1
|
Nasri A, Sghaier I, Neji A, Gharbi A, Abida Y, Mrabet S, Gargouri A, Djebara MB, Kacem I, Gouider R. Phenotypic Spectrum of Progressive Supranuclear Palsy: Clinical Study and Apolipoprotein E Effect. J Mov Disord 2024; 17:158-170. [PMID: 38290492 PMCID: PMC11082606 DOI: 10.14802/jmd.23178] [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: 09/09/2023] [Revised: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Progressive supranuclear palsy (PSP) is a rare neurodegenerative disorder encompassing several phenotypes with various motor and cognitive deficits. We aimed to study motor and cognitive characteristics across PSP phenotypes and to assess the influence of apolipoprotein E (APOE) gene variants on PSP phenotypic expression. METHODS In this 20-year cross-sectional study, we retrospectively reviewed the charts of all patients classified as PSP patients and recategorized them according to phenotype using the Movement Disorder Society criteria (2017). Phenotypes were divided into three subgroups, Richardson's syndrome (PSP-RS), PSP-cortical (PSP with predominant frontal presentation [PSP-F] + PSP with predominant speech/language disorder [PSP-SL] + PSP with predominant corticobasal syndrome [PSP-CBS]) and PSP-subcortical (PSP with predominant parkinsonism [PSP-P] + PSP with progressive gait freezing [PSP-PGF] + PSP with predominant postural instability [PSP-PI] + PSP with predominant ocular motor dysfunction [PSP-OM] + PSP with cerebellar ataxia [PSP-C] + PSP with primary lateral sclerosis [PSP-PLS]), based on clinical presentation during the first 3 years after symptom onset, which defines the early disease stage. Clinical and neuropsychological assessment data were collected. Genotyping of APOE was performed using restriction fragment length polymorphism polymerase chain reaction and verified by Sanger sequencing. RESULTS We included 112 PSP patients comprising 10 phenotypes classified into 48 PSP-RS, 34 PSP-cortical (PSP-CBS, 17.6%; PSP-F, 9.4%; PSP-SL, 8.2%) and 30 PSP-subcortical (PSP-P, 11.6%; PSP-PI, 8%; PSP-OM, 2.7%; PSP-PGF, 1.8%; PSP-C, 1.8%; PSP-PLS, 0.9%) subgroups. PSP-RS patients were older at disease onset (p = 0.009) and had more akinetic-rigid and levodopa-resistant parkinsonism (p = 0.006), while PSP-cortical patients had more tremors and asymmetric and/or levodopa-responsive parkinsonism (p = 0.025). Cognitive domains were significantly less altered in the PSP-subcortical subgroup. Overall, PSP-APOEε4 carriers developed parkinsonism earlier (p = 0.038), had earlier oculomotor dysfunction (p = 0.052) and had more altered cognitive profiles. The APOEε4 allele was also associated with a younger age of parkinsonism onset in the PSP-RS phenotype group (p = 0.026). CONCLUSION This study demonstrated the wide phenotypic spectrum of PSP among Tunisians. Disease onset and akinetic-rigid and levodopa-resistant parkinsonism were the hallmarks of the PSP-RS phenotype, while milder cognitive impairment was characteristic of the PSP-subcortical subgroup. The APOEε4 allele was associated with earlier parkinsonism and oculomotor dysfunction and seemed to play a role in defining a more altered cognitive profile in PSP patients.
