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Lin CYR, Kuo SH, Opal P. Cognitive, Emotional, and Other Non-motor Symptoms of Spinocerebellar Ataxias. Curr Neurol Neurosci Rep 2024; 24:47-54. [PMID: 38270820 PMCID: PMC10922758 DOI: 10.1007/s11910-024-01331-4] [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] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Spinocerebellar ataxias (SCAs) are autosomal dominant degenerative syndromes that present with ataxia and brain stem abnormalities. This review describes the cognitive and behavioral symptoms of SCAs in the context of recent knowledge of the role of the cerebellum in higher intellectual function. RECENT FINDINGS Recent studies suggest that patients with spinocerebellar ataxia can display cognitive deficits even early in the disease. These have been given the term cerebellar cognitive affective syndrome (CCAS). CCAS can be tracked using newly developed rating scales. In addition, patients with spinocerebellar ataxia also display impulsive and compulsive behavior, depression, anxiety, fatigue, and sleep disturbances. This review stresses the importance of recognizing non-motor symptoms in SCAs. There is a pressing need for novel therapeutic interventions to address these symptoms given their deleterious impact on patients' quality of life.
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Affiliation(s)
- Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Sheng-Han Kuo
- Department of Neurology and Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Puneet Opal
- Davee Department of Neurology and Department of Cell and Developmental Biology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
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2
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Leon M, Woo CC. Olfactory loss is a predisposing factor for depression, while olfactory enrichment is an effective treatment for depression. Front Neurosci 2022; 16:1013363. [PMID: 36248633 PMCID: PMC9558899 DOI: 10.3389/fnins.2022.1013363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
The loss of olfactory stimulation correlates well with at least 68 widely differing neurological disorders, including depression, and we raise the possibility that this relationship may be causal. That is, it seems possible that olfactory loss makes the brain vulnerable to expressing the symptoms of these neurological disorders, while daily olfactory enrichment may decrease the risk of expressing these symptoms. This situation resembles the cognitive reserve that is thought to protect people with Alzheimer’s neuropathology from expressing the functional deficit in memory through the cumulative effect of intellectual stimulation. These relationships also resemble the functional response of animal models of human neurological disorders to environmental enrichment, wherein the animals continue to have the induced neuropathology, but do not express the symptoms as they do in a standard environment with restricted sensorimotor stimulation.
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Affiliation(s)
- Michael Leon
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
- Center for the Neurobiology of Learning and Memory, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Michael Leon,
| | - Cynthia C. Woo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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3
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Melis M, Haehner A, Mastinu M, Hummel T, Tomassini Barbarossa I. Molecular and Genetic Factors Involved in Olfactory and Gustatory Deficits and Associations with Microbiota in Parkinson's Disease. Int J Mol Sci 2021; 22:ijms22084286. [PMID: 33924222 PMCID: PMC8074606 DOI: 10.3390/ijms22084286] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022] Open
Abstract
Deficits in olfaction and taste are among the most frequent non-motor manifestations in Parkinson’s disease (PD) that start very early and frequently precede the PD motor symptoms. The limited data available suggest that the basis of the olfactory and gustatory dysfunction related to PD are likely multifactorial and may include the same determinants responsible for other non-motor symptoms of PD. This review describes the most relevant molecular and genetic factors involved in the PD-related smell and taste impairments, and their associations with the microbiota, which also may represent risk factors associated with the disease.
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Affiliation(s)
- Melania Melis
- Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy; (M.M.); (M.M.)
| | - Antje Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University of Dresden, 01307 Dresden, Germany; (A.H.); (T.H.)
| | - Mariano Mastinu
- Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy; (M.M.); (M.M.)
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University of Dresden, 01307 Dresden, Germany; (A.H.); (T.H.)
| | - Iole Tomassini Barbarossa
- Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy; (M.M.); (M.M.)
- Correspondence: ; Tel.: +39-070-675-4144
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Laing DG, Epps A, Jinks AL. Chemosensory Loss during a Traumatic Brain Injury Suggests a Central Pathway for the Rehabilitation of Anosmia. Chem Senses 2021; 46:6225237. [PMID: 33893484 DOI: 10.1093/chemse/bjab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Currently, no method has been developed for rehabilitating olfaction in anosmic patients following a traumatic brain injury (TBI). Here a method for rehabilitation is described which is based on a recent finding that the human posterior pyriform cortex (PPC) generates predictive odor "search images" in advance of an encounter with an olfactory stimulus. The search image enhances perceptual sensitivity and allows the odor it represents to be identified without input occurring from the olfactory receptors or bulbs. Furthermore, based on the finding here that anosmics with a TBI often have normal trigeminal and gustatory function, it is proposed that normality in these chemosensory systems may indicate that key cortical regions including the PPC are intact in anosmics and capable of processing olfactory information. In addition, the results of chemosensory tests of the olfactory, gustatory, and intranasal trigeminal systems of 18 patients with a TBI are given that identify which patients would most likely benefit from the rehabilitation procedure.
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Affiliation(s)
- David G Laing
- Discipline of Paediatrics, School of Women's and Children's Health, University of NSW Medicine, Level 3, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia
| | - Adrienne Epps
- Rehab2Kids, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia
| | - Anthony L Jinks
- School of Psychology, Western Sydney University, Kingswood Campus, Second Avenue, NSW 2747, Australia
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Olfaction as a Marker for Dystonia: Background, Current State and Directions. Brain Sci 2020; 10:brainsci10100727. [PMID: 33066144 PMCID: PMC7601998 DOI: 10.3390/brainsci10100727] [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: 09/01/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023] Open
Abstract
Dystonia is a heterogeneous group of hyperkinetic movement disorders. The unifying descriptor of dystonia is the motor manifestation, characterized by continuous or intermittent contractions of muscles that cause abnormal movements and postures. Additionally, there are psychiatric, cognitive, and sensory alterations that are possible or putative non-motor manifestations of dystonia. The pathophysiology of dystonia is incompletely understood. A better understanding of dystonia pathophysiology is highly relevant in the amelioration of significant disability associated with motor and non-motor manifestations of dystonia. Recently, diminished olfaction was found to be a potential non-motor manifestation that may worsen the situation of subjects with dystonia. Yet, this finding may also shed light into dystonia pathophysiology and yield novel treatment options. This article aims to provide background information on dystonia and the current understanding of its pathophysiology, including the key structures involved, namely, the basal ganglia, cerebellum, and sensorimotor cortex. Additionally, involvement of these structures in the chemical senses are reviewed to provide an overview on how olfactory (and gustatory) deficits may occur in dystonia. Finally, we describe the present findings on altered chemical senses in dystonia and discuss directions of research on olfactory dysfunction as a marker in dystonia.
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Auditory and Olfactory Deficits in Essential Tremor - Review of the Current Evidence. Tremor Other Hyperkinet Mov (N Y) 2020; 10:3. [PMID: 32775017 PMCID: PMC7394198 DOI: 10.5334/tohm.57] [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] [Indexed: 11/20/2022] Open
Abstract
Background: Essential tremor (ET) is the most common adult movement disorder, characterized by several motor and increasingly well recognized non-motor symptoms. Sensory deficits, such as hearing impairment and olfactory dysfunction, are amongst them. This review analyzes the available evidence of these sensory deficits and their possible mechanistic basis in patients with ET. Method: A PubMed literature search on the topic was performed in the May 2019 database. Results: Nineteen articles on hearing impairment and olfactory dysfunction in ET patients were identified. The prevalence of hearing impairment is higher in ET patients than healthy controls or Parkinson disease. Cochlear pathologies are suggested as the underlying cause, but there is still a lack of information about retrocochlear pathologies and central auditory processing. Reports on olfactory dysfunction have conflicting results. The presence of mild olfactory dysfunction in ET was suggested. Conflicting results may be due to the lack of consideration of the disease’s heterogeneity, but according to recent data, most studies do not find prominent evidence of olfactory loss in ET. Conclusion: Although there is increasing interest in studies on non-motor symptoms in ET, there are few studies on sensory deficits, which are of particularly high prevalence. More studies are needed on to investigate the basis of non-motor symptoms, including sensory deficits.
