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Tahara D, Tahara N, Akagi A, Riku Y, Sone J, Miyahara H, Nagai A, Yoshida M, Iwasaki Y. Clinical characteristics of Japanese patients with corticobasal degeneration. J Neurol Sci 2024; 466:123212. [PMID: 39243604 DOI: 10.1016/j.jns.2024.123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Corticobasal degeneration (CBD) is a clinically heterogeneous neurodegenerative disorder, for which pathological investigations are essential for a definitive diagnosis. This study explored the clinical characteristics of Japanese patients with pathologically confirmed CBD. METHODS We reviewed the data of Japanese patients with pathologically confirmed CBD who were consecutively autopsied at our institute. Clinical data were obtained from medical records and clinicopathological conferences. RESULTS Of the 34 patients initially reviewed, three were excluded because of a lack of detailed clinical data. Of the remaining 31 patients, 16 were men and 15 were women. The mean ages at onset and death were 63.3 ± 6.7 (51-79) years and 69.1 ± 6.9 (54-86), respectively. The median disease duration was 6.0 (2.5-12) years. The clinical phenotypes were as follows: progressive supranuclear palsy syndrome (PSPS; n = 20, 64.5 %), probable or possible corticobasal syndrome (n = 6, 19.4 %), frontal behavioral-spatial syndrome (n = 4, 12.9 %), nonfluent/agrammatic variant of primary progressive aphasia (n = 1, 3.2 %). Furthermore, 28 (90.3 %) patients exhibited dysphagia with a median latency of 3.5 (1.0-10.0) years, and 22 (71.0 %) patients who underwent tube feeding survived longer than those who did not (P = 0.013). CONCLUSIONS Compared with Western populations, a high prevalence of PSPS may be a clinical characteristic of Japanese patients with CBD. Additionally, dysphagia occurs in many patients with early latency and may shorten survival. Tube feeding contributes to the prolonged survival of patients with CBD.
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Affiliation(s)
- Daisuke Tahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Neurology, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Nao Tahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Neurology, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Yuichi Riku
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Jun Sone
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Atsushi Nagai
- Department of Neurology, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
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2
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Sakurai K, Tokumaru AM, Yoshida M, Saito Y, Wakabayashi K, Komori T, Hasegawa M, Ikeuchi T, Hayashi Y, Shimohata T, Murayama S, Iwasaki Y, Uchihara T, Sakai M, Yabe I, Tanikawa S, Takigawa H, Adachi T, Hanajima R, Fujimura H, Hayashi K, Sugaya K, Hasegawa K, Sano T, Takao M, Yokota O, Miki T, Kobayashi M, Arai N, Ohkubo T, Yokota T, Mori K, Ito M, Ishida C, Idezuka J, Toyoshima Y, Kanazawa M, Aoki M, Hasegawa T, Watanabe H, Hashizume A, Niwa H, Yasui K, Ito K, Washimi Y, Kubota A, Toda T, Nakashima K, Aiba I. Conventional magnetic resonance imaging key features for distinguishing pathologically confirmed corticobasal degeneration from its mimics: a retrospective analysis of the J-VAC study. Neuroradiology 2024:10.1007/s00234-024-03432-w. [PMID: 39039147 DOI: 10.1007/s00234-024-03432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Due to the indistinguishable clinical features of corticobasal syndrome (CBS), the antemortem differentiation between corticobasal degeneration (CBD) and its mimics remains challenging. However, the utility of conventional magnetic resonance imaging (MRI) for the diagnosis of CBD has not been sufficiently evaluated. This study aimed to investigate the diagnostic performance of conventional MRI findings in differentiating pathologically confirmed CBD from its mimics. METHODS Semiquantitative visual rating scales were employed to assess the degree and distribution of atrophy and asymmetry on conventional T1-weighted and T2-weighted images. Additionally, subcortical white matter hyperintensity (SWMH) on fluid-attenuated inversion recovery images were visually evaluated. RESULTS In addition to 19 patients with CBD, 16 with CBD mimics (progressive supranuclear palsy (PSP): 9, Alzheimer's disease (AD): 4, dementia with Lewy bodies (DLB): 1, frontotemporal lobar degeneration with TAR DNA-binding protein of 43 kDa(FTLD-TDP): 1, and globular glial tauopathy (GGT): 1) were investigated. Compared with the CBD group, the PSP-CBS subgroup showed severe midbrain atrophy without SWMH. The non-PSP-CBS subgroup, comprising patients with AD, DLB, FTLD-TDP, and GGT, showed severe temporal atrophy with widespread asymmetry, especially in the temporal lobes. In addition to over half of the patients with CBD, two with FTLD-TDP and GGT showed SWMH, respectively. CONCLUSION This study elucidates the distinct structural changes between the CBD and its mimics based on visual rating scales. The evaluation of atrophic distribution and SWMH may serve as imaging biomarkers of conventional MRI for detecting background pathologies.
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Affiliation(s)
- Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan.
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, 173-0015, Japan
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, 187-8551, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, 036-8562, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, 183-0042, Japan
| | - Masato Hasegawa
- Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, 156-8506, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo, Niigata, 951-8585, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan
| | - Shigeo Murayama
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, 173-0015, Japan
- Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Toshiki Uchihara
- Department of General Internal Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, 904-2293, Japan
- Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, 156-8506, Japan
| | - Motoko Sakai
- Department of Neurology, NHO Suzuka National Hospital, Suzuka, Mie, 513-8501, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoshi Tanikawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan
| | - Hiroshi Takigawa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Tadashi Adachi
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Harutoshi Fujimura
- Department of Neurology, NHO Osaka Toneyama Medical Center, Toyonaka, Osaka, 560-8552, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, 183-0042, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, 183-0042, Japan
| | - Kazuko Hasegawa
- Department of Neurology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, 252-0392, Japan
| | - Terunori Sano
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, 187-8551, Japan
| | - Masaki Takao
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, National Center Hospital, Kodaira, Tokyo, 187-8551, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama, 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama, 700-8558, Japan
| | - Tomoko Miki
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama, 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama, 700-8558, Japan
| | - Michio Kobayashi
- Department of Neurology, NHO Akita National Hospital, Yurihonjo, Akita, 018-1393, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, 156-8506, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8519, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8519, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie, 512-1111, Japan
| | - Masumi Ito
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie, 512-1111, Japan
| | - Chiho Ishida
- Department of Neurology, NHO Iou National Hospital, Kanazawa, Ishikawa, 920-0192, Japan
| | - Jiro Idezuka
- Department of Neurology, Ojiya Sakura Hospital, Ojiya, Niigata, 947-0041, Japan
| | - Yasuko Toyoshima
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata, 959-2221, Japan
- Department of Pathology, Brain Research Institute, Niigata University, Chuo, Niigata, 951-8585, Japan
| | - Masato Kanazawa
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Chuo, Niigata, 951-8585, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Atsushi Hashizume
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, 466-8650, Japan
| | - Keita Ito
- Department of Neurology, Hekinan Municipal Hospital, Hekinan, Aichi, 447-8502, Japan
| | - Yukihiko Washimi
- Department of Neurology, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, 113-8655, Japan
| | - Kenji Nakashima
- Department of Neurology, NHO Matsue Medical Center, Matsue, Shimane, 690-8556, Japan
| | - Ikuko Aiba
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi, 465-8620, Japan
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Jellinger KA. Pathomechanisms of cognitive and behavioral impairment in corticobasal degeneration. J Neural Transm (Vienna) 2023; 130:1509-1522. [PMID: 37659990 DOI: 10.1007/s00702-023-02691-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Corticobasal degeneration (CBD) is a rare, sporadic, late-onset progressive neurodegenerative disorder of unknown etiology, clinically characterized by an akinetic-rigid syndrome, behavior and personality disorders, language problems (aphasias), apraxia, executive and cognitive abnormalities and limb dystonia. The syndrome is not specific, as clinical features of pathologically proven CBD include several phenotypes. This 4-repeat (4R) tauopathy is morphologically featured by often asymmetric frontoparietal atrophy, ballooned/achromatic neurons containing filamentous 4R-tau aggregates in cortex and striatum, thread-like processes that are more widespread than in progressive supranuclear palsy (PSP), pathognomonic "astroglial plaques", and numerous inclusions in both astrocytes and oligodendroglia ("coiled bodies") in the white matter. Cognitive deficits in CBD are frequent initial presentations before onset of motor symptoms, depending on the phenotypic variant. They predominantly include executive and visuospatial dysfunction, sleep disorders and language deficits with usually preserved memory domains. Neuroimaging studies showed heterogenous locations of brain atrophy, particularly contralateral to the dominant symptoms, with disruption of striatal connections to prefrontal cortex and basal ganglia circuitry. Asymmetric hypometabolism, mainly involving frontal and parietal regions, is associated with brain cholinergic deficits, and dopaminergic nigrostriatal degeneration. Widespread alteration of cortical and subcortical structures causing heterogenous changes in various brain functional networks support the concept that CBD, similar to PSP, is a brain network disruption disorder. Putative pathogenic factors are hyperphosphorylated tau-pathology, neuroinflammation and oxidative injury, but the basic mechanisms of cognitive impairment in CBD, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for early diagnosis and adequate treatment of this fatal disorder.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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4
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Aiba I, Hayashi Y, Shimohata T, Yoshida M, Saito Y, Wakabayashi K, Komori T, Hasegawa M, Ikeuchi T, Tokumaru AM, Sakurai K, Murayama S, Hasegawa K, Uchihara T, Toyoshima Y, Saito Y, Yabe I, Tanikawa S, Sugaya K, Hayashi K, Sano T, Takao M, Sakai M, Fujimura H, Takigawa H, Adachi T, Hanajima R, Yokota O, Miki T, Iwasaki Y, Kobayashi M, Arai N, Ohkubo T, Yokota T, Mori K, Ito M, Ishida C, Tanaka M, Idezuka J, Kanazawa M, Aoki K, Aoki M, Hasegawa T, Watanabe H, Hashizume A, Niwa H, Yasui K, Ito K, Washimi Y, Mukai E, Kubota A, Toda T, Nakashima K. Clinical course of pathologically confirmed corticobasal degeneration and corticobasal syndrome. Brain Commun 2023; 5:fcad296. [PMID: 38090279 PMCID: PMC10715783 DOI: 10.1093/braincomms/fcad296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/01/2023] [Accepted: 11/02/2023] [Indexed: 12/28/2023] Open
Abstract
The clinical presentation of corticobasal degeneration is diverse, while the background pathology of corticobasal syndrome is also heterogeneous. Therefore, predicting the pathological background of corticobasal syndrome is extremely difficult. Herein, we investigated the clinical findings and course in patients with pathologically, genetically and biochemically verified corticobasal degeneration and corticobasal syndrome with background pathology to determine findings suggestive of background disorder. Thirty-two patients were identified as having corticobasal degeneration. The median intervals from the initial symptoms to the onset of key milestones were as follows: gait disturbance, 0.0 year; behavioural changes, 1.0 year; falls, 2.0 years; cognitive impairment, 2.0 years; speech impairment, 2.5 years; supranuclear gaze palsy, 3.0 years; urinary incontinence, 3.0 years; and dysphagia, 5.0 years. The median survival time was 7.0 years; 50% of corticobasal degeneration was diagnosed as corticobasal degeneration/corticobasal syndrome at the final presentation. Background pathologies of corticobasal syndrome (n = 48) included corticobasal degeneration (33.3%), progressive supranuclear palsy (29.2%) and Alzheimer's disease (12.5%). The common course of corticobasal syndrome was initial gait disturbance and early fall. In addition, corticobasal degeneration-corticobasal syndrome manifested behavioural change (2.5 years) and cognitive impairment (3.0 years), as the patient with progressive supranuclear palsy-corticobasal syndrome developed speech impairment (1.0 years) and supranuclear gaze palsy (6.0 years). The Alzheimer's disease-corticobasal syndrome patients showed cognitive impairment (1.0 years). The frequency of frozen gait at onset was higher in the corticobasal degeneration-corticobasal syndrome group than in the progressive supranuclear palsy-corticobasal syndrome group [P = 0.005, odds ratio (95% confidence interval): 31.67 (1.46-685.34)]. Dysarthria at presentation was higher in progressive supranuclear palsy-corticobasal syndrome than in corticobasal degeneration-corticobasal syndrome [P = 0.047, 6.75 (1.16-39.20)]. Pyramidal sign at presentation and personality change during the entire course were higher in Alzheimer's disease-corticobasal syndrome than in progressive supranuclear palsy-corticobasal syndrome [P = 0.011, 27.44 (1.25-601.61), and P = 0.013, 40.00 (1.98-807.14), respectively]. In corticobasal syndrome, decision tree analysis revealed that 'freezing at onset' or 'no dysarthria at presentation and age at onset under 66 years in the case without freezing at onset' predicted corticobasal degeneration pathology with a sensitivity of 81.3% and specificity of 84.4%. 'Dysarthria at presentation and age at onset over 61 years' suggested progressive supranuclear palsy pathology, and 'pyramidal sign at presentation and personality change during the entire course' implied Alzheimer's disease pathology. In conclusion, frozen gait at onset, dysarthria, personality change and pyramidal signs may be useful clinical signs for predicting background pathologies in corticobasal syndrome.