Collapse
Affiliation(s)
- Amina Nasri
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Ikram Sghaier
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Anis Neji
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
| | - Alya Gharbi
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Youssef Abida
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Saloua Mrabet
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Amina Gargouri
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Mouna Ben Djebara
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Imen Kacem
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| | - Riadh Gouider
- Department of Neurology, LR18SP03, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) “Neurosciences and Mental Health”, Razi University Hospital, Tunis, Tunisia
| |
Collapse
|
2
|
Toś M, Grażyńska A, Antoniuk S, Siuda J. Impulse Control Disorders in Parkinson's Disease and Atypical Parkinsonian Syndromes-Is There a Difference? Brain Sci 2024; 14:181. [PMID: 38391755 PMCID: PMC10886884 DOI: 10.3390/brainsci14020181] [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: 01/22/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Impulse control disorders (ICDs) are characterized by potentially harmful actions resulting from disturbances in the self-control of emotions and behavior. ICDs include disorders such as gambling, hypersexuality, binge eating, and compulsive buying. ICDs are known non-motor symptoms in Parkinson's disease (PD) and are associated primarily with the use of dopaminergic treatment (DRT) and especially dopamine agonists (DA). However, in atypical parkinsonism (APS), such as progressive supranuclear palsy (PSP) or multiple system atrophy (MSA), there are only single case reports of ICDs without attempts to determine the risk factors for their occurrence. Moreover, numerous reports in the literature indicate increased impulsivity in PSP. Our study aimed to determine the frequency of individual ICDs in APS compared to PD and identify potential factors for developing ICDs in APS. MATERIALS AND METHODS Our prospective study included 185 patients with PD and 35 with APS (27 patients with PSP and 9 with MSA) hospitalized between 2020 and 2023 at the Neurological Department of University Central Hospital in Katowice. Each patient was examined using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) to assess ICDs. Additionally, other scales were used to assess the advancement of the disease, the severity of depression, and cognitive impairment. Information on age, gender, age of onset, disease duration, and treatment used were collected from medical records and patient interviews. RESULTS ICDs were detected in 23.39% of patients with PD (including binge eating in 11.54%, compulsive buying in 10.44%, hypersexuality in 8.79%, and pathological gambling in 4.40%), in one patient with MSA (hypersexuality and pathological gambling), and in 18.52% of patients with PSP (binge eating in 3.70%, compulsive buying in 7.41%, and hypersexuality in 11.11%). We found no differences in the frequency of ICDs between individual diseases (p = 0.4696). We confirmed that the use of higher doses of DA and L-dopa in patients with PD, as well as a longer disease duration and the presence of motor complications, were associated with a higher incidence of ICDs. However, we did not find any treatment effect on the incidence of ICDs in APS. CONCLUSIONS ICDs are common and occur with a similar frequency in PD and APS. Well-described risk factors for ICDs in PD, such as the use of DRT or longer disease duration, are not fully reflected in the risk factors for ICDs in APS. This applies especially to PSP, which, unlike PD and MSA, is a tauopathy in which, in addition to the use of DRT, other mechanisms related to the disease, such as disorders in neuronal loops and neurotransmitter deficits, may influence the development of ICDs. Further prospective multicenter studies recruiting larger groups of patients are needed to fully determine the risk factors and mechanisms of ICD development in APS.
Collapse
Affiliation(s)
- Mateusz Toś
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Grażyńska
- Department of Imaging Diagnostics and Interventional Radiology, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sofija Antoniuk
- St. Barbara Regional Specialist Hospital No. 5, 41-200 Sosnowiec, Poland
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| |
Collapse
|
3
|
Isella V, Licciardo D, Ferri F, Crivellaro C, Morzenti S, Appollonio I, Ferrarese C. Reduced phonemic fluency in progressive supranuclear palsy is due to dysfunction of dominant BA6. Front Aging Neurosci 2022; 14:969875. [PMID: 36158541 PMCID: PMC9492952 DOI: 10.3389/fnagi.2022.969875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reduced phonemic fluency is extremely frequent in progressive supranuclear palsy (PSP), but its neural correlate is yet to be defined. Objective We explored the hypothesis that poor fluency in PSP might be due to neurodegeneration within a dominant frontal circuit known to be involved in speech fluency, including the opercular area, the superior frontal cortex (BA6), and the frontal aslant tract connecting these two regions. Methods We correlated performance on a letter fluency task (F, A, and S, 60 s for each letter) with brain metabolism as measured with Fluoro-deoxy-glucose Positron Emission Tomography, using Statistical Parametric Mapping, in 31 patients with PSP. Results Reduced letter fluency was associated with significant hypometabolism at the level of left BA6. Conclusion Our finding is the first evidence that in PSP, as in other neurogical disorders, poor self-initiated, effortful verbal retrieval appears to be linked to dysfunction of the dominant opercular-aslant-BA6 circuit.
