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O’Shea DM, Arkhipenko A, Galasko D, Goldman JG, Sheikh ZH, Petrides G, Toledo JB, Galvin JE. Practical use of DAT SPECT imaging in diagnosing dementia with Lewy bodies: a US perspective of current guidelines and future directions. Front Neurol 2024; 15:1395413. [PMID: 38711561 PMCID: PMC11073567 DOI: 10.3389/fneur.2024.1395413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
Background Diagnosing Dementia with Lewy Bodies (DLB) remains a challenge in clinical practice. The use of 123I-ioflupane (DaTscan™) SPECT imaging, which detects reduced dopamine transporter (DAT) uptake-a key biomarker in DLB diagnosis-could improve diagnostic accuracy. However, DAT imaging is underutilized despite its potential, contributing to delays and suboptimal patient management. Methods This review evaluates DLB diagnostic practices and challenges faced within the U.S. by synthesizing information from current literature, consensus guidelines, expert opinions, and recent updates on DaTscan FDA filings. It contrasts DAT SPECT with alternative biomarkers, provides recommendations for when DAT SPECT imaging may be indicated and discusses the potential of emerging biomarkers in enhancing diagnostic approaches. Results The radiopharmaceutical 123I-ioflupane for SPECT imaging was initially approved in Europe (2000) and later in the US (2011) for Parkinsonism/Essential Tremor. Its application was extended in 2022 to include the diagnosis of DLB. DaTscan's diagnostic efficacy for DLB, with its sensitivity, specificity, and predictive values, confirms its clinical utility. However, US implementation faces challenges such as insurance barriers, costs, access issues, and regional availability disparities. Conclusion 123I-ioflupane SPECT Imaging is indicated for DLB diagnosis and differential diagnosis of Alzheimer's Disease, particularly in uncertain cases. Addressing diagnostic obstacles and enhancing physician-patient education could improve and expedite DLB diagnosis. Collaborative efforts among neurologists, geriatric psychiatrists, psychologists, and memory clinic staff are key to increasing diagnostic accuracy and care in DLB management.
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Affiliation(s)
- Deirdre M. O’Shea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Coral Gables, FL, United States
| | | | - Douglas Galasko
- Department of Neurosciences, UC San Diego, San Diego, CA, United States
| | - Jennifer G. Goldman
- JPG Enterprises LLC, Chicago, IL, United States
- Barrow Neurological Institute, Phoenix, AZ, United States
| | | | - George Petrides
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jon B. Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Coral Gables, FL, United States
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Quadalti C, Palmqvist S, Hall S, Rossi M, Mammana A, Janelidze S, Dellavalle S, Mattsson-Carlgren N, Baiardi S, Stomrud E, Hansson O, Parchi P. Clinical effects of Lewy body pathology in cognitively impaired individuals. Nat Med 2023; 29:1964-1970. [PMID: 37464058 PMCID: PMC10427416 DOI: 10.1038/s41591-023-02449-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023]
Abstract
There is poor knowledge about the clinical effects of Lewy body (LB) pathology in patients with cognitive impairment, especially when coexisting with Alzheimer's disease (AD) pathology (amyloid-β and tau). Using a seed amplification assay, we analyzed cerebrospinal fluid for misfolded LB-associated α-synuclein in 883 memory clinic patients with mild cognitive impairment or dementia from the BioFINDER study. Twenty-three percent had LB pathology, of which only 21% fulfilled clinical criteria of Parkinson's disease or dementia with Lewy bodies at baseline. Among these LB-positive patients, 48% had AD pathology. Fifty-four percent had AD pathology in the whole sample (17% of mild cognitive impairment and 24% of patients with dementia were also LB-positive). When examining independent cross-sectional effects, LB pathology but not amyloid-β or tau, was associated with hallucinations and worse attention/executive, visuospatial and motor function. LB pathology was also associated with faster longitudinal decline in all examined cognitive functions, independent of amyloid-β, tau, cognitive stage and a baseline diagnosis of dementia with Lewy bodies/Parkinson's disease. LB status provides a better precision-medicine approach to predict clinical trajectories independent of AD biomarkers and a clinical diagnosis, which could have implications for the clinical management of cognitive impairment and the design of AD and LB drug trials.
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Affiliation(s)
- Corinne Quadalti
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sara Hall
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Sofia Dellavalle
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Neurology Clinic, Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Simone Baiardi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
| | - Piero Parchi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Phillips JR, Matar E, Ehgoetz Martens KA, Moustafa AA, Halliday GM, Lewis SJG. Exploring the Sensitivity of Prodromal Dementia with Lewy Bodies Research Criteria. Brain Sci 2022; 12:1594. [PMID: 36552054 PMCID: PMC9775171 DOI: 10.3390/brainsci12121594] [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: 10/28/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is an insidious neurodegenerative disease characterised by a precipitous decline in cognition, sleep disturbances, motor impairment and psychiatric features. Recently, criteria for prodromal DLB (pDLB) including clinical features and biomarkers have been put forward to aid the classification and research of this ambiguous cohort of patients. Researchers can use these criteria to classify patients with mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) as either possible (either one core clinical feature or one biomarker are present) or probable pDLB (at least two core clinical features, or one core clinical feature and at least one biomarker present). However, as isolated REM sleep behaviour disorder (iRBD) confirmed with polysomnography (PSG) can be included as both a clinical and a biomarker feature, potentially reducing the specificity of these diagnostic criteria. To address this issue, the current study classified a cohort of 47 PSG-confirmed iRBD patients as probable prodromal DLB only in the presence of an additional core feature or if there was an additional non-PSG biomarker. Thirteen iRBD patients demonstrated MCI (iRBD-MCI). In the iRBD-MCI group, one presented with parkinsonism and was thus classified as probable pDLB, whilst the remaining 12 were classified as only possible pDLB. All patients performed three tasks designed to measure attentional deficits, visual hallucinations and visuospatial impairment. Patients also attended clinical follow-ups to monitor for transition to DLB or another synucleinopathy. Findings indicated that the only patient categorised by virtue of having two core clinical features as probable pDLB transitioned over 28 months to a diagnosis of DLB. The performance of this probable pDLB patient was also ranked second-highest for their hallucinatory behaviours and had comparatively lower visuospatial accuracy. These findings highlight the need for more stringent diagnostic research criteria for pDLB, given that only one of the 13 patients who would have satisfied the current guidelines for probable pDLB transitioned to DLB after two years and was indeed the patient with two orthogonal core clinical features.
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Affiliation(s)
- Joseph R. Phillips
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology & Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, NSW 2145, Australia
| | - Elie Matar
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia
| | - Kaylena A. Ehgoetz Martens
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ahmed A. Moustafa
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg 2092, South Africa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD 4217, Australia
| | - Glenda M. Halliday
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia
- Dementia and Movement Disorders Laboratory, Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - Simon J. G. Lewis
- Faculty of Medicine and Health, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia
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Blanc F, Bouteloup V, Paquet C, Chupin M, Pasquier F, Gabelle A, Ceccaldi M, de Sousa PL, Krolak-Salmon P, David R, Fischer C, Dartigues JF, Wallon D, Moreaud O, Sauvée M, Belin C, Harston S, Botzung A, Albasser T, Demuynck C, Namer I, Habert MO, Kremer S, Bousiges O, Verny M, Muller C, Philippi N, Chene G, Cretin B, Mangin JF, Dufouil C. Prodromal characteristics of dementia with Lewy bodies: baseline results of the MEMENTO memory clinics nationwide cohort. Alzheimers Res Ther 2022; 14:96. [PMID: 35854388 PMCID: PMC9295361 DOI: 10.1186/s13195-022-01037-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/11/2022] [Indexed: 12/22/2022]
Abstract
Background Isolated subjective cognitive impairment (SCI) and mild cognitive impairment (MCI) are the prodromal phases of dementia with Lewy bodies (DLB). MEMENTO is a nationwide study of patients with SCI and MCI with clinic, neuropsychology, biology, and brain imaging data. We aimed to compare SCI and MCI patients with symptoms of prodromal DLB to others in this study at baseline. Methods Participants of the French MEMENTO cohort study were recruited for either SCI or MCI. Among them, 892 were included in the Lewy sub-study, designed to search specifically for symptoms of DLB. Probable prodromal DLB diagnosis (pro-DLB group) was done using a two-criteria cutoff score among the four core clinical features of DLB. This Pro-DLB group was compared to two other groups at baseline: one without any core symptoms (NS group) and the one with one core symptom (1S group). A comprehensive cognitive battery, questionnaires on behavior, neurovegetative and neurosensory symptoms, brain 3D volumetric MRI, CSF, FDG PET, and amyloid PET were done. Results The pro-DLB group comprised 148 patients (16.6%). This group showed more multidomain (59.8%) MCI with slower processing speed and a higher proportion of patients with depression, anxiety, apathy, constipation, rhinorrhea, sicca syndrome, and photophobia, compared to the NS group. The pro-DLB group had isolated lower P-Tau in the CSF (not significant after adjustments for confounders) and on brain MRI widening of sulci including fronto-insular, occipital, and olfactory sulci (FDR corrected), when compared to the NS group. Evolution to dementia was not different between the three groups over a median follow-up of 2.6 years. Conclusions Patients with symptoms of prodromal DLB are cognitively slower, with more behavioral disorders, autonomic symptoms, and photophobia. The occipital, fronto-insular, and olfactory bulb involvement on brain MRI was consistent with symptoms and known neuropathology. The next step will be to study the clinical, biological, and imaging evolution of these patients. Trial registration Clinicaltrials.gov, NCT01926249
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Affiliation(s)
- Frederic Blanc
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France. .,CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France.