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Affiliation(s)
- Ikuko Aiba
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Yuko Saito
- Department of Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
- Department of Pathology and Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Masato Hasegawa
- Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Shigeo Murayama
- Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, Suita, Osaka 565-0871, Japan
- Department of Neurology and Neuropathology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo 173-0015, Japan
| | - Kazuko Hasegawa
- Department of Neurology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa 252-0392, Japan
| | - Toshiki Uchihara
- Neurology Clinic with Neuromorphomics Laboratory, Nitobe-Memorial Nakano General Hospital, Nakano, Tokyo 164-8607, Japan
- Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Yasuko Toyoshima
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata 959-2221, Japan
- Department of Pathology, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Yufuko Saito
- Department of Neurology, NHO Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Satoshi Tanikawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido 001-0021, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo 183-0042, Japan
| | - Terunori Sano
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Masaki Takao
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Motoko Sakai
- Department of Neurology, NHO Suzuka National Hospital, Suzuka, Mie 513-8501, Japan
| | - Harutoshi Fujimura
- Department of Neurology, NHO Osaka Toneyama Medical Center, Toyonaka, Osaka 560-8552, Japan
| | - Hiroshi Takigawa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Tadashi Adachi
- Division of Neuropathology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Osamu Yokota
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama 700-8558, Japan
| | - Tomoko Miki
- Department of Psychiatry, Kinoko Espoir Hospital, Kasaoka, Okayama 714-0071, Japan
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita, Okayama 700-8558, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Michio Kobayashi
- Department of Neurology, NHO Akita National Hospital, Yurihonjo, Akita 018-1393, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie 512-1111, Japan
| | - Masumi Ito
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Mie 512-1111, Japan
| | - Chiho Ishida
- Department of Neurology, NHO Iou National Hospital, Kanazawa, Ishikawa 920-0192, Japan
| | - Masaharu Tanaka
- Department of Psychiatry, Mishima Hospital, Nagaoka, Niigata 940-2302, Japan
| | - Jiro Idezuka
- Department of Neurology, Ojiya Sakura Hospital, Ojiya, Niigata 947-0041, Japan
| | - Masato Kanazawa
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Chuo, Niigata 951-8585, Japan
| | - Kenju Aoki
- Department of Neurology, Brain Disease Center Agano Hospital, Agano, Niigata 959-2221, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Atsushi Hashizume
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, Kariya, Aichi 448-8505, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi 466-8650, Japan
| | - Keita Ito
- Department of Neurology, Hekinan Municipal Hospital, Hekinan, Aichi 447-8502, Japan
| | - Yukihiko Washimi
- Department of Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Eiichiro Mukai
- Department of Neurology, Aichi-pref Saiseikai Rehabilitation Hospital, Nagoya, Aichi 451-0052, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo 113-8655, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo 113-8655, Japan
| | - Kenji Nakashima
- Department of Neurology, NHO Matsue Medical Center, Matsue, Shimane 690-8556, Japan
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5
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Street D, Bevan-Jones WR, Malpetti M, Jones PS, Passamonti L, Ghosh BC, Rittman T, Coyle-Gilchrist IT, Allinson K, Dawson CE, Rowe JB. Structural correlates of survival in progressive supranuclear palsy. Parkinsonism Relat Disord 2023; 116:105866. [PMID: 37804622 PMCID: PMC7615224 DOI: 10.1016/j.parkreldis.2023.105866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Many studies of the Richardson's syndrome phenotype of progressive supranuclear palsy (PSP) have elucidated regions of progressive atrophy and neural correlates of clinical severity. However, the neural correlates of survival and how these differ according to variant phenotypes are poorly understood. We set out to identify structural changes that predict severity and survival from scanning date to death. METHODS Structural magnetic resonance imaging data from 112 deceased people with clinically defined 'probable' or 'possible' PSP were analysed. Neuroanatomical regions of interest volumes, thickness and area were correlated with 'temporal stage', defined as the ratio of time from symptom onset to death, time from scan to death ('survival from scan'), and in a subset of patients, clinical severity, adjusting for age and total intracranial volume. Forty-nine participants had post mortem confirmation of the diagnosis. RESULTS Using T1-weighted magnetic resonance imaging, we confirmed the midbrain, and bilateral cortical structural correlates of contemporary disease severity. Atrophy of the striatum, cerebellum and frontotemporal cortex correlate with temporal stage and survival from scan, even after adjusting for severity. Subcortical structure-survival relationships were stronger in Richardson's syndrome than variant phenotypes. CONCLUSIONS Although the duration of PSP varies widely between people, an individual's progress from disease onset to death (their temporal stage) reflects atrophy in striatal, cerebellar and frontotemporal cortical regions. Our findings suggest magnetic resonance imaging may contribute to prognostication and stratification of patients with heterogenous clinical trajectories and clarify the processes that confer mortality risk in PSP.
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Affiliation(s)
- Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | | | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Consiglio Nazionale Delle Ricerche (CNR), Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Milano, Italy
| | - Boyd Cp Ghosh
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Ian Ts Coyle-Gilchrist
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Kieren Allinson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Department of Pathology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Catherine E Dawson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
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6
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Ananthavarathan P, Patel B, Peeros S, Obrocki R, Malek N. Neurological update: non-motor symptoms in atypical parkinsonian syndromes. J Neurol 2023; 270:4558-4578. [PMID: 37316556 PMCID: PMC10421812 DOI: 10.1007/s00415-023-11807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Among people with Parkinson's disease (PD), non-motor symptoms (NMS) are a well-recognised cause of significant morbidity and poor quality of life. Yet, it is only more recently that NMS have been recognised to affect the lives of patients with atypical parkinsonian syndromes in a similar fashion. The aim of this article is to highlight and compare the relative prevalence of NMS among patients with atypical parkinsonian syndromes in the published literature, which largely remain underreported and unaddressed in routine clinical practice. All NMS that are recognised to occur in PD are also found to commonly occur in atypical parkinsonian syndromes. In particular, excessive daytime sleepiness is more prevalent among atypical parkinsonian syndromes (94.3%) compared to PD (33.9%) or normal controls (10.5%) (p < 0.001). Urinary dysfunction (not limited to urinary incontinence) is not only found to occur in MSA (79.7%) and PD (79.9%), but has also been reported in nearly half of the patients with PSP (49.3%), DLB (42%) and CBD (53.8%) (p < 0.001). Apathy is significantly more common among the atypical parkinsonian syndromes [PSP (56%), MSA (48%), DLB (44%), CBD (43%)] compared to PD (35%) (p = 0.029). Early recognition and addressing of NMS among atypical parkinsonian syndromes may help improve the holistic patient care provided and may encompass a range of conservative and pharmacotherapeutic treatments to address these symptoms.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Department of Neuroinflammation, Institute of Neurology, University College London, 1st Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
| | - B Patel
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - S Peeros
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - R Obrocki
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - N Malek
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
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7
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Aina A, Hsueh SCC, Gibbs E, Peng X, Cashman NR, Plotkin SS. De Novo Design of a β-Helix Tau Protein Scaffold: An Oligomer-Selective Vaccine Immunogen Candidate for Alzheimer's Disease. ACS Chem Neurosci 2023; 14:2603-2617. [PMID: 37458595 DOI: 10.1021/acschemneuro.3c00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Tau pathology is associated with many neurodegenerative disorders, including Alzheimer's disease (AD), where the spatio-temporal pattern of tau neurofibrillary tangles strongly correlates with disease progression, which motivates therapeutics selective for misfolded tau. Here, we introduce a new avidity-enhanced, multi-epitope approach for protein-misfolding immunogen design, which is predicted to mimic the conformational state of an exposed epitope in toxic tau oligomers. A predicted oligomer-selective tau epitope 343KLDFK347 was scaffolded by designing a β-helix structure that incorporated multiple instances of the 16-residue tau fragment 339VKSEKLDFKDRVQSKI354. Large-scale conformational ensemble analyses involving Jensen-Shannon Divergence and the embedding depth D showed that the multi-epitope scaffolding approach, employed in designing the β-helix scaffold, was predicted to better discriminate toxic tau oligomers than other "monovalent" strategies utilizing a single instance of an epitope for vaccine immunogen design. Using Rosetta, 10,000 sequences were designed and screened for the linker portions of the β-helix scaffold, along with a C-terminal stabilizing α-helix that interacts with the linkers, to optimize the folded structure and stability of the scaffold. Structures were ranked by energy, and the lowest 1% (82 unique sequences) were verified using AlphaFold. Several selection criteria involving AlphaFold are implemented to obtain a lead-designed sequence. The structure was further predicted to have free energetic stability by using Hamiltonian replica exchange molecular dynamics (MD) simulations. The synthesized β-helix scaffold showed direct binding in surface plasmon resonance (SPR) experiments to several antibodies that were raised to the structured epitope using a designed cyclic peptide. Moreover, the strength of binding of these antibodies to in vitro tau oligomers correlated with the strength of binding to the β-helix construct, suggesting that the construct presents an oligomer-like conformation and may thus constitute an effective oligomer-selective immunogen.
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Affiliation(s)
- Adekunle Aina
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Shawn C C Hsueh
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Ebrima Gibbs
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Xubiao Peng
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - Steven S Plotkin
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
- Genome Science and Technology Program, The University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
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8
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Santillo AF, Leuzy A, Honer M, Landqvist Waldö M, Tideman P, Harper L, Ohlsson T, Moes S, Giannini L, Jögi J, Groot C, Ossenkoppele R, Strandberg O, van Swieten J, Smith R, Hansson O. [ 18F]RO948 tau positron emission tomography in genetic and sporadic frontotemporal dementia syndromes. Eur J Nucl Med Mol Imaging 2023; 50:1371-1383. [PMID: 36513817 PMCID: PMC10027632 DOI: 10.1007/s00259-022-06065-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine [18F]RO948 retention in FTD, sampling the underlying protein pathology heterogeneity. METHODS A total of 61 individuals with FTD (n = 35), matched cases of AD (n = 13) and Aβ-negative cognitively unimpaired individuals (n = 13) underwent [18F]RO948PET and MRI. FTD included 21 behavioral variant FTD (bvFTD) cases, 11 symptomatic C9orf72 mutation carriers, one patient with non-genetic bvFTD-ALS, one individual with bvFTD due to a GRN mutation, and one due to a MAPT mutation (R406W). Tracer retention was examined using a region-of-interest and voxel-wise approaches. Two individuals (bvFTD due to C9orf72) underwent postmortem neuropathological examination. Tracer binding was additionally assessed in vitro using [3H]RO948 autoradiography in six separate cases. RESULTS [18F]RO948 retention across ROIs was clearly lower than in AD and comparable to that in Aβ-negative cognitively unimpaired individuals. Only minor loci of tracer retention were seen in bvFTD; these did not overlap with the observed cortical atrophy in the cases, the expected pattern of atrophy, nor the expected or verified protein pathology distribution. Autoradiography analyses showed no specific [3H]RO948 binding. The R406W MAPT mutation carriers were clear exceptions with AD-like retention levels and specific in-vitro binding. CONCLUSION [18F]RO948 uptake is not significantly increased in the majority of FTD patients, with a clear exception being specific MAPT mutations.
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Affiliation(s)
- Alexander F Santillo
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden.
- Memory Clinic, Skåne University Hospital, SE-20502, Malmö, Sweden.
| | - Antoine Leuzy
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
| | - Michael Honer
- Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Maria Landqvist Waldö
- Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pontus Tideman
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
| | - Luke Harper
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
| | - Tomas Ohlsson
- Radiation Physics, Skane University Hospital, Scania, Sweden
| | - Svenja Moes
- Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Lucia Giannini
- Alzheimer Center, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jonas Jögi
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Colin Groot
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
| | - Rik Ossenkoppele
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Olof Strandberg
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
| | - John van Swieten
- Alzheimer Center, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ruben Smith
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Oskar Hansson
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund/Malmö, Sweden
- Memory Clinic, Skåne University Hospital, SE-20502, Malmö, Sweden
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9
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Naito R, Watanabe Y, Naito A, Sugasawa K, Nakata Y, Kamiyama T, Okiyama R, Yokochi F, Isozaki E, Yamasoba T, Takahashi K. Visual fixation suppression of caloric nystagmus in progressive supranuclear palsy - A comparison with Parkinson's disease. J Vestib Res 2023; 33:385-401. [PMID: 37599554 DOI: 10.3233/ves-210147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Impairment of visual fixation suppression (VS) in progressive supranuclear palsy (PSP) is not well documented. OBJECTIVE To evaluate the usefulness of impaired VS of caloric nystagmus as an index for differential diagnosis between PSP and Parkinson's disease (PD), which is often difficult, especially in the early stage. METHODS Subjects comprised 26 PSP patients and 26 PD patients clinically diagnosed at Tokyo Metropolitan Neurological Hospital. We retrospectively investigated VS of caloric nystagmus, horizontal pursuit, saccades, and horizontal optokinetic nystagmus recorded on direct-current-electronystagmography, and neuroradiological findings. RESULTS The median of the average VS% was 0% and 50.0% in PSP and PD patients, respectively. In PSP, VS was impaired even in the early stage of disease. We found a significant correlation between VS and velocity of saccades or maximum slow phase velocity of optokinetic nystagmus only in PSP patients. PSP patients with atrophy of the subthalamic nucleus or with decreased blood flow in the frontal lobe showed significantly more severe impairment of VS. CONCLUSIONS VS may be a useful biomarker to differentiate patients with PSP from those with PD. Cerebellar networks that connect with the cerebral cortex and basal ganglia may contribute to impaired VS of caloric nystagmus in PSP.
