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Klein IL, van de Loo KFE, Smeitink JAM, Janssen MCH, Kessels RPC, van Karnebeek CD, van der Veer E, Custers JAE, Verhaak CM. Cognitive functioning and mental health in mitochondrial disease: A systematic scoping review. Neurosci Biobehav Rev 2021; 125:57-77. [PMID: 33582231 DOI: 10.1016/j.neubiorev.2021.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/06/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
Mitochondrial diseases (MDs) are rare, heterogeneous, hereditary and progressive in nature. In addition to the serious somatic symptoms, patients with MD also experience problems regarding their cognitive functioning and mental health. We provide an overview of all published studies reporting on any aspect of cognitive functioning and/or mental health in patients with MD and their relatives. A total of 58 research articles and 45 case studies were included and critically reviewed. Cognitive impairments in multiple domains were reported. Mental disorders were frequently reported, especially depression and anxiety. Furthermore, most studies showed impairments in self-reported psychological functioning and high prevalence of mental health problems in (matrilineal) relatives. The included studies showed heterogeneity regarding patient samples, measurement instruments and reference groups, making comparisons cautious. Results highlight a high prevalence of cognitive impairments and mental disorders in patients with MD. Recommendations for further research as well as tailored patientcare with standardized follow-up are provided. Key gaps in the literature are identified, of which studies on natural history are of highest importance.
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Affiliation(s)
- Inge-Lot Klein
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Kim F E van de Loo
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Jan A M Smeitink
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Khondrion BV, Philips van Leydenlaan 15, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Radboud University Medical Center, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Thomas van Aquinostraat 4, Postbus 9104, 6500 HE, Nijmegen, the Netherlands; Vincent van Gogh Institute for Psychiatry, d'n Herk 90, 5803 DN, Venray, the Netherlands
| | - Clara D van Karnebeek
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Elja van der Veer
- International Mito Patients Association, 2861 AD, Bergambacht, the Netherlands
| | - José A E Custers
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Christianne M Verhaak
- Radboud University Medical Center, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
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Moore HL, Blain AP, Turnbull DM, Gorman GS. Systematic review of cognitive deficits in adult mitochondrial disease. Eur J Neurol 2019; 27:3-17. [PMID: 31448495 PMCID: PMC6916601 DOI: 10.1111/ene.14068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/21/2019] [Indexed: 11/27/2022]
Abstract
The profile and trajectory of cognitive impairment in mitochondrial disease are poorly defined. This systematic review sought to evaluate the current literature on cognition in mitochondrial disease, and to determine future research directions. A systematic review was conducted, employing PubMed, Medline, Psycinfo, Embase and Web of Science, and 360‐degree citation methods. English language papers on adult patients were included. The literature search yielded 2421 articles, of which 167 met inclusion criteria. Case reports and reviews of medical reports of patients yielded broad diagnoses of dementia, cognitive impairment and cognitive decline. In contrast, systematic investigations of cognitive functioning using detailed cognitive batteries identified focal cognitive rather than global deficits. Results were variable, but included visuospatial functioning, memory, attention, processing speed and executive functions. Conclusions from studies have been hampered by small sample sizes, variation in genotype and the breadth and depth of assessments undertaken. Comprehensive cognitive research with concurrent functional neuroimaging and physical correlates of mitochondrial disease in larger samples of well‐characterized patients may discern the aetiology and progression of cognitive deficits. These data provide insights into the pattern and trajectory of cognitive impairments, which are invaluable for clinical monitoring, health planning and clinical trial readiness.
