1
|
Doskas T, Vadikolias K, Ntoskas K, Vavougios GD, Tsiptsios D, Stamati P, Liampas I, Siokas V, Messinis L, Nasios G, Dardiotis E. Neurocognitive Impairment and Social Cognition in Parkinson's Disease Patients. Neurol Int 2024; 16:432-449. [PMID: 38668129 PMCID: PMC11054167 DOI: 10.3390/neurolint16020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
In addition to motor symptoms, neurocognitive impairment (NCI) affects patients with prodromal Parkinson's disease (PD). NCI in PD ranges from subjective cognitive complaints to dementia. The purpose of this review is to present the available evidence of NCI in PD and highlight the heterogeneity of NCI phenotypes as well as the range of factors that contribute to NCI onset and progression. A review of publications related to NCI in PD up to March 2023 was performed using PubMed/Medline. There is an interconnection between the neurocognitive and motor symptoms of the disease, suggesting a common underlying pathophysiology as well as an interconnection between NCI and non-motor symptoms, such as mood disorders, which may contribute to confounding NCI. Motor and non-motor symptom evaluation could be used prognostically for NCI onset and progression in combination with imaging, laboratory, and genetic data. Additionally, the implications of NCI on the social cognition of afflicted patients warrant its prompt management. The etiology of NCI onset and its progression in PD is multifactorial and its effects are equally grave as the motor effects. This review highlights the importance of the prompt identification of subjective cognitive complaints in PD patients and NCI management.
Collapse
Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Konstantinos Vadikolias
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | | | - George D. Vavougios
- Department of Neurology, Athens Naval Hospital, 11521 Athens, Greece;
- Department of Neurology, Faculty of Medicine, University of Cyprus, 1678 Lefkosia, Cyprus
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece
| | - Dimitrios Tsiptsios
- Department of Neurology, General University Hospital of Alexandroupoli, 68100 Alexandroupoli, Greece; (K.V.); (D.T.)
| | - Polyxeni Stamati
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Vasileios Siokas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| | - Lambros Messinis
- School of Psychology, Laboratory of Neuropsychology and Behavioural Neuroscience, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece;
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.S.); (I.L.); (V.S.); (E.D.)
| |
Collapse
|
2
|
Barbosa R, Mendonça M, Bastos P, Pita Lobo P, Valadas A, Correia Guedes L, Ferreira JJ, Rosa MM, Matias R, Coelho M. 3D Kinematics Quantifies Gait Response to Levodopa earlier and to a more Comprehensive Extent than the MDS-Unified Parkinson's Disease Rating Scale in Patients with Motor Complications. Mov Disord Clin Pract 2024. [PMID: 38610081 DOI: 10.1002/mdc3.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/20/2024] [Accepted: 02/13/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Quantitative 3D movement analysis using inertial measurement units (IMUs) allows for a more detailed characterization of motor patterns than clinical assessment alone. It is essential to discriminate between gait features that are responsive or unresponsive to current therapies to better understand the underlying pathophysiological basis and identify potential therapeutic strategies. OBJECTIVES This study aims to characterize the responsiveness and temporal evolution of different gait subcomponents in Parkinson's disease (PD) patients in their OFF and various ON states following levodopa administration, utilizing both wearable sensors and the gold-standard MDS-UPDRS motor part III. METHODS Seventeen PD patients were assessed while wearing a full-body set of 15 IMUs in their OFF state and at 20-minute intervals following the administration of a supra-threshold levodopa dose. Gait was reconstructed using a biomechanical model of the human body to quantify how each feature was modulated. Comparisons with non-PD control subjects were conducted in parallel. RESULTS Significant motor changes were observed in both the upper and lower limbs according to the MDS-UPDRS III, 40 minutes after levodopa intake. IMU-assisted 3D kinematics detected significant motor alterations as early as 20 minutes after levodopa administration, particularly in upper limbs metrics. Although all "pace-domain" gait features showed significant improvement in the Best-ON state, most rhythmicity, asymmetry, and variability features did not. CONCLUSION IMUs are capable of detecting motor alterations earlier and in a more comprehensive manner than the MDS-UPDRS III. The upper limbs respond more rapidly to levodopa, possibly reflecting distinct thresholds to levodopa across striatal regions.
Collapse
Affiliation(s)
- Raquel Barbosa
- Neurology Deparment, Centre Hospitalier Universitaire Toulouse, Toulouse, France
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marcelo Mendonça
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Paulo Bastos
- Neurology Deparment, Centre Hospitalier Universitaire Toulouse, Toulouse, France
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Patrícia Pita Lobo
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Anabela Valadas
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Leonor Correia Guedes
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS- Campus Neurológico Senior, Torres Vedras, Portugal
| | - Mário Miguel Rosa
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo Matias
- Physics Department & Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Kinetikos, Coimbra, Portugal
| | - Miguel Coelho
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
3
|
Kim YJ, Park I, Choi HC, Ahn ME, Ryu OH, Jang D, Lee U, Lee SK. Relationship of Neural Correlates of Gait Characteristics and Cognitive Dysfunction in Patients with Mild Cognitive Impairment. J Clin Med 2023; 12:5347. [PMID: 37629389 PMCID: PMC10455461 DOI: 10.3390/jcm12165347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/09/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Some patients with mild cognitive impairment (MCI) experience gait disturbances. However, there are few reports on the relationship between gait disturbance and cognitive function in patients with MCI. Therefore, we investigated the neural correlates of gait characteristics related to cognitive dysfunction. Methods: Eighty patients diagnosed with MCI from three dementia centers in Gangwon-do, Korea, were recruited for this study. We defined MCI as a Clinical Dementia Rating global score of 0.5 or higher, with a memory domain score of 0.5 or greater. The patients were classified as having either higher or lower MMSE and the groups were based on their Mini Mental Status Examination z-scores. Multiple logistic regression analysis was performed to examine the association between the gait characteristics and cognitive impairment. Analyses included variables such as age, sex, years of education, number of comorbidities, body mass index, and height. Results: Gait velocity, step count, step length, heel-to-heel base support, swing and stance phase duration, and support time were associated with cognitive function. A decrease in gray matter volume in the right pericalcarine area was associated with gait characteristics related to cognitive dysfunction. An increase in the curvature of gray matter in the right entorhinal, right lateral orbitofrontal, right cuneus, and right and left pars opercularis areas was also associated with gait characteristics related to cognitive dysfunction. Conclusion: Since gait impairment is an important factor in determining activities of daily living in patients with mild cognitive impairment, the evaluation of gait and cognitive functions in patients with mild cognitive impairment is important.
Collapse
Affiliation(s)
- Yeo Jin Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea;
| | - Ingyu Park
- Department of Electronic Engineering, Hallym University, Chuncheon 24252, Republic of Korea; (I.P.); (D.J.)
| | - Hui-Chul Choi
- Department of Neurology, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Moo-Eob Ahn
- Department of Emergency Medicine, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Ohk-Hyun Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Daehun Jang
- Department of Electronic Engineering, Hallym University, Chuncheon 24252, Republic of Korea; (I.P.); (D.J.)
| | - Unjoo Lee
- Division of Software, School of Information Science, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Kyu Lee
- Department of Psychiatry, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| |
Collapse
|
4
|
Vale TC, Cardoso FEC, da Silva DJ, Resende EDPF, Maia DP, Cunningham MCQ, Guimarães HC, Machado JCB, Teixeira AL, Caramelli P, Barbosa MT. Clinical and functional correlates of parkinsonism in a population-based sample of individuals aged 75 + : the Pietà study. BMC Neurol 2023; 23:276. [PMID: 37479964 PMCID: PMC10360246 DOI: 10.1186/s12883-023-03290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/16/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Parkinsonism is strongly associated with ageing, and many studies have suggested that parkinsonian signs may affect up to half of older adults and is associated with a wide range of adverse health outcomes. We compared clinical and functional characteristics of oldest-old community-dwelling individuals with parkinsonism (parkinsonian group [PG]) to individuals without parkinsonism (non-parkinsonian group [NPG]. METHODS The Pietà study is a population-based study conducted in Caeté, southeast Brazil, involving 607 individuals aged 75 + years submitted to an extensive clinical evaluation. A subset of 65 PG individuals (61.5% women, median age of 82 years) was compared to 542 NPG individuals (64.8% women, median age of 80 years). RESULTS PG individuals had significantly more functional impairment, clinical comorbidities (including number of falls, loss of bladder control and dysphagia) and major depression. Multivariate analysis revealed that older age, higher UPDRSm scores, lower category fluency test (animals/minute) and delayed recall memory scores were associated with PG. This group was also more cognitively impaired, with lower performance than NPG individuals in the Mini-Mental State Examination, category fluency test (animals/minute), clock drawing and in delayed recall (p < 0.001 for all tests). UPDRSm scores were the most contributing factor to cognition that independently explained variability in functionality of the entire sample. CONCLUSION Individuals aged 75 + years with parkinsonism were significantly more clinically and functionally impaired in this population-based sample. Cognitive dysfunction explained most of the loss of functionality in these patients. UPDRS-m scores contributed independently to explain variability in functionality in the whole sample.
Collapse
Affiliation(s)
- Thiago Cardoso Vale
- Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.
- Movement Disorders Unit, Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.
| | - Francisco Eduardo Costa Cardoso
- Movement Disorders Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Danilo Jorge da Silva
- Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Elisa de Paula Franca Resende
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Palma Maia
- Movement Disorders Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Henrique Cerqueira Guimarães
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Antônio Lúcio Teixeira
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
5
|
Algotsson C, Rosso A, Elmståhl S, Siennicki-Lantz A. Prevalence and functional impact of parkinsonian signs in older adults from the Good Aging in Skåne study. Parkinsonism Relat Disord 2023; 111:105416. [PMID: 37130449 DOI: 10.1016/j.parkreldis.2023.105416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/05/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Mild parkinsonian signs (MPS) have been characterized by several definitions, using the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). We aimed to investigate the prevalence of MPS and their association with functional level and comorbidities in the oldest old. METHOD Community-dwelling older adults (n = 559, median age 85, range 80-102 years) were examined regarding MPS, possible parkinsonism (PP) and subthreshold parkinsonism (SP) according to four previously used definitions and concerning the impact of parkinsonian signs on cognitive, physical, and autonomic function. MPS, PP and SP are different terms describing a very similar phenomenon and there is no gradation between these. In two of the four definitions more advanced symptoms were categorized as parkinsonism. RESULTS Median UPDRS score in the whole study group was 10 points (range: 0-58) and was predominated by bradykinesia. MPS/PP/SP were present in 17-85%, and parkinsonism in 33-71% of the cohort. Independently of age and gender, MPS/PP/SP and especially parkinsonism, were associated with a higher risk of fear of falling and accomplished falls, with lower: cognition, ADL, physical activity and quality of life, and with urinary incontinence, obstipation and orthostatic intolerance. CONCLUSIONS In a population of older adults above 80 years, MPS are highly prevalent as well as more advanced symptoms defined as parkinsonism, and only 9-17% of the cohort is symptom-free. Predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions to improve their sensibility.