| | - Vincent Bouteloup
- CHU de Bordeaux, Pôle de santé publique, Bordeaux, France.,Centre INSERM U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, Bordeaux, France
| | - Claire Paquet
- CM2R of Paris Nord, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand Widal, Paris, France
| | - Marie Chupin
- CATI Multicenter Neuroimaging Platform, Saclay, France
| | - Florence Pasquier
- INSERM U1171 and CM2R of Lille, CHRU de Lille, Hôpital Roger Salengro, University of Lille, Lille, France
| | - Audrey Gabelle
- CM2R of Montpellier, CHU de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
| | - Mathieu Ceccaldi
- CM2R of Marseille, CHU de Marseille, Hôpital La Timone, Marseille, France
| | - Paulo Loureiro de Sousa
- CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
| | | | - Renaud David
- CM2R of Nice, CHU de Nice, Institut Claude Pompidou, EA 7276 CoBTeK "Cognition Behaviour Technology", Nice, France
| | - Clara Fischer
- CATI Multicenter Neuroimaging Platform, Saclay, France
| | - Jean-François Dartigues
- CHU de Bordeaux, Pôle de santé publique, Bordeaux, France.,CM2R of Bordeaux, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - David Wallon
- CM2R of Rouen, Neurology Department, Rouen University Hospital, Rouen, France
| | - Olivier Moreaud
- CM2R of Grenoble, CHU de Grenoble Alpes, Hôpital de la Tronche, Grenoble, France
| | - Mathilde Sauvée
- CM2R of Grenoble, CHU de Grenoble Alpes, Hôpital de la Tronche, Grenoble, France
| | - Catherine Belin
- Memory Clinic, Hôpital Avicenne, AP-HP, Hôpitaux Universitaires, Paris-Seine-Saint-Denis, Bobigny, France
| | - Sandrine Harston
- CM2R of Bordeaux, CHU de Bordeaux, Hôpital Xavier Arnozan, Bordeaux, France
| | - Anne Botzung
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Timothée Albasser
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Izzie Namer
- CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
| | | | - Stéphane Kremer
- CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
| | - Olivier Bousiges
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Marc Verny
- CM2R Île-de-France Sud and Geriatrics Centre, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.,Université Pierre et Marie Curie et DHU FAST, UMR 8256 (CNRS), Paris, France
| | - Candice Muller
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France
| | - Nathalie Philippi
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France.,CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
| | - Geneviève Chene
- CHU de Bordeaux, Pôle de santé publique, Bordeaux, France.,Centre INSERM U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, Bordeaux, France
| | - Benjamin Cretin
- CM2R (Memory Resource and Research Centre), Day Hospital, Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France.,CNRS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg, Strasbourg, France
| | - Jean-François Mangin
- CATI Multicenter Neuroimaging Platform, Saclay, France.,NeuroSpin, I2BM, Commissariat à l'Énergie Atomique, Université Paris-Saclay, Saclay, France
| | - Carole Dufouil
- CHU de Bordeaux, Pôle de santé publique, Bordeaux, France.,Centre INSERM U1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, Bordeaux, France
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5
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Phillips JR, Matar E, Ehgoetz Martens KA, Moustafa AA, Halliday GM, Lewis SJ. An adaptive measure of visuospatial impairment in Dementia with Lewy Bodies. Mov Disord Clin Pract 2022; 9:619-627. [PMID: 35844276 PMCID: PMC9274351 DOI: 10.1002/mdc3.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/07/2022] [Accepted: 03/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dementia with Lewy bodies (DLB) is a common cause of dementia with poor prognosis and high hospitalization rates. DLB is frequently misdiagnosed, with clinical features that overlap significantly with other diseases including Parkinson's disease (PD). Clinical instruments that discriminate and track the progression of cognitive impairment in DLB are needed. Objectives The current study was designed to assess the utility of a mental rotation (MR) task for assessing visuospatial impairments in early DLB. Methods Accuracy of 22 DLB patients, 22 PD patients and 22 age‐matched healthy controls in the MR task were compared at comparing shapes with 0°, 45° and 90° rotations. Results Healthy controls and PD patients performed at similar levels while the DLB group were significantly impaired. Further, impairment in the visuospatial and executive function measures correlated with MR poor outcomes. Conclusion These findings support the MR task as an objective measure of visuospatial impairment with the ability to adjust difficulty to suit impairments in a DLB population. This would be a useful tool within clinical trials.
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Affiliation(s)
- Joseph R. Phillips
- Faculty of Medicine and Health Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown Sydney Australia
- School of Psychology & Marcs Institute for Brain and Behaviour Western Sydney University Sydney New South Wales Australia
| | - Elie Matar
- Faculty of Medicine and Health Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown Sydney Australia
- Dementia and Movement Disorders Laboratory, Brain and Mind Centre University of Sydney Sydney New South Wales Australia
| | - Kaylena A. Ehgoetz Martens
- Faculty of Medicine and Health Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown Sydney Australia
- Department of Kinesiology, Faculty of Health University of Waterloo Waterloo Ontario Canada
| | - Ahmed A. Moustafa
- Faculty of Medicine and Health Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown Sydney Australia
- School of Psychology & Marcs Institute for Brain and Behaviour Western Sydney University Sydney New South Wales Australia
| | - Glenda M. Halliday
- Faculty of Medicine and Health Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown Sydney Australia
- Dementia and Movement Disorders Laboratory, Brain and Mind Centre University of Sydney Sydney New South Wales Australia
| | - Simon J.G. Lewis
- Faculty of Medicine and Health Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown Sydney Australia
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Foska A, Tsantzali I, Sideri E, Stefanou MI, Bakola E, Kitsos DK, Zompola C, Bonakis A, Giannopoulos S, Voumvourakis KI, Tsivgoulis G, Paraskevas GP. Classical Cerebrospinal Fluid Biomarkers in Dementia with Lewy Bodies. Medicina (B Aires) 2022; 58:medicina58050612. [PMID: 35630029 PMCID: PMC9144333 DOI: 10.3390/medicina58050612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
The use and interpretation of diagnostic cerebrospinal fluid (CSF) biomarkers for neurodegenerative disorders, such as Dementia with Lewy bodies (DLB), represent a clinical challenge. According to the literature, the composition of CSF in DLB patients varies. Some patients present with reduced levels of amyloid, others with full Alzheimer Disease CSF profile (both reduced amyloid and increased phospho-tau) and some with a normal profile. Some patients may present with abnormal levels of a-synuclein. Continuous efforts will be required to establish useful CSF biomarkers for the early diagnosis of DLB. Given the heterogeneity of methods and results between studies, further validation is fundamental before conclusions can be drawn.
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7
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Olivieri P, Lebouvier T, Hardouin JB, Courtemanche H, Le Dily S, Barbin L, Pallardy A, Derkinderen P, Boutoleau-Bretonnière C. LeSCoD: a new clinical scale for the detection of Lewy body disease in neurocognitive disorders. J Neurol 2021; 268:3886-3896. [PMID: 33830336 DOI: 10.1007/s00415-021-10539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dementia with Lewy bodies remains underdiagnosed in clinical practice mainly because of the low sensitivity of existing diagnostic criteria and a strong overlap with Alzheimer's pathology that can mask the Lewy phenotype. OBJECTIVE The objective of this study was therefore to develop and validate a new clinical scale designed to detect signs of Lewy body disease, called LeSCoD for Lewy body Screening scale in Cognitive Disorders. METHODS 128 patients who fulfilled the clinical criteria of dementia with Lewy bodies (DLB; n = 32), Alzheimer's disease (AD; n = 77) or both (n = 19) was prospectively enrolled. 18F-DOPA PET imaging and/or CSF biomarkers were available in some patients. LeSCoD scale was systematically administered and the potential correlation with 18F-DOPA PET imaging was evaluated in a subgroup of patients. RESULTS LeSCoD scale showed robust internal and external validity. We determined a cut-off of 10 above which the sensitivity and specificity for Lewy body disease diagnosis were 86% and 95%, respectively. The LeSCoD scale correlated with striatal dopamine uptake in 18F-DOPA PET. CONCLUSION LeSCoD scale is a simple and reliable tool for the evaluation of Lewy body disease in routine clinical practice, with a higher sensitivity and specificity than the existing criteria. It might be an alternative to the use of dopamine-specific imaging.
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Affiliation(s)
- Pauline Olivieri
- Department of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Thibaud Lebouvier
- University of Lille, Inserm U1172, CHU Lille, DISTALZ, Lille, France
| | - Jean-Benoît Hardouin
- UMR INSERM 1246-SPHERE "Methods in Patient-Centered Outcomes and Health Research", Université de Nantes, Université de Tours, Tours, France.,Unit of Methodology and Biostatistics, Université de Nantes, Nantes, France
| | - Hélène Courtemanche
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France.,INSERM CIC 04, Nantes, France
| | | | | | | | | | - Claire Boutoleau-Bretonnière
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France. .,INSERM CIC 04, Nantes, France. .,Claire Boutoleau-Bretonnière, Centre Mémoire Ressource et Recherche (CMRR), Centre Hospitalier Universitaire de Nantes Hôpital Laennec, Boulevard Jacques Monod, 44000, Nantes, France.
