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Bentivenga GM, Baiardi S, Mastrangelo A, Ruggeri E, Mammana A, Ticca A, Rossi M, Capellari S, Parchi P. Clinical, neuropathological, and molecular characteristics of rapidly progressive dementia with Lewy bodies: a distinct clinicopathological entity? Alzheimers Res Ther 2024; 16:201. [PMID: 39256877 PMCID: PMC11384710 DOI: 10.1186/s13195-024-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND The term rapidly progressive dementia (RPD) with Lewy bodies (rpDLB) is used for DLB patients who develop a rapidly progressive neurological syndrome and have reduced survival. Here, we characterise the clinical, neuropathological, and molecular characteristics of a large rpDLB neuropathological series. METHODS We included all RPD patients with a disease duration < 4 years submitted to our prion disease referral centre between 2003 and 2022 who showed Lewy body pathology (LBP) in limbic or neocortical stages as primary neuropathological diagnosis, had no systemic condition justifying the rapid deterioration and were previously neurologically unimpaired. Clinical features were retrieved and compared with Creutzfeldt-Jakob disease (CJD) and rapidly progressive Alzheimer's disease (rpAD) cohorts. Neuropathological and genetic (whole exome sequencing, APOE genotyping, and C9orf72 repeat expansion analysis) characteristics of rpDLB patients were systematically investigated. We scored semi-quantitatively the LBP load and performed a α-synuclein (αSyn) RT-QuIC seeding amplification assay (SAA) on cerebrospinal fluid (CSF) and tenfold serially diluted brain homogenates from different brain areas in rpDLB patients and typical long-lasting Lewy body disease (LBD) with dementia patients as control group. RESULTS RpDLB patients were older (p = 0.047) and presented more cognitive fluctuations (p = 0.005), visual hallucinations (p = 0.020), neuropsychiatric symptoms (p = 0.006) and seizures (p = 0.032), and fewer cerebellar (p < 0.001) and visual (p = 0.004) signs than CJD ones. Delirium onset was more common than in both CJD (p < 0.001) and rpAD (p = 0.008). Atypical LBD signs (pyramidal, myoclonus, akinetic mutism) were common. All tested patients were positive by CSF αSyn SAA. Concomitant pathologies were common, with only four cases showing relatively "pure" LBP. LBP load and αSyn seeding activity measured through αSyn RT-QuIC SAA were not significantly different between rpDLB patients and typical LBD. We found a likely pathogenic variant in GBA in one patient. CONCLUSIONS Our results indicate that: 1) rpDLB exhibits a distinct clinical signature (2) CSF αSyn SAA is a reliable diagnostic test; 3) rpDLB is a heterogeneous neuropathological entity that can be underlain by both widespread pure LBP, or multiple copathologies 4) rpDLB is likely not sustained by distinct αSyn conformational strains; 5) genetic defects may, at least occasionally, contribute to the poor prognosis in these patients.
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Affiliation(s)
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Edoardo Ruggeri
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Angela Mammana
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Alice Ticca
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Marcello Rossi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Ospedale Bellaria, Via Altura 1/8, Bologna, 40139, Italy.
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Kovalenko EA, Makhnovich EV, Bogolepova AN, Osinovskaya NA, Beregov MM. [Features of the clinical and neuroimaging picture in patients with early-onset Alzheimer's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:56-63. [PMID: 38696152 DOI: 10.17116/jnevro202412404256] [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: 06/27/2024]
Abstract
The most common cause of severe cognitive impairment in adults is Alzheimer's disease (AD). Depending on the age of onset, AD is divided into early (<65 years) and late (≥65 years) forms. Early-onset AD (EOAD) is significantly less common than later-onset AD (LOAD) and accounts for only about 5-10% of cases. However, its medical and social significance, as a disease leading to loss of ability to work and legal capacity, as well as premature death in patients aged 40-64 years, is extremely high. Patients with EOAD compared with LOAD have a greater number of atypical clinical variants - 25% and 6-12.5%, respectively, which complicates the differential diagnosis of EOAD with other neurodegenerative diseases. However, the typical classical amnestic variant predominates in both EOAD and LOAD. Also, patients with EOAD have peculiarities according to neuroimaging data: when performing MRI of the brain, patients with EOAD often have more pronounced parietal atrophy and less pronounced hippocampal atrophy compared to patients with LOAD. The article pays attention to the features of the clinical and neuroimaging data in patients with EOAD; a case of a patient with EOAD is presented.