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Herr T, Hummel T, Vollmer M, Willert C, Veit B, Gamain J, Fleischmann R, Lehnert B, Mueller JU, Stenner A, Kronenbuerger M. Smell and taste in cervical dystonia. J Neural Transm (Vienna) 2020; 127:347-354. [PMID: 32062706 PMCID: PMC8102446 DOI: 10.1007/s00702-020-02156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
The pathophysiology of cervical dystonia is not completely understood. Current concepts of the pathophysiology propose that it is a network disorder involving the basal ganglia, cerebellum and sensorimotor cortex. These structures are primarily concerned with sensorimotor control but are also involved in non-motor functioning such as the processing of information related to the chemical senses. This overlap lets us hypothesize a link between cervical dystonia and altered sense of smell and taste. To prove this hypothesis and to contribute to the better understanding of cervical dystonia, we assessed olfactory and gustatory functioning in 40 adults with idiopathic cervical dystonia and 40 healthy controls. The Sniffin Sticks were used to assess odor threshold, discrimination and identification. Furthermore, the Taste Strips were applied to assess the combined taste score. Motor and non-motor deficits of cervical dystonia including neuropsychological and psychiatric alterations were assessed as cofactors for regression analyses. We found that cervical dystonia subjects had lower scores than healthy controls for odor threshold (5.8 ± 2.4 versus 8.0 ± 3.2; p = 0.001), odor identification (11.7 ± 2.3 versus 13.1 ± 1.3; p = 0.001) and the combined taste score (9.5 ± 2.2 versus 11.7 ± 2.7; p < 0.001), while no difference was found in odor discrimination (12.0 ± 2.5 versus 12.9 ± 1.8; p = 0.097). Regression analysis suggests that age is the main predictor for olfactory decline in subjects with cervical dystonia. Moreover, performance in the Montreal Cognitive Assessment is a predictor for gustatory decline in cervical dystonia subjects. Findings propose that cervical dystonia is associated with diminished olfactory and gustatory functioning.
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Affiliation(s)
- Thorsten Herr
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | | | - Birgitt Veit
- Neurology Group Practice, Neubrandenburg, Germany
| | - Julie Gamain
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Bernhard Lehnert
- Department of Otorhinolaryngology, University Medicine Greifswald, Greifswald, Germany
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Andrea Stenner
- Outpatient Department of Neurology, Paracelsus Clinic Zwickau, Zwickau, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Moro A, Moscovich M, Farah M, Camargo CHF, Teive HAG, Munhoz RP. Nonmotor symptoms in spinocerebellar ataxias (SCAs). CEREBELLUM & ATAXIAS 2019; 6:12. [PMID: 31485334 PMCID: PMC6712685 DOI: 10.1186/s40673-019-0106-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
Nonmotor symptoms (NMS) have been increasingly recognized in a number of neurodegenerative diseases with a burden of disability that parallels or even surpasses that induced by motor symptoms. As NMS have often been poorly recognized and inadequately treated, much of the most recent developments in the investigation of these disorders has focused on the recognition and quantification of NMS, which will form the basis of improved clinical care for these complex cases. NMS have been only sparsely investigated in a limited number of spinocerebellar ataxias (SCAs), particularly SCA3, and have not been systematically reviewed for other forms of SCAs. The aim of the present study was to review the available literature on the presence of NMS among different types of SCAs.
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Affiliation(s)
- Adriana Moro
- 1Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, 50 Teixeira Soares Street, Batel, Curitiba, PR CEP 80240-440 Brazil.,Department of Medicine, Pequeno Príncipe College, Curitiba, PR Brazil
| | - Mariana Moscovich
- 3Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Marina Farah
- 4Neurology Service, Hospital Universitário Cajurú, Catholic University of Paraná, Curitiba, PR Brazil
| | - Carlos Henrique F Camargo
- 5Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR Brazil
| | - Hélio A G Teive
- 1Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, 50 Teixeira Soares Street, Batel, Curitiba, PR CEP 80240-440 Brazil.,5Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR Brazil
| | - Renato P Munhoz
- 6Department of Medicine, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, ON Canada
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Georgiopoulos C, Witt ST, Haller S, Dizdar N, Zachrisson H, Engström M, Larsson EM. A study of neural activity and functional connectivity within the olfactory brain network in Parkinson's disease. NEUROIMAGE-CLINICAL 2019; 23:101946. [PMID: 31491835 PMCID: PMC6661283 DOI: 10.1016/j.nicl.2019.101946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/23/2019] [Accepted: 07/17/2019] [Indexed: 01/16/2023]
Abstract
Olfactory dysfunction is an early manifestation of Parkinson's disease (PD). The present study aimed to illustrate potential differences between PD patients and healthy controls in terms of neural activity and functional connectivity within the olfactory brain network. Twenty PD patients and twenty healthy controls were examined with olfactory fMRI and resting-state fMRI. Data analysis of olfactory fMRI included data-driven tensorial independent component (ICA) and task-driven general linear model (GLM) analyses. Data analysis of resting-state fMRI included probabilistic ICA based on temporal concatenation and functional connectivity analysis within the olfactory network. ICA of olfactory fMRI identified an olfactory network consisting of the posterior piriform cortex, insula, right orbitofrontal cortex and thalamus. Recruitment of this network was less significant for PD patients. GLM analysis revealed significantly lower activity in the insula bilaterally and the right orbitofrontal cortex in PD compared to healthy controls but no significant differences in the olfactory cortex itself. Analysis of resting-state fMRI did not reveal any differences in the functional connectivity within the olfactory, default mode, salience or central executive networks between the two groups. In conclusion, olfactory dysfunction in PD is associated with less significant recruitment of the olfactory brain network. ICA could demonstrate differences in both the olfactory cortex and its main projections, compared to GLM that revealed differences only on the latter. Resting-state fMRI did not reveal any significant differences in functional connectivity within the olfactory, default mode, salience and central executive networks in this cohort. Less significant recruitment of the olfactory brain network was found in Parkinson's disease. Independent component analysis reveals differences in both olfactory cortex and its projections. Differences in functional connectivity within the olfactory network were not significant.
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Affiliation(s)
- Charalampos Georgiopoulos
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Suzanne T Witt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Sven Haller
- Centre Imagerie Rive Droite SA, Geneva, Switzerland; Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Nil Dizdar
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
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Moscovich M, Munhoz RP, Moro A, Raskin S, McFarland K, Ashizawa T, Teive HAG, Silveira-Moriyama L. Olfactory Function in SCA10. THE CEREBELLUM 2019; 18:85-90. [PMID: 29922950 DOI: 10.1007/s12311-018-0954-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although the main clinical manifestations of spinocerebellar ataxias (SCAs) result from damage of the cerebellum, other systems may also be involved. Olfactory deficits have been reported in other types of ataxias, especially in SCA3; however, there are no studies on olfactory deficits in SCA type 10 (SCA10). To analyze olfactory function of SCA10 patients compared with that of SCA3, Parkinson's, and healthy controls. Olfactory identification was tested in three groups of 30 patients (SCA10, SCA3, and Parkinson's disease (PD)) and 44 healthy controls using the Sniffin' Sticks (SS16) test. Mean SS16 score was 11.9 ± 2.9 for the SCA10 group, 12.3 ± 1.9 for the SCA3 group, 6.6 ± 2.8 for the PD group, and 12.1 ± 2.0 for the control group. Mean SS16 score for the SCA10 group was not significantly different from the scores for the SCA3 and control groups but was significantly higher than the score for the PD group (p < 0.001) when adjusted for age, gender, and history of smoking. There was no association between SS16 scores and disease duration in the SCA10 or SCA3 groups or number of repeat expansions. SS16 and Mini Mental State Examination scores were correlated in the three groups: SCA10 group (r = 0.59, p = 0.001), SCA3 group (r = 0.50, p = 0.005), and control group (r = 0.40, p = 0.007). We found no significant olfactory deficits in SCA10 in this large series.