Collapse
Affiliation(s)
- Valeria Isella
- Department of Neurology, School of Medicine, University of Milano - Bicocca, Monza, Italy
- Milan Center for Neurosciences, Milan, Italy
| | - Daniele Licciardo
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| | - Francesca Ferri
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Ildebrando Appollonio
- Department of Neurology, School of Medicine, University of Milano - Bicocca, Monza, Italy
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| | - Carlo Ferrarese
- Department of Neurology, School of Medicine, University of Milano - Bicocca, Monza, Italy
- Milan Center for Neurosciences, Milan, Italy
- Neurology Unit, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
4
|
Goldman JG, Holden SK. Cognitive Syndromes Associated With Movement Disorders. Continuum (Minneap Minn) 2022; 28:726-749. [PMID: 35678400 DOI: 10.1212/con.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recognition and management of cognitive syndromes in movement disorders, including those with parkinsonism, chorea, ataxia, dystonia, and tremor. RECENT FINDINGS Cognitive and motor syndromes are often intertwined in neurologic disorders, including neurodegenerative diseases such as Parkinson disease, atypical parkinsonian syndromes, Huntington disease, and other movement disorders. Cognitive symptoms often affect attention, working memory, and executive and visuospatial functions preferentially, rather than language and memory, but heterogeneity can be seen in the various movement disorders. A distinct cognitive syndrome has been recognized in patients with cerebellar syndromes. Appropriate recognition and screening for cognitive changes in movement disorders may play a role in achieving accurate diagnoses and guiding patients and their families regarding progression and management decisions. SUMMARY In the comprehensive care of patients with movement disorders, recognition of cognitive syndromes is important. Pharmacologic treatments for the cognitive syndromes, including mild cognitive impairment and dementia, in these movement disorders lag behind the therapeutics available for motor symptoms, and more research is needed. Patient evaluation and management require a comprehensive team approach, often linking neurologists as well as neuropsychologists, psychologists, psychiatrists, social workers, and other professionals.
Collapse
|
5
|
Ortelli P, Ferrazzoli D, Versace V, Cian V, Zarucchi M, Gusmeroli A, Canesi M, Frazzitta G, Volpe D, Ricciardi L, Nardone R, Ruffini I, Saltuari L, Sebastianelli L, Baranzini D, Maestri R. Optimization of cognitive assessment in Parkinsonisms by applying artificial intelligence to a comprehensive screening test. NPJ Parkinsons Dis 2022; 8:42. [PMID: 35410449 PMCID: PMC9001753 DOI: 10.1038/s41531-022-00304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
The assessment of cognitive deficits is pivotal for diagnosis and management in patients with parkinsonisms. Low levels of correspondence are observed between evaluations assessed with screening cognitive tests in comparison with those assessed with in-depth neuropsychological batteries. A new tool, we named CoMDA (Cognition in Movement Disorders Assessment), was composed by merging Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Frontal Assessment Battery (FAB). In total, 500 patients (400 with Parkinson’s disease, 41 with vascular parkinsonism, 31 with progressive supranuclear palsy, and 28 with multiple system atrophy) underwent CoMDA (level 1–L1) and in-depth neuropsychological battery (level 2–L2). Machine learning was developed to classify the CoMDA score and obtain an accurate prediction of the cognitive profile along three different classes: normal cognition (NC), mild cognitive impairment (MCI), and impaired cognition (IC). The classification accuracy of CoMDA, assessed by ROC analysis, was compared with MMSE, MoCA, and FAB. The area under the curve (AUC) of CoMDA was significantly higher than that of MMSE, MoCA and FAB (p < 0.0001, p = 0.028 and p = 0.0007, respectively). Among 15 different algorithmic methods, the Quadratic Discriminant Analysis algorithm (CoMDA-ML) showed higher overall-metrics performance levels in predictive performance. Considering L2 as a 3-level continuous feature, CoMDA-ML produces accurate and generalizable classifications: micro-average ROC curve, AUC = 0.81; and AUC = 0.85 for NC, 0.67 for MCI, and 0.83 for IC. CoMDA and COMDA-ML are reliable and time-sparing tools, accurate in classifying cognitive profile in parkinsonisms. This study has been registered on ClinicalTrials.gov (NCT04858893).
Collapse
Affiliation(s)
- Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy. .,Department of Parkinson's disease and Movement disorders Rehabilitation, Fresco Parkinson Center, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy.