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Affiliation(s)
- E A Kovalenko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - E V Makhnovich
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - N A Osinovskaya
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - M M Beregov
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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3
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Hermann P, Schmitz M, Cramm M, Goebel S, Bunck T, Schütte-Schmidt J, Schulz-Schaeffer W, Stadelmann C, Matschke J, Glatzel M, Zerr I. Application of real-time quaking-induced conversion in Creutzfeldt-Jakob disease surveillance. J Neurol 2023; 270:2149-2161. [PMID: 36624183 PMCID: PMC9829526 DOI: 10.1007/s00415-022-11549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Evaluation of the application of CSF real-time quaking-induced conversion in Creutzfeldt-Jakob disease surveillance to investigate test accuracy, influencing factors, and associations with disease incidence. METHODS In a prospective surveillance study, CSF real-time quaking-induced conversion was performed in patients with clinical suspicion of prion disease (2014-2022). Clinically or histochemically characterized patients with sporadic Creutzfeldt-Jakob disease (n = 888) and patients with final diagnosis of non-prion disease (n = 371) were included for accuracy and association studies. RESULTS The overall test sensitivity for sporadic Creutzfeldt-Jakob disease was 90% and the specificity 99%. Lower sensitivity was associated with early disease stage (p = 0.029) and longer survival (p < 0.001). The frequency of false positives was significantly higher in patients with inflammatory CNS diseases (3.7%) than in other diagnoses (0.4%, p = 0.027). The incidence increased from 1.7 per million person-years (2006-2017) to 2.0 after the test was added to diagnostic the criteria (2018-2021). CONCLUSION We validated high diagnostic accuracy of CSF real-time quaking-induced conversion but identified inflammatory brain disease as a potential source of (rare) false-positive results, indicating thorough consideration of this condition in the differential diagnosis of Creutzfeldt-Jakob disease. The surveillance improved after amendment of the diagnostic criteria, whereas the incidence showed no suggestive alterations during the COVID-19 pandemic.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany.
| | - Matthias Schmitz
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Göttingen, Germany
| | - Maria Cramm
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | - Stefan Goebel
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | - Timothy Bunck
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | - Julia Schütte-Schmidt
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
| | | | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Zerr
- Department of Neurology, National Reference Center for CJD Surveillance, University Medical Center Göttingen, Robert-Koch Street 40, 37075, Goettingen, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Göttingen, Germany
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Hermann P, Zerr I. Rapidly progressive dementias - aetiologies, diagnosis and management. Nat Rev Neurol 2022; 18:363-376. [PMID: 35508635 PMCID: PMC9067549 DOI: 10.1038/s41582-022-00659-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/15/2022]
Abstract
Rapidly progressive dementias (RPDs) are a group of heterogeneous disorders that include immune-mediated, infectious and metabolic encephalopathies, as well as prion diseases and atypically rapid presentations of more common neurodegenerative diseases. Some of these conditions are treatable, and some must be diagnosed promptly because of their potential infectivity. Prion disease is considered to be the prototypical RPD, but over the past two decades, epidemiological reports and the identification of various encephalitis-mediating antibodies have led to a growing recognition of other encephalopathies as potential causes of rapid cognitive decline. Knowledge of RPD aetiologies, syndromes and diagnostic work-up protocols will help clinicians to establish an early, accurate diagnosis, thereby reducing morbidity and mortality, especially in immune-mediated and other potentially reversible dementias. In this Review, we define the syndrome of RPD and shed light on its different aetiologies and on secondary factors that might contribute to rapid cognitive decline. We describe an extended diagnostic procedure in the context of important differential diagnoses, discuss the utility of biomarkers and summarize potential treatment options. In addition, we discuss treatment options such as high-dose steroid therapy in the context of therapy and diagnosis in clinically ambiguous cases. The term ‘rapidly progressive dementia’ (RPD) describes a cognitive disorder with fast