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Affiliation(s)
- Mariana Moscovich
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil. .,Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany.
| | - Renato Puppi Munhoz
- Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Adriana Moro
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Salmo Raskin
- Group for Advanced Molecular Investigation (NIMA), School of Health and Biosciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Karen McFarland
- Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - Tetsuo Ashizawa
- Department of Neurology, Houston Methodist, Weill Cornell Medical College, Houston, TX, USA
| | - Helio A G Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Laura Silveira-Moriyama
- Postgraduate Program in Medicine, Universidade Nove de Julho, Uninove, São Paulo, Brazil.,Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, UK.,Departamento de Neurologia, Universidade Estadual de Campinas, UNICAMP, Campinas, Brazil.,Departamento de Neurologia, Universidade de São Paulo, USP, São Paulo, Brazil
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Doty RL, Hawkes CH. Chemosensory dysfunction in neurodegenerative diseases. HANDBOOK OF CLINICAL NEUROLOGY 2019; 164:325-360. [PMID: 31604557 DOI: 10.1016/b978-0-444-63855-7.00020-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A number of neurodegenerative diseases are accompanied by disordered smell function. The degree of dysfunction can vary among different diseases, such that olfactory testing can aid in differentiating, for example, Alzheimer's disease (AD) from major affective disorder and Parkinson's disease (PD) from progressive supranuclear palsy. Unfortunately, altered smell function often goes unrecognized by patients and physicians alike until formal testing is undertaken. Such testing uniquely probes brain regions not commonly examined in physical examinations and can identify, in some cases, patients who are already in the "preclinical" stage of disease. Awareness of this fact is one reason why the Quality Standards Committee of the American Academy of Neurology has designated smell dysfunction as one of the key diagnostic criteria for PD. The same recommendation has been made by the Movement Disorder Society for both the diagnosis of PD and identification of prodromal PD. Similar suggestions are proposed to include olfactory dysfunction as an additional research criterion for the diagnosis of AD. Although taste impairment, i.e., altered sweet, sour, bitter, salty, and umami perception, has also been demonstrated in some disorders, taste has received much less scientific attention than smell. In this review, we assess what is known about the smell and taste disorders of a wide range of neurodegenerative diseases and describe studies seeking to understand their pathologic underpinnings.
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Affiliation(s)
- Richard L Doty
- Smell and Taste Center and Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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12
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Kronenbuerger M, Belenghi P, Ilgner J, Freiherr J, Hummel T, Neuner I. Olfactory functioning in adults with Tourette syndrome. PLoS One 2018; 13:e0197598. [PMID: 29874283 PMCID: PMC5991349 DOI: 10.1371/journal.pone.0197598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/04/2018] [Indexed: 01/19/2023] Open
Abstract
Tourette syndrome is a chronic tic disorder characterized by motor and vocal tics. Comorbidities such as attention deficit hyperactivity disorder and obsessive compulsive disorder can be found. The overlap between neuroanatomical regions and neurotransmitter systems in the olfactory system and the pathophysiology of Tourette syndrome let us hypothesize altered olfactory performance in Tourette syndrome. The main objective of this study was to systematically assess olfactory functioning in subjects with Tourette syndrome and to compare it to healthy controls. We assessed 28 adults with Tourette syndrome (age 33.1±9.4 years, disease duration 23.7±9.7 years) and 28 healthy controls (age 32.9±9.0 years) matched in regard to age, sex, education and smoking habits. The “Sniffin Sticks” test battery was applied to assess odor threshold, discrimination, and identification. Additionally, the combined score of the odor threshold test, the odor discrimination test and the odor identification test of the “Sniffin Sticks” test battery was calculated. Although it was not the primary aim of this study, we assessed whether tics and comorbidity could contribute to olfactory alterations in adults with Tourette syndrome. Therefore, clinical scores were used to assess severity of tics and co-morbidity such as attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety and depression in subjects with Tourette syndrome. Pathology of the nasal cavities was excluded with rhinoendoscopy. Independent sample t-tests were applied to compare performance in olfactory tests. In the case of statistically significant differences (critical p-value: 0.05), multiple linear regression analysis was carried out to explore whether tic severity, social impairment, co-morbidity or medical treatment had an impact on the differences found. Descriptive values are reported as mean ± standard deviation. Tourette syndrome subjects showed lower combined scores (Tourette syndrome subjects 31.9 ± 5.1 versus healthy controls 35.0 ± 3.1; p = 0.007), odor identification scores (Tourette syndrome subjects 12.4 ± 2.0 versus healthy controls 13.7 ± 1.4; p = 0.008) and odor discrimination scores (Tourette syndrome subjects 12.1 ± 2.1 versus healthy controls 13.2 ± 1.6; p = 0.041) in comparison to healthy subjects, while there was no difference in odor threshold (Tourette syndrome subjects 7.3 ± 2.7 versus healthy controls 8.1 ± 2.2; p = 0.22). Seven out of 28 Tourette syndrome subjects (25%) scored in the range of the age- and sex-dependent combined score for hyposmia, while two of 28 healthy controls (7%) had a similar low combined score. None of the participants were found to have functional anosmia. Multiple linear regression analyses suggest that social impairment may a predictor for low combined score and odor identification score in Tourette syndrome subjects (p = 0.003). Compared to healthy controls, altered olfaction in adults with Tourette syndrome was found in this study. Normal odor threshold level but lower scores at tasks involving supra-threshold odor concentrations point towards a central-nervous alteration in the processing of olfactory information in Tourette syndrome.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- Department of Neurology, University of Greifswald, Greifswald, Germany
- * E-mail:
| | - Patrizia Belenghi
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Justus Ilgner
- Department of Otorhinolaryngology and Plastic Head and Neck Surgery, RWTH Aachen University, Aachen, Germany
| | - Jessica Freiherr
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- JARA—Translational Brain Medicine, Aachen, Germany
- Institute of Neuroscience and Medicine 4, Forschungszentrum, Jülich, Germany
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Reichert JL, Postma EM, Smeets PAM, Boek WM, de Graaf K, Schöpf V, Boesveldt S. Severity of olfactory deficits is reflected in functional brain networks-An fMRI study. Hum Brain Mapp 2018; 39:3166-3177. [PMID: 29602198 DOI: 10.1002/hbm.24067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 02/02/2018] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
Even though deficits in olfactory function affect a considerable part of the population, the neuronal basis of olfactory deficits remains scarcely investigated. To achieve a better understanding of how smell loss affects neural activation patterns and functional networks, we set out to investigate patients with olfactory dysfunction using functional magnetic resonance imaging (fMRI) and olfactory stimulation. We used patients' scores on a standardized olfactory test as continuous measure of olfactory function. 48 patients (mean olfactory threshold discrimination identification (TDI) score = 16.33, SD = 6.4, range 6 - 28.5) were investigated. Overall, patients showed piriform cortex activation during odor stimulation compared to pure sniffing. Group independent component analysis indicated that the recruitment of three networks during odor stimulation was correlated with olfactory function: a sensory processing network (including regions such as insula, thalamus and piriform cortex), a cerebellar network and an occipital network. Interestingly, recruitment of these networks during pure sniffing was related to olfactory function as well. Our results support previous findings that sniffing alone can activate olfactory regions. Extending this, we found that the severity of olfactory deficits is related to the extent to which neural networks are recruited both during olfactory stimulation and pure sniffing. This indicates that olfactory deficits are not only reflected in changes in specific olfactory areas but also in the recruitment of occipital and cerebellar networks. These findings pave the way for future investigations on whether characteristics of these networks might be of use for the prediction of disease prognosis or of treatment success.
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Affiliation(s)
- Johanna L Reichert
- Institute of Psychology, University of Graz, Graz, Austria.,BioTechMed, Graz, Austria
| | - Elbrich M Postma
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.,ENT Department, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Paul A M Smeets
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilbert M Boek
- ENT Department, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Kees de Graaf
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Veronika Schöpf
- Institute of Psychology, University of Graz, Graz, Austria.,BioTechMed, Graz, Austria
| | - Sanne Boesveldt
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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14
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Abstract
Machado-Joseph disease (MJD) also known as Spinocerebellar ataxia type 3, is a hereditary neurodegenerative disease associated with severe clinical manifestations and premature death. Although rare, it is the most common autosomal dominant spinocerebellar ataxia worldwide and has a distinct geographic distribution, reaching peak prevalence in certain regions of Brazil, Portugal and China. Due to its clinical heterogeneity, it was initially described as several different entities and as had many designations over the last decades. An accurate diagnosis become possible in 1994, after the identification of the MJD1 gene. Among its wide clinical spectrum, progressive cerebellar ataxia is normally present. Other symptoms include pyramidal syndrome, peripheral neuropathy, oculomotor abnormalities, extrapyramidal signs and sleep disorders. On the basis of the presence/absence of important extra-pyramidal signs, and the presence/absence of peripheral signs, five clinical types have been defined. Neuroimaging studies like MRI, DTI and MRS, can be useful as they can characterize structural and functional differences in specific subgroups of patients with MJD. There is no effective treatment for MJD. Symptomatic therapies are used to relieve some of the clinical symptoms and physiotherapy is also helpful in improving quality of live. Several clinical trials have been carried out using different molecules like sulfamethoxazole-trimethoprim, varenicline and lithium carbonate, but the results of these trials were negative or showed little benefit. Future studies sufficiently powered and adequately designed are warranted.
