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Van den Broecke A, Decruyenaere A, Schuermans N, Verdin H, Ghijsels J, Sieben A, Dermaut B, Hemelsoet D. Pooled analysis of patients with inherited prion disease caused by two- to twelve-octapeptide repeat insertions in the prion protein gene (PRNP). J Neurol 2024; 271:263-273. [PMID: 37689591 DOI: 10.1007/s00415-023-11968-9] [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: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
Inherited prion diseases caused by two- to twelve-octapeptide repeat insertions (OPRIs) in the prion protein gene (PRNP) show significant clinical heterogeneity. This study describes a family with two new cases with a 4-OPRI mutation and two asymptomatic mutation carriers. The pooled analysis summarizes all cases reported in the literature to date and describes the relation between survival, age of onset, number of OPRI and codon 129 polymorphism. MEDLINE and Google Scholar were queried from database inception up to December 31, 2022. Age of onset was compared per number of OPRI and per codon 129 polymorphism using the Kruskal-Wallis and Wilcoxon-Mann-Whitney tests, respectively. Disease duration was modeled non-parametrically by a Kaplan-Meier model and semi-parametrically by a Cox model. This study comprised 164 patients. Lower number of OPRI and presence of valine (cis-V) versus methionine (cis-M) on codon 129 were associated with an older age of onset (P < 0.001 and P = 0.025, respectively) and shorter disease duration (P < 0.001 and P = 0.003, respectively). Within patients with 5- or more OPRI codon cis-V remained significantly associated with a shorter disease duration. Codon 129 homozygosity versus heterozygosity was not significantly associated with age of onset or disease duration (P = 0.076 and P = 0.409, respectively). This study summarized the largest cohort of patients with two- to twelve-OPRI to date. Lower number of OPRI and codon 129 cis-V is associated with an older age of onset and shorter disease duration, while homozygosity or heterozygosity on codon 129 was not.
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Affiliation(s)
| | | | - Nika Schuermans
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jody Ghijsels
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anne Sieben
- Born-Bunge Institute, Laboratory for Neuropathology, University of Antwerp, Antwerp, Belgium
| | - Bart Dermaut
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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2
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Nan H, Liu L, Chen Z, Chu M, Li J, Jing D, Wang Y, Wu L. Octapeptide repeat alteration mutations of the prion protein gene in clinically diagnosed Alzheimer's disease and frontotemporal dementia. Clin Genet 2023. [PMID: 37148197 DOI: 10.1111/cge.14354] [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: 03/20/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Studies focusing on octapeptide repeat alteration mutations in PRNP in Alzheimer's disease (AD) and frontotemporal dementia (FTD) cohorts have been rare. We aim to screen sporadic AD and FTD patients with unknown etiology for the octapeptide repeat insertions and deletions in PRNP. Two hundred and six individuals were screened for alterations to the repeat region in the PRNP gene, including 146 sporadic AD and 60 sporadic FTD patients. Our study showed a 1.5% (3/206) occurrence of the octapeptide repeat alteration mutations in PRNP in a Chinese cohort of sporadic dementia. One late-onset FTD patient and one early-onset AD patient each had a two-octapeptide repeat deletion in PRNP, while one early-onset AD patient had a five-octapeptide repeat insertion mutation. PRNP octapeptide repeat alteration mutations are present in sporadic AD and FTD patients. The genetic investigation for PRNP octapeptide repeat alteration mutations in sporadic dementia patients should be carried out in future clinical studies.