progression, leading to dementia within a relatively short time. This Review discusses the wide range of RPD aetiologies, as well as the diagnostic approach and treatment options. Definitions of rapidly progressive dementia (RPD) vary according to the aetiological background and relate to the speed of cognitive decline, time from first symptom to dementia syndrome and/or overall survival. RPD can occur in rapidly progressive neurodegenerative diseases, such as prion diseases, or in primarily slowly progressive diseases as a consequence of intrinsic factors or concomitant pathologies. Besides neurodegenerative diseases, inflammatory (immune-mediated and infectious), vascular, metabolic and neoplastic CNS diseases are important and frequent causes of RPD. To identify treatable causes of RPD, the technical diagnostic work-up must include MRI and analyses of blood and cerebrospinal fluid, and further diagnostics might be indicated in unclear cases. Therapeutic options for many non-neurodegenerative causes of RPD are already available; disease-modifying therapies for neurodegenerative RPDs are an important focus of current research and could become a treatment option in the near future.
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Affiliation(s)
- Peter Hermann
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center and National Reference Center for CJD Surveillance, University Medical Center, Göttingen, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.
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5
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Elziny MM, Elsaid SS. Rapidly Progressive Probable Sporadic Creutzfeldt-Jakob Disease. Cureus 2022; 14:e23245. [PMID: 35449632 PMCID: PMC9012942 DOI: 10.7759/cureus.23245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare, fatal brain infection caused by a human prion. Because CJD is associated with rapidly progressive neurological degeneration, it requires high suspicion for diagnosis. We report the case of a 79-year-old patient who presented with a rapidly progressive neurological clinical picture. The patient had positive 14-3-3 proteins in cerebrospinal fluid, electroencephalography was significant for periodic discharges, and magnetic resonance imaging of the brain showed both diffusion restriction and increased fluid-attenuated inversion recovery signal in different cortical regions, consistent with probable sporadic CJD infection. The patient was enrolled under hospice and palliative care. The patient passed away two months after the onset of her symptoms. We discuss the probable sporadic CJD diagnostic criteria and possible risk factors that might have led to a faster progressive course.
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6
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Brandel JP. [Prion diseases or transmissible spongiform encephalopathies]. Rev Med Interne 2021; 43:106-115. [PMID: 34148672 DOI: 10.1016/j.revmed.2021.05.002] [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: 03/25/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
Prion diseases or transmissible spongiform encephalopathies (TSEs) are human and animal diseases naturally or experimentally transmissible with a long incubation period and a fatal course without remission. The nature of the transmissible agent remains debated but the absence of a structure evoking a conventional microorganism led Stanley B. Prusiner to hypothesize that it could be an infectious protein (proteinaceous infectious particle or prion). The prion would be the abnormal form of a normal protein, cellular PrP (PrPc) which will change its spatial conformation and be converted into scrapie prion protein (PrPsc) with properties of partial resistance to proteases, aggregation and insolubility in detergents. No inflammatory or immune response are detected in TSEs which are characterized by brain damage combining spongiosis, neuronal loss, astrocytic gliosis, and deposits of PrPsc that may appear as amyloid plaques. Although the link between the accumulation of PrPsc and the appearance of lesions remains debated, the presence of PrPsc is constant during TSE and necessary for a definitive diagnosis. Even if they remain rare diseases (2 cases per million), the identification of kuru, at the end of the 1950s, of iatrogenic cases in the course of the 1970s and of the variant of Creutzfeldt-Jakob disease (CJD) in the mid-1990s explain the interest in these diseases but also the fears they can raise for public health. They remain an exciting research model because they belong both to the group of neurodegenerative diseases with protein accumulation (sporadic CJD), to the group of communicable diseases (iatrogenic CJD, variant of CJD) but also to the group of genetic diseases with a transmission Mendelian dominant (genetic CJD, Gerstmann-Straussler-Scheinker syndrome, fatal familial insomnia).