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15
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Turkmenoglu FP, Kasirga UB, Celik HH. Ultra-structural hair alterations in Friedreich's ataxia: A scanning electron microscopic investigation. Microsc Res Tech 2015; 78:731-6. [PMID: 26138268 DOI: 10.1002/jemt.22531] [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: 04/01/2015] [Revised: 05/05/2015] [Accepted: 05/22/2015] [Indexed: 11/07/2022]
Abstract
Friedreich's ataxia (FRDA) is an autosomal recessive inherited disorder involving progressive damage to the central and peripheral nervous systems and cardiomyopathy. FRDA is caused by the silencing of the FXN gene and reduced levels of the encoded protein, frataxin. Frataxin is a mitochondrial protein that functions primarily in iron-sulfur cluster synthesis. Skin disorders including hair abnormalities have previously been reported in patients with mitochondrial disorders. However, to our knowledge, ultra-structural hair alterations in FRDA were not demonstrated. The purpose of this study was to determine ultra-structural alterations in the hairs of FRDA patients as well as carriers. Hair specimen from four patients, who are in different stages of the disease, and two carriers were examined by scanning electron microscope. Thin and weak hair follicles with absence of homogeneities on the cuticular surface, local damages of the cuticular layer, cuticular fractures were detected in both carriers and patients, but these alterations were much more prominent in the hair follicles of patients. In addition, erosions on the surface of the cuticle and local deep cavities just under the cuticular level were observed only in patients. Indistinct cuticular pattern, pores on the cuticular surface, and presence of concavities on the hair follicle were also detected in patients in later stages of the disease. According to our results, progression of the disease increased the alterations on hair structure. We suggest that ultra-structural alterations observed in hair samples might be due to oxidative stress caused by deficient frataxin expression in mitochondria.
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Affiliation(s)
- F Pinar Turkmenoglu
- Department of Pharmaceutical Botany, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - U Baran Kasirga
- Department of Anatomy, Faculty of Medicine, Maltepe University, Ankara, Turkey
| | - H Hamdi Celik
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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16
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Evans-Galea MV, Pébay A, Dottori M, Corben LA, Ong SH, Lockhart PJ, Delatycki MB. Cell and gene therapy for Friedreich ataxia: progress to date. Hum Gene Ther 2014; 25:684-93. [PMID: 24749505 DOI: 10.1089/hum.2013.180] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neurodegenerative disorders such as Friedreich ataxia (FRDA) present significant challenges in developing effective therapeutic intervention. Current treatments aim to manage symptoms and thus improve quality of life, but none can cure, nor are proven to slow, the neurodegeneration inherent to this disease. The primary clinical features of FRDA include progressive ataxia and shortened life span, with complications of cardiomyopathy being the major cause of death. FRDA is most commonly caused by an expanded GAA trinucleotide repeat in the first intron of FXN that leads to reduced levels of frataxin, a mitochondrial protein important for iron metabolism. The GAA expansion in FRDA does not alter the coding sequence of FXN. It results in reduced production of structurally normal frataxin, and hence any increase in protein level is expected to be therapeutically beneficial. Recently, there has been increased interest in developing novel therapeutic applications like cell and/or gene therapies, and these cutting-edge applications could provide effective treatment options for FRDA. Importantly, since individuals with FRDA produce frataxin at low levels, increased expression should not elicit an immune response. Here we review the advances to date and highlight the future potential for cell and gene therapy to treat this debilitating disease.
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Affiliation(s)
- Marguerite V Evans-Galea
- 1 Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute , Parkville Victoria 3052, Australia
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17
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Galvez V, Diaz R, Hernandez-Castillo CR, Campos-Romo A, Fernandez-Ruiz J. Olfactory performance in spinocerebellar ataxia type 7 patients. Parkinsonism Relat Disord 2014; 20:499-502. [PMID: 24629799 DOI: 10.1016/j.parkreldis.2014.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/20/2014] [Accepted: 01/31/2014] [Indexed: 11/29/2022]
Abstract
A large body of evidence has shown olfactory deficits in many neurodegenerative diseases. However, the nature of the olfactory impairment remains poorly understood partly because the majority of studies have only explored smell identification capabilities. The purpose of the present study was twofold. First we wanted to test if patients with spinocerebellar ataxia type 7 (SCA7), a progressive neurodegenerative disorder characterized by cerebellar ataxia and visual loss, also have olfactory deficits. Secondly, we wanted to test the nature of the olfactory deficits by testing not only the identification level but also olfactory threshold and discrimination. Based on the olfactory dysfunction found in different neurodegenerative diseases and functional neuroimaging data showing cerebellar activation during olfaction, we hypothesized that SCA7 patients would show an olfactory impairment. To test this hypothesis we studied twenty-eight genetically confirmed SCA7 patients and twenty-seven matched controls using the Sniffing Sticks Test and the University of Pennsylvania Smell Identification Test (UPSIT). The results show that SCA7 patients' ability to discriminate and identify odors is significantly impaired, although their odor detection thresholds were at normal levels. These results suggest that SCA7 neurological damage affects olfactory perception but spares the patients' olfactory sensory capabilities.
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Affiliation(s)
- Victor Galvez
- Instituto de Neuroetología, Universidad Veracruzana, Mexico.
| | - Rosalinda Diaz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autonoma de México, Mexico
| | | | - Aurelio Campos-Romo
- Unidad periférica de Neurociencias, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Neurología y Neurocirugía "MVS", Mexico
| | - Juan Fernandez-Ruiz
- Instituto de Neuroetología, Universidad Veracruzana, Mexico; Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autonoma de México, Mexico; Facultad de Psicología, Universidad Veracruzana, Mexico.
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18
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Parkinson MH, Boesch S, Nachbauer W, Mariotti C, Giunti P. Clinical features of Friedreich's ataxia: classical and atypical phenotypes. J Neurochem 2013; 126 Suppl 1:103-17. [PMID: 23859346 DOI: 10.1111/jnc.12317] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/27/2022]
Abstract
One hundred and fifty years since Nikolaus Friedreich's first description of the degenerative ataxic syndrome which bears his name, his description remains at the core of the classical clinical phenotype of gait and limb ataxia, poor balance and coordination, leg weakness, sensory loss, areflexia, impaired walking, dysarthria, dysphagia, eye movement abnormalities, scoliosis, foot deformities, cardiomyopathy and diabetes. Onset is typically around puberty with slow progression and shortened life-span often related to cardiac complications. Inheritance is autosomal recessive with the vast majority of cases showing an unstable intronic GAA expansion in both alleles of the frataxin gene on chromosome 9q13. A small number of cases are caused by a compound heterozygous expansion with a point mutation or deletion. Understanding of the underlying molecular biology has enabled identification of atypical phenotypes with late onset, or atypical features such as retained reflexes. Late-onset cases tend to have slower progression and are associated with smaller GAA expansions. Early-onset cases tend to have more rapid progression and a higher frequency of non-neurological features such as diabetes, cardiomyopathy, scoliosis and pes cavus. Compound heterozygotes, including those with large deletions, often have atypical features. In this paper, we review the classical and atypical clinical phenotypes of Friedreich's ataxia.