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Affiliation(s)
- Haitian Nan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Chu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jieying Li
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China
| | - Donglai Jing
- Department of Neurology, Rongcheng People's Hospital, Hebei, China
| | - Yihao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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3
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Funayama M, Takata T, Nakagawa Y, Sunagawa K, Nakajima A, Kawashima H, Mimura M. Visuospatial working memory dysfunction from tapping span test as a diagnostic tool for patients with mild posterior cortical atrophy. Sci Rep 2021; 11:10580. [PMID: 34012020 PMCID: PMC8134425 DOI: 10.1038/s41598-021-90159-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Posterior cortical atrophy is a rare degenerative condition with prominent visuospatial dysfunction which commonly occurs between ages 50 and 65. A diagnosis of mild posterior cortical atrophy sometimes challenging and can be delayed because there are currently no established neuropsychological examination methods that can easily be used in clinical settings. In this study, we examined whether the tapping span test is a potential diagnostic tool for posterior cortical atrophy and what impairment the tapping span test is indicative of in this condition. Eight patients with mild posterior cortical atrophy were recruited. Age- and severity-matched individuals with amnesic Alzheimer's disease (n = 9) were also recruited as a control group. The participants were subjected to the tapping span test and several visuospatial working memory tests. The results of the tapping span and visuospatial working memory tests were worse for the posterior cortical atrophy group when compared with the control group. The results from the tapping span tests were strongly correlated with those from the visuospatial working memory tests. The tapping span test is a simple and potentially useful diagnostic tool for patients with mild posterior cortical atrophy, as it reflects visuospatial working memory function.
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Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843, Japan. .,Department of Rehabilitation, Edogawa Hospital, Tokyo, 1330052, Japan.
| | - Taketo Takata
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843, Japan
| | | | - Kosaku Sunagawa
- Faculty of Rehabilitation, Kansai Medical University, Osaka, 5820026, Japan
| | - Asuka Nakajima
- Department of Rehabilitation, Ashikaga Red Cross Hospital, Tochigi, 3260843, Japan
| | - Hiroaki Kawashima
- Department of Rehabilitation, Ashikaga Red Cross Hospital, Tochigi, 3260843, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, 1608582, Japan
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4
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Yerstein O, Parand L, Liang LJ, Isaac A, Mendez MF. Benson's Disease or Posterior Cortical Atrophy, Revisited. J Alzheimers Dis 2021; 82:493-502. [PMID: 34057092 PMCID: PMC8316293 DOI: 10.3233/jad-210368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND D. Frank Benson and colleagues first described the clinical and neuropathological features of posterior cortical atrophy (PCA) from patients in the UCLA Neurobehavior Program. OBJECTIVE We reviewed the Program's subsequent clinical experience with PCA, and its potential for clarifying this relatively rare syndrome in comparison to the accumulated literature on PCA. METHODS Using the original criteria derived from this clinic, 65 patients with neuroimaging-supported PCA were diagnosed between 1995 and 2020. RESULTS On presentation, most had visual localization complaints and related visuospatial symptoms, but nearly half had memory complaints followed by symptoms of depression. Neurobehavioral testing showed predominant difficulty with visuospatial constructions, Gerstmann's syndrome, and Balint's syndrome, but also impaired memory and naming. On retrospective application of the current Consensus Criteria for PCA, 59 (91%) met PCA criteria with a modification allowing for "significantly greater visuospatial over memory and naming deficits." There were 37 deaths (56.9%) with the median overall survival of 10.3 years (95% CI: 9.6-13.6 years), consistent with a slow neurodegenerative disorder in most patients. CONCLUSION Together, these findings recommend modifying the PCA criteria for "relatively spared" memory, language, and behavior to include secondary memory and naming difficulty and depression, with increased emphasis on the presence of Gerstmann's and Balint's syndromes.