Collapse
Affiliation(s)
- Charlotte Algotsson
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden.
| | - Aldana Rosso
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden
| | - Arkadiusz Siennicki-Lantz
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden
| |
Collapse
|
6
|
Zhou R, Li J, Chen M. The Value of Cognitive and Physical Function Tests in Predicting Falls in Older Adults: A Prospective Study. Front Med (Lausanne) 2022; 9:900488. [PMID: 35865170 PMCID: PMC9294354 DOI: 10.3389/fmed.2022.900488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/08/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Previous studies suggested that physical and cognitive function can be indicators to assess the risk of falls in the elderly. Various tests are widely used in geriatric clinical studies as assessment tools of physical and cognitive function. However, large sample studies comparing the fall predictive value of these tests are still sparse. This study was conducted to investigate the value of cognitive and physical function tests in predicting the risk of subsequent falls in the elderly, with the overarching goal of providing more evidence on fall-risk assessment. Methods The current study was based on the data of respondents aged 60 and above from the China Health and Retirement Longitudinal Study (CHARLS). Data from the 2015 CHARLS national survey were used as the baseline data, and the fall data in 2018 were used as the follow-up data. Physical function tests included balance, walking speed, the five times sit-to-stand test (FTSST), and grip strength. The value of cognitive and physical function tests in predicting falls was evaluated by logistic regression analysis and receiver operating characteristic (ROC) curves. Results The incidence of falls among the 4,857 subjects included in this study was 20.86%. Results showed that cognition (OR = 0.83, 95% CI: 0.70–0.98), the FTSST (OR = 3.51, 95% CI: 1.66–7.46), and grip strength (OR = 1.02, 95% CI: 1.01–1.03) were independent predictors of falls in the full sample after adjusting for various confounders. Notably, the above tests showed better predictive value for falls for the oldest-old (≥ 80 years) subjects. Conclusion Overall, results showed that grip strength, the FTSST, and cognition tests are simple and practicable tools for identifying individuals at higher risk of falls in the community. Moreover, the fall predictive performance of physical and cognitive function tests was age-dependent, with a higher predictive value in older adults aged 80 and above.
Collapse
Affiliation(s)
- Rong Zhou
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiayu Li
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Meiling Chen
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Meiling Chen,
| |
Collapse
|
7
|
Yoon E, Bae S, Park H. Gait Speed and Sleep Duration Is Associated with Increased Risk of MCI in Older Community-Dwelling Adults. Int J Environ Res Public Health 2022; 19. [PMID: 35805289 DOI: 10.3390/ijerph19137625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 12/29/2022]
Abstract
This study aimed to examine the linear and nonlinear associations between sleep duration and gait speed and the risk of developing mild cognitive impairment (MCI) in community-dwelling older adults. Participants were 233 older adults who met the study inclusion criteria. The MCI diagnosis was based on medical evaluations through a clinical interview conducted by a dementia specialist. Self-reported sleep duration was evaluated using the Pittsburgh Sleep Quality Index. The usual gait speed was calculated from the time taken to walk along a 4 m walkway. Multivariate logistic regression analysis was used to calculate the odds ratio (OR) and the 95% confidence interval (95% CI) of developing MCI in relation to sleep duration and gait speed. Generalized additive models were used to examine the dose−response relationships between sleep duration, gait speed, and the risk of developing MCI. Slower gait speed (OR: 1.84, 95%; CI: 1.00−3.13) and poor sleep duration (OR: 1.76, 95%; CI: 1.00−3.35) were associated with the risk of developing MCI, compared with their optimal status. In addition, the combination of poor sleep and slower gait was associated with a higher risk of developing MCI than optimal sleep duration and gait speed (OR: 3.13, 95%; CI: 1.93−5.14). Furthermore, gait speed and sleep duration were non-linearly associated with the risk of developing MCI. These results highlight the complex interplay and synergism between sleep duration and gait abilities on the risk of developing MCI in older adults. In addition, our results suggest that slower gait speed (<1.0 m/s) and short (<330 min) and long (>480 min) sleep duration may be linked to MCI risks through underlying pathways.
Collapse
|
8
|
Jung NY, Park KH, Seo SW, Kim HJ, Roh JH, Lee JH, Park KW, Kwon JC, Jeong JH, Yoon SJ, Kim BC, Park YH, Kim S, Jang JW, Youn YC, Yang DW, Choi SH, Na DL, Kim EJ. Survival in Korean Patients with Frontotemporal Dementia Syndrome: Association with Behavioral Features and Parkinsonism. J Clin Med 2022; 11:2260. [PMID: 35456351 DOI: 10.3390/jcm11082260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 02/05/2023] Open
Abstract
We investigated the survival time of each clinical syndrome of frontotemporal dementia (FTD) and the impacts of behavioral and motor features on survival of FTD. A total of 216 patients with FTD [82 behavioral variant FTD (bvFTD), 78 semantic variant primary progressive aphasia (svPPA), 43 non-fluent/agrammatic variant PPA (nfvPPA), 13 FTD-motor neuron disease (MND)] were enrolled from 16 centers across Korea. Behaviors and parkinsonism were assessed using the Frontal Behavioral Inventory and Unified Parkinson’s Disease Rating Scale Part III, respectively. The Kaplan–Meier method was used for the survival analysis and the Cox proportional hazards model was applied for analysis of the effect of behavioral and motor symptoms on survival, after controlling vascular risk factors and cancer. An overall median survival of FTD was 12.1 years. The survival time from onset was shortest for FTD-MND and longest for svPPA. The median survival time of patients with bvFTD was unavailable but likely comparable to that of patients with nfvPPA. In the bvFTD group, negative behavioral symptoms and akinetic rigidity were significantly associated with survival. In the nfvPPA group, the presence of dysarthria had a negative impact on survival. These findings provide useful information to clinicians planning for care.
Collapse
|
9
|
Buchman AS, Bennett DA. Mixed Neuropathologies, Neural Motor Resilience and Target Discovery for Therapies of Late-Life Motor Impairment. Front Hum Neurosci 2022; 16:853330. [PMID: 35399360 PMCID: PMC8987574 DOI: 10.3389/fnhum.2022.853330] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 01/14/2023] Open
Abstract
By age 85, most adults manifest some degree of motor impairment. However, in most individuals a specific etiology for motor decline and treatment to modify its inexorable progression cannot be identified. Recent clinical-pathologic studies provide evidence that mixed-brain pathologies are commonly associated with late-life motor impairment. Yet, while nearly all older adults show some degree of accumulation of Alzheimer's disease and related dementias (ADRD) pathologies, the extent to which these pathologies contribute to motor decline varies widely from person to person. Slower or faster than expected motor decline in the presence of brain injury and/or pathology has been conceptualized as more or less "resilience" relative to the average person This suggests that other factors, such as lifestyles or other neurobiologic indices may offset or exacerbate the negative effects of pathologies via other molecular pathways. The mechanisms underlying neural motor resilience are just beginning to be illuminated. Unlike its cousin, cognitive resilience which is restricted to neural mechanisms above the neck, the motor system extends the total length of the CNS and beyond the CNS to reach muscle and musculoskeletal structures, all of which are crucial for motor function. Building on prior work, we propose that by isolating motor decline unrelated to neuropathologies and degeneration, investigators can identify genes and proteins that may provide neural motor resilience. Elucidating these molecular mechanisms will advance our understanding of the heterogeneity of late-life motor impairment. This approach will also provide high value therapeutic targets for drug discovery of therapies that may offset the negative motor consequences of CNS pathologies that are currently untreatable.
Collapse
Affiliation(s)
- Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States,*Correspondence: Aron S. Buchman,
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| |
Collapse
|
10
|
Ntracha A, Iakovakis D, Hadjidimitriou S, Charisis VS, Tsolaki M, Hadjileontiadis LJ. Detection of Mild Cognitive Impairment Through Natural Language and Touchscreen Typing Processing. Front Digit Health 2021; 2:567158. [PMID: 34713039 PMCID: PMC8521910 DOI: 10.3389/fdgth.2020.567158] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Mild cognitive impairment (MCI), an identified prodromal stage of Alzheimer's Disease (AD), often evades detection in the early stages of the condition, when existing diagnostic methods are employed in the clinical setting. From an alternative perspective, smartphone interaction behavioral data, unobtrusively acquired in a non-clinical setting, can assist the screening and monitoring of MCI and its symptoms' progression. In this vein, the diagnostic ability of digital biomarkers, drawn from Fine Motor Impairment (FMI)- and Spontaneous Written Speech (SWS)-related data analysis, are examined here. In particular, keystroke dynamics derived from touchscreen typing activities, using Convolutional Neural Networks, along with linguistic features of SWS through Natural Language Processing (NLP), were used to distinguish amongst MCI patients and healthy controls (HC). Analytically, three indices of FMI (rigidity, bradykinesia and alternate finger tapping) and nine NLP features, related with lexical richness, grammatical, syntactical complexity, and word deficits, formed the feature space. The proposed approach was tested on two demographically matched groups of 11 MCI patients and 12 HC, having undergone the same neuropsychological tests, producing 4,930 typing sessions and 78 short texts, within 6 months, for analysis. A cascaded-classifier scheme was realized under three different feature combinations and validated via a Leave-One-Subject-Out cross-validation scheme. The acquired results have shown: (a) keystroke features with a k-NN classifier achieved an Area Under Curve (AUC) of 0.78 [95% confidence interval (CI):0.68-0.88; specificity/sensitivity (SP/SE): 0.64/0.92], (b) NLP features with a Logistic regression classifier achieved an AUC of 0.76 (95% CI: 0.65-0.85; SP/SE: 0.80/0.71), and (c) an ensemble model with the fusion of keystroke and NLP features resulted in AUC of 0.75 (95% CI:0.63-0.86; SP/SE 0.90/0.60). The current findings indicate the potentiality of new digital biomarkers to capture early stages of cognitive decline, providing a highly specific remote screening tool in-the-wild.
Collapse
Affiliation(s)
- Anastasia Ntracha
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Iakovakis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stelios Hadjidimitriou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios S Charisis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- Third Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leontios J Hadjileontiadis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Electrical and Computer Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| |
Collapse
|
11
|
Buchanan SM, Richards M, Schott JM, Schrag A. Mild Parkinsonian Signs: A Systematic Review of Clinical, Imaging, and Pathological Associations. Mov Disord 2021; 36:2481-2493. [PMID: 34562045 DOI: 10.1002/mds.28777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022] Open
Abstract
Mild parkinsonian signs (MPS) have been widely studied during the past 3 decades and proposed as a risk marker for neurodegenerative disease. This systematic review explores the epidemiology, clinical and prognostic associations, radiological features, and pathological findings associated with MPS in older adults free from neurodegenerative disease. We find that MPS as currently defined are strongly associated with increasing age and increased risk of development of Parkinson's disease (PD), all-cause dementia, disability, and death. Positive associations with later PD are found mainly in younger populations and those with other features of prodromal PD. There are currently no consistent radiological findings for MPS, and pathological studies have shown that MPS, at least in the oldest old, are often underpinned by mixed neuropathologies, including those associated with Alzheimer's disease, cerebrovascular disease, nigral neuronal loss, and Lewy bodies. Different subcategories of MPS appear to convey varying risk and specificity for PD and other outcomes. MPS overall are not specific for parkinsonian disorders and, although associated with increased risk of PD, can reflect multiple pathologies, particularly in older individuals. "Mild motor signs" appears a more appropriate term to avoid prognostic and pathological implications, and larger future studies to prospectively examine outcomes and associations of specific MPS subcategories are required. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Sarah M Buchanan
- Dementia Research Centre, University College London Institute of Neurology, University College London, London, United Kingdom
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Marcus Richards
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, University College London Institute of Neurology, University College London, London, United Kingdom
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology University College London, London, United Kingdom
| |
Collapse
|
12
|
Nisser J, Derlien S, Bublak P, Schwab M, Witte OW, Kesper K, Schultze T, Rupprecht S. Systematic quantitative assessment of motor function in clinically isolated REM sleep behaviour disorder: A diagnostic window into early alpha-synucleinopathies. J Sleep Res 2021; 31:e13459. [PMID: 34462975 DOI: 10.1111/jsr.13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Mild motor abnormalities can herald the beginning of Parkinson´s disease but their diagnostic value is limited by multifactorial ageing-related influences on motor function. We characterized mild motor abnormalities in different motor domains by conducting a systematic motor assessment in 20 patients with clinically isolated REM sleep behaviour disorder (iRBD) without parkinsonian motor signs and 20 healthy controls. We addressed the influence of lifestyle factors and age on motor function, which needs to be distinguished from neurodegenerative motor features, and assessed the diagnostic value of innovative and established quantitative motor tests in iRBD. Patients with iRBD showed abnormalities in perceptual motor speed (falling stick test), trunk movement coordination (bend, twist and touch test) and dynamic balance (line walk test) without alterations in simple motor speed (alternate tap test), dexterity (grooved pegboard), static balance (force plate) and gait (timed up and go test). The falling stick test showed the highest diagnostic accuracy in identifying subjects with RBD (ROC-AUC 0.85, p ≤ 0.001). Multivariate analysis revealed physical activity and age as additional determinants of motor test performance. iRBD comprises a wide spectrum of mild motor abnormalities which cannot be verified by established tests for motor speed, gait and balance. The falling stick test, an innovative screening test for perceptual motor speed, provides high diagnostic potential in identifying subjects with subclinical neurodegenerative symptoms before parkinsonian motor signs become apparent. Normative data for physical activity and age need to be obtained to ensure correct interpretation of motor test results in prodromal Parkinson-related disease.