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Affiliation(s)
- Michael H Parkinson
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
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19
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Pedroso JL, França MC, Braga-Neto P, D'Abreu A, Saraiva-Pereira ML, Saute JA, Teive HA, Caramelli P, Jardim LB, Lopes-Cendes I, Barsottini OGP. Nonmotor and extracerebellar features in Machado-Joseph disease: A review. Mov Disord 2013; 28:1200-8. [DOI: 10.1002/mds.25513] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/27/2013] [Accepted: 04/16/2013] [Indexed: 01/09/2023] Open
Affiliation(s)
- José Luiz Pedroso
- Department of Neurology, General Neurology and Ataxia Unit; Universidade Federal de São Paulo; São Paulo Brazil
| | - Marcondes C. França
- Department of Neurology; University of Campinas (Unicamp), Campinas; São Paulo Brazil
| | - Pedro Braga-Neto
- Department of Neurology, General Neurology and Ataxia Unit; Universidade Federal de São Paulo; São Paulo Brazil
| | - Anelyssa D'Abreu
- Department of Neurology; University of Campinas (Unicamp), Campinas; São Paulo Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - Jonas A. Saute
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Postgraduate Program in Medical Sciences; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Hélio A. Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas; Universidade Federal do Paraná (UFPR); Curitiba Paraná Brazil
| | - Paulo Caramelli
- Cognitive and Behavioral Neurology Unit, Department of Internal Medicine, Faculty of Medicine; Federal University of Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - Laura Bannach Jardim
- Department of Biochemistry Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Postgraduate Program in Medical Sciences; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Department of Internal Medicine; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Iscia Lopes-Cendes
- Department of Medical Genetics; School of Medical Sciences; University of Campinas (UNICAMP); Campinas São Paulo Brazil
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20
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Wu T, Hallett M. The cerebellum in Parkinson's disease. Brain 2013; 136:696-709. [PMID: 23404337 PMCID: PMC7273201 DOI: 10.1093/brain/aws360] [Citation(s) in RCA: 537] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/24/2012] [Accepted: 11/06/2012] [Indexed: 11/30/2022] Open
Abstract
Parkinson's disease is a chronic progressive neurodegenerative disorder characterized by resting tremor, slowness of movements, rigidity, gait disturbance and postural instability. Most investigations on Parkinson's disease focused on the basal ganglia, whereas the cerebellum has often been overlooked. However, increasing evidence suggests that the cerebellum may have certain roles in the pathophysiology of Parkinson's disease. Anatomical studies identified reciprocal connections between the basal ganglia and cerebellum. There are Parkinson's disease-related pathological changes in the cerebellum. Functional or morphological modulations in the cerebellum were detected related to akinesia/rigidity, tremor, gait disturbance, dyskinesia and some non-motor symptoms. It is likely that the major roles of the cerebellum in Parkinson's disease include pathological and compensatory effects. Pathological changes in the cerebellum might be induced by dopaminergic degeneration, abnormal drives from the basal ganglia and dopaminergic treatment, and may account for some clinical symptoms in Parkinson's disease. The compensatory effect may help maintain better motor and non-motor functions. The cerebellum is also a potential target for some parkinsonian symptoms. Our knowledge about the roles of the cerebellum in Parkinson's disease remains limited, and further attention to the cerebellum is warranted.
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Affiliation(s)
- Tao Wu
- Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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21
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Moscovich M, Munhoz RP, Teive HA, Raskin S, Carvalho MJ, Barbosa ER, Ranvaud R, Liu J, McFarland K, Ashizawa T, Lees AJ, Silveira-Moriyama L. Olfactory impairment in familial ataxias. J Neurol Neurosurg Psychiatry 2012; 83:970-4. [PMID: 22791905 PMCID: PMC3521149 DOI: 10.1136/jnnp-2012-302770] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The main clinical manifestations of the spinocerebellar ataxias (SCAs) result from the involvement of the cerebellum and its connections. Cerebellar activity has been consistently observed in functional imaging studies of olfaction, but the anatomical pathways responsible for this connection have not yet been elucidated. Previous studies have demonstrated olfactory deficit in SCA2, Friedreich's ataxia and in small groups of ataxia of diverse aetiology. The authors used a validated version of the 16-item smell identification test from Sniffin' Sticks (SS-16) was used to evaluate 37 patients with genetically determined autosomal dominant ataxia, and 31 with familial ataxia of unknown genetic basis. This data was also compared with results in 106 Parkinson's disease patients and 218 healthy controls. The SS-16 score was significantly lower in ataxia than in the control group (p<0.001, 95% CI for β=0.55 to 1.90) and significantly higher in ataxia than in Parkinson's disease (p<0.001, 95% CI for β=-4.58 to -3.00) when adjusted for age (p=0.001, 95% CI for β=-0.05 to -0.01), gender (p=0.19) and history of tobacco use (p=0.41). When adjusted for general cognitive function, no significant difference was found between the ataxia and control groups. This study confirms previous findings of mild hyposmia in ataxia, and further suggests this may be due to general cognitive deficits rather than specific olfactory problems.
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Affiliation(s)
- Mariana Moscovich
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
- Department of Neurology, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Renato Puppi Munhoz
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
- Department of Neurology, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Helio A Teive
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
| | - Salmo Raskin
- Department of Neurology, Hospital de Clínicas, Federal University of Paraná, Curitiba-PR, Brazil
- Core for Advanced Molecular Investigation, Graduate Program in Health Sciences, Center for Biological and Health Sciences, Pontifical Catholic University of Paraná Curitiba, Parana, Brazil
| | - Margaret J Carvalho
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Egberto R Barbosa
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ronald Ranvaud
- Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | - Jilin Liu
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Karen McFarland
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Tetsuo Ashizawa
- Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Laura Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
- Department of Neurology, University of Campinas, UNICAMP, Brazil
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22
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Juncos JL, Lazarus JT, Rohr J, Allen EG, Shubeck L, Hamilton D, Novak G, Sherman SL. Olfactory dysfunction in fragile X tremor ataxia syndrome. Mov Disord 2012; 27:1556-9. [PMID: 23079771 DOI: 10.1002/mds.25043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 04/02/2012] [Accepted: 04/18/2012] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION We investigated olfactory defects in fragile X-associated tremor/ataxia syndrome (FXTAS), a finding reported on in other neurodegenerative disorders with clinical features that overlap those of FXTAS. METHODS We measured olfactory identification capacity in 41 FMR1 premutation carriers and 42 controls using the University of Pennsylvania Smell Identification Test (UPSIT). Carriers received neurologic evaluations using motor rating scales for tremor, ataxia, and parkinsonism. Cognitive function was measured using the Montreal Cognitive Assessment test. RESULTS Frequency of olfactory defects was higher in carriers, compared to controls (61% versus 29%; P = 0.003). There was no statistically significant group difference in severity of olfaction defects, after accounting for differences in age, and in rates of head injury and smoking. However, both the frequency (odds ratio = 3.9; 95% confidence interval: 0.81-19.1) and severity (28.6 versus 33.4; P = 0.01) of these defects were greater in cognitively impaired, compared to cognitively intact, carriers. There was no correlation between UPSIT scores and the above-mentioned motor rating scales. CONCLUSIONS FMR1 premutation carriers are susceptible to olfactory identification defects. The severity of these defects is comparable to that reported in hereditary ataxias, but less than that in PD and Alzheimer's disease. This concurrence across neurodegenerative disorders suggests a shared system vulnerability that correlates with, but is not limited to, cognitive impairment, because it is also found in cognitively intact carriers. These results need to be corroborated in a larger prospective study of FMR1 premutation carriers that extends beyond olfactory identification to include measures of smell thresholds.
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Affiliation(s)
- Jorge L Juncos
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
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23
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Braga-Neto P, Dutra LA, Pedroso JL, Felício AC, Alessi H, Santos-Galduroz RF, Bertolucci PHF, Castiglioni MLV, Bressan RA, de Garrido GEJ, Barsottini OGP, Jackowski A. Cognitive Deficits in Machado–Joseph Disease Correlate with Hypoperfusion of Visual System Areas. THE CEREBELLUM 2012; 11:1037-44. [DOI: 10.1007/s12311-012-0354-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Velázquez-Pérez L, Rodríguez-Labrada R, García-Rodríguez JC, Almaguer-Mederos LE, Cruz-Mariño T, Laffita-Mesa JM. A comprehensive review of spinocerebellar ataxia type 2 in Cuba. THE CEREBELLUM 2011; 10:184-98. [PMID: 21399888 DOI: 10.1007/s12311-011-0265-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant cerebellar ataxia characterized by a progressive cerebellar syndrome associated to saccadic slowing, peripheral neuropathy, cognitive disorders, and other multisystem features. SCA2 is caused by the abnormal expansion of cytosine-adenine-guanine triplet repeats in the encoding region of the ATXN2 gene and therefore the expression of toxic polyglutamine expansions in the ataxin 2 protein, which cause progressive neuronal death of Purkinje cells in the cerebellum and several pontine, mesencephalic, and thalamic neurons among other cells. Worldwide, SCA2 is the second most frequent type of spinocerebellar ataxia, only surpassed by SCA3. Nevertheless, in Holguin, Cuba, the disease reaches the highest prevalence, resulting from a putative foundational effect. This review discusses the most important advances in the genotypical and phenotypical studies of SCA2, highlighting the comprehensive characterization reached in Cuba through clinical, neuroepidemiological, neurochemical, and neurophysiological evaluation of SCA2 patients and pre-symptomatic subjects, which has allowed the identification of new disease biomarkers and therapeutical opportunities. These findings provide guidelines, from a Cuban viewpoint, for the clinical management of the disease, its diagnosis, genetic counseling, and therapeutical options through rehabilitative therapy and/or pharmacological options.