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Affiliation(s)
- Oleg Yerstein
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Leila Parand
- Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Li-Jung Liang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Adrienne Isaac
- Department of Linguistics, Georgetown University, Washington, DC, USA
| | - Mario F. Mendez
- Department of Neurology, Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Neurology Service, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Areškevičiūtė A, Broholm H, Melchior LC, Bartoletti-Stella A, Parchi P, Capellari S, Scheie D, Lund EL. Molecular Characterization of the Danish Prion Diseases Cohort With Special Emphasis on Rare and Unique Cases. J Neuropathol Exp Neurol 2020; 78:980-992. [PMID: 31553446 DOI: 10.1093/jnen/nlz089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to perform an updated reclassification of all definite prion disease cases with available fresh-frozen samples referred to the Danish Reference Center over the past 40 years, putting a special emphasis on the molecular characterization of novel disease subtypes. Investigation of the Danish prion diseases cohort revealed rare sporadic Creutzfeldt-Jakob disease cases with mixed subtypes and subtypes with previously uncharacterized white matter plaques, a new case of sporadic fatal insomnia, and 3 novel mutations, including 2 large octapeptide repeat insertions, and a point mutation in the prion protein gene. The evaluation of methionine and valine distribution at codon 129 among the prion disease patients in the cohort revealed the increased prevalence of methionine homozygotes compared to the general population. This observation was in line with the prevalence reported in other Caucasian prion disease cohort studies. Reclassification of the old prion diseases cohort revealed unique cases, the molecular characterization of which improves prion diseases classification, diagnostic accuracy, genetic counseling of affected families, and the understanding of disease biology.
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Affiliation(s)
- Aušrinė Areškevičiūtė
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Helle Broholm
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Linea C Melchior
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Anna Bartoletti-Stella
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Piero Parchi
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Sabina Capellari
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - David Scheie
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Eva L Lund
- Department of Pathology, Danish Reference Center for Prion Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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6
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Wong B, Lucente DE, MacLean J, Padmanabhan J, Quimby M, Brandt KD, Putcha D, Sherman J, Frosch MP, McGinnis S, Dickerson BC. Diagnostic evaluation and monitoring of patients with posterior cortical atrophy. Neurodegener Dis Manag 2019; 9:217-239. [PMID: 31392920 PMCID: PMC6949516 DOI: 10.2217/nmt-2018-0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/03/2019] [Indexed: 12/21/2022] Open
Abstract
Posterior cortical atrophy (PCA) is a progressive neurocognitive syndrome, most commonly associated with the loss of complex visuospatial functions. Diagnosis is challenging, and international consensus classification and nomenclature for PCA subtypes have only recently been reached. Presently, no established treatments exist. Efforts to develop treatments are hampered by the lack of standardized methods to monitor illness progression. Although measures developed from work with Alzheimer's disease and other dementias provide a foundation for diagnosing and monitoring progression, PCA presents unique challenges for clinicians counseling patients and families on clinical status and prognosis, and experts designing clinical trials of interventions. Here, we review issues facing PCA clinical research and care, summarize our approach to diagnosis and monitoring of disease progression, and outline ideas for developing tools for these purposes.
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Affiliation(s)
- Bonnie Wong
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Diane E Lucente
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Centerfor Genomic Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Julie MacLean
- Department of Physical & Occupational Therapy, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jaya Padmanabhan
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Megan Quimby
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Massachusetts General Hospital, Boston,MA 02114, USA
- Department of Speech & Language Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Katherine D Brandt
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Massachusetts General Hospital, Boston,MA 02114, USA
| | - Deepti Putcha
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Janet Sherman
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Matthew P Frosch
- Department of Pathology, Division of Neuropathology, Massachusetts General Hospital, Boston, MA 02114, USA
- Massachusetts Alzheimer’s Disease Research Center, Boston, MA 02129, USA