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Affiliation(s)
- Rie Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yuki Watanabe
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Akira Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicines, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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10
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Journe‐Mallet I, Gouju J, Etcharry‐Bouyx F, Chauvire V, Guillet‐Pichon V, Scherer‐Gagou C, Prundean A, Godard S, Lecluse A, Cassereau J, Verny C, Letournel F, Codron P. Design and application of a customizable relational
DataBase
to assess clinicopathological correlations and concomitant pathology in neurodegenerative diseases. Brain Pathol 2022; 33:e13138. [PMID: 36536531 PMCID: PMC10154372 DOI: 10.1111/bpa.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
The diagnosis of neurodegenerative diseases is made complex by the heterogenous phenotype of the patients and the regular occurrence of concomitant pathology. Studying clinicopathological correlations in autopsy series is a central approach to improve pathological prediction in clinical practice. However, such method requires a wealth of information, and the use of standard spreadsheet software is hardly suitable. To overcome this constraint, we designed a customizable and freely available neuropathology form with 456 data entry fields driven by an open-source DataBase Management Systems (DBMS) using Structured Query Language (SQL). This approach allowed us to optimize the compilation of clinical and pathological data from our brain collection (264 autopsied patients, 22,885 data points). Information was then easily retrieved using general and specific queries, facilitating the analysis of demographics, clinicopathological correlations, and incidental and concomitant proteinopathies. Tau, amyloid-β and α-synuclein incidental pathology was observed in respectively 78.1%, 42.8%, and 10.7% of all the patients. These proportions increased with age, reaching 100% for Tau pathology after 80. Concomitant proteinopathy was observed in 46.4% of the patients diagnosed with neurodegenerative diseases and prion disease. We observed a particularly high rate of co-pathology in patients with Dementia with Lewy bodies (81.3% of associated Tau and amyloid-β pathology) and Creutzfeldt-Jakob disease (68.4% of associated Tau pathology). Finally, we used specific queries to identify old cases that could meet newly defined neuropathological criteria and revised the diagnosis of a 90-year-old patient to LATE Stage 2. Increasing our understanding of clinicopathological correlations in neurodegenerative diseases is crucial given the implications in clinical diagnosis, biomarker identification and targeted therapies assessment. The precise characterization of clinical and pathological data of autopsy series remains a central approach but the large amount of generated data should encourage a more systematic use of DBMS.
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Affiliation(s)
- Isabelle Journe‐Mallet
- Laboratoire de neurobiologie et neuropathologie Centre Hospitalier Universitaire d'Angers Angers France
| | - Julien Gouju
- Laboratoire de neurobiologie et neuropathologie Centre Hospitalier Universitaire d'Angers Angers France
| | | | - Valérie Chauvire
- Centre mémoire de ressource et de recherche Centre Hospitalier Universitaire d'Angers Angers France
| | - Virginie Guillet‐Pichon
- Centre mémoire de ressource et de recherche Centre Hospitalier Universitaire d'Angers Angers France
- Centre de référence des maladies neurogénétiques Centre Hospitalier Universitaire d'Angers Angers France
- MITOVASC Univ Angers, Inserm, CNRS, SFR ICAT Angers France
| | - Clarisse Scherer‐Gagou
- Centre de référence des maladies neurogénétiques Centre Hospitalier Universitaire d'Angers Angers France
| | - Adriana Prundean
- Centre de référence des maladies neurogénétiques Centre Hospitalier Universitaire d'Angers Angers France
| | - Sophie Godard
- Unité neurovasculaire Centre Hospitalier Universitaire d'Angers Angers France
| | - Aldéric Lecluse
- Unité neurovasculaire Centre Hospitalier Universitaire d'Angers Angers France
| | - Julien Cassereau
- Centre de référence des maladies neurogénétiques Centre Hospitalier Universitaire d'Angers Angers France
- MITOVASC Univ Angers, Inserm, CNRS, SFR ICAT Angers France
- Centre de référence des maladies neuromusculaires AOC Centre Hospitalier Universitaire d'Angers Angers France
- Centre de ressources et de compétences sur la SLA Centre Hospitalier Universitaire d'Angers Angers France
| | - Christophe Verny
- Centre de référence des maladies neurogénétiques Centre Hospitalier Universitaire d'Angers Angers France
- MITOVASC Univ Angers, Inserm, CNRS, SFR ICAT Angers France
| | - Franck Letournel
- Laboratoire de neurobiologie et neuropathologie Centre Hospitalier Universitaire d'Angers Angers France
| | - Philippe Codron
- Laboratoire de neurobiologie et neuropathologie Centre Hospitalier Universitaire d'Angers Angers France
- MITOVASC Univ Angers, Inserm, CNRS, SFR ICAT Angers France
- Unité neurovasculaire Centre Hospitalier Universitaire d'Angers Angers France
- Centre de référence des maladies neuromusculaires AOC Centre Hospitalier Universitaire d'Angers Angers France
- Centre de ressources et de compétences sur la SLA Centre Hospitalier Universitaire d'Angers Angers France
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11
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Cordella C, Gutz SE, Eshghi M, Stipancic KL, Schliep M, Dickerson BC, Green JR. Acoustic and Kinematic Assessment of Motor Speech Impairment in Patients With Suspected Four-Repeat Tauopathies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4112-4132. [PMID: 36306508 PMCID: PMC9940887 DOI: 10.1044/2022_jslhr-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs). METHOD Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features. RESULTS Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group. CONCLUSIONS Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21401778.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Megan Schliep
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | | | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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12
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Coughlin DG, Hiniker A, Peterson C, Kim Y, Arezoumandan S, Giannini L, Pizzo D, Weintraub D, Siderowf A, Litvan I, Rissman RA, Galasko D, Hansen L, Trojanowski JQ, Lee E, Grossman M, Irwin D. Digital Histological Study of Neocortical Grey and White Matter Tau Burden Across Tauopathies. J Neuropathol Exp Neurol 2022; 81:953-964. [PMID: 36269086 PMCID: PMC9677241 DOI: 10.1093/jnen/nlac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
3R/4R-tau species are found in Alzheimer disease (AD) and ∼50% of Lewy body dementias at autopsy (LBD+tau); 4R-tau accumulations are found in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Digital image analysis techniques can elucidate patterns of tau pathology more precisely than traditional methods but repeatability across centers is unclear. We calculated regional percentage areas occupied by tau pathological inclusions from the middle frontal cortex (MFC), superior temporal cortex (STC), and angular gyrus (ANG) from cases from the University of Pennsylvania and the University of California San Diego with AD, LBD+tau, PSP, or CBD (n = 150) using QuPath. In both cohorts, AD and LBD+tau had the highest grey and white matter tau burden in the STC (p ≤ 0.04). White matter tau burden was relatively higher in 4R-tauopathies than 3R/4R-tauopathies (p < 0.003). Grey and white matter tau were correlated in all diseases (R2=0.43-0.79, p < 0.04) with the greatest increase of white matter per unit grey matter tau observed in PSP (p < 0.02 both cohorts). Grey matter tau negatively correlated with MMSE in AD and LBD+tau (r = -4.4 to -5.4, p ≤ 0.02). These data demonstrate the feasibility of cross-institutional digital histology studies that generate finely grained measurements of pathology which can be used to support biomarker development and models of disease progression.
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Affiliation(s)
- David G Coughlin
- From the Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Annie Hiniker
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Claire Peterson
- Digital Neuropathology Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yongya Kim
- From the Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Sanaz Arezoumandan
- Digital Neuropathology Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lucia Giannini
- Digital Neuropathology Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Erasmus University Medical Center, Alzheimer Center, Rotterdam, The Netherlands
| | - Donald Pizzo
- Center for Advanced Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irene Litvan
- From the Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Robert A Rissman
- From the Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Douglas Galasko
- From the Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Lawrence Hansen
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward Lee
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Irwin
- Digital Neuropathology Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Snowden JS. Changing perspectives on frontotemporal dementia: A review. J Neuropsychol 2022. [DOI: 10.1111/jnp.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Julie S. Snowden
- Cerebral Function Unit, Manchester Centre for Neurosciences Salford Royal NHS Foundation Trust Salford UK
- Division of Neuroscience & Experimental Psychology School of Biological Sciences, University of Manchester Manchester UK
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14
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Yoshida M, Akagi A, Miyahara H, Riku Y, Ando T, Ikeda T, Yabata H, Moriyoshi H, Koizumi R, Iwasaki Y. Macroscopic diagnostic clue for parkinsonism. Neuropathology 2022; 42:394-419. [PMID: 35996308 DOI: 10.1111/neup.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/25/2022]
Abstract
The neuropathological background of parkinsonism includes various neurodegenerative disorders, including Lewy body disease (LBD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The pathological diagnostic procedure begins by assessing the macroscopic findings to evaluate the degenerative lesions in brains with the naked eye. Usually, degenerative lesions show variable atrophy and brownish discoloration in accordance with disease-specific profiles. These macroscopic appearances support neuropathologists in identifying the relevant regions for microscopic examination. The neuropathological diagnosis of parkinsonism is based on regional distribution and fundamental proteinopathies in neurons and glia cells. LBD and MSA are synucleinopathies, and PSP and CBD are tauopathies. Among them, glial-predominant proteinopathy (MSA, PSP, and CBD) may play a significant role in volume reduction. Therefore, macroscopic inspection provides the appropriate direction for assessment. The disease duration, the severity of lesions, and mixed pathologies make the validation of macroscopic observations more complicated. In this review, we outline the macroscopic diagnostic clues in LBD, MSA, PSP, and CBD that could help with pathological refinement.
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Affiliation(s)
- Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Yuichi Riku
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Ando
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshimasa Ikeda
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Yabata
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Shiga University of Medical Science, Ohtsu
| | - Hideyuki Moriyoshi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuichi Koizumi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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15
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Coughlin DG, Litvan I. Investigational therapeutics for the treatment of progressive supranuclear palsy. Expert Opin Investig Drugs 2022; 31:813-823. [DOI: 10.1080/13543784.2022.2087179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David G Coughlin
- Department of Neurosciences, University of California San Diego, San Diego, 92093, CA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, San Diego, 92093, CA
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16
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Gallo D, Ruiz A, Sánchez-Juan P. Genetic architecture of primary tauopathies. Neuroscience 2022; 518:27-37. [PMID: 35609758 DOI: 10.1016/j.neuroscience.2022.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/29/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
Primary Tauopathies are a group of diseases defined by the accumulation of Tau, in which the alteration of this protein is the primary driver of the neurodegenerative process. In addition to the classical syndromes (Pick's disease (PiD), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and argyrophilic grain disease (AGD)), new entities, like primary age-related Tauopathy (PART), have been recently described. Except for the classical Richardson's syndrome phenotype in PSP, the correlation between the clinical picture of the primary Tauopathies and underlying pathology is poor. This fact has challenged genetic studies. However, thanks to multicenter collaborations, several genome-wide association studies are helping us unravel the genetic structure of these diseases. The most relevant risk factor revealed by these studies is the Tau gene (MAPT), which, in addition to mutations causing rare familial forms, plays a fundamental role in sporadic cases of PSP and CBD in which there is a strong predominance of the H1 and H1c haplotypes. But outside of MAPT, several other genes have been robustly associated with PSP. These findings, pointing towards multifactorial causation, imply the participation of several pathways involving the myelin sheath integrity, the endoplasmic reticulum unfolded protein response, microglia, intracellular vesicle trafficking, or the ubiquitin-proteasome system. Additionally, GWAS show a high degree of genetic overlap across different Tauopathies. This is especially salient between PSP and CBD, but also GWAS studying the recently described PART phenotype shows genetic overlap with genes that promote Tau pathology and with others associated with Alzheimer's disease.
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17
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Riley KJ, Graner BD, Veronesi MC. The tauopathies: Neuroimaging characteristics and emerging experimental therapies. J Neuroimaging 2022; 32:565-581. [PMID: 35470528 PMCID: PMC9545715 DOI: 10.1111/jon.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
The tauopathies are a heterogeneous group of neurodegenerative disorders in which the prevailing underlying disease process is intracellular deposition of abnormal misfolded tau protein. Diseases often categorized as tauopathies include progressive supranuclear palsy, chronic traumatic encephalopathy, corticobasal degeneration, and frontotemporal lobar degeneration. Tauopathies can be classified through clinical assessment, imaging findings, histologic validation, or molecular biomarkers tied to the underlying disease mechanism. Many tauopathies vary in their clinical presentation and overlap substantially in presentation, making clinical diagnosis of a specific primary tauopathy difficult. Anatomic imaging findings are also rarely specific to a single tauopathy, and when present may not manifest until well after the point at which therapy may be most impactful. Molecular biomarkers hold the most promise for patient care and form a platform upon which emerging diagnostic and therapeutic applications could be developed. One of the most exciting developments utilizing these molecular biomarkers for assessment of tau deposition within the brain is tau‐PET imaging utilizing novel ligands that specifically target tau protein. This review will discuss the background, significance, and clinical presentation of each tauopathy with additional attention to the pathologic mechanisms at the protein level. The imaging characteristics will be outlined with select examples of emerging imaging techniques. Finally, current treatment options and emerging therapies will be discussed. This is by no means a comprehensive review of the literature but is instead intended for the practicing radiologist as an overview of a rapidly evolving topic.