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Affiliation(s)
- H L Moore
- Newcastle University, Newcastle upon Tyne, UK
| | - A P Blain
- Newcastle University, Newcastle upon Tyne, UK
| | - D M Turnbull
- Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle BRC, NuTH-NHS Foundation Trust, Newcastle upon Tyne, UK
| | - G S Gorman
- Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle BRC, NuTH-NHS Foundation Trust, Newcastle upon Tyne, UK
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Moore HL, Kelly T, Bright A, Field RH, Schaefer AM, Blain AP, Taylor RW, McFarland R, Turnbull DM, Gorman GS. Cognitive deficits in adult m.3243A>G- and m.8344A>G-related mitochondrial disease: importance of correcting for baseline intellectual ability. Ann Clin Transl Neurol 2019; 6:826-836. [PMID: 31139680 PMCID: PMC6529924 DOI: 10.1002/acn3.736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/26/2018] [Accepted: 12/17/2018] [Indexed: 11/08/2022] Open
Abstract
Objective To determine the cognitive profile of adult patients with mitochondrial disease, and the effect of disease severity on cognition. Methods Using a prospective case-control design, we compared cognition of patients to normative data and to matched controls, assessed three times over 18 months. Forty-nine patients with m.3243A>G (N = 36) and m.8344A>G (N = 13) mtDNA mutations and 32 controls, matched by age (±5 years) and premorbid cognition (±10 WTAR FSIQ points), participated. Participants completed neuropsychological assessments of general cognition (WAIS-IV), executive function (D-KEFS), and memory (WMS-IV). Potential predictors of cognition were explored. Results Patients show mild-to-moderate premorbid cognitive impairment, but substantial impairment in current general cognition and distinct domains, including verbal comprehension, perceptual reasoning, working memory, processing speed, and memory retrieval. Executive dysfunction may be caused by slower decision-making. Patients performed worse than controls, except on memory tasks, indicating intact memory, when premorbid cognition is controlled for. Premorbid cognition and disease severity were consistent predictors of cognition in patients; however, cognitive decline appears slow and is unlikely in the short-term, when other disease-specific factors remain stable. Interpretation Patients should be monitored to facilitate early identification of a complex profile of cognitive deficits and individuals with higher disease burden should be followed up more closely. On development of cognitive difficulties, appropriate compensatory strategies should be determined through in-depth assessment. Using strategies such as slower presentation of information, multiple modes of presentation, active discussion to aid understanding and decision-making, and use of memory aids, may ameliorate difficulties.
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Affiliation(s)
- Heather L Moore
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom.,Institute of Health & Society Newcastle University 3rd Floor, Sir James Spence Institute Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne NE1 4LP United Kingdom
| | - Thomas Kelly
- Department of Neuropsychology Royal Victoria Infirmary The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne NE1 4LP United Kingdom
| | - Alexandra Bright
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Robert H Field
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Andrew M Schaefer
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Alasdair P Blain
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne NE2 4HH United Kingdom
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Shurtleff H, Barry D, Chanprasert S, Firman T, Warner M, Saneto RP. Cognitive characteristics of mitochondrial diseases in children. Epilepsy Behav 2018; 88:235-243. [PMID: 30316150 DOI: 10.1016/j.yebeh.2018.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This retrospective descriptive study was undertaken to further define the intelligence profiles of children with mitochondrial disorders, in the context of seizures and age of symptom onset. METHODS We retrospectively identified forty-nine pediatric patients with definitive mitochondrial disease diagnoses and complete intelligence or adaptive functioning testing data. Patients were 0-216 months at onset of symptoms and 61-250 months of age at testing. Twenty-four of 49 patients had seizures. Twenty-one of the 24 patients with seizures had medically intractable seizures. All patients had Wechsler Intellectual Quotient (IQ) testing, except nine patients with seizures who were unable to engage in IQ testing and were assessed with a structured parent interview measure, the Vineland Adaptive Behavior Scales. We used descriptive and exploratory data analysis methods to characterize test results. RESULTS Distribution of ages for patients with the Vineland assessment was younger than those given the Wechsler. The median overall score (combining Wechsler and Vineland summary scores) for all patients was 85 (interquartile range [IQR]: 50, 102), with the group without seizures obtaining a higher median Full Scale IQ (FSIQ) of 100 (IQR: 86, 109), compared to the group with seizures with a median FSIQ of 67 (IQR: 49.5, 89), a difference that is both statistically and clinically different (Δ = 33; 95% CI: 9, 52). The adaptive function measure was composed of patients only with intractable epilepsy and yielded the lowest overall median summary score of 43 (IQR: 37, 50). This general trend in differences between the FSIQ scores of the groups with and without seizures was also seen across all subscale measures analyzed-IQ index scores and two subtest scores, Digit Span and Coding-though differences were not always statistically different. Vargha-Delaney's A effect sizes ranged between 0.68 and 0.90, trends that mirrored those of distributional and median differences. Groups without versus with seizures differed most distinctly in Performance IQ (PIQ), with the group without seizures' median PIQ being 100 (IQR 94, 112) versus the group with seizures' median PIQ being 63 (IQR 54, 84), a difference of 37 points (95% CI). DISCUSSION Results suggest that patients with mitochondrial diseases with seizures and early onset disease represent a worse cognitive phenotype, as compared with those with no seizures, who can have average intelligence. Results are discussed in the context of current literature.