| | - Scott McGinnis
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Massachusetts General Hospital, Boston,MA 02114, USA
- Department of Neurology, Division of Cognitive & Behavioral Neurology, Brigham & Women's Hospital, Boston, MA 02115, USA
| | - Bradford C Dickerson
- Posterior Cortical Atrophy Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Massachusetts General Hospital, Boston,MA 02114, USA
- Massachusetts Alzheimer’s Disease Research Center, Boston, MA 02129, USA
- Athinoula A Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA
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Baiardi S, Capellari S, Bartoletti Stella A, Parchi P. Unusual Clinical Presentations Challenging the Early Clinical Diagnosis of Creutzfeldt-Jakob Disease. J Alzheimers Dis 2019; 64:1051-1065. [PMID: 30010123 DOI: 10.3233/jad-180123] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The introduction of prion RT-QuIC, an ultrasensitive specific assay for the in vivo detection of the abnormal prion protein, has significantly increased the potential for an early and accurate clinical diagnosis of Creutzfeldt-Jakob disease (CJD). However, in the clinical setting, the early identification of patients with possible CJD is often challenging. Indeed, CJD patients may present with isolated symptoms that remain the only clinical manifestation for some time, or with neurological syndromes atypical for CJD. To enhance awareness of unusual disease presentations and promote earlier diagnosis, we reviewed the entire spectrum of atypical early manifestations of CJD, mainly reported to date as case descriptions or small case series. They included sensory either visual or auditory disturbances, seizures, isolated psychiatric manifestations, atypical parkinsonian syndromes (corticobasal syndrome, progressive supranuclear palsy-like), pseudobulbar syndrome, isolated involuntary movements (dystonia, myoclonus, chorea, blepharospasm), acute or subacute onsets mimicking a stroke, isolated aphasia, and neuropathy. Since CJD is a rare disease and its clinical course rapidly progressive, an in-depth understanding and awareness of early clinical features are mandatory to enhance the overall diagnostic accuracy in its very early stages and to recruit optimal candidates for future therapeutic trials.
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Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Piero Parchi
- IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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8
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Abstract
Genetic prion diseases (gPrDs) caused by mutations in the prion protein gene (PRNP) have been classified as genetic Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker disease, or fatal familial insomnia. Mutations in PRNP can be missense, nonsense, and/or octapeptide repeat insertions or, possibly, deletions. These mutations can produce diverse clinical features. They may also show varying ancillary testing results and neuropathological findings. Although the majority of gPrDs have a rapid progression with a short survival time of a few months, many also present as ataxic or parkinsonian disorders, which have a slower decline over a few to several years. A few very rare mutations manifest as neuropsychiatric disorders, with systemic symptoms that include gastrointestinal disorders and neuropathy; these forms can progress over years to decades. In this review, we classify gPrDs as rapid, slow, or mixed types based on their typical rate of progression and duration, and we review the broad spectrum of phenotypes manifested by these diseases.
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Affiliation(s)
- Mee-Ohk Kim
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California 94158
| | - Leonel T Takada
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of São Paulo, São Paulo, 05403-900, Brazil
| | - Katherine Wong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California 94158
| | - Sven A Forner
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California 94158
| | - Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California 94158
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9
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Esteves S, Ramirez Romero DA, Torralva T, Martínez Cuitiño M, Herndon S, Couto B, Ibañez A, Manes F, Roca M. Posterior cortical atrophy: a single case cognitive and radiological follow-up. Neurocase 2018; 24:16-30. [PMID: 29308699 DOI: 10.1080/13554794.2017.1421667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome characterized by initial predominant visuoperceptual deficits followed by a progressive decline in other cognitive functions. This syndrome has not been as thoroughly described as other dementias, particularly from a neuropsychological evolution perspective with only a few studies describing the evolution of its cognitive progression. In this investigation we review the literature on this rare condition and we perform a 7-year neuropsychological and neuroradiological follow-up of a 64-year-old man with PCA. The subject's deficits initially appeared in his visuoperceptual skills with later affectation appearing in language and other cognitive functions, this being coherent with the patient's parieto-temporal atrophy evolution.