Collapse
Affiliation(s)
- Jenny Nisser
- Department of Physiotherapy, Jena University Hospital, Jena, Germany
| | - Steffen Derlien
- Department of Physiotherapy, Jena University Hospital, Jena, Germany
| | - Peter Bublak
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Neuropsychology Section, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Matthias Schwab
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Karl Kesper
- Respiratory Medicine, University of Marburg, University Hospital of Gießen and Marburg, Marburg, Germany
| | - Torsten Schultze
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sven Rupprecht
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Research Programme, "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena, Germany
| |
Collapse
|
13
|
Sasaki S. High Prevalence of Early Parkinson's Disease in Patients With Subtle Parkinsonian Signs. Front Neurol 2021; 12:656679. [PMID: 34305780 PMCID: PMC8299703 DOI: 10.3389/fneur.2021.656679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Little is known about how frequently patients with a Unified Parkinson Disease Rating Scale part III (UPDRS-III) score of 3 or 4, including postural and action tremor, could be classified into early Parkinson's disease (PD). Objective: To examine the prevalence of early PD in patients with subtle parkinsonian signs (rest tremor, postural tremor, and rigidity) without bradykinesia, having a UPDRS-III score of 3 or 4. Methods: Parkinsonism was assessed using UPDRS-III based on both the United Kingdom PD Society Brain Bank criteria and the Movement Disorder Society PD criteria. Ninety patients with a UPDRS-III score of 3 or 4, including postural tremor, were evaluated by 123I-FP-CIT SPECT (DaTscan), brain MRI, the Mini-Mental State Examination, and smell test. Some patients were additionally examined by 123I-metaiodobenzylguanidine myocardial scintigraphy or 123I-N-isopropyl-p-iodoamphetamine SPECT. Results: Seventy-five [mean age (standard deviation): 76.9 (8.1)] out of 90 patients (83.3%) showed abnormal findings on DaTscan imaging: 57 out of 75 (76.0%) showed a reduced specific binding ratio (SBR) accompanied by an egg shape pattern (n = 37, 49.3%) or a mixed type pattern (n = 14, 18.7%), both reduced SBR and increased asymmetry index (AI) with a normal shape (n = 4, 5.3%), and reduced SBR only (n = 2, 2.7%); 18 (24.0%) showed an egg shape pattern or a mixed type pattern without reduced SBR. In other words, 69 out of 75 patients (92.0%) showed either an egg shape or a mixed type pattern with or without reduced SBR. All patients were free of dementia, and their olfactory function was significantly impaired compared with controls (n = 141) on the odor-stick identification test for Japanese (p < 0.0001). Conclusions: The prevalence of patients with subtle parkinsonian signs having a UPDRS-III score of 3 or 4, including postural tremor, is unexpectedly high in daily clinical practice, and most of these patients could be categorized into mild early-stage PD.
Collapse
Affiliation(s)
- Shoichi Sasaki
- Department of Neurology, Agano City Hospital, Niigata, Japan.,Department of Neurology, Toyosaka Hospital, Niigata, Japan
| |
Collapse
|
14
|
Abstract
Mild Parkinsonian Signs (MPS) describe a spectrum that exists between the expected motor decline of normal aging and a more serious motor deterioration resulting from Parkinson’s disease (PD) and neurodegeneration. Although MPS are a feature of the prodromal stage of PD, their formal definition is unclear and still relies somewhat on conventional clinical criteria for PD. This review will summarise the early motor features of PD and methods of assessment, from conventional clinical scales to advances in quantitative measures. Finally, the boundaries of motor decline as part of normal aging and pathological neurodegeneration will be discussed.
Collapse
|
15
|
Tian Q, Ehrenkranz R, Rosso AL, Glynn NW, Chahine LM, Hengenius J, Zhu X, Rosano C. Mild parkinsonian signs, energy decline, and striatal volume in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2021; 77:800-806. [PMID: 34049395 DOI: 10.1093/gerona/glab150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mild Parkinsonian Signs (MPS), highly prevalent in older adults, predict disability. It is unknown whether energy decline, a predictor of mobility disability, is also associated with MPS. We hypothesized that those with MPS had greater decline in self-reported energy levels (SEL) than those without MPS, and that SEL decline and MPS share neural substrates. METHODS Using data from the Health, Aging and Body Composition Study, we analyzed 293 Parkinson's Disease-free participants (83±3 years old, 39% Black, 58% women) with neuroimaging data, MPS evaluation by Unified Parkinson Disease Rating Scale in 2006-2008, and ≥ 3 measures of SEL since 1999-2000. Individual SEL slopes were computed via linear mixed models. Associations of SEL slopes with MPS were tested using logistic regression models. Association of SEL slope with volume of striatum, sensorimotor, and cognitive regions were examined using linear regression models adjusted for normalized total gray matter volume. Models were adjusted for baseline SEL, mobility, demographics, and comorbidities. RESULTS Compared to those without MPS (n=165), those with MPS (n=128) had 37% greater SEL decline in the prior eight years (p=0.001). Greater SEL decline was associated with smaller right striatal volume (adjusted standardized β=0.126, p=0.029). SEL decline was not associated with volumes in other regions. The association of SEL decline with MPS remained similar after adjustment for right striatal volume (adjusted OR=2.03, 95% CI: 1.16 - 3.54). CONCLUSION SEL decline may be faster in those with MPS. Striatal atrophy may be important for declining energy but does not explain the association with MPS.
Collapse
Affiliation(s)
- Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland
| | - Rebecca Ehrenkranz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lana M Chahine
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James Hengenius
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xiaonan Zhu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
16
|
Paparella G, Fasano A, Hallett M, Berardelli A, Bologna M. Emerging concepts on bradykinesia in non-parkinsonian conditions. Eur J Neurol 2021; 28:2403-2422. [PMID: 33793037 DOI: 10.1111/ene.14851] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Bradykinesia is one of the cardinal motor symptoms of Parkinson's disease. However, clinical and experimental studies indicate that bradykinesia may also be observed in various neurological diseases not primarily characterized by parkinsonism. These conditions include hyperkinetic movement disorders, such as dystonia, chorea, and essential tremor. Bradykinesia may also be observed in patients with neurological conditions that are not seen as "movement disorders," including those characterized by the involvement of the cerebellum and corticospinal system, dementia, multiple sclerosis, and psychiatric disorders. METHODS We reviewed clinical reports and experimental studies on bradykinesia in non-parkinsonian conditions and discussed the major findings. RESULTS Bradykinesia is a common motor abnormality in non-parkinsonian conditions. From a pathophysiological standpoint, bradykinesia in neurological conditions not primarily characterized by parkinsonism may be explained by brain network dysfunction. CONCLUSION In addition to the pathophysiological implications, the present paper highlights important terminological issues and the need for a new, more accurate, and more widely used definition of bradykinesia in the context of movement disorders and other neurological conditions.
Collapse
Affiliation(s)
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
17
|
Colella D, Guerra A, Paparella G, Cioffi E, Di Vita A, Trebbastoni A, Berardelli A, Bologna M. Motor dysfunction in mild cognitive impairment as tested by kinematic analysis and transcranial magnetic stimulation. Clin Neurophysiol 2021; 132:315-322. [DOI: 10.1016/j.clinph.2020.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/16/2020] [Accepted: 10/24/2020] [Indexed: 01/07/2023]
|
18
|
Aye YM, Liew GM, Ng SY, Wen MC, Lim LL, Chua ST, Chotphoksap U, Chao Y, Ng AS, Tan EK, Tan LCS, Xu Z. Mild Parkinsonian Signs in a Community Ambulant Population. JPD 2020; 10:1231-1237. [DOI: 10.3233/jpd-191849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yin Minn Aye
- Department of Neurology, National Neuroscience Institute, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore
| | - Gerald M. Liew
- Duke-National University of Singapore Medical School, Singapore
| | - Samuel Y.E. Ng
- Department of Research, National Neuroscience Institute, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore
| | - Ming-Ching Wen
- Department of Research, National Neuroscience Institute, Singapore
| | - Linda L.H. Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Shu-Ting Chua
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Yinxia Chao
- Department of Research, National Neuroscience Institute, Singapore
| | - Adeline S.Y. Ng
- Department of Neurology, National Neuroscience Institute, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | - Eng King Tan
- Department of Neurology, National Neuroscience Institute, Singapore
- Department of Research, National Neuroscience Institute, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | - Louis Chew Seng Tan
- Department of Neurology, National Neuroscience Institute, Singapore
- Department of Research, National Neuroscience Institute, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore
| |
Collapse
|
19
|
Oveisgharan S, Dawe RJ, Leurgans SE, Yu L, Schneider JA, Bennett DA, Buchman AS. Total daily physical activity, brain pathologies, and parkinsonism in older adults. PLoS One 2020; 15:e0232404. [PMID: 32348372 PMCID: PMC7190120 DOI: 10.1371/journal.pone.0232404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/14/2020] [Indexed: 01/01/2023] Open
Abstract
Objective We examined the association of physical activity, postmortem brain pathologies, and parkinsonism proximate to death in older adults. Methods We studied the brains of 447 older decedents participating in a clinical-autopsy cohort study. We deployed a wrist worn activity monitor to record total daily physical activity during everyday living in the community-setting. Parkinsonism was assessed with 26 items of a modified motor portion of Unified Parkinson’s Disease Rating Scale (UPDRS). We used linear regression models, controlling for age and sex, to examine the association of physical activity with parkinsonism with and without indices of Alzheimer’s disease and related disorders (ADRD) pathologies. In separate models, we added interaction terms to examine if physical activity modified the associations of brain pathologies with parkinsonism. Results Mean age at death was 90.9 (SD, 6.2), mean severity of parkinsonism was 14.1 (SD, 9.2, Range 0–59.4), and 350 (77%) had evidence of more than one ADRD pathologies. Higher total daily physical activity was associated with less severe parkinsonism (Estimate, -0.315, S.E., 0.052, p<0.001). The association of more physical activity with less severe parkinsonism persisted after adding terms for ten brain pathologies (Estimate, -0.283, S.E., 0.052, p<0.001). The associations of brain pathologies with more severe parkinsonism did not vary with the level of physical activity. Conclusion The association of higher physical activity with less severe parkinsonism may be independent of the presence of ADRD brain pathologies. Further work is needed to identify mechanisms through which physical activity may maintain motor function in older adults.