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.,Department of Parkinson's disease and Movement disorders Rehabilitation, Fresco Parkinson Center, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Veronica Cian
- Department of Parkinson's disease and Movement disorders Rehabilitation, Fresco Parkinson Center, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Marianna Zarucchi
- Department of Parkinson's disease and Movement disorders Rehabilitation, Fresco Parkinson Center, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Anna Gusmeroli
- Department of Parkinson's disease and Movement disorders Rehabilitation, Fresco Parkinson Center, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Margherita Canesi
- Department of Parkinson's disease and Movement disorders Rehabilitation, Fresco Parkinson Center, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | | | - Daniele Volpe
- Fresco Parkinson Center, "Villa Margherita", S. Stefano Riabilitazione, Arcugnano, Italy
| | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital (SABES-ASDAA), Merano-Meran, Italy.,Department of Neurology, Christian Doppler Medical Center, Paracelsus University Salzburg, Salzburg, Austria
| | - Ingrid Ruffini
- Department of Geriatrics, Memory Clinic, Franz Tappeiner Hospital (SABES-ASDAA), Merano-Meran, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Daniele Baranzini
- Ergonomica SRLS, Varese, Italy.,Centre of Innovative Human Systems, Trinity College, Dublin, Ireland
| | - Roberto Maestri
- Department of Biomedical Engineering, Scientific Institute of Montescano - IRCCS, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| |
Collapse
|
6
|
Pereira MF, Buchanan T, Höglinger GU, Bogdanovic M, Tofaris G, Prangnell S, Sarangmat N, FitzGerald JJ, Antoniades CA. Longitudinal changes of early motor and cognitive symptoms in progressive supranuclear palsy: the OxQUIP study. BMJ Neurol Open 2022; 4:e000214. [PMID: 35128403 PMCID: PMC8785161 DOI: 10.1136/bmjno-2021-000214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare neurodegenerative condition characterised by a range of motor and cognitive symptoms. Very little is known about the longitudinal change in these symptoms over time. Moreover, the effectiveness of clinical scales to detect early changes in PSP is still a matter of debate. OBJECTIVE We aimed to determine longitudinal changes in PSP features using multiple closely spaced follow-up time points over a period of 2 years. Methods 28 healthy control and 28 PSP participants, with average time since onset of symptoms of 1.9 years, were prospectively studied every 3 months for up to 24 months. Changes from baseline scores were calculated at each follow-up time point using multiple clinical scales to identify longitudinal progression of motor and cognitive symptoms. RESULTS The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, detected cognitive decline at baseline. Both scales revealed poor longitudinal sensitivity to clinical change in global cognitive symptoms. Conversely, the Movement Disorders Society Unified Parkinson's disease Rating Scale - part III and the PSP Rating Scale (PSPRS) reliably detected motor decline less than 2 years after disease onset. The 'Gait/Midline' PSPRS subscore consistently declined over time, with the earliest change being observed 6 months after baseline assessment. CONCLUSION While better cognitive screening tools are still needed to monitor cognitive decline in PSP, motor decline is consistently captured by clinical rating scales. These results support the inclusion of multiple follow-up time points in longitudinal studies in the early stages of PSP.
Collapse
Affiliation(s)
- Marta F Pereira
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Günter U Höglinger
- Department of Neurology, Technische Universität München & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Marko Bogdanovic
- Department of Neurology, Oxford University Hospitals, Oxford, UK
| | - George Tofaris
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon Prangnell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - James J FitzGerald
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
7
|
Kok ZQ, Murley AG, Rittman T, Rowe J, Passamonti L. Co-Occurrence of Apathy and Impulsivity in Progressive Supranuclear Palsy. Mov Disord Clin Pract 2021; 8:1225-1233. [PMID: 34761056 PMCID: PMC8564809 DOI: 10.1002/mdc3.13339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/21/2021] [Accepted: 08/21/2021] [Indexed: 01/02/2023] Open
Abstract
Background Apathy and impulsivity are common consequences of progressive supranuclear palsy (PSP) and can worsen its prognosis. They can co‐exist in the same patients although their concomitant prevalence remains unclear. Their relationship to emotional lability is unknown. Objectives To estimate the co‐occurrence of apathy and impulsivity and their relationship to emotional lability in PSP. To characterize the demographic, clinical, and cognitive features of PSP patients with apathy and impulsivity. Methods In a retrospective study of a long‐term clinical cohort, we assessed the prevalence of apathy, impulsivity, and emotional lability from clinical interviews, medical records, and contemporary carer questionnaires. One hundred fifty‐four patients with a diagnosis of probable or possible PSP (according to the 2017 Movement Disorder Society criteria) were identified. Sixty‐four of these patients had neuropathological confirmation of PSP. PSP patients with both apathy and impulsivity were compared in terms of demographic, clinical, and cognitive characteristics to PSP patients with either one or neither of these neuropsychiatric features. Results Apathy and impulsivity co‐existed in two‐thirds of people with PSP. A fifth displayed emotional lability in addition to apathy and impulsivity. Apathy and impulsivity were more commonly co‐expressed than by chance. There was no single demographic, clinical or cognitive feature that distinguished between PSP patients with versus patients without apathy and impulsivity. Conclusions The co‐existence of apathy and impulsivity in PSP suggests that these neuropsychiatric features may share similar risk factors and etio‐pathogenetic mechanisms. Apathy and impulsivity should be jointly assessed when planning symptomatic treatments for detrimental behavioral problems caused by PSP.