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8
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Nicastro N, Mak E, Surendranathan A, Rittman T, Rowe JB, O'Brien JT. Altered structural connectivity networks in dementia with lewy bodies. Brain Imaging Behav 2021; 15:2445-2453. [PMID: 33511557 PMCID: PMC8500905 DOI: 10.1007/s11682-020-00444-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 08/18/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
The impairment of large-scale brain networks has been observed in dementia with Lewy bodies (DLB) using functional connectivity, but the potential for an analogous effect on structural covariance patterns has not been determined. Twenty-four probable DLB subjects (mean age 74.3 ± 6.7 years, 16.7% female) and 23 similarly aged Controls were included. All participants underwent 3T MRI imaging with high-resolution T1-weighted magnetization-prepared rapid gradient echo (MPRAGE) sequence. Graph theoretical analyses were performed using variation in regional cortical thickness to construct a structural association matrix with pairwise Pearson correlations. Global and nodal graph parameters were computed to assess between-group differences and community structure was studied in order to quantify large-scale brain networks in both groups. In comparison to Controls, DLB subjects had decreased global efficiency, clustering, modularity and small-worldness of structural networks (all p < 0.05). Nodal measures showed that DLB subjects also had decreased clustering in bilateral temporal regions and decreased closeness centrality in extensive areas including right middle frontal, left cingulate and bilateral occipital lobe (all false-discovery rate (FDR)-corrected q < 0.05). Whereas four distinct modules could be clearly identified in Controls, DLB showed extensively disorganized modules, including default-mode network and dorsal attentional network. Our results suggest a marked impairment in large-scale brain structural networks in DLB, mirroring functional connectivity networks disruption.
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Affiliation(s)
- Nicolas Nicastro
- Department of Psychiatry, University of Cambridge, Cambridge, UK. .,Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, 4, rue G. Perret-Gentil, 1205, Geneva, Switzerland.
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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9
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Bousiges O, Philippi N, Lavaux T, Perret-Liaudet A, Lachmann I, Schaeffer-Agalède C, Anthony P, Botzung A, Rauch L, Jung B, de Sousa PL, Demuynck C, Martin-Hunyadi C, Cretin B, Blanc F. Differential diagnostic value of total alpha-synuclein assay in the cerebrospinal fluid between Alzheimer's disease and dementia with Lewy bodies from the prodromal stage. ALZHEIMERS RESEARCH & THERAPY 2020; 12:120. [PMID: 32993772 PMCID: PMC7523311 DOI: 10.1186/s13195-020-00684-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
Background Several studies have investigated the value of alpha-synuclein assay in the cerebrospinal fluid (CSF) of Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) patients in the differential diagnosis of these two pathologies. However, very few studies have focused on this assay in AD and DLB patients at the MCI stage. Methods All patients were enrolled under a hospital clinical research protocol from the tertiary Memory Clinic (CM2R) of Alsace, France, by an experienced team of clinicians. A total of 166 patients were included in this study: 21 control subjects (CS), 51 patients with DLB at the prodromal stage (pro-DLB), 16 patients with DLB at the demented stage (DLB-d), 33 AD patients at the prodromal stage (pro-AD), 32 AD patients at the demented stage (AD-d), and 13 patients with mixed pathology (AD+DLB). CSF levels of total alpha-synuclein were assessed using a commercial enzyme-linked immunosorbent assay (ELISA) for alpha-synuclein (AJ Roboscreen). Alzheimer’s biomarkers (t-Tau, P-Tau, Aβ42, and Aβ40) were also measured. Results The alpha-synuclein assays showed a significant difference between the AD and DLB groups. Total alpha-synuclein levels were significantly higher in AD patients than in DLB patients. However, the ROC curves show a moderate discriminating power between AD and DLB (AUC = 0.78) which does not improve the discriminating power of the combination of Alzheimer biomarkers (AUC = 0.95 with or without alpha-synuclein). Interestingly, the levels appeared to be altered from the prodromal stage in both AD and DLB. Conclusions The modification of total alpha-synuclein levels in the CSF of patients occurs early, from the prodromal stage. The adding of alpha-synuclein total to the combination of Alzheimer’s biomarker does not improve the differential diagnosis between AD and DLB. Trial registration ClinicalTrials.gov, NCT01876459 (AlphaLewyMa)
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Affiliation(s)
- Olivier Bousiges
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000, Strasbourg, France. .,Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), University of Strasbourg, 67000, Strasbourg, France. .,CNRS UMR7364, 67000, Strasbourg, France. .,CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.
| | - Nathalie Philippi
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
| | - Thomas Lavaux
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Armand Perret-Liaudet
- Neurochemistry Laboratory, Biochemistry Department, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, 59 bd Pinel, 69677, Bron, France.,BIORAN Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028, Université de Lyon - Université Claude Bernard, 95 bd Pinel, 69675, Bron, France.,Center for Memory Resources and Research, Hospices Civils de Lyon, Charpennes Hospital, Lyon 1 University, 69100, Villeurbanne, France
| | - Ingolf Lachmann
- AJ Roboscreen GmbH, Hohmannstraße 7, 04129, Leipzig, Germany
| | - Caroline Schaeffer-Agalède
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Pierre Anthony
- Geriatrics Department, General Hospital Centre, CM2R, Geriatric Day Hospital, Colmar, France
| | - Anne Botzung
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Lucie Rauch
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Barbara Jung
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Benjamin Cretin
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
| | - Frédéric Blanc
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
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10
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Dumurgier J, Tzourio C. Epidemiology of neurological diseases in older adults. Rev Neurol (Paris) 2020; 176:642-648. [PMID: 32145981 DOI: 10.1016/j.neurol.2020.01.356] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/20/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023]
Abstract
Neurological diseases refer to the diseases that target the nervous system (brain, spine or nerves). They are the second leading cause of death, and the first cause of severe long-term disability in the world. The prevalence of most neurological diseases increases sharply with age, and age also modulates the impact of risk factors, clinical presentation and the natural course of these diseases. Longitudinal population-based studies provide useful insights for a better understanding of the specificities of neurological diseases in older adults by assessment of a wide range of risk factors. Rapid population aging, especially in low-income countries, presents challenges in terms of health and social care. A multidisciplinary approach is necessary to find solutions to tackle the burden of neurological diseases in older adults.
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Affiliation(s)
- J Dumurgier
- Cognitive Neurology Center, Saint-Louis - Lariboisière - Fernand-Widal Hospital, AP-HP, université de Paris, Paris, France; Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, université de Paris, Paris, France.
| | - C Tzourio
- Bordeaux Population Health Research Center, UMR1219, université de Bordeaux, Bordeaux, France
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11
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Paraskevas GP, Bougea A, Constantinides VC, Bourbouli M, Petropoulou O, Kapaki E. In vivo Prevalence of Alzheimer Biomarkers in Dementia with Lewy Bodies. Dement Geriatr Cogn Disord 2020; 47:289-296. [PMID: 31311013 DOI: 10.1159/000500567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neuropathological studies indicate concomitant Alzheimer's disease (AD) pathology in patients with dementia with Lewy bodies (DLB). OBJECTIVES To measure cerebrospinal fluid (CSF) levels of β-amyloid peptide with 42 amino acids (Aβ42), total tau protein (τT), and tau phosphorylated at threonine 181 (τP-181) in 38 patients fulfilling the diagnostic criteria of probable DLB according to the most recent (4th consensus) report. METHODS Double-sandwich commercial ELISAs (Innotest; Fujirebio, Gent, Belgium) were used for measurements. RESULTS According to the current cutoff values of our laboratory, 4 biomarker profiles were noted: abnormal levels of Aβ42 only (44.7%), full AD profile (39.5%), abnormal levels of τT only (5.3%), and normal levels of all 3 biomarkers (10.5%). AD profile was associated with female sex, older age, lower education, and lower MMSE scores. CONCLUSIONS Reduction in Αβ42 in DLB may be more common (>80% of patients) than previously thought, and ∼40% may have the typical CSF AD biomarker profile. AD biochemistry in DLB may be an evolving process showing increasing frequency with disease progression.