Collapse
Affiliation(s)
- Shahram Oveisgharan
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- * E-mail:
| | - Robert J. Dawe
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| |
Collapse
|
20
|
Woytowicz EJ, Sainburg RL, Westlake KP, Whitall J. Competition for limited neural resources in older adults leads to greater asymmetry of bilateral movements than in young adults. J Neurophysiol 2020; 123:1295-1304. [PMID: 31913762 DOI: 10.1152/jn.00405.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously demonstrated that lateralization in the neural control of predictive and impedance mechanisms is reflected by interlimb differences in control of bilateral tasks. Aging has been shown to reduce lateralization during unilateral performance, presumably due to greater recruitment of the ipsilateral hemisphere. We now hypothesize that aging-related reduction in the efficiency of neural resources should produce greater behavioral asymmetry during bilateral actions that require hemispheric specialization for each arm. This is because simultaneous control of dominant and nondominant arm function should induce competition for hemisphere-specific resources. To test this hypothesis, we now examine the effect of aging (young, n = 20; old, n = 20) on performance of a mechanically coupled task, in which one arm reaches toward targets while the other arm stabilizes against a spring that connects the two arms. Results indicate better dominant arm reaching performance and better nondominant arm stabilizing performance for both groups. Most notably, limb and joint compliance was lower in the dominant arm, leading to dominant arm deficits in stabilizing performance. Group analysis indicated that older adults showed substantially greater asymmetry in stabilizing against the spring load than did the younger adults. We propose that competition for limited neural resources in older adults is associated with reduced contributions of right hemisphere mechanisms to right-dominant arm stabilizing performance, and thus to greater asymmetry of performance.NEW & NOTEWORTHY We provide evidence for greater asymmetry of interlimb differences in bilateral coordination for stabilizing and preserved asymmetry of reaching with aging. These results provide the first evidence for increased lateralization with aging within the context of a complementary bilateral task.
Collapse
Affiliation(s)
- Elizabeth J Woytowicz
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert L Sainburg
- Department of Kinesiology, Penn State University, University Park, Pennsylvania.,Department of Neurology, Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, Pennsylvania
| | - Kelly P Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
21
|
Simonet C, Schrag A, Lees AJ, Noyce AJ. The motor prodromes of parkinson's disease: from bedside observation to large-scale application. J Neurol 2019; 268:2099-2108. [PMID: 31802219 PMCID: PMC8179909 DOI: 10.1007/s00415-019-09642-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022]
Abstract
There is sufficient evidence that the pathological process that causes Parkinson's disease begins years before the clinical diagnosis is made. Over the last 15 years, there has been much interest in the existence of a prodrome in some patients, with a particular focus on non-motor symptoms such as reduced sense of smell, REM-sleep disorder, depression, and constipation. Given that the diagnostic criteria for Parkinson's disease depends on the presence of bradykinesia, it is somewhat surprising that there has been much less research into the possibility of subtle motor dysfunction as a pre-diagnostic pointer. This review will focus on early motor features and provide some advice on how to detect and measure them.
Collapse
Affiliation(s)
- C Simonet
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - A Schrag
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - A J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
| | - A J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. .,Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK.
| |
Collapse
|
22
|
Benito-León J, Louis ED, Mato-Abad V, Sánchez-Ferro A, Romero JP, Matarazzo M, Serrano JI. A data mining approach for classification of orthostatic and essential tremor based on MRI-derived brain volume and cortical thickness. Ann Clin Transl Neurol 2019; 6:2531-2543. [PMID: 31769622 PMCID: PMC6917333 DOI: 10.1002/acn3.50947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 01/22/2023] Open
Abstract
Objective Orthostatic tremor (OT) is an extremely rare, misdiagnosed, and underdiagnosed disorder affecting adults in midlife. There is debate as to whether it is a different condition or a variant of essential tremor (ET), or even, if both conditions coexist. Our objective was to use data mining classification methods, using magnetic resonance imaging (MRI)‐derived brain volume and cortical thickness data, to identify morphometric measures that help to discriminate OT patients from those with ET. Methods MRI‐derived brain volume and cortical thickness were obtained from 14 OT patients and 15 age‐, sex‐, and education‐matched ET patients. Feature selection and machine learning methods were subsequently applied. Results Four MRI features alone distinguished the two, OT from ET, with 100% diagnostic accuracy. More specifically, left thalamus proper volume (normalized by the total intracranial volume), right superior parietal volume, right superior parietal thickness, and right inferior parietal roughness (i.e., the standard deviation of cortical thickness) were shown to play a key role in OT and ET characterization. Finally, the left caudal anterior cingulate thickness and the left caudal middle frontal roughness allowed us to separate with 100% diagnostic accuracy subgroups of OT patients (primary and those with mild parkinsonian signs). Conclusions A data mining approach applied to MRI‐derived brain volume and cortical thickness data may differentiate between these two types of tremor with an accuracy of 100%. Our results suggest that OT and ET are distinct conditions.
Collapse
Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Chronic Disease, Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut
| | | | - Alvaro Sánchez-Ferro
- Department of Neurology, HM CINAC, University Hospital HM Puerta del Sur, Móstoles, Madrid, Spain.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Juan P Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain.,Brain Damage Unit, Hospital Beata Maria Ana, Madrid, Spain
| | - Michele Matarazzo
- Pacific Parkinson's Research Centre and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - J Ignacio Serrano
- Neural and Cognitive Engineering group, Center for Automation and Robotics, CAR CSIC-UPM, Arganda del Rey, Madrid, Spain
| |
Collapse
|
23
|
Benito-León J, Romero JP, Louis ED, Sánchez-Ferro A, Matarazzo M, Molina-Arjona JA, Mato-Abad V. Diffusion tensor imaging in orthostatic tremor: a tract-based spatial statistics study. Ann Clin Transl Neurol 2019; 6:2212-2222. [PMID: 31588694 PMCID: PMC6856595 DOI: 10.1002/acn3.50916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The pathogenesis of orthostatic tremor (OT) is unknown. We investigated OT‐related white matter changes and their correlations with scores from a neuropsychological testing battery. Methods Diffusion tensor imaging measures were compared between 14 OT patients and 14 age‐ and education‐matched healthy controls, using whole‐brain tract‐based spatial statistics analysis. Correlations between altered diffusion metrics and cognitive performance in OT group were assessed. Results In all cognitive domains (attention, executive function, visuospatial ability, verbal memory, visual memory, and language), OT patients’ cognitive performance was significantly worse than that of healthy controls. OT patients demonstrated altered diffusivity metrics not only in the posterior lobe of the cerebellum (left cerebellar lobule VI) and in its efferent cerebellar fibers (left superior cerebellar peduncle), but also in medial lemniscus bilaterally (pontine tegmentum), anterior limb of the internal capsule bilaterally, right posterior limb of the internal capsule, left anterior corona radiata, right insula, and the splenium of corpus callosum. No relationship was found between diffusion measures and disease duration in OT patients. Diffusion white matter changes, mainly those located in right anterior limb of the internal capsule, were correlated with poor performance on tests of executive function, visuospatial ability, verbal memory, and visual memory in OT patients. Interpretation White matter changes were preferentially located in the cerebellum, its efferent pathways, as well as in the pontine tegmentum and key components of the frontal–thalamic–cerebellar circuit. Further work needs to be done to understand the evolution of these white matter changes and their functional consequences.
Collapse
Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Juan P Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain.,Brain Damage Unit, Hospital Beata Maria Ana, Madrid, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Alvaro Sánchez-Ferro
- Department of Neurology, HM CINAC, University Hospital HM Puerta del Sur, Móstoles, Spain.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Michele Matarazzo
- Pacific Parkinson's Research Centre and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Virginia Mato-Abad
- Faculty of Biosanitary Sciences, ISLA, Computer Science Faculty, A Coruña University, A Coruña, Spain
| |
Collapse
|
24
|
Santos D, Mahoney JR, Allali G, Verghese J. Physical Activity in Older Adults With Mild Parkinsonian Signs: A Cohort Study. J Gerontol A Biol Sci Med Sci 2019; 73:1682-1687. [PMID: 29931236 DOI: 10.1093/gerona/glx133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background Physical activity regimens are beneficial for older adults with Parkinson's disease; however, their beneficial effect on individuals with mild parkinsonian signs (MPS) who do not meet criteria for Parkinson's disease is not established. The current observational study aims to determine the cognitive and motor impact of physical activity in older adults with MPS over a 1-year period. Methods Three hundred and forty-one individuals underwent medical and neurologic assessment of MPS at baseline. MPS was diagnosed using the motor portion of the Unified Parkinson Disease Rating Scale. Physical activity frequency (days/month) were recorded at baseline and 1-year follow-up along with Repeatable Battery for Assessment of Neuropsychological Status (RBANS) score and gait velocity during normal walking (NW) and walking while talking (WWT) conditions. Associations over the 1-year period were assessed using linear regressions controlling for key covariates. Results One hundred and thirty (38.1%) participants met criteria for MPS. These participants demonstrated significant associations between physical activity and gait velocity at baseline (NW: p < .01; WWT: p = .03) and follow-up (NW: p < .01; WWT: p = .02). Physical activity was also associated with RBANS total score (p < .01) at follow-up. Increases in physical activity frequency over 1 year were associated with increases in NW velocity (p = .02), WWT velocity (p < .01), and RBANS total score (p < .01). Conclusions Among older adults with MPS, increased frequency of physical activity is associated with decreased risk of cognitive and motor decline. Our results highlight the importance of participation in physical activities on maintaining motor and cognitive functioning in older adults with MPS.
Collapse
Affiliation(s)
- Daniel Santos
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, New York
| | - Jeannette R Mahoney
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, New York
| | - Gilles Allali
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, New York.,Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Switzerland
| | - Joe Verghese
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
25
|
Camarda C, Camarda R, Pipia C, Azzarello D, Grassedonio E, Sottile G, Cilluffo G, Torelli P. Isolated, Subtle Neurological Abnormalities in Mild Cognitive Impairment Types. Can J Neurol Sci 2020; 47:77-91. [PMID: 31486349 DOI: 10.1017/cjn.2019.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Isolated, subtle neurological abnormalities (ISNA) are commonly seen in aging and have been related to cerebral small vessel disease (SVD) and subcortical atrophy in neurologically and cognitively healthy aging subjects. OBJECTIVE To investigate the frequency of ISNA in different mild cognitive impairment (MCI) types and to evaluate for each MCI type, the cross-sectional relation between ISNA and white matter hyperintensities (WMH), lacunes, caudate atrophy, and ventricular enlargement. METHODS One thousand two hundred fifty subjects with different MCI types were included in the analysis and underwent brain magnetic resonance imaging. WMHs were assessed through two visual rating scales. Lacunes were also rated. Atrophy of the caudate nuclei and ventricular enlargement were assessed through the bicaudate ratio (BCr) and the lateral ventricles to brain ratio (LVBr), respectively. Apolipoprotein E (APOE) genotypes were also assessed. The routine neurological examination was used to evaluate ISNAs that were clustered as central-based signs, cerebellar-based signs, and primitive reflexes. The items of Part-III of the Unified Parkinson's Disease Rating Scale were used to evaluate ISNAs that were clustered as mild parkinsonian signs. Associations of ISNAs with imaging findings were determined through logistic regression analysis. RESULTS The ISNAs increase with the age and are present in all MCI types, particularly in those multiple domains, and carrying the APOE ϵ4 allele, and are associated with WMH, lacunes, BCr, and LVBr. CONCLUSION This study demonstrates that cortical and subcortical vascular and atrophic processes contribute to ISNAs. Long prospective population-based studies are needed to disentangle the role of ISNAs in the conversion from MCI to dementia.