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Affiliation(s)
- Luis Velázquez-Pérez
- Centro para la Investigación y Rehabilitación de Ataxias Hereditarias, 80100, Holguín, Cuba.
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25
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Evans-Galea MV, Corben LA, Hasell J, Galea CA, Fahey MC, du Sart D, Delatycki MB. A novel deletion-insertion mutation identified in exon 3 of FXN in two siblings with a severe Friedreich ataxia phenotype. Neurogenetics 2011; 12:307-13. [PMID: 21830088 DOI: 10.1007/s10048-011-0296-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disease most commonly caused by a GAA trinucleotide repeat expansion in the first intron of FXN, which reduces expression of the mitochondrial protein frataxin. Approximately 98% of individuals with FRDA are homozygous for GAA expansions, with the remaining 2% compound heterozygotes for a GAA expansion and a point mutation within FXN. Two siblings with early onset of symptoms experienced rapid loss of ambulation by 8 and 10 years. Diagnostic testing for FRDA demonstrated one GAA repeat expansion of 1010 repeats and one non-expanded allele. Sequencing all five exons of FXN identified a novel deletion-insertion mutation in exon 3 (c.371_376del6ins15), which results in a modified frataxin protein sequence at amino acid positions 124-127. Specifically, the amino acid sequence changes from DVSF to VHLEDT, increasing frataxin from 211 residues to 214. Using the known structure of human frataxin, a theoretical 3D model of the mutant protein was developed. In the event that the modified protein is expressed and stable, it is predicted that the acidic interface of frataxin, known to be involved in iron binding and interactions with the iron-sulphur cluster assembly factor IscU, would be impaired.
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Affiliation(s)
- Marguerite V Evans-Galea
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia
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26
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Clinical correlates of olfactory dysfunction in spinocerebellar ataxia type 3. Parkinsonism Relat Disord 2011; 17:353-6. [DOI: 10.1016/j.parkreldis.2011.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/30/2011] [Accepted: 02/02/2011] [Indexed: 11/23/2022]
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Abstract
Impairment of olfaction is a characteristic feature of many neurodegenerative diseases. This review summarizes the available information about olfactory function in distinct neurodegenerative conditions and indicates the advantageous use of olfactory testing in the diagnosis of Parkinson's disease and Alzheimer's dementia.
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Affiliation(s)
- A Hähner
- Interdisziplinäres Zentrum Riechen und Schmecken, Universitätsklinikum der TU Dresden, Fetscherstrasse 74, 01307 Dresden.
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28
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Louis ED, Zheng W. Beta-carboline alkaloids and essential tremor: exploring the environmental determinants of one of the most prevalent neurological diseases. ScientificWorldJournal 2010; 10:1783-94. [PMID: 20842322 PMCID: PMC3700397 DOI: 10.1100/tsw.2010.159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/15/2010] [Accepted: 07/15/2010] [Indexed: 12/13/2022] Open
Abstract
Essential tremor (ET) is among the most prevalent neurological diseases, yet its etiology is not well understood. Susceptibility genotypes undoubtedly underlie many ET cases, although no genes have been identified thus far. Environmental factors are also likely to contribute to the etiology of ET. Harmane (1-methyl-9H-pyrido[3,4-beta]indole) is a potent, tremor-producing beta-carboline alkaloid, and emerging literature has provided initial links between this neurotoxin and ET. In this report, we review this literature. Two studies, both in New York, have demonstrated higher blood harmane levels in ET cases than controls and, in one study, especially high levels in familial ET cases. Replication studies of populations outside of New York and studies of brain harmane levels in ET have yet to be undertaken. A small number of studies have explored several of the biological correlates of exposure to harmane in ET patients. Studies of the mechanisms of this putative elevation of harmane in ET have explored the role of increased dietary consumption, finding weak evidence of increased exogenous intake in male ET cases, and other studies have found initial evidence that the elevated harmane in ET might be due to a hereditarily reduced capacity to metabolize harmane to harmine (7-methoxy-1-methyl-9H-pyrido[3,4-beta]-indole). Studies of harmane and its possible association with ET have been intriguing. Additional studies are needed to establish more definitively whether these toxic exposures are associated with ET and are of etiological importance.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, Columbia University, New York, USA.
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Zobel S, Hummel T, Ilgner J, Finkelmeyer A, Habel U, Timmann D, Schulz JB, Kronenbuerger M. Involvement of the human ventrolateral thalamus in olfaction. J Neurol 2010; 257:2037-43. [PMID: 20640578 DOI: 10.1007/s00415-010-5656-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 06/17/2010] [Accepted: 07/01/2010] [Indexed: 12/18/2022]
Abstract
It is widely assumed that the thalamus is not involved in olfaction. The ventrolateral thalamus is, however, closely connected to the contralateral cerebellum, which is involved in the sense of smell based on findings from functional imaging studies and findings of olfactory deficits in patients with cerebellar disease. We hypothesized that olfactory deficits following lesions of the ventrolateral thalamus may be similar to olfactory deficits following cerebellar lesions. Fifteen patients with a focal thalamic lesion involving the ventrolateral thalamus were examined and compared to 15 patients with a focal cerebellar lesion and 15 healthy controls. A detailed olfactory test ("Sniffin' Sticks") was used to assess different olfactory functions separately for each nostril. In the group of patients with a lesion of the ventrolateral thalamus, an impairment of the odor threshold was found at the ipsilateral nostril, consistent with the unilateral orientation of the olfactory system in the telencephalon. In the group of patients with a cerebellar lesion, an olfactory deficit at the contralesional nostril emerged. In controls, no significant side difference was found. The involvement of the ventrolateral thalamus in olfaction is comparable to that of the cerebellum in respect to odor threshold. Further study is needed to assess if these findings are related to an impairment of an olfactomotor loop. Present evidence for this hypothesis is indirect. Effects were subclinical as none of the patients reported olfactory disturbance. The results suggest that the cerebello-thalamic axis plays an adjuvant role in olfaction.
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Affiliation(s)
- S Zobel
- Department of Neurology, Medical Faculty, RWTH Aachen University, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Carbonic anhydrase I, II, and VI, blood plasma, erythrocyte and saliva zinc and copper increase after repetitive transcranial magnetic stimulation. Am J Med Sci 2010; 339:249-57. [PMID: 20090508 DOI: 10.1097/maj.0b013e3181cda0e3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) has been used to treat symptoms from many disorders; biochemical changes occurred with this treatment. Preliminary studies with rTMS in patients with taste and smell dysfunction improved sensory function and increased salivary carbonic anhydrase (CA) VI and erythrocyte CA I, II. To obtain more information about these changes after rTMS, we measured changes in several CA enzymes, proteins, and trace metals in their blood plasma, erythrocytes, and saliva. METHODS Ninety-three patients with taste and smell dysfunction were studied before and after rTMS in an open clinical trial. Before and after rTMS, we measured erythrocyte CA I, II and salivary CA VI, zinc and copper in parotid saliva, blood plasma, and erythrocytes, and appearance of novel salivary proteins by using mass spectrometry. RESULTS After rTMS, CA I, II and CA VI activity and zinc and copper in saliva, plasma, and erythrocytes increased with significant sensory benefit. Novel salivary proteins were induced at an m/z value of 21.5K with a repetitive pattern at intervals of 5K m/z. CONCLUSIONS rTMS induced biochemical changes in specific enzymatic activities, trace metal concentrations, and induction of novel salivary proteins, with sensory improvement in patients with taste and smell dysfunction. Because patients with several neurologic disorders exhibit taste and smell dysfunction, including Parkinson disease, Alzheimer disease, and multiple sclerosis, and because rTMS improved their clinical symptoms, the biochemical changes we observed may be relevant not only in our patients with taste and smell dysfunction but also in patients with neurologic disorders with these sensory abnormalities.