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Affiliation(s)
- George P Paraskevas
- Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece,
| | - Anastasia Bougea
- Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios C Constantinides
- Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mara Bourbouli
- Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Neurological Laboratory, Department of Neurology, School of Medicine, University of Crete, Iráklion, Greece
| | - Olga Petropoulou
- Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Kapaki
- Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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12
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Bousiges O, Blanc F. Diagnostic value of cerebro-spinal fluid biomarkers in dementia with lewy bodies. Clin Chim Acta 2019; 490:222-228. [DOI: 10.1016/j.cca.2018.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
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13
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Surendranathan A, Su L, Mak E, Passamonti L, Hong YT, Arnold R, Vázquez Rodríguez P, Bevan-Jones WR, Brain SAE, Fryer TD, Aigbirhio FI, Rowe JB, O’Brien JT. Early microglial activation and peripheral inflammation in dementia with Lewy bodies. Brain 2018; 141:3415-3427. [PMID: 30403785 PMCID: PMC6262214 DOI: 10.1093/brain/awy265] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022] Open
Abstract
Inflammation is increasingly recognized as part of the pathology of neurodegenerative conditions such as Alzheimer's disease and Parkinson's disease, but its role in dementia with Lewy bodies remains unclear. Using multimodal imaging and peripheral cytokine analysis, we therefore investigated central and peripheral inflammation in this common form of dementia. Nineteen participants with probable dementia with Lewy bodies and 16 similarly aged controls underwent 3 T MRI and PET imaging with 11C-PK11195, a marker of microglial activation in vivo. Peripheral blood inflammatory cytokines were also measured in all subjects, as well as in an additional 10 controls, using the Mesoscale Human Cytokine 36 plex panel and additional assays for high sensitivity c-reactive protein, tumour necrosis factor receptor 1, IL-34, YKL-40 (chitinase-3-like protein 1) and colony stimulating factor 1. To test for the presence of in vivo amyloid, 11C-Pittsburgh compound B PET imaging was also performed in 16 of the dementia with Lewy body participants. Microglial activation was elevated in dementia with Lewy bodies subjects with mild disease when compared to those with moderate/severe impairment, where disease severity was indexed by cognitive performance on the revised Addenbrooke's Cognitive Examination. In patients, strong correlations were found between cognitive performance and 11C-PK11195 non-displaceable binding potential in several regions including the caudate nucleus (R = 0.83, P = 0.00008) and cuneus (R = 0.77, P = 0.0005). Several inflammatory cytokines were altered in the patients compared to controls, with elevated macrophage inflammatory protein-3 (P = 0.001), IL-17A (P = 0.008) and IL-2 (P = 0.046) and reduced IL-8 (P = 0.024). There was no correlation between cortical 11C-Pittsburgh compound B standardized uptake value ratio and clinical features, regional 11C-PK11195 binding or peripheral cytokine levels. Nor was there any regional correlation between 11C-PK11195 non-displaceable binding potentials and 11C-Pittsburgh compound B standardized uptake value ratios. Our findings provide evidence for both central and peripheral inflammatory changes in dementia with Lewy bodies, with microglial activation occurring early in the disease in key regions known to be associated with pathology, before declining as cognition declines. Raised peripheral cytokines associated with T cell function further suggest a role for the adaptive immune system in the pathogenesis of the disease.
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Affiliation(s)
| | - Li Su
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Sino-Britain Centre for Cognition and Ageing Research, Faculty of Psychology, Southwest University, Chongqing, China
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Robert Arnold
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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14
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Mouton A, Blanc F, Gros A, Manera V, Fabre R, Sauleau E, Gomez-Luporsi I, Tifratene K, Friedman L, Thümmler S, Pradier C, Robert PH, David R. Sex ratio in dementia with Lewy bodies balanced between Alzheimer's disease and Parkinson's disease dementia: a cross-sectional study. ALZHEIMERS RESEARCH & THERAPY 2018; 10:92. [PMID: 30208961 PMCID: PMC6136211 DOI: 10.1186/s13195-018-0417-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023]
Abstract
Background Gender distribution varies across neurodegenerative disorders, with, traditionally, a higher female frequency reported in Alzheimer’s disease (AD) and a higher male frequency in Parkinson’s disease (PD). Conflicting results on gender distribution are reported concerning dementia with Lewy bodies (DLB), usually considered as an intermediate disease between AD and PD. The aim of the present study was to investigate gender differences in DLB in French specialized memory settings using data from the French national database spanning from 2010 to 2015 and to compare sex ratio in DLB with that in AD, Parkinson’s disease dementia (PDD), and PD. Our hypothesis was that there is a balanced sex ratio in DLB, different from that found in AD and PD. Methods We conducted a repeated cross-sectional study. The study population comprised individuals with a DLB, AD, PDD, or PD diagnosis according to the International Classification of Diseases, Tenth Revision, in the French National Alzheimer Database between 2010 and 2015. Sex ratio and demographic data were compared using multinomial logistic regression and a Bayesian statistical model. Results From 2010 to 2015 in French specialized memory settings, sex ratios (female percent/male percent) were found as follows: 1.21 (54.7%/45.3%) for DLB (n = 10,309), 2.34 (70.1%/29.9%) for AD (n = 135,664), 0.76 (43.1%/56.9%) for PD (n = 8744), and 0.83 (45.4%/54.6%) for PDD (n = 3198). Significant differences were found between each group, but not between PDD and PD, which had a similar sex ratio. Conclusions This large-sample prevalence study confirms the balanced gender distribution in the DLB population compared with AD and PD-PDD. Gender distribution and general demographic characteristics differed between DLB and PDD. This is consistent with the hypothesis that DLB is a distinct disease with characteristics intermediate between AD and PD, as well as with the hypothesis that DLB could have at least partially distinct neuropathological correlates.
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Affiliation(s)
- A Mouton
- Université Côte d'Azur, CobTeK lab, Nice, France. .,Centre Mémoire de Ressources et de Recherche, Institut Claude Pompidou, 10 rue Molière, 06100, Nice, France.
| | - F Blanc
- Geriatrics Department, University Hospitals of Strasbourg, CMRR (Research and Resources Memory Centre), Geriatric Day Hospital, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto, Strasbourg, France
| | - A Gros
- Université Côte d'Azur, CobTeK lab, Nice, France
| | - V Manera
- Université Côte d'Azur, CobTeK lab, Nice, France
| | - R Fabre
- Université Côte d'Azur, CobTeK lab, Nice, France.,Centre Hospitalier Universitaire de Nice, Department of Public Health, L'Archet Hospital, Nice University Hospital, EA 6312, Nice, France
| | - E Sauleau
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357, Strasbourg, France
| | | | - K Tifratene
- Université Côte d'Azur, CobTeK lab, Nice, France.,Antibes Hospital, Memory Center, Antibes, France
| | - L Friedman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - S Thümmler
- Université Côte d'Azur, CobTeK lab, Nice, France.,Centre Hospitalier Universitaire de Nice, University Department of Child and Adolescent Psychiatry, Children's Hospitals CHU-Lenval, Nice, France
| | - C Pradier
- Centre Hospitalier Universitaire de Nice, Department of Public Health, L'Archet Hospital, Nice University Hospital, EA 6312, Nice, France
| | - P H Robert
- Université Côte d'Azur, CobTeK lab, Nice, France
| | - R David
- Université Côte d'Azur, CobTeK lab, Nice, France
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15
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Kane JPM, Surendranathan A, Bentley A, Barker SAH, Taylor JP, Thomas AJ, Allan LM, McNally RJ, James PW, McKeith IG, Burn DJ, O'Brien JT. Clinical prevalence of Lewy body dementia. ALZHEIMERS RESEARCH & THERAPY 2018; 10:19. [PMID: 29448953 PMCID: PMC5815202 DOI: 10.1186/s13195-018-0350-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022]
Abstract
Background The prevalence of dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) in routine clinical practice is unclear. Prevalence rates observed in clinical and population-based cohorts and neuropathological studies vary greatly. Small sample sizes and methodological factors in these studies limit generalisability to clinical practice. Methods We investigated prevalence in a case series across nine secondary care services over an 18-month period, to determine how commonly DLB and PDD cases are diagnosed and reviewed within two regions of the UK. Results Patients with DLB comprised 4.6% (95% CI 4.0–5.2%) of all dementia cases. DLB was represented in a significantly higher proportion of dementia cases in services in the North East (5.6%) than those in East Anglia (3.3%; χ2 = 13.6, p < 0.01). DLB prevalence in individual services ranged from 2.4 to 5.9%. PDD comprised 9.7% (95% CI 8.3–11.1%) of Parkinson’s disease cases. No significant variation in PDD prevalence was observed between regions or between services. Conclusions We found that the frequency of clinical diagnosis of DLB varied between geographical regions in the UK, and that the prevalence of both DLB and PDD was much lower than would be expected in this case series, suggesting considerable under-diagnosis of both disorders. The significant variation in DLB diagnostic rates between these two regions may reflect true differences in disease prevalence, but more likely differences in diagnostic practice. The systematic introduction of more standardised diagnostic practice could improve the rates of diagnosis of both conditions.
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Affiliation(s)
- Joseph P M Kane
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ajenthan Surendranathan
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Allison Bentley
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Sally A H Barker
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Richard J McNally
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Peter W James
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Ian G McKeith
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - David J Burn
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. .,Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
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16
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Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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17
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Corriveau RA, Koroshetz WJ, Gladman JT, Jeon S, Babcock D, Bennett DA, Carmichael ST, Dickinson SLJ, Dickson DW, Emr M, Fillit H, Greenberg SM, Hutton ML, Knopman DS, Manly JJ, Marder KS, Moy CS, Phelps CH, Scott PA, Seeley WW, Sieber BA, Silverberg NB, Sutherland ML, Taylor A, Torborg CL, Waddy SP, Gubitz AK, Holtzman DM. Alzheimer's Disease-Related Dementias Summit 2016: National research priorities. Neurology 2017; 89:2381-2391. [PMID: 29117955 DOI: 10.1212/wnl.0000000000004717] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/05/2017] [Indexed: 01/02/2023] Open
Abstract
Goal 1 of the National Plan to Address Alzheimer's Disease is to prevent and effectively treat Alzheimer disease and Alzheimer disease-related dementias by 2025. To help inform the research agenda toward achieving this goal, the NIH hosts periodic summits that set and refine relevant research priorities for the subsequent 5 to 10 years. This proceedings article summarizes the 2016 Alzheimer's Disease-Related Dementias Summit, including discussion of scientific progress, challenges, and opportunities in major areas of dementia research, including mixed-etiology dementias, Lewy body dementia, frontotemporal degeneration, vascular contributions to cognitive impairment and dementia, dementia disparities, and dementia nomenclature.