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Affiliation(s)
- Kalen J Riley
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brian D Graner
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael C Veronesi
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Illán-Gala I, Nigro S, VandeVrede L, Falgàs N, Heuer HW, Painous C, Compta Y, Martí MJ, Montal V, Pagonabarraga J, Kulisevsky J, Lleó A, Fortea J, Logroscino G, Quattrone A, Quattrone A, Perry DC, Gorno-Tempini ML, Rosen HJ, Grinberg LT, Spina S, La Joie R, Rabinovici GD, Miller BL, Rojas JC, Seeley WW, Boxer AL. Diagnostic Accuracy of Magnetic Resonance Imaging Measures of Brain Atrophy Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Degeneration. JAMA Netw Open 2022; 5:e229588. [PMID: 35486397 PMCID: PMC9055455 DOI: 10.1001/jamanetworkopen.2022.9588] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
Importance The accurate diagnosis of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) is hampered by imperfect clinical-pathological correlations. Objective To assess and compare the diagnostic value of the magnetic resonance parkinsonism index (MRPI) and other magnetic resonance imaging-based measures of cerebral atrophy to differentiate between PSP, CBD, and other neurodegenerative diseases. Design, Setting, and Participants This prospective diagnostic study included participants with 4-repeat tauopathies (4RT), PSP, CBD, other neurodegenerative diseases and available MRI who appeared in the University of California, San Francisco, Memory and Aging Center database. Data were collected from October 27, 1994, to September 29, 2019. Data were analyzed from March 1 to September 14, 2021. Main Outcomes and Measures The main outcome of this study was the neuropathological diagnosis of PSP or CBD. The clinical diagnosis at the time of the MRI acquisition was noted. The imaging measures included the MRPI, cortical thickness, subcortical volumes, including the midbrain, pons, and superior cerebellar peduncle volumes. Multinomial logistic regression models (MLRM) combining different cortical and subcortical regions were defined to discriminate between PSP, CBD, and other pathologies. The areas under the receiver operating characteristic curves (AUROC) and cutoffs were calculated to differentiate between PSP, CBD, and other diseases. Results Of the 326 included participants, 176 (54%) were male, and the mean (SD) age at MRI was 64.1 (8.0) years. The MRPI showed good diagnostic accuracy for the differentiation between PSP and all other pathologies (accuracy, 87%; AUROC, 0.90; 95% CI, 0.86-0.95) and between 4RT and other pathologies (accuracy, 80%; AUROC, 0.82; 95% CI, 0.76-0.87), but did not allow the discrimination of participants with CBD. Its diagnostic accuracy was lower in the subgroup of patients without the canonical PSP-Richardson syndrome (PSP-RS) or probable corticobasal syndrome (CBS) at MRI. MLRM combining cortical and subcortical measurements showed the highest accuracy for the differentiation between PSP and other pathologies (accuracy, 95%; AUROC, 0.98; 95% CI, 0.97-0.99), CBD and other pathologies (accuracy, 83%; AUROC, 0.86; 95% CI, 0.81-0.91), 4RT and other pathologies (accuracy, 89%; AUROC, 0.94; 95% CI, 0.92-0.97), and PSP and CBD (accuracy, 91%; AUROC, 0.95; 95% CI, 0.91-0.99), even in participants without PSP-RS or CBS at MRI. Conclusions and Relevance In this study, the combination of widely available cortical and subcortical measures of atrophy on MRI discriminated between PSP, CBD, and other pathologies and could be used to support the diagnosis of 4RT in clinical practice.
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Affiliation(s)
- Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Atlantic Fellow for Equity in Brain Health at the University of California, San Francisco, Department of Neurology, University of California, San Francisco
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
- Institute of Nanotechnology, National Research Council, Lecce, Italy
| | - Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Neus Falgàs
- Atlantic Fellow for Equity in Brain Health at the University of California, San Francisco, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Hilary W. Heuer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Cèlia Painous
- Parkinson’s Disease & Movement Disorders Unit, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, CIBERNED, European Reference Network for Rare Neurological Diseases, Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- Parkinson’s Disease & Movement Disorders Unit, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, CIBERNED, European Reference Network for Rare Neurological Diseases, Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Maria J. Martí
- Parkinson’s Disease & Movement Disorders Unit, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, CIBERNED, European Reference Network for Rare Neurological Diseases, Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Victor Montal
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Javier Pagonabarraga
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Movement Disorders Unit, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Movement Disorders Unit, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - David C. Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | | | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Lea T. Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Julio C. Rojas
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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19
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Garrett LR, Niccoli T. Frontotemporal Dementia and Glucose Metabolism. Front Neurosci 2022; 16:812222. [PMID: 35281504 PMCID: PMC8906510 DOI: 10.3389/fnins.2022.812222] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Frontotemporal dementia (FTD), hallmarked by antero-temporal degeneration in the human brain, is the second most common early onset dementia. FTD is a diverse disease with three main clinical presentations, four different identified proteinopathies and many disease-associated genes. The exact pathophysiology of FTD remains to be elucidated. One common characteristic all forms of FTD share is the dysregulation of glucose metabolism in patients’ brains. The brain consumes around 20% of the body’s energy supply and predominantly utilizes glucose as a fuel. Glucose metabolism dysregulation could therefore be extremely detrimental for neuronal health. Research into the association between glucose metabolism and dementias has recently gained interest in Alzheimer’s disease. FTD also presents with glucose metabolism dysregulation, however, this remains largely an unexplored area. A better understanding of the link between FTD and glucose metabolism may yield further insight into FTD pathophysiology and aid the development of novel therapeutics. Here we review our current understanding of FTD and glucose metabolism in the brain and discuss the evidence of impaired glucose metabolism in FTD. Lastly, we review research potentially suggesting a causal relationship between FTD proteinopathies and impaired glucose metabolism in FTD.
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20
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Toller G, Zitser J, Sukhanov P, Grant H, Miller BL, Kramer JH, Rosen HJ, Rankin KP, Grinberg LT. Clinical, neuroimaging, and neuropathological characterization of a patient with Alzheimer's disease syndrome due to Pick's pathology. Neurocase 2022; 28:19-28. [PMID: 34402746 PMCID: PMC9472769 DOI: 10.1080/13554794.2021.1936072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The most common neurodegenerative syndrome associated with Pick's disease pathology (PiD) is behavioral variant frontotemporal dementia (bvFTD), which features profound social behavioral changes. Rarely, PiD can manifest as an Alzheimer's disease (AD)-type dementia with early memory impairment. We describe a patient with AD-type dementia and pure PiD pathology who showed slowly progressive memory impairment, early social changes, and paucity of motor symptoms. Atrophy and PiD were found mainly in frontotemporal regions underlying social behavior. This report may help predict the pathology of patients with atypical AD, which will ultimately be critical for enrolling suitable subjects into disease-modifying clinical trials.
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Affiliation(s)
- Gianina Toller
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Zitser
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA.,Movement Disorders Unit, Department of Neurology, Tel Aviv Sourazky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Paul Sukhanov
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Harli Grant
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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21
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Castro-Suarez S, Guevara-Silva E, Caparó-Zamalloa C, Osorio-Marcatinco V, Meza-Vega M, Miller B, Cornejo-Olivas M. Knowledge and Attitudes for the Management of Behavioral Variant of Frontotemporal Dementia. Front Neurol 2022; 12:786448. [PMID: 35087469 PMCID: PMC8787358 DOI: 10.3389/fneur.2021.786448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of the behavioral variant of frontotemporal dementia (bvFTD) can be especially challenging and is relatively underdiagnosed. There is scarce information on training and attitudes from care providers facing bvFTD in settings with limited resources. We aim to describe clinical knowledge and attitudes facing bvFTD from neurologists, psychiatrists, and residents in Peru. Methods: Potential participants received invitations by email to complete an online questionnaire. In addition, we reviewed 21 curricula from undergraduate medical schools' programs offered by the main schools of medicine in Peru during 2020 and 2021. Results: A total of 145 participants completed the survey. The responders were neurologists (51%), psychiatrists (25%), and residents in neurology or psychiatry (24%). Only 26% of the respondents acknowledged receiving at least one class on bvFTD in undergraduate medical training, but 66.6% received at least some training during postgraduate study. Participants identified isolated supportive symptoms for bvFTD; however, only 25% identified the possible criteria and 18% the probable bvFTD criteria. They identified MoCA in 44% and Frontal Assessment Battery (39%) as the most frequently used screening test to assess bvFTD patients. Memantine and Acetylcholinesterase inhibitors were incorrectly indicated by 40.8% of participants. Seventy six percentage of participants indicated that they did not provide education and support to the caregiver. The dementia topic was available on 95.2%, but FTD in only 19%. Conclusion: Neuropsychiatry medical specialists in Peru receive limited training in FTD. Their clinical attitudes for treating bvFTD require appropriate training focused on diagnostic criteria, assessment tools, and pharmacological and non-pharmacological management.
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Affiliation(s)
- Sheila Castro-Suarez
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Department of Neurology, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Erik Guevara-Silva
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - César Caparó-Zamalloa
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Victor Osorio-Marcatinco
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Maria Meza-Vega
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, San Francisco School of Medicine, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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22
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Stamelou M, Respondek G, Giagkou N, Whitwell JL, Kovacs GG, Höglinger GU. Evolving concepts in progressive supranuclear palsy and other 4-repeat tauopathies. Nat Rev Neurol 2021; 17:601-620. [PMID: 34426686 DOI: 10.1038/s41582-021-00541-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Tauopathies are classified according to whether tau deposits predominantly contain tau isoforms with three or four repeats of the microtubule-binding domain. Those in which four-repeat (4R) tau predominates are known as 4R-tauopathies, and include progressive supranuclear palsy, corticobasal degeneration, argyrophilic grain disease, globular glial tauopathies and conditions associated with specific MAPT mutations. In these diseases, 4R-tau deposits are found in various cell types and anatomical regions of the brain and the conditions share pathological, pathophysiological and clinical characteristics. Despite being considered 'prototype' tauopathies and, therefore, ideal for studying neuroprotective agents, 4R-tauopathies are still severe and untreatable diseases for which no validated biomarkers exist. However, advances in research have addressed the issues of phenotypic overlap, early clinical diagnosis, pathophysiology and identification of biomarkers, setting a road map towards development of treatments. New clinical criteria have been developed and large cohorts with early disease are being followed up in prospective studies. New clinical trial readouts are emerging and biomarker research is focused on molecular pathways that have been identified. Lessons learned from failed trials of neuroprotective drugs are being used to design new trials. In this Review, we present an overview of the latest research in 4R-tauopathies, with a focus on progressive supranuclear palsy, and discuss how current evidence dictates ongoing and future research goals.
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Affiliation(s)
- Maria Stamelou
- Parkinson's Disease and Movement Disorders Dept, HYGEIA Hospital, Athens, Greece. .,European University of Cyprus, Nicosia, Cyprus. .,Philipps University, Marburg, Germany.
| | - Gesine Respondek
- Department of Neurology, Hanover Medical School, Hanover, Germany
| | - Nikolaos Giagkou
- Parkinson's Disease and Movement Disorders Dept, HYGEIA Hospital, Athens, Greece
| | | | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease (CRND), University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Günter U Höglinger
- Department of Neurology, Hanover Medical School, Hanover, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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23
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Hwangbo S, Hwang S, Suh MK, Kim SJ, Kim Y, Kim HJ, Na DL, Seo SW, Suh YL. Two cases of non-fluent variant primary progressive aphasia with different pathological diagnoses. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2021.00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Non-fluent variant primary progressive aphasia (nfvPPA), a subtype of frontotemporal lobar dementia syndrome, has been proven to have various pathological diagnoses. A 63-year-old woman and 71-year-old man separately visited our clinic for language dysfunction. Both patients showed non-fluent speech. The female patient showed personality change accompanied by language dysfunction, while the male patient had parkinsonian symptoms such as bradykinesia and cogwheel rigidity. Both patients were clinically diagnosed with nfvPPA. Several years after the first visit, the patients died, and a brain autopsy was performed. On postmortem examination, the female patient was pathologically diagnosed with Pick’s disease, while the male patient was diagnosed with progressive supranuclear palsy. Our report suggests that nfvPPA patients might show distinct clinical features depending on underlying pathologies.
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Hartnell IJ, Blum D, Nicoll JAR, Dorothee G, Boche D. Glial cells and adaptive immunity in frontotemporal dementia with tau pathology. Brain 2021; 144:724-745. [PMID: 33527991 DOI: 10.1093/brain/awaa457] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022] Open
Abstract
Neuroinflammation is involved in the aetiology of many neurodegenerative disorders including Alzheimer's disease, Parkinson's disease and motor neuron disease. Whether neuroinflammation also plays an important role in the pathophysiology of frontotemporal dementia is less well known. Frontotemporal dementia is a heterogeneous classification that covers many subtypes, with the main pathology known as frontotemporal lobar degeneration. The disease can be categorized with respect to the identity of the protein that causes the frontotemporal lobar degeneration in the brain. The most common subgroup describes diseases caused by frontotemporal lobar degeneration associated with tau aggregation, also known as primary tauopathies. Evidence suggests that neuroinflammation may play a role in primary tauopathies with genome-wide association studies finding enrichment of genetic variants associated with specific inflammation-related gene loci. These loci are related to both the innate immune system, including brain resident microglia, and the adaptive immune system through possible peripheral T-cell involvement. This review discusses the genetic evidence and relates it to findings in animal models expressing pathogenic tau as well as to post-mortem and PET studies in human disease. Across experimental paradigms, there seems to be a consensus regarding the involvement of innate immunity in primary tauopathies, with increased microglia and astrocyte density and/or activation, as well as increases in pro-inflammatory markers. Whilst it is less clear as to whether inflammation precedes tau aggregation or vice versa; there is strong evidence to support a microglial contribution to the propagation of hyperphosphorylated in tau frontotemporal lobar degeneration associated with tau aggregation. Experimental evidence-albeit limited-also corroborates genetic data pointing to the involvement of cellular adaptive immunity in primary tauopathies. However, it is still unclear whether brain recruitment of peripheral immune cells is an aberrant result of pathological changes or a physiological aspect of the neuroinflammatory response to the tau pathology.