Collapse
|
26
|
Camarda C, Torelli P, Pipia C, Battaglini I, Azzarello D, Rosano R, Ventimiglia CC, Sottile G, Cilluffo G, Camarda R. Mild Parkinsonian Signs in a Hospital-based Cohort of Mild Cognitive Impairment Types: A Cross-sectional Study. Curr Alzheimer Res 2019; 16:633-649. [DOI: 10.2174/1567205016666190726100744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/24/2019] [Accepted: 06/17/2019] [Indexed: 12/27/2022]
Abstract
Background:Mild Parkinsonian Signs (MPS) have been associated with Mild Cognitive Impairment (MCI) types with conflicting results.Objective:To investigate the association of individual MPS with different MCI types using logistic ridge regression analysis, and to evaluate for each MCI type, the association of MPS with caudate atrophy, global cerebral atrophy, and the topographical location of White Matter Hyperintensities (WMH), and lacunes.Methods:A cross-sectional study was performed among 1,168 subjects with different types of MCI aged 45-97 (70,52 ± 9,41) years, who underwent brain MRI. WMH were assessed through two visual rating scales. The number and location of lacunes were also rated. Atrophy of the caudate nuclei and global cerebral atrophy were assessed through the bicaudate ratio, and the lateral ventricles to brain ratio, respectively. Apolipoprotein E (APOE) genotypes were also assessed. Using the items of the motor section of the Unified Parkinson’s Disease Rating Scale, tremor, rigidity, bradykinesia, and gait/balance/axial dysfunction were evaluated.Results:Bradykinesia, and gait/balance/axial dysfunction were the MPS more frequently encountered followed by rigidity, and tremor. MPS were present in both amnestic and non-amnestic MCI types, and were associated with WMH, lacunes, bicaudate ratio, and lateral ventricles to brain ratio.Conclusion:MPS are present in both amnestic and non-amnestic MCI types, particularly in those multiple domain, and carrying the APOE ε4 allele. Cortical and subcortical vascular and atrophic processes contribute to MPS. Long prospective studies are needed to disentangle the contribution of MPS to the conversion from MCI to dementia.
Collapse
Affiliation(s)
- Cecilia Camarda
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Paola Torelli
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Iacopo Battaglini
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Delia Azzarello
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Rosamaria Rosano
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | | | - Gianluca Sottile
- Department of Economics, Business, and Statistics Sciences, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Rosolino Camarda
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| |
Collapse
|
27
|
PESSOA REBECAMENDESP, BOMFIM ANAJULIAL, FERREIRA BIANCALCAVALMORETTI, CHAGAS MARCOSHORTESN. Diagnostic criteria and prevalence of mild cognitive impairment in older adults living in the community: a systematic review and meta-analysis. ARCH CLIN PSYCHIAT 2019. [DOI: 10.1590/0101-60830000000197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | | | - MARCOS HORTES N. CHAGAS
- University of São Paulo, Brazil; Federal University of São Carlos, Brazil; Federal University of São Carlos, Brazil
| |
Collapse
|
28
|
Massa RE, Rosso A, Metti AL, Sparto PJ, Aizenstein H, Ferrucci L, Divecha A, Rosano C. Neuroimaging correlates of lateral postural control in older ambulatory adults. Aging Clin Exp Res 2019; 31:611-619. [PMID: 30168099 DOI: 10.1007/s40520-018-1028-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In older adults, impaired postural control contributes to falls, a major source of morbidity. Understanding central mechanisms may help identify individuals at risk for impaired postural control. AIMS To determine the relationship between gray matter volume (GMV), white matter hyperintensities (WMH), mean diffusivity (MD), and fractional anisotropy (FA) with lateral postural control. METHODS Neuroimaging and postural control were assessed in 193 community-dwelling older adults (mean age 82, 55.4% female, 44.6% black). GMV, WMH, and diffusion tensor-derived markers of microstructure (MD and FA) were quantified for total brain and regions of interest. Lateral postural control was defined as the root mean square error (RMSE) of lateral sway during a visual feedback test. Associations were assessed with linear regression, adjusted for total brain atrophy and risk factors for impaired postural control. RESULTS RMSE was higher for women than men (p < 0.001) and inversely correlated with gait speed (r = - 0.20, p = 0.01), modified mini-mental state (r = - 0.27, p < 0.001), digit symbol substitution test (r = - 0.20, p = 0.01) and quadriceps strength (r = - 0.18, p = 0.01). RMSE was inversely associated with GMV of bilateral precuneus (r = - 0.26, p = 0.01) and FA of corpus callosum and selected tracts in the right hemisphere (anterior thalamic radiation, cingulum, inferior longitudinal and fronto-occipital fasciculi), independent of covariates (r = - 0.34 to - 0.18, p ≤ 0.04). DISCUSSION Lower GMV and microstructural white matter integrity in selected networks can explain worse lateral postural control in older ambulatory adults without neurologic diseases. CONCLUSION Neuroimaging markers of poor postural control in healthy aging may help identify increased fall risk and design preventative fall strategies.
Collapse
|
29
|
Sasaki S. High prevalence of parkinsonism in patients with MCI or mild Alzheimer's disease. Alzheimers Dement 2018; 14:1615-22. [PMID: 30222946 DOI: 10.1016/j.jalz.2018.06.3054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/19/2018] [Accepted: 06/15/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The objective of this study was to examine the prevalence of the coexistence of parkinsonism in patients with mild cognitive impairment (MCI) or mild Alzheimer's disease (AD). METHODS Outpatients were evaluated with Mini-Mental State Examination, Clinical Dementia Rating Scale, NIA-AA criteria, MRI, and 123I-IMP SPECT (3D-SSP). Parkinsonism in patients diagnosed with MCI (Mini-Mental State Examination ≥24, n = 63) or mild AD (Mini-Mental State Examination 20-23, n = 43) was examined using the Unified Parkinson's Disease Rating Scale-III and 123I-FP-CIT dopamine transporter SPECT. RESULTS One hundred six patients (60-97 years) were enrolled. Fifty-six patients (52.8%) were diagnosed as having concomitant parkinsonism with rigidity and resting tremor and dopamine transporter reduction in the basal ganglia. The mean (SD) age (n = 56) was 80.6 (6.1) years, significantly older than patients without parkinsonism [77.6 (7.0) years, n = 50] (P < .05). The mean (SD) UPDRS-III score was 5.8 (2.4). CONCLUSION The prevalence rate of the coexistence of mild parkinsonism in MCI or mild AD may be higher than previously recognized.
Collapse
|
30
|
Petersen RC, Lopez O, Armstrong MJ, Getchius TSD, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2017; 90:126-135. [PMID: 29282327 DOI: 10.1212/wnl.0000000000004826] [Citation(s) in RCA: 1061] [Impact Index Per Article: 151.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/22/2017] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI). METHODS The guideline panel systematically reviewed MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus. RESULTS MCI prevalence was 6.7% for ages 60-64, 8.4% for 65-69, 10.1% for 70-74, 14.8% for 75-79, and 25.2% for 80-84. Cumulative dementia incidence was 14.9% in individuals with MCI older than age 65 years followed for 2 years. No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures. MAJOR RECOMMENDATIONS Clinicians should assess for MCI with validated tools in appropriate scenarios (Level B). Clinicians should evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (Level B). Clinicians should monitor cognitive status of patients with MCI over time (Level B). Cognitively impairing medications should be discontinued where possible and behavioral symptoms treated (Level B). Clinicians may choose not to offer cholinesterase inhibitors (Level B); if offering, they must first discuss lack of evidence (Level A). Clinicians should recommend regular exercise (Level B). Clinicians may recommend cognitive training (Level C). Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).
Collapse
Affiliation(s)
- Ronald C Petersen
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Oscar Lopez
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Melissa J Armstrong
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Thomas S D Getchius
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Mary Ganguli
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - David Gloss
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Gary S Gronseth
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Daniel Marson
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Tamara Pringsheim
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Gregory S Day
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Mark Sager
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - James Stevens
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| | - Alexander Rae-Grant
- From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH
| |
Collapse
|
31
|
Myung W, Park JH, Woo SY, Kim S, Kim SH, Chung JW, Kang HS, Lim SW, Choi J, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim SY, Carroll BJ, Kim DK. Extrapyramidal Signs and Risk of Progression from Mild Cognitive Impairment to Dementia: A Clinical Research Center for Dementia of South Korea Study. Psychiatry Investig 2017; 14:754-761. [PMID: 29209378 PMCID: PMC5714716 DOI: 10.4306/pi.2017.14.6.754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer's disease (AD) and to other types of dementia. METHODS Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. RESULTS A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53-0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30-17.39, p<0.001). CONCLUSION EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.
Collapse
Affiliation(s)
- Woojae Myung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jin Hong Park
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sook-Young Woo
- Biostatistical Team, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Seonwoo Kim
- Biostatistical Team, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Sang Ha Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Won Chung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo Shin Kang
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Shinn-Won Lim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Junbae Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Sang Yun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bernard J. Carroll
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
32
|
Prasuhn J, Piskol L, Vollstedt EJ, Graf J, Schmidt A, Tadic V, Tunc S, Hampf J, Warrlich E, Bibergeil C, Hagenah J, Klein C, Kasten M, Brüggemann N. Non-motor symptoms and quality of life in subjects with mild parkinsonian signs. Acta Neurol Scand 2017; 136:495-500. [PMID: 28345787 DOI: 10.1111/ane.12760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mild parkinsonian signs (MPS) are frequent in the elderly population and associated with the presence of risk markers for Parkinson's disease (PD). Both MPS and non-motor signs may be present in prodromal PD and may significantly impair quality of life (QoL). OBJECTIVE To disentangle the contribution of motor impairment and extra-motor manifestations to QoL in subjects with MPS (n=63), manifest PD (n=69), disorders with motor symptoms due to non-neurodegenerative diseases (n=213) and healthy controls (n=258). METHODS Subjects with MPS, healthy controls, disease controls (patients with motor impairment due to, eg, arthrosis and spondylosis), and PD patients (total n=603) were selected from a large epidemiological longitudinal study, the EPIPARK cohort. Motor function was determined using the UPDRSIII protocol, and information on depressive symptoms, anxiety, sleep, and QoL was assessed via rating scales and data were analyzed. RESULTS Depressive symptoms, anxiety, and sleep problems were equally frequent in the MPS group and controls. Health-related QoL was slightly reduced in the MPS group. Motor impairment and its extent was comparable between the MPS group and disease controls (UPDRSIII 5-6 points). Higher motor dysfunction was associated with lower QoL. Depressive symptoms, but not anxiety and daytime sleepiness, was significant predictors of general QoL, independent of motor function. CONCLUSIONS Quality of life is slightly decreased in an elderly population with MPS. QoL is associated with severity of motor impairment but also with non-motor aspects, ie, depressive symptoms. Follow-up studies in large cohorts are warranted to determine the natural course of MPS and its impact on QoL.