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Affiliation(s)
- Roderick A Corriveau
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO.
| | - Walter J Koroshetz
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Jordan T Gladman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Sophia Jeon
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Debra Babcock
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David A Bennett
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - S Thomas Carmichael
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Susan L-J Dickinson
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Dennis W Dickson
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Marian Emr
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Howard Fillit
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Steven M Greenberg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Michael L Hutton
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David S Knopman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Jennifer J Manly
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Karen S Marder
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Claudia S Moy
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Creighton H Phelps
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Paul A Scott
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - William W Seeley
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Beth-Anne Sieber
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Nina B Silverberg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Margaret L Sutherland
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Angela Taylor
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Christine L Torborg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Salina P Waddy
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Amelie K Gubitz
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David M Holtzman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
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Abstract
The most definitive classification systems for dementia are based on the underlying pathology which, in turn, is categorized largely according to the observed accumulation of abnormal protein aggregates in neurons and glia. These aggregates perturb molecular processes, cellular functions and, ultimately, cell survival, with ensuing disruption of large-scale neural networks subserving cognitive, behavioural and sensorimotor functions. The functional domains affected and the evolution of deficits in these domains over time serve as footprints that the clinician can trace back with various levels of certainty to the underlying neuropathology. The process of phenotyping and syndromic classification has substantially improved over decades of careful clinicopathological correlation, and through the discovery of in vivo biomarkers of disease. Here, we present an overview of the salient features of the most common dementia subtypes - Alzheimer disease, vascular dementia, frontotemporal dementia and related syndromes, Lewy body dementias, and prion diseases - with an emphasis on neuropathology, relevant epidemiology, risk factors, and signature signs and symptoms.
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Nagahama Y, Okina T, Suzuki N. Neuropsychological Differences Related to Age in Dementia with Lewy Bodies. Dement Geriatr Cogn Dis Extra 2017; 7:188-194. [PMID: 28690632 PMCID: PMC5498935 DOI: 10.1159/000477296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To examine the influence of age on neuropsychological performances in dementia with Lewy bodies (DLB) and Alzheimer disease (AD) patients. METHODS We examined memory, executive, and visuo-constructional performances in 202 DLB patients and 236 AD patients. We divided the subjects into three age groups (65-74, 75-84, and 85-95 years old), and evaluated the differences in neuropsychological performances. RESULTS Recent memory in the DLB group was significantly better than that in the age-matched AD group when comparing the age groups 65-74 years and 75-84 years; however, memory impairment in the DLB patients in the age group 85-95 years was comparable with that in the age-matched AD patients. In contrast to recent memory, the other assessed neuropsychological performances, such as visuospatial and executive functions, showed no significant change in differences between the DLB and AD groups with advancing age. CONCLUSION Our study revealed that the nature of memory impairment in DLB patients changes according to age. DLB patients in the young-old and old-old age groups showed significantly better memory performance than the age-matched AD patients, whereas memory performance of the DLB patients in the oldest-old age group was similar to that of the age-matched AD patients. This may be associated with the increased rate of coexisting AD pathology in DLB patients with older age.
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Affiliation(s)
- Yasuhiro Nagahama
- Kawasaki Memorial Hospital, Kawasaki City, Japan.,Department of Geriatric Neurology, Shiga Medical Center, Moriyama City, Japan
| | - Tomoko Okina
- Department of Geriatric Neurology, Shiga Medical Center, Moriyama City, Japan
| | - Norio Suzuki
- Department of Geriatric Neurology, Shiga Medical Center, Moriyama City, Japan
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Blanc F, Mahmoudi R, Jonveaux T, Galmiche J, Chopard G, Cretin B, Demuynck C, Martin-Hunyadi C, Philippi N, Sellal F, Michel JM, Tio G, Stackfleth M, Vandel P, Magnin E, Novella JL, Kaltenbach G, Benetos A, Sauleau EA. Long-term cognitive outcome of Alzheimer's disease and dementia with Lewy bodies: dual disease is worse. ALZHEIMERS RESEARCH & THERAPY 2017; 9:47. [PMID: 28655337 PMCID: PMC5488368 DOI: 10.1186/s13195-017-0272-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022]
Abstract
Background Longitudinal studies of dementia with Lewy bodies (DLB) are rare. Clinically, DLB is usually considered to worsen into Alzheimer’s disease (AD). The aim of our study was to compare the rate of the cognitive decline in DLB, AD, and the association of the two diseases (AD + DLB). Methods Using the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment database, which includes all the patients seen at all memory clinics (medical consultation and day hospitals) in four French regions, and beta regression, we compared the longitudinal the Mini-Mental State Examination scores of 1159 patients with AD (n = 1000), DLB (n = 131) and AD + DLB (association of the two) (n = 28) during follow-up of at least 4 years. Results The mean follow-up of the patients was 5.88 years. Using beta regression without propensity scores, the comparison of the decline of patients with AD and patients with DLB did not show a significant difference, but the decline of patients with AD + DLB was worse than that of either patients with DLB (P = 0.006) or patients with AD (P < 0.001). Using beta regression weighted by a propensity score, comparison of patients with AD and patients with DLB showed a faster decline for patients with DLB (P < 0.001). The comparison of the decline of patients with AD + DLB with that of patients with DLB (P < 0.001) and patients with AD (P < 0.001) showed that the decline was clearly worse in the patients with dual disease. Conclusions Whatever the analysis, the rate of decline is faster in patients with AD + DLB dual disease. The identification of such patients is important to enable clinicians to optimise treatment and care and to better inform and help patients and caregivers.
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Affiliation(s)
- Frédéric Blanc
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France. .,University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Intégrative en Santé (IMIS)/Neurocrypto, Strasbourg, France. .,University of Strasbourg, Laboratory of Biostatistics and French National Centre for Scientific Research (CNRS), ICube Laboratory, Team Modèles, Images et Vision (MIV), Strasbourg, France.
| | - Rachid Mahmoudi
- Geriatrics Department, Centre Hospitalier Universitaire Reims, Memory Resource and Research Centre (CM2R) Champagne-Ardenne, Reims, France
| | - Thérèse Jonveaux
- Geriatrics Department, Centre Hospitalier Universitaire Nancy, Université de Lorraine, Memory Resource and Research Centre (CM2R) Lorraine, Nancy, France
| | - Jean Galmiche
- Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Gilles Chopard
- Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Benjamin Cretin
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France.,University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Intégrative en Santé (IMIS)/Neurocrypto, Strasbourg, France
| | - Catherine Demuynck
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Catherine Martin-Hunyadi
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Nathalie Philippi
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France.,University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Intégrative en Santé (IMIS)/Neurocrypto, Strasbourg, France
| | - François Sellal
- Geriatrics Department and Neurology Department, Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France.,Neurology Department,
- Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France
| | - Jean-Marc Michel
- Geriatrics Department and Neurology Department, Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France.,Neurology Department,
- Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France
| | - Gregory Tio
- Psychiatry Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Neurology Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Melanie Stackfleth
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Pierre Vandel
- Psychiatry Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Eloi Magnin
- Neurology Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Jean-Luc Novella
- Geriatrics Department, Centre Hospitalier Universitaire Reims, Memory Resource and Research Centre (CM2R) Champagne-Ardenne, Reims, France
| | - Georges Kaltenbach
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Athanase Benetos
- Geriatrics Department, Centre Hospitalier Universitaire Nancy, Université de Lorraine, Memory Resource and Research Centre (CM2R) Lorraine, Nancy, France
| | - Erik A Sauleau
- University of Strasbourg, Laboratory of Biostatistics and French National Centre for Scientific Research (CNRS), ICube Laboratory, Team Modèles, Images et Vision (MIV), Strasbourg, France
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21
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Bousiges O, Cretin B, Lavaux T, Philippi N, Jung B, Hezard S, Heitz C, Demuynck C, Gabel A, Martin-Hunyadi C, Blanc F. Diagnostic Value of Cerebrospinal Fluid Biomarkers (Phospho-Tau181, total-Tau, Aβ42, and Aβ40) in Prodromal Stage of Alzheimer's Disease and Dementia with Lewy Bodies. J Alzheimers Dis 2016; 51:1069-83. [PMID: 26923009 DOI: 10.3233/jad-150731] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) symptoms are close to those of Alzheimer's disease (AD), and the differential diagnosis is difficult especially early in the disease. Unfortunately, AD biomarkers in cerebrospinal fluid (CSF), and more particularly Aβ1 - 42, appear to be altered in dementia with Lewy bodies (DLB). However, the level of these biomarkers has never been studied in the prodromal stage of the disease. OBJECTIVE To compare these biomarkers between DLB and AD, with a particular focus on the prodromal stage. METHODS A total of 166 CSF samples were collected at the memory clinic of Strasbourg. They were obtained from prodromal DLB (pro-DLB), DLB dementia, prodromal AD (pro-AD), and AD dementia patients, and elderly controls. Phospho-Tau181, total-Tau, Aβ42, and Aβ40 were measured in the CSF. RESULTS At the prodromal stage, contrary to AD patients, DLB patients' biomarker levels in the CSF were not altered. At the demented stage of DLB, Aβ42 levels were reduced as well as Aβ40 levels. Thus, the Aβ42/Aβ40 ratio remained unchanged between the prodromal and demented stages, contrary to what was observed in AD. Tau and Phospho-Tau181 levels were unaltered in DLB patients. CONCLUSIONS We have shown that at the prodromal stage the DLB patients had no pathological profile. Consequently, CSF AD biomarkers are extremely useful for differentiating AD from DLB patients particularly at this stage when the clinical diagnosis is difficult. Thus, these results open up new perspectives on the interpretation of AD biomarkers in DLB.