Collapse
Affiliation(s)
- Zi Q Kok
- School of Clinical Medicine Cambridge University Hospitals Cambridge United Kingdom
| | - Alexander G Murley
- School of Clinical Medicine Cambridge University Hospitals Cambridge United Kingdom.,Department of Clinical Neurosciences University of Cambridge Cambridge United Kingdom
| | - Timothy Rittman
- School of Clinical Medicine Cambridge University Hospitals Cambridge United Kingdom.,Department of Clinical Neurosciences University of Cambridge Cambridge United Kingdom
| | - James Rowe
- School of Clinical Medicine Cambridge University Hospitals Cambridge United Kingdom.,Department of Clinical Neurosciences University of Cambridge Cambridge United Kingdom.,Cognition and Brain Sciences Unit University of Cambridge Cambridge United Kingdom
| | - Luca Passamonti
- School of Clinical Medicine Cambridge University Hospitals Cambridge United Kingdom.,Department of Clinical Neurosciences University of Cambridge Cambridge United Kingdom.,Istituto di Bioimmagini e Fisiologia Molecolare, Consiglio Nazionale Ricerche Milan Italy
| |
Collapse
|
8
|
Wilson D, Le Heron C, Anderson T. Corticobasal syndrome: a practical guide. Pract Neurol 2021. [DOI: 10.1136/practneurol-2020-002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Corticobasal syndrome is a disorder of movement, cognition and behaviour with several possible underlying pathologies, including corticobasal degeneration. It presents insidiously and is slowly progressive. Clinicians should consider the diagnosis in people presenting with any combination of extrapyramidal features (with poor response to levodopa), apraxia or other parietal signs, aphasia and alien-limb phenomena. Neuroimaging showing asymmetrical perirolandic cortical changes supports the diagnosis, while advanced neuroimaging may give insight into the underlying pathology. Identifying corticobasal syndrome carries some management implications (especially if protein-based treatments arise in the future) and prognostic significance. Its treatment is largely symptomatic and is best undertaken within a multidisciplinary setting, including a neurologist, physiotherapist, occupational therapist, speech language therapist, psychiatrist and, ultimately, a palliative care clinician. Corticobasal syndrome can be a confusing entity for neurologists, not least because it has over time evolved from being considered predominantly as a movement disorder to a condition spanning a wide range of cognitive and motor manifestations. In this practical review, we attempt to disentangle this syndrome and provide clarity around diagnosis, its underlying pathological substrates, key clinical features and potential treatments.
Collapse
|
9
|
Vaccaro MG, Sarica A, Quattrone A, Chiriaco C, Salsone M, Morelli M, Quattrone A. Neuropsychological assessment could distinguish among different clinical phenotypes of progressive supranuclear palsy: A Machine Learning approach. J Neuropsychol 2020; 15:301-318. [PMID: 33231380 DOI: 10.1111/jnp.12232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/29/2020] [Indexed: 12/23/2022]
Abstract
Progressive supranuclear palsy (PSP) is a rare, rapidly progressive neurodegenerative disease. Richardson's syndrome (PSP-RS) and predominant parkinsonism (PSP-P) are characterized by wide range of cognitive and behavioural disturbances, but these variants show similar cognitive pattern of alterations, leading difficult differential diagnosis. For this reason, we explored with an Artificial Intelligence approach, whether cognitive impairment could differentiate the phenotypes. Forty Parkinson's disease (PD) patients, 25 PSP-P, 40 PSP-RS, and 34 controls were enrolled following the consensus criteria diagnosis. Participants were evaluated with neuropsychological battery for cognitive domains. Random Forest models were used for exploring the discriminant power of the cognitive tests in distinguishing among the four groups. The classifiers for distinguishing diseases from controls reached high accuracies (86% for PD, 95% for PSP-P, 99% for PSP-RS). Regarding the differential diagnosis, PD was discriminated from PSP-P with 91% (important variables: HAMA, MMSE, JLO, RAVLT_I, BDI-II) and from PSP-RS with 92% (important variables: COWAT, JLO, FAB). PSP-P was distinguished from PSP-RS with 84% (important variables: JLO, WCFST, RAVLT_I, Digit span_F). This study revealed that PSP-P, PSP-RS and PD had peculiar cognitive deficits compared with healthy subjects, from which they were discriminated with optimal accuracies. Moreover, high accuracies were reached also in differential diagnosis. Most importantly, Machine Learning resulted to be useful to the clinical neuropsychologist in choosing the most appropriate neuropsychological tests for the cognitive evaluation of PSP patients.