Collapse
Affiliation(s)
- J. Prasuhn
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - L. Piskol
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - E.-J. Vollstedt
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Department of Psychiatry and Psychotherapy; University of Lübeck; Lübeck Germany
| | - J. Graf
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Department of Neurology; University of Lübeck; Lübeck Germany
| | - A. Schmidt
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Kurt Singer Institute for Music Physiology and Musicians’ Health; Hanns Eisler School of Music Berlin; Berlin Germany
- Berlin Center for Musicians’ Medicine; Charité - University Medicine Berlin; Berlin Germany
| | - V. Tadic
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Department of Neurology; University of Lübeck; Lübeck Germany
| | - S. Tunc
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Department of Neurology; University of Lübeck; Lübeck Germany
| | - J. Hampf
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - E. Warrlich
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - C. Bibergeil
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - J. Hagenah
- Department of Neurology; Westküstenklinikum Heide; Heide Germany
| | - C. Klein
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
| | - M. Kasten
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Department of Psychiatry and Psychotherapy; University of Lübeck; Lübeck Germany
| | - N. Brüggemann
- Institute of Neurogenetics; University of Lübeck; Lübeck Germany
- Department of Neurology; University of Lübeck; Lübeck Germany
| |
Collapse
|
33
|
Noyce AJ, Schrag A, Masters JM, Bestwick JP, Giovannoni G, Lees AJ. Subtle motor disturbances in PREDICT-PD participants. J Neurol Neurosurg Psychiatry 2017; 88:212-217. [PMID: 27986830 PMCID: PMC5529958 DOI: 10.1136/jnnp-2016-314524] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/02/2016] [Accepted: 11/20/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The PREDICT-PD study aims to identify increased risk of Parkinson''s disease (PD) using online assessments of previously identified risk and early features of PD and an evidence-based scoring algorithm. We sought to determine whether higher risk participants (defined as those above the 15th centile of risk estimates) were more likely to have mild parkinsonian signs compared with lower risk participants. METHODS Video recordings of neurological examinations, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, of 208 individuals who had previously completed an online risk assessment were scored blindly and independently by two movement-disorders experts. Higher risk and lower risk subjects were compared for MDS-UPDRS part III score (and derivations of this) to identify subclinical parkinsonism, and association of risk estimates with MDS-UPDRS III scores assessed. RESULTS Higher risk subjects had significantly higher median UPDRS part III scores (3, IQR 1-5.5) than lower risk subjects (1, IQR 0-3.0; p<0.001), and there was a significantly greater proportion of individuals classified as having subclinical parkinsonism. 18% of the higher risk subjects and 6% of the lower risk subjects exceeded the most stringent published cut-off for subtle parkinsonism of three definitions examined (p=0.027). Linear regression analysis demonstrated a continuous relationship of log-transformed risk estimates with UPDRS part III scores (increase in MDS-UPDRS per doubling of odds 0.52, 95% CI 0.31 to 0.72; p<0.001), which remained after adjustment for multiple vascular risk factors and scores on the Montreal Cognitive Assessment (0.58, 95% CI 0.30 to 0.87; p<0.001). CONCLUSIONS The PREDICT-PD algorithm identifies a population with an increased rate of motor disturbances.
Collapse
Affiliation(s)
- Alastair J Noyce
- Department of Molecular Neuroscience, Reta Lila Weston Institute, UCL Institute of Neurology, London, UK.,Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anette Schrag
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Joseph M Masters
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Department of Molecular Neuroscience, Reta Lila Weston Institute, UCL Institute of Neurology, London, UK
| |
Collapse
|
34
|
Park HK, Park KH, Yoon B, Lee JH, Choi SH, Joung JH, Yoon SJ, Kim BC, Kim SH, Kim EJ, Na DL, Park KW. Clinical characteristics of parkinsonism in frontotemporal dementia according to subtypes. J Neurol Sci 2017; 372:51-6. [PMID: 28017247 DOI: 10.1016/j.jns.2016.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND We investigated the prevalence of parkinsonism in frontotemporal dementia (FTD) subtypes and the cognitive and behavioral differences between FTD with and without parkinsonism in a well-structured, prospective cohort. METHODS One hundred and ninety-one FTD patients were enrolled and all patients underwent comprehensive neurological evaluations, neuropsychological tests, and the Unified Parkinson's Disease Rating Scale. RESULTS The prevalence of parkinsonism was 38.7% (74 patients), and included 33 (46.5%) behavioral variant FTD (bvFTD), 16 (24.2%) semantic dementia (SD), 19 (45.2%) progressive nonfluent aphasia (PNFA), and 6 (50%) FTD associated with motor neuron disease (FTD-MND). SD patients with parkinsonism had higher CDR sum of boxes scores (9.7±4.5 vs 6.2±4.5, p=0.024), frontal behavioral inventory total score (33.7±20.5 vs 24.3±14.5, p=0.045), and executive function score of frontal executive dysfunction, disinhibition, and apathy (28.9±13.7 vs 19.2±12.9, p=0.021) than those without parkinsonism. Seoul Instrumental Activities of Daily Living score (bvFTD: 23.5±11.7 vs 17.3±11.3, p=0.031, SD: 23.1±11.1 vs 11.3±9.3, p=0.005) was higher for bvFTD and SD with parkinsonism than for those without parkinsonism. CONCLUSIONS Parkinsonism is found to be more common in patients with bvFTD, PNFA, and FTD-MND patients than those with SD. Behavioral disturbances were more prominent in SD with parkinsonism than without. Additional studies are needed to determine the pathomechanism and optimal treatment of parkinsonism in different FTD subtypes.
Collapse
|
35
|
Lerche S, Brockmann K, Pilotto A, Wurster I, Sünkel U, Hobert MA, von Thaler AK, Schulte C, Stoops E, Vanderstichele H, Herbst V, Brix B, Eschweiler GW, Metzger FG, Maetzler W, Berg D. Prospective longitudinal course of cognition in older subjects with mild parkinsonian signs. Alzheimers Res Ther 2016; 8:42. [PMID: 27724983 PMCID: PMC5057460 DOI: 10.1186/s13195-016-0209-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022]
Abstract
Background Mild parkinsonian signs (MPS) are common in older people and are associated with an increased risk of different neurodegenerative diseases. This study prospectively evaluates the longitudinal course of cognitive performance in older individuals with MPS. Methods From the TREND study, 480 individuals neurologically healthy at baseline, aged between 50 and 80 years, with complete follow-up data for three assessments within a mean of 43.8 months, were included in this analysis. Participants underwent a detailed cognitive test battery, evaluation of prodromal markers for neurodegenerative diseases and history of vascular diseases at each study visit. In addition, plasma levels of amyloid-beta (Aβ)1–40 and Aβ1–42 were evaluated longitudinally. Results In 52 (11 %) of the 480 participants, MPS could be detected at baseline. These individuals had cognitive deficits significantly more often compared with controls at each time point and their cognitive performance showed a steeper decline during follow-up. In addition, their levels of plasma Aβ1–42 were significantly lower than those of controls, and declined more rapidly over time. Conclusions This longitudinal study shows that MPS are associated with cognitive decline and decrease in plasma Aβ1–42, possibly indicating an ongoing neurodegenerative process. Electronic supplementary material The online version of this article (doi:10.1186/s13195-016-0209-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stefanie Lerche
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany. .,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany.
| | - Kathrin Brockmann
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | - Andrea Pilotto
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Isabel Wurster
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | - Ulrike Sünkel
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | - Markus A Hobert
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | - Anna-Katharina von Thaler
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | - Claudia Schulte
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | | | | | - Victor Herbst
- EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Britta Brix
- EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Gerhard W Eschweiler
- Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Florian G Metzger
- Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| | - Daniela Berg
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, Tuebingen, 72076, Germany.,German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Straße 27, Tuebingen, 72076, Germany
| |
Collapse
|
36
|
Buchman AS, Leurgans SE, Yu L, Wilson RS, Lim AS, James BD, Shulman JM, Bennett DA. Incident parkinsonism in older adults without Parkinson disease. Neurology 2016; 87:1036-44. [PMID: 27488597 DOI: 10.1212/wnl.0000000000003059] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/26/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the incidence of parkinsonism in community-dwelling older adults without Parkinson disease. METHODS Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale in 2,001 older adults without parkinsonism. We used Cox proportional hazards models to determine the associations of age and sex with incident parkinsonism (2 or more signs). We calculated the number of events per 1,000 person-years of observation in 3 age strata. Next, we investigated several potential risk factors for incident parkinsonism. Then, we examined longitudinal progression of parkinsonism using discrete-time multistate Markov models. RESULTS Average age at baseline was 76.8 years (SD 7.62 years). During an average of 5 years of follow-up, 964/2,001 (48.2%) developed parkinsonism. Age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.08-1.10) but not male sex (HR 1.06, 95% CI 0.91-1.23) was associated with incident parkinsonism. The incidence of parkinsonism per 1,000 person-years of follow-up was 36.0 for adults <75 years of age, 94.8 for those 75-84, and 160.5 for those 85 years or older. Depressive symptoms, neuroticism, urinary incontinence, sleep complaints, and chronic health conditions were associated with incident parkinsonism. Secondary analyses suggest that risk factors are linked with incident parkinsonism via early motor signs of parkinsonism and cognitive function. Transition modeling suggests that while parkinsonism may fluctuate, it is progressive in most older adults and its risk factors increase the odds of its progression. CONCLUSIONS Parkinsonism is common in older adults and increases with age. Identifying modifiable risk factors may decrease the magnitude of this growing public health problem.
Collapse
Affiliation(s)
- Aron S Buchman
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
| | - Sue E Leurgans
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Lei Yu
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Robert S Wilson
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Andrew S Lim
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Bryan D James
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Joshua M Shulman
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - David A Bennett
- From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| |
Collapse
|
37
|
Valenca GT, Srivastava GP, Oliveira-Filho J, White CC, Yu L, Schneider JA, Buchman AS, Shulman JM, Bennett DA, De Jager PL. The Role of MAPT Haplotype H2 and Isoform 1N/4R in Parkinsonism of Older Adults. PLoS One 2016; 11:e0157452. [PMID: 27458716 PMCID: PMC4961370 DOI: 10.1371/journal.pone.0157452] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/31/2016] [Indexed: 01/06/2023] Open
Abstract
Background and Objective Recently, we have shown that the Parkinson’s disease (PD) susceptibility locus MAPT (microtubule associated protein tau) is associated with parkinsonism in older adults without a clinical diagnosis of PD. In this study, we investigated the relationship between parkinsonian signs and MAPT transcripts by assessing the effect of MAPT haplotypes on alternative splicing and expression levels of the most common isoforms in two prospective clinicopathologic studies of aging. Materials and Methods using regression analysis, controlling for age, sex, study and neuropathology, we evaluated 976 subjects with clinical, genotyping and brain pathology data for haplotype analysis. For transcript analysis, we obtained MAPT gene and isoform-level expression from the dorsolateral prefrontal cortex for 505 of these subjects. Results The MAPT H2 haplotype was associated with lower total MAPT expression (p = 1.2x10-14) and global parkinsonism at both study entry (p = 0.001) and proximate to death (p = 0.050). Specifically, haplotype H2 was primarily associated with bradykinesia in both assessments (p<0.001 and p = 0.008). MAPT total expression was associated with age and decreases linearly with advancing age (p<0.001). Analysing MAPT alternative splicing, the expression of 1N/4R isoform was inversely associated with global parkinsonism (p = 0.008) and bradykinesia (p = 0.008). Diminished 1N/4R isoform expression was also associated with H2 (p = 0.001). Conclusions Overall, our results suggest that age and H2 are associated with higher parkinsonism score and decreased total MAPT RNA expression. Additionally, we found that H2 and parkinsonism are associated with altered expression levels of specific isoforms. These findings may contribute to the understanding of the association between MAPT locus and parkinsonism in elderly subjects and in some extent to age-related neurodegenerative diseases.