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Affiliation(s)
- Hillary Shurtleff
- Department of Neurology, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Dwight Barry
- Seattle Children's Hospital, Seattle, WA, USA; Enterprise Analytics, Seattle Children's Hospital, Seattle, WA, USA
| | - Sirisak Chanprasert
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tim Firman
- Seattle Children's Hospital, Seattle, WA, USA
| | - Molly Warner
- Department of Neurology, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Russell P Saneto
- Department of Neurology, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, USA; Center for Integrative Brain Research, Neuroscience Institute, Seattle Children's Hospital, Seattle, WA, USA.
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Finsterer J, Zarrouk Mahjoub S. Mitochondrial epilepsy in pediatric and adult patients. Acta Neurol Scand 2013; 128:141-52. [PMID: 23480231 DOI: 10.1111/ane.12122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 01/04/2023]
Abstract
Few data are available about the difference between epilepsy in pediatric mitochondrial disorders (MIDs) and adult MIDs. This review focuses on the differences between pediatric and adult mitochondrial epilepsy with regard to seizure type, seizure frequency, and underlying MID. A literature search via Pubmed using the keywords 'mitochondrial', 'epilepsy', 'seizures', 'adult', 'pediatric', and all MID acronyms, was carried out. Frequency of mitochondrial epilepsy strongly depends on the type of MID included and is higher in pediatric compared to adult patients. In pediatric patients, mitochondrial epilepsy is more frequent due to mutations in nDNA-located than mtDNA-located genes and vice versa in adults. In pediatric patients, mitochondrial epilepsy is associated with a syndromic phenotype in half of the patients and in adults more frequently with a non-syndromic phenotype. In pediatric patients, focal seizures are more frequent than generalized seizures and vice versa in adults. Electro-clinical syndromes are more frequent in pediatric MIDs compared to adult MIDs. Differences between pediatric and adult mitochondrial epilepsy concern the onset of epilepsy, frequency of epilepsy, seizure type, type of electro-clinical syndrome, frequency of syndromic versus non-syndromic MIDs, and the outcome. To optimize management of mitochondrial epilepsy, it is essential to differentiate between early and late-onset forms.
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Affiliation(s)
| | - S. Zarrouk Mahjoub
- Laboratory of Biochemistry; UR ‘Human Nutrition and Metabolic Disorders’ Faculty of Medicine Monastir; Tunisia
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Abstract
Among the various central nervous system (CNS) manifestations of mitochondrial disorders (MIDs), cognitive impairment is increasingly recognized and diagnosed (mitochondrial cognitive dysfunction). Aim of the review was to summarize recent findings concerning the aetiology, pathogenesis, diagnosis and treatment of cognitive decline in MIDs. Among syndromic MIDs due to mitochondrial DNA (mtDNA) mutations, cognitive impairment occurs in patients with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes syndrome, myoclonus epilepsy with ragged-red fibres syndrome, mitochondrial chronic progressive external ophthalmoplegia, Kearns-Sayre syndrome, neuropathy, ataxia and retinitis pigmentosa syndrome and maternally inherited diabetes and deafness. Among syndromic MIDs due to nuclear DNA (nDNA) mutations, cognitive decline has been reported in myo-neuro-gastro-intestinal encephalopathy, mitochondrial recessive ataxia syndrome, spinocerebellar ataxia with encephalopathy, Mohr-Tranebjaerg syndrome, leuko-encephalopathy; brain and spinal cord involvement and lactic acidosis, CMT2, Wolfram syndrome, Wolf-Hirschhorn syndrome and Leigh syndrome. In addition to syndromic MIDs, a large number of non-syndromic MIDs due to mtDNA as well as nDNA mutations have been reported, which present with cognitive impairment as the sole or one among several other CNS manifestations of a MID. Delineation of mitochondrial cognitive impairment from other types of cognitive impairment is essential to guide the optimal management of these patients. Treatment of mitochondrial cognitive impairment is largely limited to symptomatic and supportive measures. Cognitive impairment may be a CNS manifestation of syndromic as well as non-syndromic MIDs. Correct diagnosis of mitochondrial cognitive impairment is a prerequisite for the optimal management of these patients.
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Affiliation(s)
- J. Finsterer
- Danube University Krems; Krems and Krankenanstalt Rudolfstiftung; Vienna; Austria
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Saneto RP, Naviaux RK. Polymerase gamma disease through the ages. ACTA ACUST UNITED AC 2010; 16:163-74. [DOI: 10.1002/ddrr.105] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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