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Affiliation(s)
- Sol Esteves
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Diana Andrea Ramirez Romero
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Teresa Torralva
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Macarena Martínez Cuitiño
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Shannon Herndon
- a Neuropsychological Research Laboratory, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina.,b Department of Psychiatry, School of Medicine, University of North Carolina Chapel Hill , Chapel Hill , USA
| | - Blas Couto
- c Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina
| | - Agustín Ibañez
- c Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, CONICET , Buenos Aires , Argentina.,d Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR) , Sydney , Australia.,e Universidad Autónoma del Caribe, Barranquilla , Colombia.,f Centre for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibañez , Santiago de Chile , Chile.,g National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
| | - Facundo Manes
- d Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR) , Sydney , Australia.,g National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
| | - María Roca
- g National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
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10
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Maia da Silva MN, Millington RS, Bridge H, James-Galton M, Plant GT. Visual Dysfunction in Posterior Cortical Atrophy. Front Neurol 2017; 8:389. [PMID: 28861031 PMCID: PMC5561011 DOI: 10.3389/fneur.2017.00389] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/21/2017] [Indexed: 01/08/2023] Open
Abstract
Posterior cortical atrophy (PCA) is a syndromic diagnosis. It is characterized by progressive impairment of higher (cortical) visual function with imaging evidence of degeneration affecting the occipital, parietal, and posterior temporal lobes bilaterally. Most cases will prove to have Alzheimer pathology. The aim of this review is to summarize the development of the concept of this disorder since it was first introduced. A critical discussion of the evolving diagnostic criteria is presented and the differential diagnosis with regard to the underlying pathology is reviewed. Emphasis is given to the visual dysfunction that defines the disorder, and the classical deficits, such as simultanagnosia and visual agnosia, as well as the more recently recognized visual field defects, are reviewed, along with the evidence on their neural correlates. The latest developments on the imaging of PCA are summarized, with special attention to its role on the differential diagnosis with related conditions.
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Affiliation(s)
- Mari N Maia da Silva
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Cognitive and Behavioural Neurology Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Rebecca S Millington
- Oxford Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Holly Bridge
- Oxford Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Merle James-Galton
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gordon T Plant
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom.,St. Thomas' Hospital, London, United Kingdom
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11
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Crutch SJ, Schott JM, Rabinovici GD, Murray M, Snowden JS, van der Flier WM, Dickerson BC, Vandenberghe R, Ahmed S, Bak TH, Boeve BF, Butler C, Cappa SF, Ceccaldi M, de Souza LC, Dubois B, Felician O, Galasko D, Graff-Radford J, Graff-Radford NR, Hof PR, Krolak-Salmon P, Lehmann M, Magnin E, Mendez MF, Nestor PJ, Onyike CU, Pelak VS, Pijnenburg Y, Primativo S, Rossor MN, Ryan NS, Scheltens P, Shakespeare TJ, Suárez González A, Tang-Wai DF, Yong KXX, Carrillo M, Fox NC. Consensus classification of posterior cortical atrophy. Alzheimers Dement 2017; 13:870-884. [PMID: 28259709 PMCID: PMC5788455 DOI: 10.1016/j.jalz.2017.01.014] [Citation(s) in RCA: 360] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/06/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION A classification framework for posterior cortical atrophy (PCA) is proposed to improve the uniformity of definition of the syndrome in a variety of research settings. METHODS Consensus statements about PCA were developed through a detailed literature review, the formation of an international multidisciplinary working party which convened on four occasions, and a Web-based quantitative survey regarding symptom frequency and the conceptualization of PCA. RESULTS A three-level classification framework for PCA is described comprising both syndrome- and disease-level descriptions. Classification level 1 (PCA) defines the core clinical, cognitive, and neuroimaging features and exclusion criteria of the clinico-radiological syndrome. Classification level 2 (PCA-pure, PCA-plus) establishes whether, in addition to the core PCA syndrome, the core features of any other neurodegenerative syndromes are present. Classification level 3 (PCA attributable to AD [PCA-AD], Lewy body disease [PCA-LBD], corticobasal degeneration [PCA-CBD], prion disease [PCA-prion]) provides a more formal determination of the underlying cause of the PCA syndrome, based on available pathophysiological biomarker evidence. The issue of additional syndrome-level descriptors is discussed in relation to the challenges of defining stages of syndrome severity and characterizing phenotypic heterogeneity within the PCA spectrum. DISCUSSION There was strong agreement regarding the definition of the core clinico-radiological syndrome, meaning that the current consensus statement should be regarded as a refinement, development, and extension of previous single-center PCA criteria rather than any wholesale alteration or redescription of the syndrome. The framework and terminology may facilitate the interpretation of research data across studies, be applicable across a broad range of research scenarios (e.g., behavioral interventions, pharmacological trials), and provide a foundation for future collaborative work.