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Affiliation(s)
- Iain J Hartnell
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Blum
- University of Lille, Inserm, CHU-Lille, UMR-S 1172-Lille Neuroscience and Cognition, Lille, France.,Alzheimer & Tauopathies, LabEx DISTALZ, France
| | - James A R Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Guillaume Dorothee
- Inserm, Sorbonne University, UMRS 938 Saint-Antoine Research Center, Immune System and Neuroinflammation Laboratory, Hôpital Saint-Antoine, Paris, France
| | - Delphine Boche
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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25
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Whitwell JL, Tosakulwong N, Weigand SD, Graff-Radford J, Duffy JR, Clark HM, Machulda MM, Botha H, Utianski RL, Schwarz CG, Senjem ML, Strand EA, Ertekin-Taner N, Jack CR, Lowe VJ, Josephs KA. Longitudinal Amyloid-β PET in Atypical Alzheimer's Disease and Frontotemporal Lobar Degeneration. J Alzheimers Dis 2021; 74:377-389. [PMID: 32039841 DOI: 10.3233/jad-190699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rates of amyloid-β (Aβ) accumulation have been characterized across the cognitively normal to typical Alzheimer's dementia spectrum, but little is known about Aβ accumulation in atypical Alzheimer's disease (AD) and other neurodegenerative diseases, such as frontotemporal lobar degeneration (FTLD). OBJECTIVE We aimed tocharacterize longitudinal Aβ accumulation anddetermine the influence of age, apolipoprotein E (APOE) genotype, disease duration, and sexin atypical AD and FTLD. METHODS 322 patients (138 atypical AD, 184 FTLD) underwent Pittsburgh compound B PET scanning, with 73 having serialPiB-PET scans (42 atypical AD, 31 FTLD). Global Aβ standard uptake value ratios were calculated for every scan. Mixed effects models were used to assess the effect of age, APOE genotype, disease duration, and sex on baseline and change measures of Aβ. RESULTS Atypical AD showed higher baseline Aβ than FTLD. Rate of Aβ accumulation was not associated with baseline Aβ in either group. Older age was associated with greater baseline Aβ and faster rates of accumulation in FTLD. In patients under age 70, atypical AD showed faster rates of accumulation than FTLD. APOEɛ4 genotype was associated with greater baseline Aβ in FTLD but did not influence rates of accumulation. Rates of Aβ accumulation were faster in FTLD patents with time from onset-to-PET≤4 years. Female sex was associated with faster rates of accumulation in atypical AD. CONCLUSION Accumulation of Aβ is observed in atypical AD and FTLD, although different demographic factors influence accumulation in these diseases providing insight into potentially different biological mechanisms of Aβ deposition.
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Affiliation(s)
| | | | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Graff-Radford
- Department of Neurology, Division of Behavioral Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | - Heather M Clark
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Division of Behavioral Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rene L Utianski
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Edythe A Strand
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology, Division of Behavioral Neurology, Mayo Clinic, Rochester, MN, USA
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26
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Bouvier L, Monetta L, Laforce RJ, Vitali P, Bocti C, Martel-Sauvageau V. Progressive apraxia of speech in Quebec French speakers: A case series. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:528-548. [PMID: 33570823 DOI: 10.1111/1460-6984.12606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The term progressive apraxia of speech (PAOS) is used to describe speakers presenting with isolated or dominant apraxia of speech in the context of a neurodegenerative syndrome, including primary progressive apraxia of speech (PPAOS) and dominant progressive apraxia of speech (DAOS), respectively. Its motor speech profile has been increasingly explored in the last decade, but description remains vague and very English oriented, although the effect of speakers' language on motor speech phenotypes is increasingly recognized. Although some studies suggest that speakers presenting with isolated PAOS (PPAOS) versus dominant PAOS with concomitant aphasia (DAOS) should be differentiated, distinct characteristics of the two presentations are unclear. Furthermore, a careful description of their clinical presentation in languages other than English is required. AIMS To describe the motor speech characteristics of Quebec French-speaking participants with prominent PAOS and to explore the communication profile of those presenting more specifically with isolated PAOS (PPAOS), and with dominant PAOS and concomitant aphasia (DAOS). METHODS & PROCEDURES A thorough effort to recruit all speakers presenting with PAOS in the larger population areas of the province of Quebec was conducted over a 3-year span. A total of nine participants with PAOS (pwPAOS; PPAOS = 5, DAOS = 4) underwent a comprehensive language and motor speech assessment, and a cognitive screening. Their performance was compared with 30 matched healthy controls. OUTCOMES & RESULTS As a group, pwPAOS differed from healthy speakers on all acoustic and perceptual measures. The PPAOS and PAOS subgroups were similar on several measures, but participants from the PPAOS subgroup tended to perform better on articulatory measures and maximum speech rate tasks. CONCLUSIONS & IMPLICATIONS This study provides an in-depth analysis of motor speech characteristics of PAOS in Quebec French speakers and adds further evidence for the differentiation of PPAOS and DAOS. Combining simple perceptual and acoustic analyses represent a promising approach to distinguish the two variants and identify treatment targets. What this paper adds What is already known on this subject Progressive apraxia of speech (PAOS) is a neurodegenerative syndrome characterized by progressive and initially isolated or dominant apraxia of speech (primary progressive apraxia of speech [PPAOS] and dominant progressive apraxia of speech [DAOS], respectively). Studies mostly report articulatory and prosodic deficits in PAOS, but concomitant deficits such as dysarthria and executive dysfunction are also reported. The description of motor speech skills in PAOS remains vague and English-oriented. Studies suggest that speakers presenting with isolated PAOS vs dominant PAOS with concomitant aphasia should be differentiated, but distinct characteristics of the two presentations are unclear. What this study adds to existing knowledge To the best of the authors' knowledge, this study is the first to report transversal data of Quebec-French participants with PPAOS and DAOS. Moreover, this study is a first step towards identifying potential characteristics that could facilitate the diagnosis of PPAOS and DAOS in Quebec French. It makes a significant contribution to our understanding of progressive apraxia of speech in different cultural languages. What are the potential or actual clinical implications of this work? This study also initiates the search for sensitive tasks for the diagnosis of those speakers (which is an important process), in addition to identifying the core characteristics of PAOS, DAOS, and PPAOS in the development of an assessment battery for this population.
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Affiliation(s)
- Liziane Bouvier
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec, QC, Canada
- Centre de recherche CERVO Research Centre, Quebec, QC, Canada
| | - Laura Monetta
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre de recherche CERVO Research Centre, Quebec, QC, Canada
| | - Robert Jr Laforce
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Quebec, QC, Canada
| | - Paolo Vitali
- CIUSSS Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Christian Bocti
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Service de Neurologie, Département de Médecine, CHUS, Sherbrooke, QC, Canada
- Clinique de la Mémoire et Centre de Recherche sur le Vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Vincent Martel-Sauvageau
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Service de Neurologie, Département de Médecine, CHUS, Sherbrooke, QC, Canada
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27
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Ye LQ, Gao PR, Zhang YB, Cheng HR, Tao QQ, Wu ZY, Li HL. Application of Cerebrospinal Fluid AT(N) Framework on the Diagnosis of AD and Related Cognitive Disorders in Chinese Han Population. Clin Interv Aging 2021; 16:311-323. [PMID: 33654388 PMCID: PMC7910151 DOI: 10.2147/cia.s294756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Studies concerning the impact of the AT(N) framework on diagnostic capability in the dementia population are lacking. We aimed to explore the diagnostic application of CSF AT(N) framework in clinical routines of Alzheimer's disease (AD) as well as differential diagnosis of other cognitive diseases in the Chinese Han population. Patients and Methods A total of 137 patients with cognitive disorders received CSF tests of Aβ42, t-tau and p-tau181. Their CSF biomarker results were categorized and interpreted by the AT(N) framework. Neurologists provided a diagnosis both pre- and post-CSF biomarker disclosure with corresponding diagnostic confidence. Results The total initial diagnosis included 79 patients with AD and 58 patients with non-AD (NAD). The results of CSF biomarkers led to a diagnostic change of 28% in the cohort. Approximately 81.5% (n=53) of 65 patients whose CSF biomarker showed an underlying AD pathology were finally diagnosed as AD, with an increase of 17.5% in diagnostic confidence. Thirty-seven CSF results indicating NAD pathologic changes contributed to an exclusion of AD in 56.8% (n=21) of the patients along with a modest increase of 9.8% in average confidence. Thirty-five patients with normal CSF biomarkers maintained the diagnosis of NAD in 68.6% (n=24) of the group, leading to a slight elevation of 7.6% in confidence. Conclusion We found that the presence of amyloid pathology (A+) is contributable to diagnosing AD and improving confidence. On occasion of negative amyloid pathology (A-), with or without tau pathology, gaining uncertainty of the primary AD diagnosis would diminish the corresponding confidence. To the best of our knowledge, this is the first study performed in the Chinese Han population with cognitive disorders that explores the clinical capability of CSF AT(N) framework in a quantitative way.
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Affiliation(s)
- Ling-Qi Ye
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Rehabilitation Medicine and Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Pei-Rong Gao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yan-Bin Zhang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurology and Institute of Neurology in First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Hong-Rong Cheng
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurology in Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, People's Republic of China
| | - Qing-Qing Tao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hong-Lei Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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28
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Teichmann M. The current international consensus criteria can lead to under and over-diagnosis of primary progressive aphasia variants. Rev Neurol (Paris) 2021; 177:370-375. [PMID: 33618891 DOI: 10.1016/j.neurol.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
In the field of primary progressive aphasia (PPA), the most recent international consensus criteria of 2011 for diagnosis and variant classification have been shown not to capture accurately the whole range of PPA patients. Up to 30-40% of PPA patients appear not to satisfy the criteria of the three 'classical' PPA variants (non-fluent/agrammatic, logopenic, semantic) and are labelled either 'mixed PPA' or 'unclassifiable PPA'. Based on the PPA literature since 2011, this article discusses why patients might be under-diagnosed with respect to the three PPA variants, thus leading to the default concept of 'mixed/unclassifiable PPA' and, conversely, why the non-fluent/agrammatic variant appears to be over-diagnosed. It analyses and attempts to show how to resolve these issues, and it accordingly proposes clinical criteria, which are more inclusive to diminish the proportion of so-called mixed/unclassifiable PPA diagnoses and to reduce the proportion of questionable non-fluent/agrammatic diagnoses, which frequently correspond to progressive speech apraxia, rather than to aphasia.
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Affiliation(s)
- M Teichmann
- Department of Neurology, Institute of Memory and Alzheimer's Disease, National reference centre for 'rare or early onset dementias', Pitié-Salpêtrière hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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29
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Feis RA, van der Grond J, Bouts MJRJ, Panman JL, Poos JM, Schouten TM, de Vos F, Jiskoot LC, Dopper EGP, van Buchem MA, van Swieten JC, Rombouts SARB. Classification using fractional anisotropy predicts conversion in genetic frontotemporal dementia, a proof of concept. Brain Commun 2021; 2:fcaa079. [PMID: 33543126 PMCID: PMC7846185 DOI: 10.1093/braincomms/fcaa079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 11/14/2022] Open
Abstract
Frontotemporal dementia is a highly heritable and devastating neurodegenerative disease. About 10–20% of all frontotemporal dementia is caused by known pathogenic mutations, but a reliable tool to predict clinical conversion in mutation carriers is lacking. In this retrospective proof-of-concept case-control study, we investigate whether MRI-based and cognition-based classifiers can predict which mutation carriers from genetic frontotemporal dementia families will develop symptoms (‘convert’) within 4 years. From genetic frontotemporal dementia families, we included 42 presymptomatic frontotemporal dementia mutation carriers. We acquired anatomical, diffusion-weighted imaging, and resting-state functional MRI, as well as neuropsychological data. After 4 years, seven mutation carriers had converted to frontotemporal dementia (‘converters’), while 35 had not (‘non-converters’). We trained regularized logistic regression models on baseline MRI and cognitive data to predict conversion to frontotemporal dementia within 4 years, and quantified prediction performance using area under the receiver operating characteristic curves. The prediction model based on fractional anisotropy, with highest contribution of the forceps minor, predicted conversion to frontotemporal dementia beyond chance level (0.81 area under the curve, family-wise error corrected P = 0.025 versus chance level). Other MRI-based and cognitive features did not outperform chance level. Even in a small sample, fractional anisotropy predicted conversion in presymptomatic frontotemporal dementia mutation carriers beyond chance level. After validation in larger data sets, conversion prediction in genetic frontotemporal dementia may facilitate early recruitment into clinical trials.