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Affiliation(s)
- Olivier Bousiges
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, Strasbourg, France.,University of Strasbourg and CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, Strasbourg, France
| | - Benjamin Cretin
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France.,University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France.,University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Thomas Lavaux
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, Strasbourg, France
| | - Nathalie Philippi
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France.,University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France.,University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France.,University Hospital of Strasbourg, Geriatrics Day Hospital, Geriatrics Service, Strasbourg, France
| | - Barbara Jung
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France.,University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France.,University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France.,University Hospital of Strasbourg, Geriatrics Day Hospital, Geriatrics Service, Strasbourg, France
| | - Sylvie Hezard
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, Strasbourg, France
| | - Camille Heitz
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France.,University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France.,University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Catherine Demuynck
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France.,University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France.,University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France.,University Hospital of Strasbourg, Geriatrics Day Hospital, Geriatrics Service, Strasbourg, France
| | - Aurelia Gabel
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, Strasbourg, France
| | - Catherine Martin-Hunyadi
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France.,University Hospital of Strasbourg, Geriatrics Day Hospital, Geriatrics Service, Strasbourg, France
| | - Frédéric Blanc
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France.,University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France.,University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France.,University Hospital of Strasbourg, Geriatrics Day Hospital, Geriatrics Service, Strasbourg, France
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22
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The association between SBP and mortality risk differs with level of cognitive function in very old individuals. J Hypertens 2016; 34:745-52. [PMID: 26938812 PMCID: PMC4947532 DOI: 10.1097/hjh.0000000000000831] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: Cognitive impairment and dementia are highly prevalent in very old populations. Cardiovascular disease is a common cause of death in people with dementia. This study investigated whether the association of blood pressure (BP) with mortality differed with respect to mini-mental state examination (MMSE) score in a representative sample of very old individuals. Methods: The sample consisted of 1115 participants aged 85, 90, and at least 95 years from the Umeå85+/GErontological Regional DAtabase cohort study. The main outcome was all-cause mortality within 2 years according to BP and MMSE score, using Cox proportional-hazard regression models adjusted for sociodemographic and clinical characteristics associated with death. Results: Mean age, MMSE score, and SBP and DBP were 89.4 ± 4.6 years, 21.1 ± 7.6, 146.1 ± 23.4 mmHg, and 74.1 ± 11.7 mmHg, respectively. Within 2 years, 293 (26%) participants died. BP was not associated independently with mortality risk, except among participants with MMSE scores of 0–10 among whom mortality risk was increased in association with SBP at least 165 mmHg and 125 mmHg or less, compared with 126–139 mmHg (adjusted hazard ratio 4.54, 95% confidence interval = 1.52–13.60 and hazard ratio 2.23, 95% confidence interval = 1.12–4.45, respectively). In age and sex-adjusted analyses, SBP 125 mmHg or less was associated with increased mortality risk in participants with MMSE scores at least 18. Conclusion: In people aged at least 85 years, the association of SBP with mortality appears to differ with respect to MMSE score. Very old individuals with very severe cognitive impairment and low or high BP may have increased mortality risk.
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23
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Milisav I, Šuput D, Ribarič S. Unfolded Protein Response and Macroautophagy in Alzheimer's, Parkinson's and Prion Diseases. Molecules 2015; 20:22718-56. [PMID: 26694349 PMCID: PMC6332363 DOI: 10.3390/molecules201219865] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022] Open
Abstract
Proteostasis are integrated biological pathways within cells that control synthesis, folding, trafficking and degradation of proteins. The absence of cell division makes brain proteostasis susceptible to age-related changes and neurodegeneration. Two key processes involved in sustaining normal brain proteostasis are the unfolded protein response and autophagy. Alzheimer’s disease (AD), Parkinson’s disease (PD) and prion diseases (PrDs) have different clinical manifestations of neurodegeneration, however, all share an accumulation of misfolded pathological proteins associated with perturbations in unfolded protein response and macroautophagy. While both the unfolded protein response and macroautophagy play an important role in the prevention and attenuation of AD and PD progression, only macroautophagy seems to play an important role in the development of PrDs. Macroautophagy and unfolded protein response can be modulated by pharmacological interventions. However, further research is necessary to better understand the regulatory pathways of both processes in health and neurodegeneration to be able to develop new therapeutic interventions.
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Affiliation(s)
- Irina Milisav
- Institute of Pathophysiology, Faculty of Medicine, Zaloška 4, Ljubljana SI-1000, Slovenia.
- Faculty of Health Sciences, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenija.
| | - Dušan Šuput
- Institute of Pathophysiology, Faculty of Medicine, Zaloška 4, Ljubljana SI-1000, Slovenia.
| | - Samo Ribarič
- Institute of Pathophysiology, Faculty of Medicine, Zaloška 4, Ljubljana SI-1000, Slovenia.
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24
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Wallon D, Nicolas G. Genetica delle demenze degenerative. Neurologia 2015. [DOI: 10.1016/s1634-7072(15)73962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Mackin RS, Insel P, Zhang J, Mohlenhoff B, Galasko D, Weiner M, Mattsson N. Cerebrospinal fluid α-synuclein and Lewy body-like symptoms in normal controls, mild cognitive impairment, and Alzheimer's disease. J Alzheimers Dis 2015; 43:1007-16. [PMID: 25125463 DOI: 10.3233/jad-141287] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Reduced cerebrospinal fluid (CSF) α-synuclein has been described in synucleinopathies, including dementia with Lewy bodies (DLB). Common symptoms of DLB include visual hallucinations and visuospatial and executive deficits. Co-occurrence of Lewy body pathology is common in Alzheimer's disease (AD) patients, but it is unknown if reduced CSF α-synuclein is associated with Lewy body-like symptomatology in AD. OBJECTIVE Determine associations between CSF α-synuclein and Lewy body-like symptomatology. METHODS We included 73 controls (NC), 121 mild cognitive impairment (MCI) patients, and 61 AD patients (median follow-up 3.5 years, range 0.6-7.8). We tested associations between baseline CSF α-synuclein and visual hallucinations and (longitudinal) cognition. Models were tested with and without co-varying for CSF total tau (T-tau), which is elevated in AD patients, and believed to reflect neurodegeneration. RESULTS Hallucinations were reported in 20% of AD patients, 13% of MCI patients, and 8% of NC. In AD, low CSF α-synuclein was associated with hallucinations. When adjusting for CSF T-tau, low CSF α-synuclein was associated with accelerated decline of executive function (NC, MCI, and AD), memory (MCI and AD), and language (MCI). CONCLUSION The associations of low CSF α-synuclein with hallucinations and poor executive function, which are hallmarks of DLB, indirectly suggest that this biomarker may reflect underlying synuclein pathology. The associations with memory and language in MCI and AD suggests either that reduced CSF α-synuclein also partly reflects global impaired neuronal/synaptic function, or that non-specific overall cognitive deterioration is accelerated in the presence of synuclein related pathology. The findings will require autopsy verification.
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Affiliation(s)
- R Scott Mackin
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Philip Insel
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Brian Mohlenhoff
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Psychiatry, University of California, San Francisco, CA, USA Mental Health Service, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Michael Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Niklas Mattsson
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
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26
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Kawas CH, Kim RC, Sonnen JA, Bullain SS, Trieu T, Corrada MM. Multiple pathologies are common and related to dementia in the oldest-old: The 90+ Study. Neurology 2015; 85:535-42. [PMID: 26180144 DOI: 10.1212/wnl.0000000000001831] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/14/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the role of multiple pathologies in the expression of dementia in the oldest-old. METHODS A total of 183 participants of The 90+ Study with longitudinal follow-up and autopsy were included in this clinical-pathologic investigation. Eight pathologic diagnoses (Alzheimer disease [AD], microinfarcts, hippocampal sclerosis, macroinfarcts, Lewy body disease, cerebral amyloid angiopathy, white matter disease, and others) were dichotomized. We estimated the odds of dementia in relation to each individual pathologic diagnosis and to the total number of diagnoses. We also examined dementia severity in relation to number of pathologic diagnoses. RESULTS The presence of multiple pathologic diagnoses was common and occurred more frequently in those with dementia compared with those without dementia (45% vs 14%). Higher numbers of pathologic diagnoses were also associated with greater dementia severity. Participants with intermediate/high AD pathology alone were 3 times more likely to have dementia (odds ratio = 3.5), but those with single non-AD pathologies were 12 times more likely to have dementia (odds ratio = 12.4). When a second pathology was present, the likelihood of dementia increased 4-fold in those with intermediate/high AD pathology but did not change in those with non-AD pathologies, suggesting that pathologies may interrelate in different ways. CONCLUSIONS In the oldest-old, the presence of multiple pathologies is associated with increased likelihood and severity of dementia. The effect of the individual pathologies may be additive or perhaps synergistic and requires further research. Multiple pathologies will need to be targeted to reduce the burden of dementia in the population.