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Affiliation(s)
| | | | - Gil D Rabinovici
- Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Julie S Snowden
- Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Wiesje M van der Flier
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Samrah Ahmed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas H Bak
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stefano F Cappa
- Center for Cognitive Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Mathieu Ceccaldi
- INSERM U 1106, Institut des Neurosciences des Systèmes, Aix Marseille Université, Marseilles, France
| | - Leonardo Cruz de Souza
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Dubois
- Institute for Memory and Alzheimer's Disease, UMR-S975, Salpêtrière Hospital, Pierre & Marie Curie University, Paris, France
| | - Olivier Felician
- Aix-Marseille Université, INSERM, Institut de Neurosciences des Systèmes, Marseille, France; AP-HM Hôpitaux de la Timone, Service de Neurologie et Neuropsychologie, Marseille, France
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, USA
| | | | | | - Patrick R Hof
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, INSERM U1028, CNRS UMR5292, University of Lyon, Lyon, France
| | - Manja Lehmann
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eloi Magnin
- Department of Neurology, Regional Memory Centre (CMRR), CHU Besançon, Besançon, France
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter J Nestor
- Cognitive Neurology and Neurodegeneration Group, German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yolande Pijnenburg
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Silvia Primativo
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Philip Scheltens
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Aida Suárez González
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Memory Disorders Unit, Neurology Department, University Hospital Virgen del Rocio, Seville, Spain
| | - David F Tang-Wai
- Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, Ontario, Canada
| | - Keir X X Yong
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Maria Carrillo
- Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
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Takada LT, Kim MO, Cleveland RW, Wong K, Forner SA, Gala II, Fong JC, Geschwind MD. Genetic prion disease: Experience of a rapidly progressive dementia center in the United States and a review of the literature. Am J Med Genet B Neuropsychiatr Genet 2017; 174:36-69. [PMID: 27943639 PMCID: PMC7207989 DOI: 10.1002/ajmg.b.32505] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022]
Abstract
Although prion diseases are generally thought to present as rapidly progressive dementias with survival of only a few months, the phenotypic spectrum for genetic prion diseases (gPrDs) is much broader. The majority have a rapid decline with short survival, but many patients with gPrDs present as slowly progressive ataxic or parkinsonian disorders with progression over a few to several years. A few very rare mutations even present as neuropsychiatric disorders, sometimes with systemic symptoms such as gastrointestinal disorders and neuropathy, progressing over years to decades. gPrDs are caused by mutations in the prion protein gene (PRNP), and have been historically classified based on their clinicopathological features as genetic Jakob-Creutzfeldt disease (gJCD), Gerstmann-Sträussler-Scheinker (GSS), or Fatal Familial Insomnia (FFI). Mutations in PRNP can be missense, nonsense, and octapeptide repeat insertions or a deletion, and present with diverse clinical features, sensitivities of ancillary testing, and neuropathological findings. We present the UCSF gPrD cohort, including 129 symptomatic patients referred to and/or seen at UCSF between 2001 and 2016, and compare the clinical features of the gPrDs from 22 mutations identified in our cohort with data from the literature, as well as perform a literature review on most other mutations not represented in our cohort. E200K is the most common mutation worldwide, is associated with gJCD, and was the most common in the UCSF cohort. Among the GSS-associated mutations, P102L is the most commonly reported and was also the most common at UCSF. We also had several octapeptide repeat insertions (OPRI), a rare nonsense mutation (Q160X), and three novel mutations (K194E, E200G, and A224V) in our UCSF cohort. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonel T. Takada
