hcy, IFN-γ, BDNF, and NO in elderly patients with VD after cerebral infarction which might strongly reflect the severity of VD. Moreover, after intervention of donepezil alone or combined with idebenone, the changes of serum levels of Hcy, IFN-γ, BDNF, and NO may reflect the curative effect of the disease.
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Affiliation(s)
- Jianlin Liu
- Department of Neurology, Hubei Third People's Hospital of Jianghan University, Wuhan, China
| | - Qin Li
- Department of Neurology, Hubei Third People's Hospital of Jianghan University, Wuhan, China
| | - Tao Peng
- Department of Neurology, Hubei Third People's Hospital of Jianghan University, Wuhan, China
| | - Qianwen Zhou
- Department of Neurology, Hubei Third People's Hospital of Jianghan University, Wuhan, China
| | - Bihua He
- Department of Neurology, Hubei Third People's Hospital of Jianghan University, Wuhan, China
| | - Bifeng Zhu
- Department of Neurology, Hubei Third People's Hospital of Jianghan University, Wuhan, China
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Anjum MF, Espinoza A, Cole R, Singh A, May P, Uc E, Dasgupta S, Narayanan N. Resting-state EEG measures cognitive impairment in Parkinson's disease. RESEARCH SQUARE 2023:rs.3.rs-2666578. [PMID: 36993450 PMCID: PMC10055637 DOI: 10.21203/rs.3.rs-2666578/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background Cognitive dysfunction is common in Parkinson's disease (PD) and is diagnosed by complex, time-consuming psychometric tests which are affected by language and education, subject to learning effects, and not suitable for continuous monitoring of cognition. Objectives We developed and evaluated an EEG-based biomarker to index cognitive functions in PD from a few minutes of resting-state EEG. Methods We hypothesized that synchronous changes in EEG across the power spectrum can measure cognition. We optimized a data-driven algorithm to efficiently capture these changes and index cognitive function in 100 PD and 49 control participants. We compared our EEG-based cognitive index with the Montreal cognitive assessment (MoCA) and cognitive tests across different domains from the National Institutes of Health (NIH) Toolbox using cross-validation schemes, regression models, and randomization tests. Results We observed cognition-related changes in EEG activities over multiple spectral rhythms. Utilizing only 8 best-performing EEG electrodes, our proposed index strongly correlated with cognition (rho = 0.68, p value < 0.001 with MoCA; rho ≥ 0.56, p value < 0.001 with cognitive tests from the NIH Toolbox) outperforming traditional spectral markers (rho = -0.30 - 0.37). The index showed a strong fit in regression models (R2 = 0.46) with MoCA, yielded 80% accuracy in detecting cognitive impairment, and was effective in both PD and control participants. Conclusions Our approach is computationally efficient for real-time indexing of cognition across domains, implementable even in hardware with limited computing capabilities, making it potentially compatible with dynamic therapies such as closed-loop neurostimulation, and will inform next-generation neurophysiological biomarkers for monitoring cognition in PD and other neurological diseases.
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Jin L, Nawaz H, Ono K, Nowell J, Haley E, Berman BD, Mukhopadhyay ND, Barrett MJ. One Minute of EEG Data Provides Sufficient and Reliable Data for Identifying Lewy Body Dementia. Alzheimer Dis Assoc Disord 2023; 37:66-72. [PMID: 36413637 PMCID: PMC9974530 DOI: 10.1097/wad.0000000000000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the minimum duration of electroencephalography (EEG) data necessary to differentiate EEG features of Lewy body dementia (LBD), that is, dementia with Lewy bodies and Parkinson disease dementia, from non-LBD patients, that is, Alzheimer disease and Parkinson disease. METHODS We performed quantitative EEG analysis for 16 LBD and 14 non-LBD patients. After artifact removal, a fast Fourier transform was performed on 90, 60, and thirty 2-second epochs to derive dominant frequency; dominant frequency variability; and dominant frequency prevalence. RESULTS In LBD patients, there were no significant differences in EEG features derived from 90, 60, and thirty 2-second epochs (all P >0.05). There were no significant differences in EEG features derived from 3 different groups of thirty 2-second epochs (all P >0.05). When analyzing EEG features derived from ninety 2-second epochs, we found that LBD had significantly reduced dominant frequency, reduced dominant frequency variability, and reduced dominant frequency prevalence alpha compared with the non-LBD group (all P <0.05). These same differences were observed between the LBD and non-LBD groups when analyzing thirty 2-second epochs. CONCLUSIONS There were no differences in EEG features derived from 1 minute versus 3 minutes of EEG data, and both durations of EEG data equally differentiated LBD from non-LBD.