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Arnold SE, Lee EB, Moberg PJ, Stutzbach L, Kazi H, Han LY, Lee VMY, Trojanowski JQ. Olfactory epithelium amyloid-beta and paired helical filament-tau pathology in Alzheimer disease. Ann Neurol 2010; 67:462-9. [PMID: 20437581 PMCID: PMC2864948 DOI: 10.1002/ana.21910] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Olfactory dysfunction is common in Alzheimer disease (AD) and other neurodegenerative diseases. Paired helical filament (PHF)-tau, alpha-synuclein, and amyloid-beta lesions occur early and severely in cerebral regions of the olfactory system, and they have also been observed in olfactory epithelium (OE). However, their frequency, abundance, and disease specificity, and the relationships of OE pathology to brain pathology have not been established. METHODS We investigated the pathological expression of amyloid-beta, PHFtau, alpha-synuclein, and TDP-43 in postmortem OE of 79 cases with AD, 63 cases with various other neurodegenerative diseases, and 45 neuropathologically normal cases. RESULTS Amyloid-beta was present as punctate and small patchy aggregates in 71% of AD cases, compared with 22% of normal cases and 14% of cases with other diseases, and in greater amounts in AD than in either of the other 2 diagnostic categories. PHFtau was evident in dystrophic neurites in 55% of cases with AD, 34% with normal brains, and 39% with other neurodegenerative diseases, also at higher densities in AD. alpha-Synuclein was present in dystrophic neurites in 7 cases, 6 of which also had cerebral Lewy bodies. Pathological TDP-43 inclusions were not observed in the OE in any cases. Amyloid-beta and to a lesser degree, PHFtau ratings in OE significantly correlated with cortical Abeta and PHFtau lesion ratings in the brain. INTERPRETATION These data demonstrate that AD pathology in the OE is present in the majority of cases with pathologically verified AD and correlates with brain pathology. Future work may assess the utility of amyloid-beta and PHFtau measurement in OE as a biomarker for AD.
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Affiliation(s)
- Steven E Arnold
- Alzheimer's Disease Core Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Effects of deep brain stimulation of the cerebellothalamic pathways on the sense of smell. Exp Neurol 2010; 222:144-52. [PMID: 20051243 DOI: 10.1016/j.expneurol.2009.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 12/20/2009] [Accepted: 12/22/2009] [Indexed: 11/21/2022]
Abstract
The cerebellum and the motor thalamus, connected by cerebellothalamic pathways, are traditionally considered part of the motor-control system. Yet, functional imaging studies and clinical studies including patients with cerebellar disease suggest an involvement of the cerebellum in olfaction. Additionally, there are anecdotal clinical reports of olfactory disturbances elicited by electrical stimulation of the motor thalamus and its neighbouring subthalamic region. Deep brain stimulation (DBS) targeting the cerebellothalamic pathways is an effective treatment for essential tremor (ET), which also offers the possibility to explore the involvement of cerebellothalamic pathways in the sense of smell. This may be important for patient care given the increased use of DBS for the treatment of tremor disorders. Therefore, 21 none-medicated patients with ET treated with DBS (13 bilateral, 8 unilateral) were examined with "Sniffin' Sticks," an established and reliable method for olfactory testing. Patients were studied either with DBS switched on and then off or in reversed order. DBS impaired odor threshold and, to a lesser extent, odor discrimination. These effects were sub-clinical as none of the patients reported changes in olfactory function. The findings, however, demonstrate that olfaction can be modulated in a circumscribed area of the posterior (sub-) thalamic region. We propose that the impairment of the odor threshold with DBS is related to effects on an olfacto-motor loop, while disturbed odor discrimination may be related to effects of DBS on short-term memory.
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Parsons LM, Petacchi A, Schmahmann JD, Bower JM. Pitch discrimination in cerebellar patients: Evidence for a sensory deficit. Brain Res 2009; 1303:84-96. [DOI: 10.1016/j.brainres.2009.09.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 09/11/2009] [Accepted: 09/12/2009] [Indexed: 01/08/2023]
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Shemshadi H, Azimian M, Onsori MA, Azizabadi Farahani M. Olfactory function following open rhinoplasty: A 6-month follow-up study. BMC EAR, NOSE, AND THROAT DISORDERS 2008; 8:6. [PMID: 18831771 PMCID: PMC2567921 DOI: 10.1186/1472-6815-8-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 10/03/2008] [Indexed: 11/10/2022]
Abstract
Background Patients undergoing any type of nasal surgery may experience degrees of postoperative olfactory dysfunction. We sought to investigate "when" the olfactory function recovers to its preoperative levels. Methods In this cohort design, 40 of 65 esthetic open rhinoplasty candidates with equal gender distribution, who met the inclusion criteria, were assessed for their olfactory function using the Smell Identification Test (SIT) with 40 familiar odors in sniffing bottles. All the patients were evaluated for the SIT scores preoperatively and postoperatively (at week 1, week 6, and month 6). Results At postoperative week one, 87.5% of the patients had anosmia, and the rest exhibited at least moderate levels of hyposmia. The anosmia, which was the dominant pattern at postoperative week 1, resolved and converted to various levels of hyposmia, so that no one at postoperative week 6 showed any such complain. At postoperative week six, 85% of the subjects experienced degrees of hyposmia, almost all being mild to moderate. At postoperative six month, the olfactory function had already reverted to the preoperative levels: no anosmia or moderate to severe hyposmia. A repeated ANOVA was indicative of significant differences in the olfactory function at the different time points. According to our post hoc Benfronney, the preoperative scores had a significant difference with those at postoperative week 1, week 6, but not with the ones at month 6. Conclusion Esthetic open rhinoplasty may be accompanied by some degrees of postoperative olfactory dysfunction. Patients need a time interval of 6 weeks to 6 months to fully recover their baseline olfactory function.
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Affiliation(s)
- Hashem Shemshadi
- University of Social Welfare and Rehabilitation Sciences, Department of Clinical Sciences and Speech Reconstructive Surgery, Tehran, Iran.
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Louis ED, Rios E, Pellegrino KM, Jiang W, Factor-Litvak P, Zheng W. Higher blood harmane (1-methyl-9H-pyrido[3,4-b]indole) concentrations correlate with lower olfactory scores in essential tremor. Neurotoxicology 2008; 29:460-5. [PMID: 18417221 PMCID: PMC2488156 DOI: 10.1016/j.neuro.2008.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 02/28/2008] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Harmane (1-methyl-9H-pyrido[3,4-b]indole), a neurotoxin, may be an environmental risk factor for essential tremor (ET). Harmane and related chemicals are toxic to the cerebellum. Whether it is through this mechanism (cerebellar toxicity) that harmane leads to ET is unknown. Impaired olfaction may be a feature of cerebellar disease. OBJECTIVE To determine whether blood harmane concentrations correlate with olfactory test scores in patients with ET. METHODS Blood harmane concentrations were quantified using high performance liquid chromatography. Odor identification testing was performed with the University of Pennsylvania Smell Identification Test (UPSIT). RESULTS In 83 ET cases, higher log blood harmane concentration was correlated with lower UPSIT score (rho=-0.46, p<0.001). 25/40 (62.5%) cases with high log blood harmane concentration (based on a median split) had low UPSIT scores (based on a median split) vs. 12/43 (27.9%) ET cases with low log blood harmane concentration (adjusted odd ratios (OR) 4.04, 95% confidence intervals (CI) 1.42-11.50, p=0.009). When compared with the low log blood harmane tertile, the odds of olfactory dysfunction were 2.64 times higher in cases in the middle tertile and 10.95 times higher in cases in the high tertile. In 69 control subjects, higher log blood harmane concentration was not correlated with lower UPSIT score (rho=0.12, p=0.32). CONCLUSIONS Blood harmane concentrations were correlated with UPSIT scores in ET cases but not controls. These analyses set the stage for postmortem studies to further explore the role of harmane as a cerebellar toxin in ET.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Simonyan K, Saad ZS, Loucks TMJ, Poletto CJ, Ludlow CL. Functional neuroanatomy of human voluntary cough and sniff production. Neuroimage 2007; 37:401-9. [PMID: 17574873 PMCID: PMC2018653 DOI: 10.1016/j.neuroimage.2007.05.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 05/06/2007] [Accepted: 05/11/2007] [Indexed: 02/06/2023] Open
Abstract
Cough and sniff are both spontaneous respiratory behaviors that can be initiated voluntarily in humans. Disturbances of cough may be life threatening, while inability to sniff impairs the sense of smell in neurological patients. Cortical mechanisms of voluntary cough and sniff production have been predicted to exist; however, the localization and function of supramedullary areas responsible for these behaviors are poorly understood. We used functional magnetic resonance imaging to identify the central control of voluntary cough and sniff compared with breathing. We determined that both voluntary cough and sniff require a widespread pattern of sensorimotor activation along the Sylvian fissure convergent with voluntary breathing. Task-specific activation occurred in a pontomesencephalic region during voluntary coughing and in the hippocampus and piriform cortex during voluntary sniffing. Identification of the localization of cortical activation for cough control in humans may help potential drug development to target these regions in patients with chronic cough. Understanding the sensorimotor sniff control mechanisms may provide a new view on the cerebral functional reorganization of olfactory control in patients with neurological disorders.