Collapse
Affiliation(s)
- Maria Grazia Vaccaro
- Neuroscience Research Center, Magna Graecia University, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy.,Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Alessia Sarica
- Neuroscience Research Center, Magna Graecia University, Catanzaro, Italy
| | - Andrea Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Carmelina Chiriaco
- Neuroscience Research Center, Magna Graecia University, Catanzaro, Italy
| | - Maria Salsone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Department of Clinical Neuroscience, Neurology-Sleep Disorder Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Morelli
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, Magna Graecia University, Catanzaro, Italy.,Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| |
Collapse
|
10
|
Abstract
Objectives: Recently, new criteria for sensitive and specific clinical diagnosis of progressive supranuclear palsy (PSP) have been addressed while distinct clinical phenotypes of the disorder have been increasingly described in the literature. This study aimed to describe past and present aspects of the disease as well as to highlight the cognitive and behavioral profile of PSP patients in relation to the underlying pathology, genetics and treatment procedures.Methods: A Medline and Scopus search was performed to identify articles published on this topic. Articles published solely in English were considered.Results: The most common clinical characteristics of PSP included early postural instability and falls, vertical supranuclear gaze palsy, parkinsonism with poor response to levodopa and pseudobulbar palsy. Frontal dysfunction and verbal fluency deficits were the most distinct cognitive impairments in PSP while memory, visuospatial and social cognition could also be affected. Apathy and impulsivity were also present in PSP patients and had significant impact on relatives and caregivers.Conclusions: PSP is a neurodegenerative disorder with prominent tau neuropathology. Movement, motivation and communication impairments in patients with PSP may limit participation in everyday living activities. Comprehensive neuropsychological assessments are of significant importance for PSP cognitive evaluation. Pharmacologic and non-pharmacologic approaches could be applied in order to relieve patients and improve quality of life.Clinical Implications: Executive dysfunction is the most notable cognitive impairment and dominates the neuropsychological profile of patients with PSP.
Collapse
Affiliation(s)
| | - Kleopatra H Schulpis
- Institute of Child Health, Research Center, "Aghia Sophia" Children's Hospital, Athens, Greece
| |
Collapse
|
11
|
Fiorenzato E, Antonini A, Camparini V, Weis L, Semenza C, Biundo R. Characteristics and progression of cognitive deficits in progressive supranuclear palsy vs. multiple system atrophy and Parkinson's disease. J Neural Transm (Vienna) 2019; 126:1437-1445. [PMID: 31432258 DOI: 10.1007/s00702-019-02065-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/13/2019] [Indexed: 01/03/2023]
Abstract
Cognitive impairment is frequent in progressive supranuclear palsy (PSP) and less common in multiple system atrophy (MSA), but characteristics and progression compared with Parkinson's disease (PD) need to be properly defined. We evaluated 35 PSP with Richardson's syndrome (PSP-RS), 30 MSA as well as 65 age-, sex-, and education-matched PD with an extensive clinical and neuropsychological assessment, allowing Level II cognitive diagnosis. Eighteen PSP, 12 MSA and 30 PD had a second evaluation between 12 and 18 months (mean 15 months) after the first assessment. PSP performance at Montreal Cognitive Assessment (MoCA), verbal fluencies (phonemic and semantic tasks), Stroop test (Error and Time), Digit Span Sequencing (DSS), incomplete letters of Visual Object and Space Perception (VOSP) and Benton's Judgment of Line Orientation (JLO) performance were significantly poorer at baseline compared to PD and MSA. Executive, language and visuospatial abilities declined longitudinally in PSP, but not in PD and MSA. After 1.5 year, 16% of PSP converted to dementia. Our study provides evidence that cognitive progression is more severe and rapid in PSP-RS than PD and MSA. Further, we observed that MoCA, verbal fluency (particularly semantic), DSS and Benton's JLO are valuable tests to detect cognitive progression in PSP-RS and may be proposed as possible biomarker to assess efficacy of disease modification strategies.