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Mee-Ohk Kim
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Ross W. Cleveland
- Department of Pediatrics, The University of Vermont Children’s Hospital, University of Vermont, Burlington, VT 05401
| | - Katherine Wong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Sven A. Forner
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Ignacio Illán Gala
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jamie C. Fong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
| | - Michael D. Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94107
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First report of PSEN2 mutation presenting as posterior cortical atrophy. Alzheimer Dis Assoc Disord 2016; 29:249-51. [PMID: 25010293 DOI: 10.1097/wad.0000000000000052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Peng G, Liu P, He F, Luo B. Posterior cortical atrophy as a primary clinical phenotype of corticobasal syndrome with a progranulin gene rs5848 TT genotype. Orphanet J Rare Dis 2016; 11:13. [PMID: 26852323 PMCID: PMC4744454 DOI: 10.1186/s13023-016-0396-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/28/2016] [Indexed: 01/12/2023] Open
Abstract
Posterior cortical atrophy (PCA) represents a special clinicoradiologic syndrome characterized by progressive visuospatial and visuoperceptual deficits. PCA and corticobasal syndrome (CBS) may share similar pathogenetic mechanisms. We report the clinical, neuropsychological, imaging, and genetic features of a patient with initial visual problems, who further developed other cognitive impairments and asymmetric extrapyramidal signs fitting into the diagnosis of CBS. Genetic testing revealed homozygous for the T allele of the rs5848 GRN variant. This study provided an evidence for CBS belonging to the clinical spectrum of GRN genetic variant and demonstrated CBS may initially present with symptoms of PCA in rare cases.
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Affiliation(s)
- Guoping Peng
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
| | - Ping Liu
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
| | - Fangping He
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
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Carrasquillo MM, Barber I, Lincoln SJ, Murray ME, Camsari GB, Khan QUA, Nguyen T, Ma L, Bisceglio GD, Crook JE, Younkin SG, Dickson DW, Boeve BF, Graff-Radford NR, Morgan K, Ertekin-Taner N. Evaluating pathogenic dementia variants in posterior cortical atrophy. Neurobiol Aging 2015; 37:38-44. [PMID: 26507310 DOI: 10.1016/j.neurobiolaging.2015.09.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/26/2015] [Accepted: 09/29/2015] [Indexed: 12/18/2022]
Abstract
Posterior cortical atrophy (PCA) is an understudied visual impairment syndrome most often due to "posterior Alzheimer's disease (AD)" pathology. Case studies detected mutations in PSEN1, PSEN2, GRN, MAPT, and PRNP in subjects with clinical PCA. To detect the frequency and spectrum of mutations in known dementia genes in PCA, we screened 124 European-American subjects with clinical PCA (n = 67) or posterior AD neuropathology (n = 57) for variants in genes implicated in AD, frontotemporal dementia, and prion disease using NeuroX, a customized exome array. Frequencies in PCA of the variants annotated as pathogenic or potentially pathogenic were compared against ∼ 4300 European-American population controls from the NHLBI Exome Sequencing Project. We identified 2 rare variants not previously reported in PCA, TREM2 Arg47His, and PSEN2 Ser130Leu. No other pathogenic or potentially pathogenic variants were detected in the screened dementia genes. In this first systematic variant screen of a PCA cohort, we report 2 rare mutations in TREM2 and PSEN2, validate our previously reported APOE ε4 association, and demonstrate the utility of NeuroX.