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Affiliation(s)
- Claudia H Kawas
- From the Departments of Neurology (C.H.K., S.S.B., M.M.C.), Neurobiology & Behavior (C.H.K.), and Epidemiology (C.H.K., M.M.C.), Institute for Memory Impairments and Neurological Disorders (C.H.K., M.M.C.), and School of Biological Sciences (T.T.), University of California, Irvine; Department of Pathology (R.K.), University of California, Irvine Medical Center, Orange, CA; Department of Pathology (J.S.), Huntsman Cancer Institute, University of Utah, Salt Lake City.
| | - Ronald C Kim
- From the Departments of Neurology (C.H.K., S.S.B., M.M.C.), Neurobiology & Behavior (C.H.K.), and Epidemiology (C.H.K., M.M.C.), Institute for Memory Impairments and Neurological Disorders (C.H.K., M.M.C.), and School of Biological Sciences (T.T.), University of California, Irvine; Department of Pathology (R.K.), University of California, Irvine Medical Center, Orange, CA; Department of Pathology (J.S.), Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Joshua A Sonnen
- From the Departments of Neurology (C.H.K., S.S.B., M.M.C.), Neurobiology & Behavior (C.H.K.), and Epidemiology (C.H.K., M.M.C.), Institute for Memory Impairments and Neurological Disorders (C.H.K., M.M.C.), and School of Biological Sciences (T.T.), University of California, Irvine; Department of Pathology (R.K.), University of California, Irvine Medical Center, Orange, CA; Department of Pathology (J.S.), Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Szofia S Bullain
- From the Departments of Neurology (C.H.K., S.S.B., M.M.C.), Neurobiology & Behavior (C.H.K.), and Epidemiology (C.H.K., M.M.C.), Institute for Memory Impairments and Neurological Disorders (C.H.K., M.M.C.), and School of Biological Sciences (T.T.), University of California, Irvine; Department of Pathology (R.K.), University of California, Irvine Medical Center, Orange, CA; Department of Pathology (J.S.), Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Thomas Trieu
- From the Departments of Neurology (C.H.K., S.S.B., M.M.C.), Neurobiology & Behavior (C.H.K.), and Epidemiology (C.H.K., M.M.C.), Institute for Memory Impairments and Neurological Disorders (C.H.K., M.M.C.), and School of Biological Sciences (T.T.), University of California, Irvine; Department of Pathology (R.K.), University of California, Irvine Medical Center, Orange, CA; Department of Pathology (J.S.), Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - María M Corrada
- From the Departments of Neurology (C.H.K., S.S.B., M.M.C.), Neurobiology & Behavior (C.H.K.), and Epidemiology (C.H.K., M.M.C.), Institute for Memory Impairments and Neurological Disorders (C.H.K., M.M.C.), and School of Biological Sciences (T.T.), University of California, Irvine; Department of Pathology (R.K.), University of California, Irvine Medical Center, Orange, CA; Department of Pathology (J.S.), Huntsman Cancer Institute, University of Utah, Salt Lake City
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27
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Guerreiro R, Bras J, Toombs J, Heslegrave A, Hardy J, Zetterberg H. Genetic Variants and Related Biomarkers in Sporadic Alzheimer's Disease. CURRENT GENETIC MEDICINE REPORTS 2015; 3:19-25. [PMID: 25664224 PMCID: PMC4317514 DOI: 10.1007/s40142-014-0062-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
From a neuropathological perspective, elderly patients who die with a clinical diagnosis of sporadic Alzheimer's disease (AD) are a heterogeneous group with several different pathologies contributing to the AD phenotype. This poses a challenge when searching for low effect size susceptibility genes for AD. Further, control groups may be contaminated by significant numbers of preclinical AD patients, which also reduces the power of genetic association studies. Here, we discuss how cerebrospinal fluid and imaging biomarkers can be used to increase the chance of finding novel susceptibility genes and as a means to study the functional consequences of risk alleles.
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Affiliation(s)
- Rita Guerreiro
- Department of Molecular Neuroscience, UCL Institute of Neurology, 1 Wakefield Street (1st Floor), London, WC1N 1PJ UK
| | - Jose Bras
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG UK
| | - Jamie Toombs
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG UK
| | - Amanda Heslegrave
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG UK
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of Neurology, 1 Wakefield Street (1st Floor), London, WC1N 1PJ UK
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG UK
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
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28
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Abstract
The increasing prevalence of Alzheimer's disease (AD) and a lack of effective prevention or disease-modifying therapies are global challenges with devastating personal, social and economic consequences. The amyloid β (Aβ) hypothesis posits that cerebral β-amyloidosis is a critical early event in AD pathogenesis. However, failed clinical trials of Aβ-centric drug candidates have called this hypothesis into question. Whereas we acknowledge that the Aβ hypothesis is far from disproven, we here re-visit the links between Aβ, tau and neurodegeneration. We review the genetics, epidemiology and pathology of sporadic AD and give an updated account of what is currently known about the molecular pathogenesis of the disease.
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Affiliation(s)
- Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, S-431 80 Mölndal, Sweden
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29
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Lebouvier T, Delrieu J, Evain S, Pallardy A, Sauvaget A, Letournel F, Chevrier R, Lepetit M, Vercelletto M, Boutoleau-Bretonnière C, Derkinderen P. [Dementia: Where are the Lewy bodies?]. Rev Neurol (Paris) 2013; 169:844-57. [PMID: 24103321 DOI: 10.1016/j.neurol.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/25/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second cause of degenerative dementia in autopsy studies. In clinical pratice however, the prevalence of DLB is much lower with important intercenter variations. Among the reasons for this low sensitivity of DLB diagnosis are (1) the imprecision and subjectivity of the diagnostic criteria; (2) the underestimation of non-motor symptoms (REM-sleep behavior disorder, dysautonomia, anosmia); mostly (3) the nearly constant association of Lewy bodies with Alzheimer's disease pathology, which dominates the clinical phenotype. With the avenue of targeted therapies against the protein agregates, new clinical scales able to apprehend the coexistence of Lewy pathology in Alzheimer's disease are expected.
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Affiliation(s)
- T Lebouvier
- CMRR des Pays de Loire, hôpital Laënnec, CHU de Nantes, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France.
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30
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Toledo JB, Arnold SE, Raible K, Brettschneider J, Xie SX, Grossman M, Monsell SE, Kukull WA, Trojanowski JQ. Contribution of cerebrovascular disease in autopsy confirmed neurodegenerative disease cases in the National Alzheimer's Coordinating Centre. ACTA ACUST UNITED AC 2013; 136:2697-706. [PMID: 23842566 DOI: 10.1093/brain/awt188] [Citation(s) in RCA: 538] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cerebrovascular disease and vascular risk factors are associated with Alzheimer's disease, but the evidence for their association with other neurodegenerative disorders is limited. Therefore, we compared the prevalence of cerebrovascular disease, vascular pathology and vascular risk factors in a wide range of neurodegenerative diseases and correlate them with dementia severity. Presence of cerebrovascular disease, vascular pathology and vascular risk factors was studied in 5715 cases of the National Alzheimer's Coordinating Centre database with a single neurodegenerative disease diagnosis (Alzheimer's disease, frontotemporal lobar degeneration due to tau, and TAR DNA-binding protein 43 immunoreactive deposits, α-synucleinopathies, hippocampal sclerosis and prion disease) based on a neuropathological examination with or without cerebrovascular disease, defined neuropathologically. In addition, 210 'unremarkable brain' cases without cognitive impairment, and 280 cases with pure cerebrovascular disease were included for comparison. Cases with cerebrovascular disease were older than those without cerebrovascular disease in all the groups except for those with hippocampal sclerosis. After controlling for age and gender as fixed effects and centre as a random effect, we observed that α-synucleinopathies, frontotemporal lobar degeneration due to tau and TAR DNA-binding protein 43, and prion disease showed a lower prevalence of coincident cerebrovascular disease than patients with Alzheimer's disease, and this was more significant in younger subjects. When cerebrovascular disease was also present, patients with Alzheimer's disease and patients with α-synucleinopathy showed relatively lower burdens of their respective lesions than those without cerebrovascular disease in the context of comparable severity of dementia at time of death. Concurrent cerebrovascular disease is a common neuropathological finding in aged subjects with dementia, is more common in Alzheimer's disease than in other neurodegenerative disorders, especially in younger subjects, and lowers the threshold for dementia due to Alzheimer's disease and α-synucleinopathies, which suggests that these disorders should be targeted by treatments for cerebrovascular disease.