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Affiliation(s)
- Lucy Jin
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Huma Nawaz
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenichiro Ono
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
- U.S. Dept. of Veterans Affairs – Central Virginia Healthcare System, Richmond, VA, USA
| | - Justin Nowell
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Erik Haley
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Brian D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nitai D. Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Matthew J. Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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Prasad S, Katta MR, Abhishek S, Sridhar R, Valisekka SS, Hameed M, Kaur J, Walia N. Recent advances in Lewy body dementia: A comprehensive review. Dis Mon 2022; 69:101441. [PMID: 35690493 DOI: 10.1016/j.disamonth.2022.101441] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lewy Body Dementia is the second most frequent neurodegenerative illness proven to cause dementia, after Alzheimer's disease (AD). It is believed to be vastly underdiagnosed, as there is a significant disparity between the number of cases diagnosed clinically and those diagnosed via neuropathology at the time of postmortem autopsy. Strikingly, many of the pharmacologic treatments used to treat behavioral and cognitive symptoms in other forms of dementia exacerbate the symptoms of DLB. Therefore, it is critical to accurately diagnose DLB as these patients require a specific treatment approach. This article focuses on its pathophysiology, risk factors, differentials, and its diverse treatment modalities. In this study, an English language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till April 2022. The following search strings and Medical Subject Headings (MeSH) terms were used: "Lewy Body Dementia," "Dementia with Lewy bodies," and "Parkinson's Disease Dementia." We explored the literature on Lewy Body Dementia for its epidemiology, pathophysiology, the role of various genes and how they bring about the disease, biomarkers, its differential diagnoses and treatment options.
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Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, 21018, Vinnytsya, Ukraine.
| | | | | | | | | | - Maha Hameed
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
| | | | - Namrata Walia
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, Texas, United States of America
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Keser Z, Buchl SC, Seven NA, Markota M, Clark HM, Jones DT, Lanzino G, Brown RD, Worrell GA, Lundstrom BN. Electroencephalogram (EEG) With or Without Transcranial Magnetic Stimulation (TMS) as Biomarkers for Post-stroke Recovery: A Narrative Review. Front Neurol 2022; 13:827866. [PMID: 35273559 PMCID: PMC8902309 DOI: 10.3389/fneur.2022.827866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/31/2022] [Indexed: 01/20/2023] Open
Abstract
Stroke is one of the leading causes of death and disability. Despite the high prevalence of stroke, characterizing the acute neural recovery patterns that follow stroke and predicting long-term recovery remains challenging. Objective methods to quantify and characterize neural injury are still lacking. Since neuroimaging methods have a poor temporal resolution, EEG has been used as a method for characterizing post-stroke recovery mechanisms for various deficits including motor, language, and cognition as well as predicting treatment response to experimental therapies. In addition, transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, has been used in conjunction with EEG (TMS-EEG) to evaluate neurophysiology for a variety of indications. TMS-EEG has significant potential for exploring brain connectivity using focal TMS-evoked potentials and oscillations, which may allow for the system-specific delineation of recovery patterns after stroke. In this review, we summarize the use of EEG alone or in combination with TMS in post-stroke motor, language, cognition, and functional/global recovery. Overall, stroke leads to a reduction in higher frequency activity (≥8 Hz) and intra-hemispheric connectivity in the lesioned hemisphere, which creates an activity imbalance between non-lesioned and lesioned hemispheres. Compensatory activity in the non-lesioned hemisphere leads mostly to unfavorable outcomes and further aggravated interhemispheric imbalance. Balanced interhemispheric activity with increased intrahemispheric coherence in the lesioned networks correlates with improved post-stroke recovery. TMS-EEG studies reveal the clinical importance of cortical reactivity and functional connectivity within the sensorimotor cortex for motor recovery after stroke. Although post-stroke motor studies support the prognostic value of TMS-EEG, more studies are needed to determine its utility as a biomarker for recovery across domains including language, cognition, and hemispatial neglect. As a complement to MRI-based technologies, EEG-based technologies are accessible and valuable non-invasive clinical tools in stroke neurology.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Samuel C. Buchl
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Nathan A. Seven
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Matej Markota
- Department of Psychiatry, Mayo Clinic, Rochester, MN, United States
| | - Heather M. Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Robert D. Brown
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Chiu SY, Bowers D, Armstrong MJ. Lewy Body Dementias: Controversies and Drug Development. Neurotherapeutics 2022; 19:55-67. [PMID: 34859379 PMCID: PMC9130410 DOI: 10.1007/s13311-021-01161-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 01/03/2023] Open
Abstract
Lewy body dementia (LBD) is one of the most common neurodegenerative dementias. Clinical trials for symptomatic and disease-modifying therapies in LBD remain a national research priority, but there are many challenges in both past and active drug developments in LBD. This review highlights the controversies in picking the appropriate populations, interventions, target selections, and outcome measures, which are all critical components of clinical trial implementation in LBD. The heterogeneity of LBD neuropathology and clinical presentations, limited understanding of core features such as cognitive fluctuations, and lack of validated LBD-specific outcome measures and biomarkers represent some of the major challenges in LBD trials.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, University of Florida, PO Box 100268, Gainesville, FL, 32611, USA.