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Affiliation(s)
- Rogier A Feis
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, 2333 ZA, Leiden, the Netherlands.,Institute of Psychology, Leiden University, 2333 AK, Leiden, the Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands
| | - Mark J R J Bouts
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, 2333 ZA, Leiden, the Netherlands.,Institute of Psychology, Leiden University, 2333 AK, Leiden, the Netherlands
| | - Jessica L Panman
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Department of Neurology, Erasmus Medical Centre, 3015 GD, Rotterdam, the Netherlands
| | - Jackie M Poos
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Department of Neurology, Erasmus Medical Centre, 3015 GD, Rotterdam, the Netherlands
| | - Tijn M Schouten
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, 2333 ZA, Leiden, the Netherlands.,Institute of Psychology, Leiden University, 2333 AK, Leiden, the Netherlands
| | - Frank de Vos
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, 2333 ZA, Leiden, the Netherlands.,Institute of Psychology, Leiden University, 2333 AK, Leiden, the Netherlands
| | - Lize C Jiskoot
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Department of Neurology, Erasmus Medical Centre, 3015 GD, Rotterdam, the Netherlands.,Dementia Research Centre, University College London, London, WC1N 3AR, UK
| | - Elise G P Dopper
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Department of Neurology, Erasmus Medical Centre, 3015 GD, Rotterdam, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, 2333 ZA, Leiden, the Netherlands
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, 3015 GD, Rotterdam, the Netherlands
| | - Serge A R B Rombouts
- Department of Radiology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, 2333 ZA, Leiden, the Netherlands.,Institute of Psychology, Leiden University, 2333 AK, Leiden, the Netherlands
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30
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Kini G, Bhat M, Amithabh S, Kakunje A. A rare case of frontotemporal dementia with amyotrophic lateral sclerosis. ARCHIVES OF MENTAL HEALTH 2021. [DOI: 10.4103/amh.amh_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Coughlin DG, Dickson DW, Josephs KA, Litvan I. Progressive Supranuclear Palsy and Corticobasal Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:151-176. [PMID: 33433875 DOI: 10.1007/978-3-030-51140-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are neurodegenerative tauopathies with neuronal and glial lesions composed of tau that is composed predominantly of isomers with four repeats in the microtubule-binding domain (4R tau). The brain regions vulnerable to pathology in PSP and CBD overlap, but there are differences, particularly with respect to distribution of neuronal loss, the relative abundance of neuronal and glial lesions, the morphologic features of glial lesions, and the frequency of comorbid pathology. Both PSP and CBD have a wide spectrum of clinical manifestations, including disorders of movement and cognition. Recognition of phenotypic diversity in PSP and CBD may improve antemortem diagnostic accuracy, which tends to be very good for the most common presentation of PSP (Richardson syndrome), but poor for the most characteristic presentation of CBD (corticobasal syndrome: CBS). Development of molecular and imaging biomarkers may improve antemortem diagnostic accuracy. Currently, multidisciplinary symptomatic and supportive treatment with pharmacological and non-pharmacological strategies remains the standard of care. In the future, experimental therapeutic trials will be important to slow disease progression.
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Affiliation(s)
| | | | | | - Irene Litvan
- UC San Diego Department of Neurosciences, La Jolla, CA, USA.
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32
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De Luca A, Fostinelli S, Ferrari C, Binetti G, Benussi L, Borroni B, Rossi L, Rongioletti M, Ghidoni R, Squitti R. Iron Serum Markers Profile in Frontotemporal Lobar Degeneration. J Alzheimers Dis 2020; 78:1373-1380. [PMID: 33185611 DOI: 10.3233/jad-201047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) is a progressive neurodegenerative syndrome. Defects of copper (Cu) and iron (Fe) homeostasis are involved in the development of several neurodegenerative diseases and their homeostasis is interconnected by the Cu-protein ceruloplasmin (Cp), responsible for Fe oxidative state. In this study we assessed Fe, transferrin (Trf), ferritin, Cp specific activity (eCp/iCp), Cp/Trf ratio, and Trf saturation in 60 FTLD patients and 43 healthy controls, and discussed the results in relation to Cu homeostasis. The significant decrease of the eCp/iCp in the FTLD patients supports the involvement of Fe imbalance in the onset and progression of FTLD.
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Affiliation(s)
| | - Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Statistics Service, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luisa Rossi
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Rongioletti
- Department of Laboratory Medicine, Research and Development Division, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Rosanna Squitti
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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33
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de Pablo-Fernández E, González-Herrero B, Cerdán Santacruz D, Rossor MN, Schott JM, Lashley T, Holton JL, Fox NC, Revesz T, Warren JD, Jaunmuktane Z, Rohrer JD, Warner TT. A Clinicopathologic Study of Movement Disorders in Frontotemporal Lobar Degeneration. Mov Disord 2020; 36:632-641. [PMID: 33155746 DOI: 10.1002/mds.28356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the considerable overlap with atypical parkinsonism, a systematic characterization of the movement disorders associated with frontotemporal lobar degeneration (FTLD) is lacking. OBJECTIVE The aim of this study is to provide a detailed description of the phenomenology and neuropathologic correlations of movement disorders in FTLD. METHODS In this cohort study, movement disorder clinical data were retrospectively collected from medical records of consecutive patients with a postmortem diagnosis of FTLD from the Queen Square Brain Bank between January 2010 and December 2018. At postmortem, neurodegenerative pathologies were systematically evaluated following consensus criteria. Degeneration of the substantia nigra was assessed as a marker of presynaptic dopaminergic parkinsonism using semiquantitative methods. RESULTS A total of 55 patients (35 men [64%]) were included with median (interquartile range) age at diagnosis of 58.8 (52.6-63.9) years and a disease duration of 9.6 (6.2-12.9) years. Movement disorders were present in 19 (35%) patients without differences among disease subtypes. The most common syndromes were parkinsonism (9 patients [16%]), usually as an additional late feature, and corticobasal syndrome (CBS, 7 patients [13%]), commonly as a presenting feature. Substantia nigra degeneration was present in 37 (67%) patients although it did not show a good clinical correlation with movement disorders. Those with Pick's disease showed milder substantia nigra degeneration and better response to levodopa. CONCLUSIONS Movement disorders can present in all FTLD subtypes, more commonly as a late additional feature (parkinsonism) or as a presenting symptom (CBS). The underlying pathophysiology is complex and likely to involve structures outside the presynaptic striatonigral system. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eduardo de Pablo-Fernández
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Belén González-Herrero
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Bellvitge University Hospital and Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Debora Cerdán Santacruz
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Neurology Department, Complejo Asistencial de Segovia, Segovia, Spain
| | - Martin N Rossor
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jonathan M Schott
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tammaryn Lashley
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Janice L Holton
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Nick C Fox
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tamas Revesz
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jason D Warren
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jonathan D Rohrer
- Department of Neurodegenerative Diseases, Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Department of Clinical and Movement Neurosciences, Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Clinical and Movement Neurosciences, Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, United Kingdom
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Lang AE, Stebbins GT, Wang P, Jabbari E, Lamb R, Morris H, Boxer AL, Boxer (PI) A, Boeve B, Dickerson B, Grossman M, Litvan I, Ljubenkov P, Pantelyat A, Rojas-Martinez J, Tartaglia MC, Wills AM, Morris (PI) H, Amar K, Capps E, Carey G, Church A, Critchley P, Ghosh B, Houlden H, Hu M, Jabbari E, Kobylecki C, Massey L, Molloy S, Nath U, Pavese N, Rowe J. The Cortical Basal ganglia Functional Scale (CBFS): Development and preliminary validation. Parkinsonism Relat Disord 2020; 79:121-126. [DOI: 10.1016/j.parkreldis.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/05/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022]
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Whitwell JL, Tosakulwong N, Schwarz CC, Senjem ML, Spychalla AJ, Duffy JR, Graff-Radford J, Machulda MM, Boeve BF, Knopman DS, Petersen RC, Lowe VJ, Jack CR, Dickson DW, Parisi JE, Josephs KA. Longitudinal anatomic, functional, and molecular characterization of Pick disease phenotypes. Neurology 2020; 95:e3190-e3202. [PMID: 32989107 DOI: 10.1212/wnl.0000000000010948] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/30/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize longitudinal MRI and PET abnormalities in autopsy-confirmed Pick disease (PiD) and determine how patterns of neurodegeneration differ with respect to clinical syndrome. METHODS Seventeen patients with PiD were identified who had antemortem MRI (8 with behavioral variant frontotemporal dementia [bvFTD-PiD], 6 with nonfluent/agrammatic primary progressive aphasia [naPPA-PiD], 1 with semantic primary progressive aphasia, 1 with unclassified primary progressive aphasia, and 1 with corticobasal syndrome). Thirteen patients had serial MRI for a total of 56 MRIs, 7 had [18F]fluorodeoxyglucose PET, 4 had Pittsburgh compound B (PiB) PET, and 1 patient had [18F]flortaucipir PET. Cross-sectional and longitudinal comparisons of gray matter volume and metabolism were performed between bvFTD-PiD, naPPA-PiD, and controls. Cortical PiB summaries were calculated to determine β-amyloid positivity. RESULTS The bvFTD-PiD and naPPA-PiD groups showed different foci of volume loss and hypometabolism early in the disease, with bvFTD-PiD involving bilateral prefrontal and anterior temporal cortices and naPPA-PiD involving left inferior frontal gyrus, insula, and orbitofrontal cortex. However, patterns merged over time, with progressive spread into prefrontal and anterior temporal lobe in naPPA-PiD, and eventual involvement of posterior temporal lobe, motor cortex, and parietal lobe in both groups. Rates of frontotemporal atrophy were faster in bvFTD-PiD than naPPA-PiD. One patient was β-amyloid-positive on PET with low Alzheimer neuropathologic changes at autopsy. Flortaucipir PET showed elevated uptake in frontotemporal white matter. CONCLUSION Patterns of atrophy and hypometabolism differ in PiD according to presenting syndrome, although patterns of neurodegeneration appear to converge over time.
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Affiliation(s)
- Jennifer L Whitwell
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL.
| | - Nirubol Tosakulwong
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Christopher C Schwarz
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Matthew L Senjem
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Anthony J Spychalla
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Joseph R Duffy
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Jon Graff-Radford
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Mary M Machulda
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Bradley F Boeve
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Val J Lowe
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Joseph E Parisi
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Keith A Josephs
- From the Departments of Radiology (J.L.W., C.C.S., M.L.S., A.J.S., V.J.L., C.R.J.), Health Sciences Research (N.T.), Neurology (J.R.D., J.G.-R., B.F.B., D.S.K., R.C.P., K.A.J.), Psychiatry and Psychology (M.M.M.), and Neuropathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuropathology (D.W.D.), Mayo Clinic, Jacksonville, FL
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Sakae N, Santos OA, Pedraza O, Litvan I, Murray ME, Duara R, Uitti RJ, Wszolek ZK, Graff-Radford NR, Josephs KA, Dickson DW. Clinical and pathologic features of cognitive-predominant corticobasal degeneration. Neurology 2020; 95:e35-e45. [PMID: 32518146 PMCID: PMC7371382 DOI: 10.1212/wnl.0000000000009734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe clinical and pathologic characteristics of corticobasal degeneration (CBD) with cognitive predominant problems during the disease course. METHODS In a series of autopsy-confirmed cases of CBD, we identified patients with cognitive rather than motor predominant features (CBD-Cog), including 5 patients thought to have Alzheimer disease (AD) and 10 patients thought to have behavioral variant frontotemporal dementia (FTD). We compared clinical and pathologic features of CBD-Cog with those from a series of 31 patients with corticobasal syndrome (CBD-CBS). For pathologic comparisons between CBD-Cog and CBD-CBS, we used semiquantitative scoring of neuronal and glial lesion types in multiple brain regions and quantitative assessments of tau burden from image analysis. RESULTS Five of 15 patients with CBD-Cog never had significant motor problems during their disease course. The most common cognitive abnormalities in CBD-Cog were executive and visuospatial dysfunction. The frequency of language problems did not differ between CBD-Cog and CBD-CBS. Argyrophilic grain disease, which is a medial temporal tauopathy associated with mild cognitive impairment, was more frequent in CBD-Cog. Apathy was also more frequent in CBD-Cog. Tau pathology in CBD-Cog was greater in the temporal and less in perirolandic cortices than in CBD-CBS. CONCLUSION A subset of patients with CBD has a cognitive predominant syndrome than can be mistaken for AD or FTD. Our findings suggest that distribution of tau cortical pathology (greater in temporal and less in perirolandic cortices) may be the basis of this uncommon clinical variant of CBD.
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Affiliation(s)
- Nobutaka Sakae
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Octavio A Santos
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Otto Pedraza
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Irene Litvan
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Melissa E Murray
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Ranjan Duara
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Ryan J Uitti
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Zbigniew K Wszolek
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Neill R Graff-Radford
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Keith A Josephs
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN
| | - Dennis W Dickson
- From the Departments of Neuroscience (N.S., M.E.M., D.W.D.), Psychiatry and Psychology (O.A.S., O.P.), and Neurology (R.J.U., Z.K.W., N.R.G.-R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (I.L.), University of California San Diego, La Jolla; Department of Neurology (R.D.), Mount Sinai Medical Center, Miami Beach, FL; and Department of Neurology (K.A.J.), Mayo Clinic, Rochester, MN.