Collapse
Affiliation(s)
- Guilherme T. Valenca
- Movement Disorders Clinic, Roberto Santos General Hospital, Salvador, BA, Brazil
- Health Sciences Center, Federal University of Reconcavo of Bahia, Santo Antonio de Jesus, BA, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology & Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Gyan P. Srivastava
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology & Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Jamary Oliveira-Filho
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Charles C. White
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology & Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Joshua M. Shulman
- Departments of Neurology, Molecular and Human Genetics, and Neuroscience, and Program in Developmental Biology, Baylor College of Medicine, Houston, Texas, United States of America
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Philip L. De Jager
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology & Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
38
|
Buchman AS, Wilson RS, Shulman JM, Leurgans SE, Schneider JA, Bennett DA. Parkinsonism in Older Adults and Its Association With Adverse Health Outcomes and Neuropathology. J Gerontol A Biol Sci Med Sci 2016; 71:549-56. [PMID: 26362440 PMCID: PMC5014188 DOI: 10.1093/gerona/glv153] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 08/12/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Mild parkinsonian signs have been documented in community-dwelling older adults without Parkinson's disease. We estimated the proportion of older adults with parkinsonism and examined its association with adverse health outcomes and indices of brain pathology. METHODS Four parkinsonian signs were assessed with the motor portion of the Unified Parkinson's Disease Rating Scale in 2,962 older adults who agreed to annual evaluation and brain autopsy. We used Cox proportional hazards models to examine the association of parkinsonism (two or more signs) and possible parkinsonism (one sign) with adverse health outcomes and regression models in 1,160 decedents to examine the association of parkinsonism and neuropathology. RESULTS At study entry about 25% (N = 776, 26.2%) had parkinsonism and 30% had possible parkinsonism (N = 885, 29.9%). Parkinsonism was strongly related to age. The frequency was 11.8% for people younger than 75 years, 29.1% for those aged 75-84 years, and 43.7% for those aged 85 years or older. Parkinsonism was associated with an increased hazard of death, of mild cognitive impairment, of Alzheimer's disease and disability. Individuals with possible parkinsonism also had an increased risk for adverse health outcomes compared to individuals without parkinsonism. Postmortem indices of macroscopic and microscopic infarcts, arteriolosclerosis, and atherosclerosis were associated with parkinsonism proximate to death. CONCLUSIONS Parkinsonism is common in older adults and is associated with an increased risk of adverse health outcomes and postmortem indices of brain pathology. Its association with age suggests that it will increase in our aging population.
Collapse
Affiliation(s)
- Aron S. Buchman
- Rush Alzheimer’s Disease Center,,Department of Neurological Sciences, and
| | - R. S. Wilson
- Rush Alzheimer’s Disease Center,,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Joshua M. Shulman
- Department of Neurology,,Department of Molecular and Human Genetics, and,Department of Neuroscience, Baylor College of Medicine, Houston, Texas;,Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center,,Department of Neurological Sciences, and
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center,,Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - David A. Bennett
- Rush Alzheimer’s Disease Center,,Department of Neurological Sciences, and
| |
Collapse
|
39
|
Caixeta L, Vieira RT, Paes F, Carta MG, Nardi AE, Arias-Carrión O, Rocha NBF, Budde H, Machado S. Comparative study of subcortical atrophy in patients with frontotemporal dementia and dementia with extrapyramidal signs. Clin Pract Epidemiol Ment Health 2015; 11:125-9. [PMID: 25870648 PMCID: PMC4391205 DOI: 10.2174/1745017901511010125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 09/22/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022]
Abstract
Objectives :
To investigate the severity of subcortical atrophy in frontotemporal dementia (FTD) without extrapyramidal symptoms (EPS) and dementia with EPS. In addition, we aim to verify if there is correlation between demographic and clinical characteristics and subcortical atrophy in the groups. Methodology : The sample was composed of 21 patients with dementia and EPS as well as 19 patients with FTD without EPS. A linear assessment was conducted in order to identify the degree of subcortical atrophy (i.e., bifrontal index - BFI) using MRI. Moreover, the Mini-Mental State Examination (MMSE), Pfeffer Functional Activities Questionnaire (FAQ) and the Clinical Dementia Rating (CDR) were used to investigate clinical aspects. Results : It was verified that patients with dementia and EPS was older than the patients with FTD (p=0.01). The severity of cognitive deficits was associated with BFI, as well as the dementia severity in the EPS group. Conclusion : FTD group presented mean BFI scores above the cutoff for normal elderly population, indicating the presence of subcortical atrophy in this group. Mean BFI was higher (although not statistically significant) in FTD group than in dementia with EPS, which can suggest at least that subcortical pathology in FTD may be as important as in the dementia with EPS group. Subcortical atrophy is a good biological marker for cognitive deterioration in FTD and in dementia with EPS.
Collapse
Affiliation(s)
- Leonardo Caixeta
- Neuropsychiatry, School of Medicine, Federal University of Goiás (UFG). Dementia Outpatient Unit, Hospital das Clínicas-UFG, Brazil
| | - Renata Teles Vieira
- Behavioral and Cognitive Neurology Unit, Hospital das Clínicas, Federal University of Goiás, Goiânia (GO), Brazil
| | - Flávia Paes
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
| | - Mauro Giovanni Carta
- Department of Public Health, Clinic and Molecular Medicine - University of Cagliari, Italy
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea Gonzalez, Secretaria de Salud, México, DF, México
| | - Nuno B F Rocha
- Polytechnic Institute of Porto, School of Allied Health Sciences, Portugal
| | - Henning Budde
- Medical School Hamburg, Faculty of Human Sciences, Department of Pedagogy, Germany; Reykjavik University, School of Science and Engineering, Department of Sport Science, Iceland
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; National Institute for Translational Medicine (INCT-TM), Brazil ; Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, RJ, Brazil
| |
Collapse
|
40
|
Abstract
Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementing disorder after Alzheimer's disease (AD), but there is limited information regarding the prodromal DLB state compared with that of AD. Parkinson's disease (PD) and DLB share common prodromal symptoms with Lewy body disease (LBD), allowing us to use a common strategy for identifying the individuals with an underlying pathophysiology of LBD. Dysautonomia, olfactory dysfunction, rapid eye movement sleep behavior disorder (RBD) and psychiatric symptoms antedate the onset of dementia by years or even decades in patients with DLB. Although RBD is the most potentially accurate prodromal predictor of DLB, disease progression before the onset of dementia could differ between the prodromal DLB state with and without RBD. Experts who specialize in idiopathic RBD and DLB might need communication in order to clarify the clinical relevance of RBD with the disease progression of DLB. The presence of prodromal LBD symptoms or findings of occipital hypoperfusion/hypometabolism helps us to predict the possible pathophysiological process of LBD in non-demented patients. This approach might provide the opportunity for additional neuroimaging, including cardiac (123) I-metaiodobenzylguanidine scintigraphy and dopamine transporter imaging. Although limited radiological findings in patients with prodromal DLB states have been reported, there is now a need for larger clinical multisite studies with pathological verification. The long prodromal phase of DLB provides a critical opportunity for potential intervention with disease-modifying therapy, but only if we are able to clearly identify the diversity in the clinical courses of DLB. In the present article, we reviewed the limited literature regarding the clinical profiles of prodromal DLB.
Collapse
Affiliation(s)
- Hiroshige Fujishiro
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kiyoshi Sato
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Japan
| | - Eizo Iseki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Japan
| |
Collapse
|
41
|
Liepelt-Scarfone I, Lerche S, Behnke S, Godau J, Gaenslen A, Pausch C, Fassbender K, Brockmann K, Srulijes K, Huber H, Wurster I, Berg D. Clinical characteristics related to worsening of motor function assessed by the Unified Parkinson's Disease Rating Scale in the elderly population. J Neurol 2014; 262:451-8. [PMID: 25451854 DOI: 10.1007/s00415-014-7584-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
There is evidence that nigrostriatal pathology may at least partly underlie mild Parkinsonian signs. We evaluated whether an increase in the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) could be predicted by the presence of risk and prodromal markers for neurodegenerative diseases in elderly individuals without those diseases. Therefore, we analyzed the UPDRS-III score and various risk and prodromal markers known to antecede neurodegenerative diseases in a population-based cohort comprising 807 individuals free of neurodegenerative diseases at baseline. After 5 years, eight persons (1.0 %) were diagnosed with Parkinson's Disease (PD). Of those, seven (87.5 %) had motor worsening ≥3 points on the UPDRS-III from baseline to follow-up, one had two points increase. Of the 788 people without PD, 568 (72.1 %) showed no increase in the UPDRS-III scale, 220 (27.9 %) had ≥1 point increase and out of these 104 (13.2 %) had an increase of ≥3 points in the UPDRS-III score after 5 years. We identified an age >60 years (relative risk, RR = 1.7; confidence interval, CI 1.3-2.1) and the occurrence of ≥2 risk factors (RR = 1.5; CI 1.2-1.9) as possible predictors of motor progression. After 5 years, individuals with an increase in the UPDRS-III score had more often a one-sided reduced arm swing (p < 0.001) and identified less odors in the Sniffin' sticks test (p < 0.041) than persons with stable motor performance. Our data support the assumption that progression of Parkinsonian signs assessed by the UPDRS-III parallels the development of prodromal markers for neurodegenerative diseases in the elderly population.
Collapse
Affiliation(s)
- Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Fellows L, Bergman H, Wolfson C, Chertkow H. Can Clinical Data Predict Progression to Dementia in Amnestic Mild Cognitive Impairment? Can J Neurol Sci 2008; 35:314-22. [DOI: 10.1017/s0317167100008891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background:To determine whether clinical data obtained by history and physical examination can predict eventual progression to dementia in a cohort of elderly people with mild cognitive impairment.Methods:A prospective, longitudinal study of a cohort of elderly subjects with amnestic Mild Cognitive Impairment (MCI). Ninety subjects meeting the criteria for amnestic MCI were recruited and followed annually for an average of 3.3 years. Main outcome measure was the development of dementia determined by clinical assessment with confirmatory neuropsychological evaluation.Results:Fifty patients (56%) developed dementia on follow-up. They were older, had lower Mini-mental status exam (MMSE) scores and a shorter duration of symptoms at the time of first assessment. Multivariate logistic regression analysis identified age at symptom onset as the only clinical parameter which distinguished the group that deteriorated to dementia from the group that did not. The odds ratio for age was 1.1 (confidence interval 1.04 - 1.18).Conclusions:Patients presenting with amnestic MCI insufficient for the diagnosis of dementia are at high risk of developing dementia on follow-up. In our cohort, 56% were diagnosed with dementia over an average period of 5.9 years from symptom onset. The only clinical predictor for the eventual development of dementia was older age at symptom onset. Clinical features alone were insufficient to predict development of dementia.
Collapse
|
43
|
Lerche S, Brockmann K, Wurster I, Gaenslen A, Roeben B, Holz D, Eschweiler GW, Maetzler W, Berg D. Reasons for mild parkinsonian signs - which constellation may indicate neurodegeneration? Parkinsonism Relat Disord 2014; 21:126-30. [PMID: 25511329 DOI: 10.1016/j.parkreldis.2014.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Mild parkinsonian signs (MPS) are common in the elderly population. Several factors including physical decline and comorbidities in addition to neurodegeneration may be possible sources for MPS. The objective was to examine whether MPS are associated with a history of orthopedic disturbances, vascular diseases or prodromal markers for neurodegeneration. METHODS The TREND study is a prospective longitudinal cohort study in individuals >50 years with biennial assessments designed to identify prodromal markers for neurodegeneration. In this substudy, 1091 elderly individuals were evaluated for a possible association of MPS with prodromal markers for neurodegeneration, orthopedic disturbances, vascular diseases, as well as cerebral abnormalities. These factors were assessed by self-administered questionnaires, with a structured health interview, a neurological examination and by transcranial sonography. RESULTS 82 participants showed MPS. They were found to have more often hyposmia and RBD, had a higher autonomic dysfunction score and they more frequently showed hyperechogenicity of the substantia nigra compared to controls. Neither orthopedic disturbances nor vascular diseases were significantly associated with the prevalence of MPS. CONCLUSION MPS might be a sign of early neurodegeneration rather than caused by other motor influencing diseases.