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Affiliation(s)
- Jon B Toledo
- Department of Pathology and Laboratory Medicine, Institute on Ageing, Centre for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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31
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Gardner RC, Valcour V, Yaffe K. Dementia in the oldest old: a multi-factorial and growing public health issue. ALZHEIMERS RESEARCH & THERAPY 2013; 5:27. [PMID: 23809176 PMCID: PMC3706944 DOI: 10.1186/alzrt181] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The population of oldest old, or people aged 85 and older, is growing rapidly. A better understanding of dementia in this population is thus of increasing national and global importance. In this review, we describe the major epidemiological studies, prevalence, clinical presentation, neuropathological and imaging features, risk factors, and treatment of dementia in the oldest old. Prevalence estimates for dementia among those aged 85+ ranges from 18 to 38%. The most common clinical syndromes are Alzheimer's dementia, vascular dementia, and mixed dementia from multiple etiologies. The rate of progression appears to be slower than in the younger old. Single neuropathological entities such as Alzheimer's dementia and Lewy body pathology appear to have declining relevance to cognitive decline, while mixed pathology with Alzheimer's disease, vascular disease (especially cortical microinfarcts), and hippocampal sclerosis appear to have increasing relevance. Neuroimaging data are sparse. Risk factors for dementia in the oldest old include a low level of education, poor mid-life general health, low level of physical activity, depression, and delirium, whereas apolipoprotein E genotype, late-life hypertension, hyperlipidemia, and elevated peripheral inflammatory markers appear to have less relevance. Treatment approaches require further study, but the oldest old may be more prone to negative side effects compared with younger patients and targeted therapies may be less efficacious since single pathologies are less frequent. We also highlight the limitations and challenges of research in this area, including the difficulty of defining functional decline, a necessary component for a dementia diagnosis, the lack of normative neuropsychological data, and other shortcomings inherent in existing diagnostic criteria. In summary, our understanding of dementia in the oldest old has advanced dramatically in recent years, but more research is needed, particularly among varied racial, ethnic, and socioeconomic groups, and with respect to biomarkers such as neuroimaging, modifiable risk factors, and therapy.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA
| | - Victor Valcour
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA ; Division of Geriatric Medicine, Department of Medicine, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, Epidemiology and Biostatistics, School of Medicine, University of California, 4150 Clement Street - Box 181, San Francisco, CA 94121, USA ; Veterans Affairs Medical Center, 4150 Clement Street - Box 181, San Francisco, CA 94121, USA
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Stein J, Luppa M, Maier W, Tebarth F, Heser K, Scherer M, Zimmermann T, Eisele M, Bickel H, Mösch E, Weyerer S, Werle J, Pentzek M, Fuchs A, Wiese B, Prokein J, König HH, Leicht H, Riedel-Heller SG. The assessment of changes in cognitive functioning in the elderly: age- and education-specific reliable change indices for the SIDAM. Dement Geriatr Cogn Disord 2012; 33:73-83. [PMID: 22414525 DOI: 10.1159/000336864] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The diagnostic criteria for dementia include reliable evidence of cognitive deterioration over time measured by cognitive tests. The Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-infarct Dementia and Dementia of other Etiology according to DSM-III-R, DSM-IV and ICD-10 (SIDAM) is a neuropsychological instrument to determine cognitive status in patients with mild cognitive impairment (MCI) and dementia. Normative data for changes in cognitive functioning that normally occur in cognitively healthy individuals are required to interpret changes in SIDAM test scores. METHODS A sample of 1,090 cognitively healthy individuals participating in the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe) aged 75 years and older was assessed four times at 1.5-year intervals over a period of 4.5 years using the SIDAM. Age- and education-specific reliable change indices (RCIs) accounting for probable measurement error and practice effects were computed for a 90% confidence interval. RESULTS Across different age and education subgroups, changes from at least 3-5 points indicated significant (i.e. reliable) changes in SIDAM test scores at the 90% confidence level. CONCLUSION This study offers age- and education-specific normative data for the SIDAM based upon established RCI methods. The RCI scores provided in this study may help clinicians and researchers to interpret cognitive changes in SIDAM test scores and may contribute to the early detection and diagnosis of MCI and dementia in the elderly.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Strasse 55, Leipzig, Germany.
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33
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Uetani H, Hirai T, Hashimoto M, Ikeda M, Kitajima M, Sakamoto F, Utsunomiya D, Oda S, Sugiyama S, Matsubara J, Yamashita Y. Prevalence and topography of small hypointense foci suggesting microbleeds on 3T susceptibility-weighted imaging in various types of dementia. AJNR Am J Neuroradiol 2012; 34:984-9. [PMID: 23124636 DOI: 10.3174/ajnr.a3332] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE The prevalence and topography of small hypointense foci suggesting microbleeds on 3T SWI in various types of dementia have not been systematically investigated. The purpose of this study was to determine the prevalence and topography of SHF on 3T SWI in patients with different dementia subtypes. MATERIALS AND METHODS We included 347 consecutive patients (217 women, 130 men; age range, 42-93 years; mean age, 74 years) who attended our memory clinic and underwent 3T SWI. They were divided into 6 groups: subjective complaints, MCI, AD, DLB, VaD, and FTLD. Two neuroradiologists evaluated the number and location of SHF on SWIs. Statistical analyses were performed to evaluate inter- and intragroup differences. RESULTS Of the 347 patients, 160 (46.1%) exhibited at least 1 small hypointense focus. This was true in 86% with VaD, 54% with DLB, 48% with AD, 41% with MCI, 27% with FTLD, and 22% with subjective complaints. With the subjective complaints group as a reference, the odds ratio adjusted by age, sex, and arterial hypertension was 9.2 (95% CI, 2.0-43.6) for VaD; 5.4 (95% CI, 1.2-24.3) for AD; 3.1 for DLB (95% CI, 1.1-8.8); 2.0 for MCI (95% CI, 0.5-8.1); and 1.5 for FTLD (95% CI, 0.4-5.4). There was a significant lobar predilection for AD, DLB, and FTLD groups (P < .05). CONCLUSIONS On 3T SWI, patients with VaD, AD, and DLB manifested a high SHF prevalence. In patients with AD, DLB, and FTLD, the SHF exhibited a lobar predilection.
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Affiliation(s)
- H Uetani
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Horvath J, Burkhard PR, Bouras C, Kövari E. Etiologies of Parkinsonism in a century-long autopsy-based cohort. Brain Pathol 2012; 23:28-33. [PMID: 22702335 DOI: 10.1111/j.1750-3639.2012.00611.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 06/06/2012] [Indexed: 11/30/2022] Open
Abstract
We investigated the distribution of different etiologies underlying Parkinsonism in a hospital-based autopsy collection, studied the demographic data and evaluated diagnostic accuracy using histopathological examination as the gold standard. Out of a total of 9359 consecutive autopsy cases collected between 1914 and 2010, we identified 261 individuals who carried a clinical diagnosis of a Parkinsonian syndrome at death. A detailed neuropathological examination revealed idiopathic Parkinson's disease (PD) in 62.2%, progressive supranuclear palsy (PSP) in 4.2%, multiple system atrophy (MSA) in 2.3%, corticobasal degeneration (CBD) in 1.2%, postencephalitic Parkinsonism (PEP) in 2.7%, vascular Parkinsonism (VaP) in 8.8% and Alzheimer-type pathology (ATP) of the substantia nigra in 8%. The diagnostic accuracy of PD in our cohort was lower (71.2%) than those reported in previous studies, although it tended to increase during the last decades up to 85.7%. Of particular interest, we found that PD, while being the most frequent cause of Parkinsonism, was greatly overdiagnosed, with VaP and ATP being the most frequent confounding conditions.
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Affiliation(s)
- Judit Horvath
- Department of Neurology, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Kume K, Kikukawa M, Hanyu H, Takata Y, Umahara T, Sakurai H, Kanetaka H, Ohyashiki K, Ohyashiki JH, Iwamoto T. Telomere length shortening in patients with dementia with Lewy bodies. Eur J Neurol 2012; 19:905-10. [DOI: 10.1111/j.1468-1331.2011.03655.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Halliday GM, Holton JL, Revesz T, Dickson DW. Neuropathology underlying clinical variability in patients with synucleinopathies. Acta Neuropathol 2011; 122:187-204. [PMID: 21720849 DOI: 10.1007/s00401-011-0852-9] [Citation(s) in RCA: 307] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/18/2011] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
Abstract
Abnormal aggregates of the synaptic protein, α-synuclein, are the dominant pathology in syndromes known as the synucleinopathies. The cellular aggregation of the protein occurs in three distinct types of inclusions in three main clinical syndromes. α-Synuclein deposits in neuronal Lewy bodies and Lewy neurites in idiopathic Parkinson's disease (PD) and dementia with Lewy bodies (DLB), as well as incidentally in a number of other conditions. In contrast, α-synuclein deposits largely in oligodendroglial cytoplasmic inclusions in multiple system atrophy (MSA). Lastly, α-synuclein also deposits in large axonal spheroids in a number of rarer neuroaxonal dystrophies. Disorders are usually defined by their most dominant pathology, but for the synucleinopathies, clinical heterogeneity within the main syndromes is well documented. MSA was originally viewed as three different clinical phenotypes due to different anatomical localization of the lesions. In PD, recent meta-analyses have identified four main clinical phenotypes, and clinicopathological correlations suggest that more severe and more rapid progression of pathology with chronological age, as well as the involvement of additional neuropathologies, differentiates these phenotypes. In DLB, recent large studies show that clinical diagnosis is too insensitive to identify the syndrome itself, although clinicopathological studies suggest variable clinical features occur in the different pathological forms of this syndrome (pure DLB, DLB with Alzheimer's disease (AD), and AD with amygdala predominant Lewy pathology). The recognition of considerable heterogeneity within the synucleinopathy syndromes is important for the identification of factors involved in changing their pathological phenotype.
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Affiliation(s)
- Glenda M Halliday
- Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia.
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