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32603, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida, PO Box 100268, Gainesville, FL, 32611, USA
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Milán-Tomás Á, Fernández-Matarrubia M, Rodríguez-Oroz MC. Lewy Body Dementias: A Coin with Two Sides? Behav Sci (Basel) 2021; 11:94. [PMID: 34206456 PMCID: PMC8301188 DOI: 10.3390/bs11070094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Lewy body dementias (LBDs) consist of dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which are clinically similar syndromes that share neuropathological findings with widespread cortical Lewy body deposition, often with a variable degree of concomitant Alzheimer pathology. The objective of this article is to provide an overview of the neuropathological and clinical features, current diagnostic criteria, biomarkers, and management of LBD. Literature research was performed using the PubMed database, and the most pertinent articles were read and are discussed in this paper. The diagnostic criteria for DLB have recently been updated, with the addition of indicative and supportive biomarker information. The time interval of dementia onset relative to parkinsonism remains the major distinction between DLB and PDD, underpinning controversy about whether they are the same illness in a different spectrum of the disease or two separate neurodegenerative disorders. The treatment for LBD is only symptomatic, but the expected progression and prognosis differ between the two entities. Diagnosis in prodromal stages should be of the utmost importance, because implementing early treatment might change the course of the illness if disease-modifying therapies are developed in the future. Thus, the identification of novel biomarkers constitutes an area of active research, with a special focus on α-synuclein markers.
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Affiliation(s)
- Ángela Milán-Tomás
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
| | - Marta Fernández-Matarrubia
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Cruz Rodríguez-Oroz
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIMA, Center of Applied Medical Research, Universidad de Navarra, Neurosciences Program, 31008 Pamplona, Spain
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Rosenblum Y, Maidan I, Fahoum F, Giladi N, Bregman N, Shiner T, Mirelman A. Differential changes in visual and auditory event-related oscillations in dementia with Lewy bodies. Clin Neurophysiol 2020; 131:2357-2366. [PMID: 32828038 DOI: 10.1016/j.clinph.2020.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Aside from the cognitive impairment, patients with dementia with Lewy bodies (DLB) have a high frequency of visual hallucinations and a number of other vision-related symptoms, whereas auditory hallucinations are less frequent. To better understand the differential dysfunction of the visual network in DLB, we compared auditory and visual event-related potentials and oscillations in patients with DLB. METHODS Event-related potentials elicited by visual and auditory oddball tasks were recorded in 23 patients with DLB and 22 healthy controls and analyzed in time and time-frequency domain. RESULTS DLB patients had decreased theta band activity related to both early sensory and later cognitive processing in the visual, but not in the auditory task. Patients had lower delta and higher alpha and beta bands power related to later cognitive processing in both auditory and visual tasks. CONCLUSIONS In DLB visual event-related oscillations are characterized by a decrease in theta and lack of inhibition in alpha bands. SIGNIFICANCE Decreased theta and a lack of inhibition in alpha band power might be an oscillatory underpinning of some classical DLB symptoms such as fluctuations in attention and high-level visual disturbances and a potential marker of dysfunction of the visual system in DLB.
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Affiliation(s)
- Yevgenia Rosenblum
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Firas Fahoum
- Epilepsy Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Epilepsy Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Noa Bregman
- Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tamara Shiner
- Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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