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Duffy JR, Utianski RL, Josephs KA. Primary Progressive Apraxia of Speech: From Recognition to Diagnosis and Care. APHASIOLOGY 2020; 35:560-591. [PMID: 34219857 PMCID: PMC8247786 DOI: 10.1080/02687038.2020.1787732] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Apraxia of speech (AOS) can be caused by neurodegenerative disease and sometimes is its presenting sign (i.e., primary progressive apraxia of speech, PPAOS). During the last several decades our understanding of PPAOS has evolved from clinical recognition to a fuller understanding of its core and associated clinical features, its distinction from but relationship with primary progressive aphasia, its temporal course and eventual progression to include other neurological deficits, and its neuroimaging correlates and underlying pathology. AIMS This paper provides a comprehensive summary of the literature that has built the current knowledge base about PPAOS and progressive AOS as it co-occurs with progressive aphasia. It reviews the history of its emergence as a recognized syndrome; its relationship with the agrammatic/nonfluent variant of primary progressive aphasia; its salient perceptual features and subtypes; the acoustic and structural/physiological imaging measures that index its presence, severity, and distinction from aphasia; and principles and available data regarding its management and care. MAIN CONTRIBUTION A broad summary of what is known about AOS as a manifestation of neurodegenerative disease. CONCLUSIONS Primary progressive apraxia of speech is a recognizable syndrome that can be distinguished from other neurodegenerative conditions that affect speech and language.
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Affiliation(s)
- Joseph R Duffy
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
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Abstract
Frontotemporal dementia (FTD) encompasses a group of clinical syndromes, including behavioral-variant FTD, nonfluent variant primary progressive aphasia, semantic variant primary progressive aphasia, FTD motor neuron disease, progressive supranuclear palsy syndrome, and corticobasal syndrome. Early on in its course, FTD is commonly seen in psychiatric clinics. We review the clinical features and diagnostic criteria in FTD spectrum disorders.
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Affiliation(s)
- Kyan Younes
- UCSF Memory and Aging Center, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143, USA.
| | - Bruce L Miller
- UCSF Memory and Aging Center, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143, USA. https://twitter.com/brucemillerucsf
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Dinkelbach L, Südmeyer M, Hartmann CJ, Roeber S, Arzberger T, Felsberg J, Ferrea S, Moldovan AS, Amunts K, Schnitzler A, Caspers S. Somatosensory area 3b is selectively unaffected in corticobasal syndrome: combining MRI and histology. Neurobiol Aging 2020; 94:89-100. [PMID: 32593032 DOI: 10.1016/j.neurobiolaging.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/04/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
An increasing number of neuroimaging studies addressing patients with corticobasal syndrome use macroscopic definitions of brain regions. As a closer link to functionally relevant units, we aimed at identifying magnetic resonance-based atrophy patterns in regions defined by probability maps of cortical microstructure. For this purpose, three analyses were conducted: (1) Whole-brain cortical thickness was compared between 36 patients with corticobasal syndrome and 24 controls. A pattern of pericentral atrophy was found, covering primary motor area 4, premotor area 6, and primary somatosensory areas 1, 2, and 3a. Within the central region, only area 3b was without atrophy. (2) In 18 patients, longitudinal measures with follow-ups of up to 59 months (mean 21.3 ± 15.4) were analyzed. Areas 1, 2, and 6 showed significantly faster atrophy rates than primary somatosensory area 3b. (3) In an individual autopsy case, longitudinal in vivo morphometry and postmortem pathohistology were conducted. The rate of magnetic resonance-based atrophy was significantly correlated with tufted-astrocyte load in those cytoarchitectonically defined regions also seen in the group study, with area 3b being selectively unaffected.
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Affiliation(s)
- Lars Dinkelbach
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Institute for Anatomy I, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Neurology, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Christian Johannes Hartmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Neurology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Thomas Arzberger
- Center for Neuropathology and Prion Research, Ludwig Maximilian University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Felsberg
- Department of Neuropathology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Stefano Ferrea
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Alexia-Sabine Moldovan
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Neurology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany; JARA-BRAIN, Jülich-Aachen Research Alliance, Research Centre Jülich, Jülich, Germany; C. & O. Vogt Institute for Brain Research, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Neurology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Svenja Caspers
- Institute for Anatomy I, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany; JARA-BRAIN, Jülich-Aachen Research Alliance, Research Centre Jülich, Jülich, Germany.
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Coughlin DG, Litvan I. Progressive supranuclear palsy: Advances in diagnosis and management. Parkinsonism Relat Disord 2020; 73:105-116. [PMID: 32487421 PMCID: PMC7462164 DOI: 10.1016/j.parkreldis.2020.04.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
Progressive supranuclear palsy (PSP) is a complex clinicopathologic disease with no current cure or disease modulating therapies that can only be definitively confirmed at autopsy. Growing understanding of the phenotypic diversity of PSP has led to expanded clinical criteria and new insights into etiopathogenesis that coupled with improved in vivo biomarkers makes increased access to current clinical trials possible. Current standard-of-care treatment of PSP is multidisciplinary, supportive and symptomatic, and several trials of potentially disease modulating agents have already been completed with disappointing results. Current ongoing clinical trials target the abnormal aggregation of tau through a variety of mechanisms including immunotherapy and gene therapy offer a more direct method of treatment. Here we review PSP clinicopathologic correlations, in vivo biomarkers including MRI, PET, and CSF biomarkers. We additionally review current pharmacologic and non-pharmacologic methods of treatment, prior and ongoing clinical trials in PSP. Newly expanded clinical criteria and improved specific biomarkers will aid in identifying patients with PSP earlier and more accurately and expand access to these potentially beneficial clinical trials.
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Affiliation(s)
- David G Coughlin
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA.
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San Lee J, Yoo S, Park S, Kim HJ, Park KC, Seong JK, Suh MK, Lee J, Jang H, Kim KW, Kim Y, Cho SH, Kim SJ, Kim JP, Jung YH, Kim EJ, Suh YL, Lockhart SN, Seeley WW, Na DL, Seo SW. Differences in neuroimaging features of early- versus late-onset nonfluent/agrammatic primary progressive aphasia. Neurobiol Aging 2019; 86:92-101. [PMID: 31784276 DOI: 10.1016/j.neurobiolaging.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 01/18/2023]
Abstract
This study investigated distinct neuroimaging features measured by cortical thickness and subcortical structural shape abnormality in early-onset (EO, onset age <65 years) and late-onset (LO, onset age ≥65 years) nonfluent/agrammatic variant of primary progressive aphasia (nfvPPA) patients. Cortical thickness and subcortical structural shape analyses were performed using a surface-based method from 38 patients with nfvPPA and 76 cognitively normal individuals. To minimize the effects of physiological aging, we used W-scores in comparisons between the groups. The EO-nfvPPA group exhibited more extensive cortical thickness reductions predominantly in the left perisylvian, lateral and medial prefrontal, temporal, posterior cingulate, and precuneus regions than the LO-nfvPPA group. The EO-nfvPPA group also exhibited significantly greater subcortical structural shape abnormality than the LO-nfvPPA group, mainly in the left striatum, hippocampus, and amygdala. Our findings suggested that there were differences in neuroimaging features between these groups by the age of symptom onset, which might be explained by underlying heterogeneous neuropathological differences or the age-related brain reserve hypothesis.
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Affiliation(s)
- Jin San Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea; Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Sole Yoo
- Department of Cognitive Science, Yonsei University, Seoul, Korea
| | - Seongbeom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Key-Chung Park
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Joon-Kyung Seong
- Department of Bio-convergence Engineering, School of Biomedical Engineering, Korea University, Seoul, Korea
| | - Mee Kyung Suh
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Juyoun Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Ko Woon Kim
- Department of Neurology, Chonbuk National University Medical School & Hospital, Jeonju, Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Joo Kim
- Department of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Young Hee Jung
- Department of Neurology, Myungji Hospital, Goyang, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Samuel N Lockhart
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Neuroscience Center, Samsung Medical Center, Seoul, Korea; Samsung Alzheimer Research Center, Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea; Department of Health Sciences and Technology, Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Saranza GM, Whitwell JL, Kovacs GG, Lang AE. Corticobasal degeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 149:87-136. [PMID: 31779825 DOI: 10.1016/bs.irn.2019.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Corticobasal degeneration (CBD) is a rare neurodegenerative disease characterized by the predominance of pathological 4 repeat tau deposition in various cell types and anatomical regions. Corticobasal syndrome (CBS) is one of the clinical phenotypes associated with CBD pathology, manifesting as a progressive asymmetric akinetic-rigid, poorly levodopa-responsive parkinsonism, with cerebral cortical dysfunction. CBD can manifest as several clinical phenotypes, and similarly, CBS can also have a pathologic diagnosis other than CBD. This chapter discusses the clinical manifestations of pathologically confirmed CBD cases, the current diagnostic criteria, as well as the pathologic and neuroimaging findings of CBD/CBS. At present, therapeutic options for CBD remain symptomatic. Further research is needed to improve the clinical diagnosis of CBD, as well as studies on disease-modifying therapies for this relentlessly progressive neurodegenerative disorder.
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Affiliation(s)
- Gerard M Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Gabor G Kovacs
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Tanz Centre for Research in Neurodegenerative Disease and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Tanaka H, Toyoshima Y, Kawakatsu S, Kobayashi R, Yokota O, Terada S, Kuroda S, Miura T, Higuchi Y, Otsu H, Sanpei K, Otani K, Ikeuchi T, Onodera O, Kakita A, Takahashi H. Morphological characterisation of glial and neuronal tau pathology in globular glial tauopathy (Types II and III). Neuropathol Appl Neurobiol 2019; 46:344-358. [DOI: 10.1111/nan.12581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022]
Affiliation(s)
- H. Tanaka
- Department of Pathology Brain Research Institute Niigata University Niigata Japan
| | - Y. Toyoshima
- Department of Pathology Brain Research Institute Niigata University Niigata Japan
| | - S. Kawakatsu
- Department of Neuropsychiatry Aizu Medical Center Fukushima Medical University Aizu Fukushima Japan
| | - R. Kobayashi
- Department of Psychiatry Yamagata University School of Medicine Yamagata Japan
| | - O. Yokota
- Department of Psychiatry Kinoko Espoir Hospital Okayama Japan
| | - S. Terada
- Department of Neuropsychiatry Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - S. Kuroda
- Department of Psychiatry Zikei Institute of Psychiatry Okayama Japan
| | - T. Miura
- Department of Neurology Brain Research Institute Niigata University Niigata Japan
| | - Y. Higuchi
- Department of Neurology Brain Research Institute Niigata University Niigata Japan
| | - H. Otsu
- Department of Neurology Brain Research Institute Niigata University Niigata Japan
| | - K. Sanpei
- Department of Neurology Sado General Hospital Niigata Japan
| | - K. Otani
- Department of Psychiatry Yamagata University School of Medicine Yamagata Japan
| | - T. Ikeuchi
- Department of Molecular Genetics Brain Research Institute Niigata University Niigata Japan
| | - O. Onodera
- Department of Neurology Brain Research Institute Niigata University Niigata Japan
| | - A. Kakita
- Department of Pathology Brain Research Institute Niigata University Niigata Japan
| | - H. Takahashi
- Department of Pathology Brain Research Institute Niigata University Niigata Japan
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Shoeibi A, Olfati N, Litvan I. Frontrunner in Translation: Progressive Supranuclear Palsy. Front Neurol 2019; 10:1125. [PMID: 31695675 PMCID: PMC6817677 DOI: 10.3389/fneur.2019.01125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/08/2019] [Indexed: 12/26/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a four-repeat tau proteinopathy. Abnormal tau deposition is not unique for PSP and is the basic pathologic finding in some other neurodegenerative disorders such as Alzheimer's disease (AD), age-related tauopathy, frontotemporal degeneration, corticobasal degeneration, and chronic traumatic encephalopathy. While AD research has mostly been focused on amyloid beta pathology until recently, PSP as a prototype of a primary tauopathy with high clinical-pathologic correlation and a rapid course is a crucial candidate for tau therapeutic research. Several novel approaches to slow disease progression are being developed. It is expected that the benefits of translational research in this disease will extend beyond the PSP population. This article reviews advances in the diagnosis, epidemiology, pathology, hypothesized etiopathogenesis, and biomarkers and disease-modifying therapeutic approaches of PSP that is leading it to become a frontrunner in translation.
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Affiliation(s)
- Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- UC San Diego Department of Neurosciences, Parkinson and Other Movement Disorder Center, La Jolla, CA, United States
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Abstract
BACKGROUND Published approaches to the evaluation and management of patients with rapidly progressive dementia (RPD) have been largely informed by experience at academic hospitals and national centers specializing in the diagnosis of Creutzfeldt-Jakob disease. Whether these approaches can be applied to patients assessed within lower-acuity outpatient settings is unknown. METHODS A total of 96 patients with suspected RPD were assessed within the Washington University School of Medicine (Saint Louis, MO) outpatient memory clinic from February 2006 to February 2016. Consensus etiologic diagnoses were established following independent review of clinical data by 2 dementia specialists. RESULTS In total, 67/90 (70%) patients manifested with faster-than-expected cognitive decline leading to dementia within 2 years of symptom onset. Female sex (42/67, 63%), median patient age (68.3 y; range, 45.4 to 89.6), and years of education (12 y; range, 6 to 14) were consistent with clinic demographics. Atypical presentations of common neurodegenerative dementing illnesses accounted for 90% (60/67) of RPD cases. Older age predicted a higher odds of amnestic Alzheimer disease dementia (OR, 2.1 per decade; 95% CI, 1.1-3.8; P=0.02). Parkinsonism (OR, 6.9; 95% CI, 1.6-30.5; P=0.01) or cortical visual dysfunction (OR, 10.8; 95% CI, 1.7-69.4; P=0.01) predicted higher odds of another neurodegenerative cause of RPD, including sporadic Creutzfeldt-Jakob disease. CONCLUSIONS AND RELEVANCE The clinical environment influences the prevalence of RPD causes. The clinical evaluation should be adapted to promote detection of common causes of RPD, specific to the practice setting.