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Affiliation(s)
- Kristina Simonyan
- Laryngeal and Speech Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 5D38, Bethesda, MD 20814-1416, USA.
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Velázquez-Pérez L, Fernandez-Ruiz J, Díaz R, González RP, Ochoa NC, Cruz GS, Mederos LEA, Góngora EM, Hudson R, Drucker-Colin R. Spinocerebellar ataxia type 2 olfactory impairment shows a pattern similar to other major neurodegenerative diseases. J Neurol 2006; 253:1165-9. [PMID: 16609806 DOI: 10.1007/s00415-006-0183-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 02/02/2006] [Indexed: 10/24/2022]
Abstract
Olfactory function is affected in different neurodegenerative diseases. Recently, it has been found that some hereditary ataxias are also associated with significant olfactory impairment. However, the initial findings did not examine the nature of the olfactory impairment associated with these ataxias. In the present article the effect of spinocerebellar ataxia type 2 (SCA2) on olfactory function was studied in 53 SCA2 patients and 53 healthy control subjects from Holguín, Cuba. Several tests were applied to evaluate olfactory threshold, description, identification and discrimination. The results show significant impairment in SCA2 patients on all olfactory measurements, and the pattern of olfactory deficits found suggests that they have much in common with those reported for other neurodegenerative diseases such as Parkinson's and Alzheimer's diseases.
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Affiliation(s)
- Luis Velázquez-Pérez
- Centro para la Investigación y Rehabilitación de las Ataxias Hereditarias Carlos J. Finlay, Holguín, Cuba
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Mainland JD, Johnson BN, Khan R, Ivry RB, Sobel N. Olfactory impairments in patients with unilateral cerebellar lesions are selective to inputs from the contralesional nostril. J Neurosci 2006; 25:6362-71. [PMID: 16000626 PMCID: PMC6725278 DOI: 10.1523/jneurosci.0920-05.2005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Functional imaging studies of olfaction have consistently reported odorant-induced activation of the cerebellum. However, the cerebellar role in olfaction remains unknown. We examined the olfactory and olfactomotor abilities of patients with unilateral cerebellar lesions, comparing performance within subjects across nostrils, as well as between subjects with age-matched and young controls. Regarding olfactory performance, initial testing revealed that patients had a contralesional impairment in olfactory identification but not olfactory detection threshold. However, when tested under conditions that prevented compensatory sniffing strategies, the patients also exhibited a contralesional olfactory detection impairment. Regarding olfactomotor function, a healthy olfactomotor system generates sniffs that are (1) sufficiently vigorous and (2) inversely proportional to odorant concentration in sniff mean airflow velocity, maximum airflow velocity, volume, and duration. Patients' sniffs were lower in overall airflow velocity and volume in comparison with control participants. Furthermore, reduced sniff velocity predicted poorer detection thresholds in patients. Finally, whereas young controls used concentration-dependent sniffs, there was a trend in that direction only for age-matched controls. Patients used sniffs that were concentration invariant. In conclusion, cerebellar lesions impacted olfactory and olfactomotor performance. These findings strongly implicate an olfactocerebellar pathway prominent in odor identification and detection that functionally connects each nostril primarily to the contralateral cerebellum.
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Affiliation(s)
- Joel D Mainland
- Helen Wills Neuroscience Institute, University of California at Berkeley, Berkeley, California 94720, USA.
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Abstract
The past 15 years have seen significant advances in the study of olfaction, with particular emphasis on elucidating the molecular building blocks of the sensory process. However, much of the systems-level organization of olfaction remains unexplored. Here, we provide an overview at this level, highlighting results obtained from studying humans, whom we think provide an underutilized, yet critical, animal model for olfaction.
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Affiliation(s)
- Christina Zelano
- Program in Biophysics, University of California, Berkeley, Berkeley, California 94720, USA.
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Abstract
In this review, we use data obtained primarily from humans to argue that sniffs are not merely a stimulus carrier but are rather a central component of the olfactory percept. We argue that sniffs 1) are necessary for the olfactory percept, 2) affect odorant intensity perception and identity perception, 3) drive activity in olfactory cortex, 4) are rapidly modulated in an odorant-dependent fashion by a dedicated olfactomotor system, and 5) are sufficient to generate an olfactory percept of some sort even in the absence of odor.
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Affiliation(s)
- Joel Mainland
- Helen Wills Neuroscience Institute and Department of Psychology, University of California at Berkeley, Berkeley, CA 94720, USA.
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Applegate LM, Louis ED. Essential tremor: mild olfactory dysfunction in a cerebellar disorder. Parkinsonism Relat Disord 2005; 11:399-402. [PMID: 16102998 DOI: 10.1016/j.parkreldis.2005.03.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 03/02/2005] [Accepted: 03/03/2005] [Indexed: 11/16/2022]
Abstract
Olfactory dysfunction has been reported to occur in patients with cerebellar disorders, including degenerative ataxias and essential tremor (ET). Previous studies have not considered the effects of mild cognitive deficits, which can occur in ET, and could explain the lower olfaction test scores in ET cases. We more than doubled our initial sample (37 ET cases and 37 controls) [Louis ED, Bromley SM, Jurewicz EC, Watner D. Olfactory dysfunction in essential tremor: a deficit unrelated to disease duration or severity. Neurology 2002;59:1631-3. ] and made adjustments for the mini mental status test score. The University of Pennsylvania Smell Identification Test score remained lower in 87 ET cases compared to 92 controls after adjustment for mini mental status test score and other potential confounders (p = 0.04). These findings: suggest that olfactory dysfunction in ET patients occurs independently of mild cognitive deficits and support recent work that the cerebellum may play a role in central olfactory processing.
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Affiliation(s)
- LaKeisha M Applegate
- Gertude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Marked olfactory dysfunction (hyposmia) is a frequent and early abnormality in Parkinson's disease. We review recent advances related to its cause and its clinical relevance with respect to the differential diagnosis of Parkinsonian syndromes. RECENT FINDINGS Marked olfactory dysfunction occurs in Parkinson's disease and dementia with Lewy bodies but is not found in progressive supranuclear palsy and corticobasal degeneration. In multiple system atrophy, the deficit is mild and indistinguishable from cerebellar syndromes of other aetiologies, including the spino-cerebllar ataxias. This is in keeping with evidence of cerebellar involvement in olfactory processing, which may also help to explain recent findings of mild olfactory dysfunction in essential tremor. Smell testing remains, however, a clinically relevant tool in the differential diagnosis of indeterminate tremors. Intact olfaction has also been reported recently in Parkin disease (PARK 2) and vascular Parkinsonism. The relevance of sniffing ability to olfaction and a possible role of increased tyrosine hydroxylase and dopamine in parts of the olfactory bulb are issues of current interest with respect to pathophysiology. The early or 'pre-clinical' detection of Parkinson's disease is increasingly recognized as an area in which olfactory testing may be of value. SUMMARY Research findings have confirmed a role for olfactory testing in the differential diagnosis of movement disorders, and suggest that this approach is currently underused in clinical practice. Validated test batteries are now available that may prove to be of practical use in the differential diagnosis of Parkinsonian syndromes and indeterminate tremors.
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