Collapse
Affiliation(s)
| | - Angelo Antonini
- Department of Neurosciences, Padova Neuroscience Center, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | | | - Luca Weis
- IRCCS San Camillo Hospital, Via Alberoni, 70, 30126, Venice, Italy
| | - Carlo Semenza
- IRCCS San Camillo Hospital, Via Alberoni, 70, 30126, Venice, Italy.,Department of Neurosciences, Padova Neuroscience Center, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Roberta Biundo
- IRCCS San Camillo Hospital, Via Alberoni, 70, 30126, Venice, Italy
| |
Collapse
|
12
|
Picillo M, Cuoco S, Tepedino MF, Cappiello A, Volpe G, Erro R, Santangelo G, Pellecchia MT, Barone P. Motor, cognitive and behavioral differences in MDS PSP phenotypes. J Neurol 2019; 266:1727-1735. [PMID: 30989369 DOI: 10.1007/s00415-019-09324-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Movement Disorder Society (MDS) new diagnostic criteria for Progressive Supranuclear palsy (PSP) identifying different disease phenotypes were recently released. The aim of the present study is to report on the cognitive and behavioral features of the different phenotypes diagnosed according to the MDS criteria. METHODS Forty-nine PSP patients underwent an extensive battery of clinical assessments. Differences between PSP subtypes were computed with χ2 or ANOVA tests. Using the z scores, subjects were classified as having normal cognition, mild cognitive impairment, single or multiple domain, and dementia. A logistic regression model was implemented to investigate the major determinants of PSP non-Richardson's syndrome phenotype. RESULTS Half of the cohort presented Richardson's syndrome (46.9%), followed by PSP with parkinsonism and corticobasal syndrome (22.4% and 14.2%, respectively). Richardson's syndrome and PSP with corticobasal syndrome presented a similar burden of disease. The only cognitive testing differentiating the phenotypes were semantic fluency and ideomotor apraxia. The majority of our cohort was either affected by dementia or presented normal cognition. Richardson's syndrome presented the highest rate of dementia. The only marker of PSP non-Richardson's syndrome phenotype was better performance in visuo-spatial testing, implying worse visuo-spatial abilities in PSP Richardson's syndrome. CONCLUSION Available clinical assessments hardly capture differences between PSP phenotypes. The cognitive testing differentiating the PSP phenotypes were semantic fluency and ideomotor apraxia. In PSP, mild cognitive impairment likely represents an intermediate step from normal cognition to dementia. The only marker of PSP non-Richardson's syndrome phenotype was better performance in visuo-spatial testing.
Collapse
Affiliation(s)
- Marina Picillo
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy.
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Maria Francesca Tepedino
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Arianna Cappiello
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Giampiero Volpe
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | | |
Collapse
|
13
|
Medical decision-making in progressive supranuclear palsy: A comparison to other neurodegenerative disorders. Parkinsonism Relat Disord 2019; 61:77-81. [DOI: 10.1016/j.parkreldis.2018.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/15/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
|
14
|
Comparative cognitive and neuropsychiatric profiles between Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. J Neurol 2018; 265:2602-2613. [DOI: 10.1007/s00415-018-9038-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023]
|
15
|
Kuzel AR, Lodhi MU, Syed IA, Rahim M. Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature. Cureus 2017; 9:e1837. [PMID: 29340258 PMCID: PMC5762189 DOI: 10.7759/cureus.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyotrophic lateral sclerosis. We report the case of a 51-year-old male, who presented with dull muscle cramps in the right upper shoulder and arm. After a careful history and physical exam, it was found that patient had both upper and lower motor neuron signs; therefore, a diagnosis of amyotrophic lateral sclerosis was made. Amyotrophic lateral sclerosis should strongly be considered in the differential diagnosis of patients presenting with an atypical initial presentation of progressively painful muscle cramps.
Collapse
Affiliation(s)
- Aaron R Kuzel
- Department of Emergency Medicine, Lincoln Memorial University-Debusk College of Osteopathic Medicine
| | | | - Intekhab Askari Syed
- Medical Student, Department of Medicine, Beckley Appalachian Regional Healthcare
| | - Mustafa Rahim
- Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine
| |
Collapse
|