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Affiliation(s)
| | - Imelda Barber
- Human Genetics Group, University of Nottingham, Nottingham, UK
| | - Sarah J Lincoln
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Thuy Nguyen
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Li Ma
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Julia E Crook
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | - Kevin Morgan
- Human Genetics Group, University of Nottingham, Nottingham, UK
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
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Rossi G, Bastone A, Piccoli E, Morbin M, Mazzoleni G, Fugnanesi V, Beeg M, Del Favero E, Cantù L, Motta S, Salsano E, Pareyson D, Erbetta A, Elia AE, Del Sorbo F, Silani V, Morelli C, Salmona M, Tagliavini F. Different mutations at V363 MAPT codon are associated with atypical clinical phenotypes and show unusual structural and functional features. Neurobiol Aging 2014; 35:408-17. [DOI: 10.1016/j.neurobiolaging.2013.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/02/2013] [Accepted: 08/04/2013] [Indexed: 02/06/2023]
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A patient with posterior cortical atrophy possesses a novel mutation in the presenilin 1 gene. PLoS One 2013; 8:e61074. [PMID: 23593396 PMCID: PMC3625161 DOI: 10.1371/journal.pone.0061074] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/05/2013] [Indexed: 12/17/2022] Open
Abstract
Posterior cortical atrophy is a dementia syndrome with symptoms of cortical visual dysfunction, associated with amyloid plaques and neurofibrillary tangles predominantly affecting visual association cortex. Most patients diagnosed with posterior cortical atrophy will finally develop a typical Alzheimer's disease. However, there are a variety of neuropathological processes, which could lead towards a clinical presentation of posterior cortical atrophy. Mutations in the presenilin 1 gene, affecting the function of γ-secretase, are the most common genetic cause of familial, early-onset Alzheimer's disease. Here we present a patient with a clinical diagnosis of posterior cortical atrophy who harbors a novel Presenilin 1 mutation (I211M). In silico analysis predicts that the mutation could influence the interaction between presenilin 1 and presenilin1 enhancer-2 protein, a protein partner within the γ-secretase complex. These findings along with published literature support the inclusion of posterior cortical atrophy on the Alzheimer's disease spectrum.
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Abstract
Variant syndromes of Alzheimer disease (AD), led by deficits that extend beyond memory dysfunction, are of considerable clinical and neurobiological importance. Such syndromes present major challenges for both diagnosis and monitoring of disease, and serve to illustrate the apparent paradox of a clinically diverse group of disorders underpinned by a common histopathological substrate. This Review focuses on the most common variant AD phenotypes: posterior cortical atrophy, logopenic variant primary progressive aphasia and frontal variant AD. The neuroanatomical, molecular and pathological correlates of these phenotypes are highlighted, and the heterogeneous clinical presentations of the syndromes are discussed in the context of the emerging network paradigm of neurodegenerative disease. We argue that these apparently diverse clinical phenotypes reflect the differential involvement of a common core temporoparietofrontal network that is vulnerable to AD. According to this interpretation, the network signatures corresponding to AD variant syndromes are produced by genetic and other modulating factors that have yet to be fully characterized. The clinical and neurobiological implications of this network paradigm in the quest for disease-modifying treatments are also explored.
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Abstract
Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterised by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. The progressive neurodegeneration affecting parietal, occipital, and occipitotemporal cortices that underlies PCA is attributable to Alzheimer's disease in most patients. However, alternative underlying causes, including dementia with Lewy bodies, corticobasal degeneration, and prion disease, have also been identified, and not all patients with PCA have atrophy on clinical imaging. This heterogeneity has led to inconsistencies in diagnosis and terminology and difficulties in comparing studies from different centres, and has restricted the generalisability of findings from clinical trials and investigations of factors that drive phenotypic variability. Important challenges remain, including the identification of factors associated not only with the selective vulnerability of posterior cortical regions but also with the young age of onset of PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-level and disease-level classifications are needed to improve diagnostic accuracy, clinical management, and the design of research studies.
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Affiliation(s)
- Sebastian J Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK.
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