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Guzman-Martinez L, Maccioni RB, Andrade V, Navarrete LP, Pastor MG, Ramos-Escobar N. Neuroinflammation as a Common Feature of Neurodegenerative Disorders. Front Pharmacol 2019; 10:1008. [PMID: 31572186 PMCID: PMC6751310 DOI: 10.3389/fphar.2019.01008] [Citation(s) in RCA: 428] [Impact Index Per Article: 85.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022] Open
Abstract
Neurodegenerative diseases share the fact that they derive from altered proteins that undergo an unfolding process followed by formation of β-structures and a pathological tendency to self-aggregate in neuronal cells. This is a characteristic of tau protein in Alzheimer’s disease and several tauopathies associated with tau unfolding, α-synuclein in Parkinson’s disease, and huntingtin in Huntington disease. Usually, the self-aggregation products are toxic to these cells, and toxicity spreads all over different brain areas. We have postulated that these protein unfolding events are the molecular alterations that trigger several neurodegenerative disorders. Most interestingly, these events occur as a result of neuroinflammatory cascades involving alterations in the cross-talks between glial cells and neurons as a consequence of the activation of microglia and astrocytes. The model we have hypothesized for Alzheimer’s disease involves damage signals that promote glial activation, followed by nuclear factor NF-kβ activation, synthesis, and release of proinflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, and IL-12 that affect neuronal receptors with an overactivation of protein kinases. These patterns of pathological events can be applied to several neurodegenerative disorders. In this context, the involvement of innate immunity seems to be a major paradigm in the pathogenesis of these diseases. This is an important element for the search for potential therapeutic approaches for all these brain disorders.
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Affiliation(s)
- Leonardo Guzman-Martinez
- Laboratory of Neuroscience, Faculty of Sciences, University of Chile & International Center for Biomedicine (ICC), Santiago, Chile
| | - Ricardo B Maccioni
- Laboratory of Neuroscience, Faculty of Sciences, University of Chile & International Center for Biomedicine (ICC), Santiago, Chile.,Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Víctor Andrade
- Laboratory of Neuroscience, Faculty of Sciences, University of Chile & International Center for Biomedicine (ICC), Santiago, Chile
| | - Leonardo Patricio Navarrete
- Laboratory of Neuroscience, Faculty of Sciences, University of Chile & International Center for Biomedicine (ICC), Santiago, Chile
| | - María Gabriela Pastor
- Laboratory of Neuroscience, Faculty of Sciences, University of Chile & International Center for Biomedicine (ICC), Santiago, Chile.,Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Nicolas Ramos-Escobar
- Laboratory of Neuroscience, Faculty of Sciences, University of Chile & International Center for Biomedicine (ICC), Santiago, Chile
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Santangelo R, Dell'Edera A, Sala A, Cecchetti G, Masserini F, Caso F, Pinto P, Leocani L, Falautano M, Passerini G, Martinelli V, Comi G, Perani D, Magnani G. The CSF p-tau181/Aβ42 Ratio Offers a Good Accuracy “In Vivo” in the Differential Diagnosis of Alzheimer’s Dementia. Curr Alzheimer Res 2019; 16:587-595. [DOI: 10.2174/1567205016666190725150836] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
Background:
The incoming disease-modifying therapies against Alzheimer’s disease (AD)
require reliable diagnostic markers to correctly enroll patients all over the world. CSF AD biomarkers,
namely amyloid-β 42 (Aβ42), total tau (t-tau), and tau phosphorylated at threonine 181 (p-tau181),
showed good diagnostic accuracy in detecting AD pathology, but their real usefulness in daily clinical
practice is still a matter of debate. Therefore, further validation in complex clinical settings, that is patients
with different types of dementia, is needed to uphold their future worldwide adoption.
Methods:
We measured CSF AD biomarkers’ concentrations in a sample of 526 patients with a clinical
diagnosis of dementia (277 with AD and 249 with Other Type of Dementia, OTD). Brain FDG-PET was
also considered in a subsample of 54 patients with a mismatch between the clinical diagnosis and the
CSF findings.
Results:
A p-tau181/Aβ42 ratio higher than 0.13 showed the best diagnostic performance in differentiating
AD from OTD (86% accuracy index, 74% sensitivity, 81% specificity). In cases with a mismatch
between clinical diagnosis and CSF findings, brain FDG-PET partially agreed with the p-tau181/Aβ42
ratio, thus determining an increase in CSF accuracy.
Conclusions:
The p-tau181/Aβ42 ratio alone might reliably detect AD pathology in heterogeneous samples
of patients suffering from different types of dementia. It might constitute a simple, cost-effective
and reproducible in vivo proxy of AD suitable to be adopted worldwide not only in daily clinical practice
but also in future experimental trials, to avoid the enrolment of misdiagnosed AD patients.
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Affiliation(s)
- Roberto Santangelo
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Alessandro Dell'Edera
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Arianna Sala
- Nuclear Medicine Unit, IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giordano Cecchetti
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Federico Masserini
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Francesca Caso
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Patrizia Pinto
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Letizia Leocani
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | | | - Gabriella Passerini
- Department of Laboratory Medicine, IRCCS-San Raffaele Hospital, Milan, Italy
| | - Vittorio Martinelli
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Daniela Perani
- Nuclear Medicine Unit, IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
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Ali F, Martin PR, Botha H, Ahlskog JE, Bower JH, Masumoto JY, Maraganore D, Hassan A, Eggers S, Boeve BF, Knopman DS, Drubach D, Petersen RC, Dunkley ED, van Gerpen J, Uitti R, Whitwell JL, Dickson DW, Josephs KA. Sensitivity and Specificity of Diagnostic Criteria for Progressive Supranuclear Palsy. Mov Disord 2019; 34:1144-1153. [PMID: 30726566 PMCID: PMC6688972 DOI: 10.1002/mds.27619] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/08/2018] [Accepted: 12/23/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In 2017, the International Parkinson and Movement Disorder Society put forward new clinical criteria for the diagnosis of PSP, recognizing diverse PSP phenotypes. In this study, we compared the sensitivity and specificity of the new criteria with the National Institutes of Neurological Disease and Society for Progressive Supranuclear Palsy criteria at different times. METHODS Patients with clinical parkinsonism, clinical and/or neuropathological diagnosis of PSP, were identified from the Society for Progressive Supranuclear Palsy brain bank. All patients had neuropathologic diagnoses and detailed clinical examination performed by a neurologist at 1 of the 3 Mayo Clinic sites, in Florida, Arizona, and Minnesota. Clinical symptoms and signs were abstracted retrospectively in a blinded fashion and used to determine whether patients met either diagnostic criterion. Patients were divided into early and late disease stage groups using a 3-year cutoff. RESULTS A total of 129 patients were included, of whom 66 had PSP pathology (51%). The remainder had other neurodegenerative diseases. The overall sensitivity of the International Parkinson and Movement Disorder Society criteria was 87.9%, compared with 45.5% for the National Institutes of Neurological Disease and Society for Progressive Supranuclear Palsy criteria, whereas the specificity of the International Parkinson and Movement Disorder Society probable PSP criteria was 85.7%, compared with 90.5% for the National Institutes of Neurological Disease and Society for Progressive Supranuclear Palsy. Individual patients were noted to have features of multiple PSP phenotypes. CONCLUSION The International Parkinson and Movement Disorder Society criteria recognize several phenotypes of progressive supranuclear palsy and hence have higher sensitivity than the previous criteria. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Farwa Ali
- Department of Neurology Mayo Clinic Rochester
| | | | - Hugo Botha
- Department of Neurology Mayo Clinic Rochester
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ryan Uitti
- Department of Neurology Mayo Clinic Florida
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Ali F, Botha H, Whitwell JL, Josephs KA. Utility of the Movement Disorders Society Criteria for Progressive Supranuclear Palsy in Clinical Practice. Mov Disord Clin Pract 2019; 6:436-439. [PMID: 31392243 DOI: 10.1002/mdc3.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives When the 2017 Movement Disorders Society Criteria for progressive supranuclear palsy is applied, patients may appear to have multiple phenotypes. The maximum allocation extinction rules were developed to provide a consistent method for applying the criteria and reaching a single diagnostic label. In this study, we apply both to a neuropathologic cohort of progressive supranuclear palsy and other parkinsonian conditions. Methods An autopsy cohort of 54 patients with progressive supranuclear palsy and 56 patients with other neuropathologic diseases was selected. Clinical data were retrospectively abstracted, and the diagnostic criteria for progressive supranuclear palsy were applied. All possible phenotypes applicable were listed and maximum allocation extinction rules were applied to assess reduction in the number of phenotypes ascribed per patient. Results In the progressive supranuclear palsy group, 52 patients met the criteria for multiple phenotypes, with an average of 7 phenotypes per patient. In the nonprogressive supranuclear palsy group, all 56 patients had features of more than one phenotype, up to 3 per patient. After application of maximum allocation extinction rules, the majority of the patients in both groups had a single predominant phenotype. Freezing of gait, supranuclear gaze palsy, and frontal behavioral syndrome were more common in the progressive supranuclear palsy group. Conclusions The diagnostic criteria for progressive supranuclear palsy identify many clinical features, thereby leading to assignment of multiple phenotypes per patient. We demonstrate that the maximum allocation extinction rules can effectively lead to a single consensus phenotype, maintaining a uniform diagnostic label for clinical and research applications.
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Affiliation(s)
- Farwa Ali
- Department of Neurology Mayo Clinic Rochester Minnesota USA
| | - Hugo Botha
- Department of Neurology Mayo Clinic Rochester Minnesota USA
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50
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Rösler TW, Tayaranian Marvian A, Brendel M, Nykänen NP, Höllerhage M, Schwarz SC, Hopfner F, Koeglsperger T, Respondek G, Schweyer K, Levin J, Villemagne VL, Barthel H, Sabri O, Müller U, Meissner WG, Kovacs GG, Höglinger GU. Four-repeat tauopathies. Prog Neurobiol 2019; 180:101644. [PMID: 31238088 DOI: 10.1016/j.pneurobio.2019.101644] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 02/08/2023]
Abstract
Tau is a microtubule-associated protein with versatile functions in the dynamic assembly of the neuronal cytoskeleton. Four-repeat (4R-) tauopathies are a group of neurodegenerative diseases defined by cytoplasmic inclusions predominantly composed of tau protein isoforms with four microtubule-binding domains. Progressive supranuclear palsy, corticobasal degeneration, argyrophilic grain disease or glial globular tauopathy belong to the group of 4R-tauopathies. The present review provides an introduction in the current concept of 4R-tauopathies, including an overview of the neuropathological and clinical spectrum of these diseases. It describes the genetic and environmental etiological factors, as well as the contemporary knowledge about the pathophysiological mechanisms, including post-translational modifications, aggregation and fragmentation of tau, as well as the role of protein degradation mechanisms. Furthermore, current theories about disease propagation are discussed, involving different extracellular tau species and their cellular release and uptake mechanisms. Finally, molecular diagnostic tools for 4R-tauopathies, including tau-PET and fluid biomarkers, and investigational therapeutic strategies are presented. In summary, we report on 4R-tauopathies as overarching disease concept based on a shared pathophysiological concept, and highlight the challenges and opportunities on the way towards a causal therapy.
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Affiliation(s)
- Thomas W Rösler
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Dept. of Neurology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Amir Tayaranian Marvian
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Dept. of Neurology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Matthias Brendel
- Dept. of Nuclear Medicine, University of Munich, 81377 Munich, Germany
| | - Niko-Petteri Nykänen
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Matthias Höllerhage
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Dept. of Neurology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Sigrid C Schwarz
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | | | - Thomas Koeglsperger
- Dept. of Neurology, University of Munich, 81377 Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Gesine Respondek
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Dept. of Neurology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Kerstin Schweyer
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Dept. of Neurology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Johannes Levin
- Dept. of Neurology, University of Munich, 81377 Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Victor L Villemagne
- Dept. of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, 3084, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia; Dept. of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henryk Barthel
- Dept. of Nuclear Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Osama Sabri
- Dept. of Nuclear Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Ulrich Müller
- Institute for Human Genetics, University of Giessen, 35392 Giessen, Germany
| | - Wassilios G Meissner
- Service de Neurologie, CHU Bordeaux, 33000 Bordeaux, France; Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Dept. of Medicine, University of Otago, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, 1090 Vienna, Austria; Dept. of Laboratory Medicine and Pathobiology, University of Toronto, Laboratory Medicine Program, University Health Network, Toronto, Canada; Tanz Centre for Research in Neurodegenerative Disease, Krembil Brain Institute, Toronto, Canada
| | - Günter U Höglinger
- Dept. of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Dept. of Neurology, Technical University of Munich, School of Medicine, 81675 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany; Dept. of Neurology, Hannover Medical School, 30625 Hannover, Germany.
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