Collapse
Affiliation(s)
- Stefanie Lerche
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany.
| | - Kathrin Brockmann
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| | - Isabel Wurster
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| | - Alexandra Gaenslen
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| | - Benjamin Roeben
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| | - Daniel Holz
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| | - Gerhard W Eschweiler
- Geriatric Center and Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Germany
| | - Walter Maetzler
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| | - Daniela Berg
- Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076 Tuebingen, Germany; German Center for Neurodegenerative Diseases, University of Tuebingen, Otfried-Müller-Str. 27, 72076 Tuebingen, Germany
| |
Collapse
|
44
|
Shulman JM, Yu L, Buchman AS, Evans DA, Schneider JA, Bennett DA, De Jager PL. Association of Parkinson disease risk loci with mild parkinsonian signs in older persons. JAMA Neurol 2014; 71:429-35. [PMID: 24514572 PMCID: PMC4039209 DOI: 10.1001/jamaneurol.2013.6222] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Parkinsonian motor signs are common in the aging population and are associated with adverse health outcomes. Compared with Parkinson disease (PD), potential genetic risk factors for mild parkinsonian signs have been largely unexplored. OBJECTIVE To determine whether PD susceptibility loci are associated with parkinsonism or substantia nigra pathology in a large community-based cohort of older persons. DESIGN, SETTING, AND PARTICIPANTS Eighteen candidate single-nucleotide polymorphisms from PD genome-wide association studies were evaluated in a joint clinicopathologic cohort. Participants included 1698 individuals and a nested autopsy collection of 821 brains from the Religious Orders Study and the Rush Memory and Aging Project, 2 prospective community-based studies. MAIN OUTCOMES AND MEASURES The primary outcomes were a quantitative measure of global parkinsonism or component measures of bradykinesia, rigidity, tremor, and gait impairment that were based on the motor Unified Parkinson's Disease Rating Scale. In secondary analyses, we examined associations with additional quantitative motor traits and postmortem indices, including substantia nigra Lewy bodies and neuronal loss. RESULTS Parkinson disease risk alleles in the MAPT (rs2942168; P = .0006) and CCDC62 (rs12817488; P = .004) loci were associated with global parkinsonism, and these associations remained after exclusion of patients with a PD diagnosis. Based on motor Unified Parkinson's Disease Rating Scale subscores, MAPT (P = .0002) and CCDC62 (P = .003) were predominantly associated with bradykinesia, and we further discovered associations between SREBF1 (rs11868035; P = .005) and gait impairment, SNCA (rs356220; P = .04) and rigidity, and GAK (rs1564282; P = .03) and tremor. In the autopsy cohort, only NMD3 (rs34016896; P = .03) was related to nigral neuronal loss, and no associations were detected with Lewy bodies. CONCLUSIONS AND RELEVANCE In addition to the established link to PD susceptibility, our results support a broader role for several loci in the development of parkinsonian motor signs and nigral pathology in older persons.
Collapse
Affiliation(s)
- Joshua M Shulman
- Department of Neurology, Baylor College of Medicine, Houston, Texas2Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Philip L De Jager
- Program in Translational Neuropsychiatric Genomics, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts7Harvard Medical School, Boston, Massachusetts8Program in Medical and Population Genetics, Broad Institute, Cam
| |
Collapse
|
45
|
Lerche S, Hobert M, Brockmann K, Wurster I, Gaenslen A, Hasmann S, Eschweiler GW, Maetzler W, Berg D. Mild parkinsonian signs in the elderly--is there an association with PD? Crossectional findings in 992 individuals. PLoS One 2014; 9:e92878. [PMID: 24675747 DOI: 10.1371/journal.pone.0092878] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/27/2014] [Indexed: 11/30/2022] Open
Abstract
Background Mild parkinsonian signs (MPS) are common in the elderly population, and have been associated with vascular diseases, mild cognitive impairment and dementia; however their relation to Parkinson's disease (PD) is unclear. Hypothesizing that individuals with MPS may reflect a pre-stage of PD, i.e. a stage in which the nigrostriatal system is already affected although to a milder degree than at the time of PD diagnosis, aim of this study was to evaluate the similarities between MPS and PD. Methods The TREND study is a prospective cross-sectional cohort study in individuals >50 years with biennial assessments designed to identify markers for an earlier diagnosis of Parkinson's and Alzheimer's disease. For this substudy 992 individuals were included for analyses (892 controls, 73 MPS individuals, 27 PD patients). Parameters defining risk of PD (sex, age, positive family history), prodromal markers (hyposmia, REM sleep behavior disorder, depression and autonomic failure) as well as quantitative fine motor, axial motor and cognitive parameters were compared between the three cohorts. Results As expected, PD patients differed from controls with regard to 12 of 15 of the assessed parameters. MPS individuals differed significantly from controls in 12 of the PD-associated parameters, but differed from PD only in 5 parameters. Conclusion This study shows that individuals with MPS share many prodromal and clinical markers of PD with PD patients, implying that either a common dynamic process or similar constitutional factors occur in MPS individuals and PD patients.
Collapse
|
46
|
Lee JE, Cho KH, Song SK, Kim HJ, Lee HS, Sohn YH, Lee PH. Exploratory analysis of neuropsychological and neuroanatomical correlates of progressive mild cognitive impairment in Parkinson's disease. J Neurol Neurosurg Psychiatry 2014; 85:7-16. [PMID: 23828835 DOI: 10.1136/jnnp-2013-305062] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parkinson's disease with mild cognitive impairment (PD-MCI) is a heterogeneous entity in terms of cognitive profiles and conversion to dementia. However, the risk factors for ongoing cognitive decline in patients with PD-MCI are not clearly defined. METHODS 51 patients with PD-MCI were prospectively followed-up for a minimum of 2 years. Subjects were classified as MCI converters (n=15) or MCI non-converters (n=36) based on whether they were subsequently diagnosed with PD dementia. We explored cognitive profiles and neuroanatomical characteristics of PD-MCI converters using voxel based morphometry (VBM) of grey matter (GM) density and region of interest based volumetric analysis of the substantia innominata (SI). RESULTS PD-MCI converters showed more severe cognitive deficits in frontal executive functions, immediate verbal memory and visual recognition memory compared with PD-MCI non-converters. VBM analysis revealed that PD-MCI converters had significantly lower GM density in the left prefrontal areas, left insular cortex and bilateral caudate nucleus compared with that in PD-MCI non-converters. The mean normalised SI volume was significantly smaller in both PD-MCI converters (1.19±0.35, p<0.001) and PD-MCI non-converters (1.52±0.27, p<0.001) compared with that in controls (1.87±0.19). PD-MCI converters had a significantly smaller normalised SI volume than PD-MCI non-converters (p<0.001). CONCLUSIONS Our data show that atrophy in the frontostriatal areas and cholinergic structures, as well as frontal lobe associated cognitive performance, may act as predictors of dementia in PD-MCI patients, suggesting distinctive patterns of cognitive profiles and a neuroanatomical basis for progressive PD-MCI.
Collapse
Affiliation(s)
- Ji E Lee
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, , Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
47
|
Allali G, Verghese J, Mahoney JR. Contributions of mild parkinsonian signs to gait performance in the elderly. Age (Dordr) 2014; 36:9678. [PMID: 24981115 PMCID: PMC4150913 DOI: 10.1007/s11357-014-9678-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/18/2014] [Indexed: 05/20/2023]
Abstract
Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in non-demented community-dwelling older adults without idiopathic Parkinson's disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44 ± 6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β = .20, p < .01) was associated with bradykinesia, whereas cardiovascular disease (β = .15, p < .05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.
Collapse
Affiliation(s)
- Gilles Allali
- />Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY USA
- />Department of Clinical Neurosciences, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Joe Verghese
- />Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY USA
| | - Jeannette R. Mahoney
- />Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY USA
- />Albert Einstein College of Medicine, Yeshiva University, 1165 Morris Park Avenue, Room 304, Bronx, NY 10461 USA
| |
Collapse
|
48
|
Fujishiro H, Iseki E, Kasanuki K, Chiba Y, Ota K, Murayama N, Sato K. A follow up study of non-demented patients with primary visual cortical hypometabolism: Prodromal dementia with Lewy bodies. J Neurol Sci 2013; 334:48-54. [DOI: 10.1016/j.jns.2013.07.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/27/2013] [Accepted: 07/20/2013] [Indexed: 11/16/2022]
|
49
|
Uemura Y, Wada-Isoe K, Nakashita S, Nakashima K. Depression and cognitive impairment in patients with mild parkinsonian signs. Acta Neurol Scand 2013; 128:153-9. [PMID: 23397887 DOI: 10.1111/ane.12089] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mild parkinsonian signs (MPS) are reported to be associated with increased risk of dementia, Parkinson's disease, parkinsonism, and vascular lesions of white matter and are also a significant predictor of mortality. Although more than 20% of subjects aged 60 years and older suffer from MPS in Japan, it is often unrecognized and underestimated by patients and medical physicians. We used neuropsychological methods to examine cognitive function and depressive symptoms in subjects with MPS. METHODS We performed a population-based study in Ama-cho, a rural island town in western Japan. Participants included 951 subjects aged 65 years and older, 613 of whom completed all questionnaires, neurological examinations, and neuropsychological assessments and were included in the data analysis. Subjects were assessed for depression and subjective cognitive impairment using the Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and modified Unified Parkinson's Disease Rating Scale (mUPDRS). RESULTS Of the 613 participants, 143 were diagnosed with MPS. GDS scores were significantly higher in the MPS group compared with the motor control group, while MMSE scores were significantly lower. CONCLUSIONS We demonstrated that MPS correlate with both depressive symptoms and cognitive impairment.
Collapse
Affiliation(s)
- Y. Uemura
- Department of Neurology; Matsue Seikyo General Hospital; Matsue; Japan
| | - K. Wada-Isoe
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago; Japan
| | - S. Nakashita
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago; Japan
| | - K. Nakashima
- Division of Neurology; Department of Brain and Neurosciences; Faculty of Medicine; Tottori University; Yonago; Japan
| |
Collapse
|
50
|
Delbaere K, Kochan NA, Close JC, Menant JC, Sturnieks DL, Brodaty H, Sachdev PS, Lord SR. Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry 2012; 20:845-53. [PMID: 23011051 DOI: 10.1097/JGP.0b013e31824afbc4] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : Incidence of falls in people with cognitive impairment with or without a formal diagnosis of dementia is estimated to be twice that of cognitively intact older adults. This study aimed to investigate whether mild cognitive impairment (MCI) is associated with falls in older people. DESIGN : Prospective cohort study. SETTING : Community sample, Sydney Memory and Ageing Study. PARTICIPANTS : A total of 419 nondemented community-dwelling adults, age 70-90 years. MEASUREMENTS : A comprehensive neuropsychological test battery measuring four cognitive domains provided classification being with or without MCI on the basis of objective published criteria. Assessments of medical, physiologic, and psychological measures were also performed. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period. RESULTS : Of the participants, 342 (81.6%) had normal cognitive functioning, 58 (13.8%) had nonamnestic MCI, and 19 (4.5%) had amnestic MCI. People with MCI performed worse than people without MCI in measures of general health and balance. Logistic regression analyses showed that fall risk was significantly greater in people with MCI (odds ratio [OR]: 1.72, 95% confidence interval [95% CI]: 1.03-2.89). This association was mainly apparent when the analysis was restricted to those with nonamnestic MCI (OR: 1.98, 95% CI: 1.11-3.53), where the relationship was primarily explained by impaired executive functioning (OR: 1.27, 95% CI: 1.02-1.59). CONCLUSION : The findings indicate that objectively defined MCI is an independent risk factor for injurious or multiple falls in a representative sample of community-dwelling older people. The presence of nonamnestic MCI, based primarily on executive function, was found to be an important factor in increasing fall risk.
Collapse
|