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Affiliation(s)
- J-P Brandel
- Cellule nationale de référence des maladies de Creutzfeldt-Jakob, Groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Inserm U1127/Institut du cerveau et de la moelle épinière (ICM), Groupe hospitalier Pitié-Salpêtrière, Centre national de référence des agents transmissibles non conventionnels, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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7
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Cheng L, Quek C, Li X, Bellingham SA, Ellett LJ, Shambrook M, Zafar S, Zerr I, Lawson VA, Hill AF. Distribution of microRNA profiles in pre-clinical and clinical forms of murine and human prion disease. Commun Biol 2021; 4:411. [PMID: 33767334 PMCID: PMC7994852 DOI: 10.1038/s42003-021-01868-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
Prion diseases are distinguished by long pre-clinical incubation periods during which prions actively propagate in the brain and cause neurodegeneration. In the pre-clinical stage, we hypothesize that upon prion infection, transcriptional changes occur that can lead to early neurodegeneration. A longitudinal analysis of miRNAs in pre-clinical and clinical forms of murine prion disease demonstrated dynamic expression changes during disease progression in the affected thalamus region and serum. Serum samples at each timepoint were collected whereby extracellular vesicles (EVs) were isolated and used to identify blood-based biomarkers reflective of pathology in the brain. Differentially expressed EV miRNAs were validated in human clinical samples from patients with human sporadic Creutzfeldt-Jakob disease (sCJD), with the molecular subtype at codon 129 either methionine-methionine (MM, n = 14) or valine-valine (VV, n = 12) compared to controls (n = 20). EV miRNA biomarkers associated with prion infection predicted sCJD with an AUC of 0.800 (85% sensitivity and 66.7% specificity) in a second independent validation cohort (n = 26) of sCJD and control patients with MM or VV subtype. This study discovered clinically relevant miRNAs that benefit diagnostic development to detect prion-related diseases and therapeutic development to inhibit prion infectivity. Cheng et al. present differentially expressed extracellular vesicle miRNAs in human clinical samples from patients who suffer from sporadic Creutzfeldt-Jakob disease. This study identifies biomarkers that can be used to detect prion-related diseases, providing insights into drug development for inhibiting prion infectivity.
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Affiliation(s)
- Lesley Cheng
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia. .,Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, VIC, Australia.
| | - Camelia Quek
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Bundoora, VIC, Australia
| | - Shayne A Bellingham
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Laura J Ellett
- Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Mitch Shambrook
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia.,Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Saima Zafar
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases, Göttingen, Germany.,Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Victoria A Lawson
- Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew F Hill
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia. .,Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, VIC, Australia.
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Hermann P, Appleby B, Brandel JP, Caughey B, Collins S, Geschwind MD, Green A, Haïk S, Kovacs GG, Ladogana A, Llorens F, Mead S, Nishida N, Pal S, Parchi P, Pocchiari M, Satoh K, Zanusso G, Zerr I. Biomarkers and diagnostic guidelines for sporadic Creutzfeldt-Jakob disease. Lancet Neurol 2021; 20:235-246. [PMID: 33609480 DOI: 10.1016/s1474-4422(20)30477-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022]
Abstract
Sporadic Creutzfeldt-Jakob disease is a fatal neurodegenerative disease caused by misfolded prion proteins (PrPSc). Effective therapeutics are currently not available and accurate diagnosis can be challenging. Clinical diagnostic criteria use a combination of characteristic neuropsychiatric symptoms, CSF proteins 14-3-3, MRI, and EEG. Supportive biomarkers, such as high CSF total tau, could aid the diagnostic process. However, discordant studies have led to controversies about the clinical value of some established surrogate biomarkers. Development and clinical application of disease-specific protein aggregation and amplification assays, such as real-time quaking induced conversion (RT-QuIC), have constituted major breakthroughs for the confident pre-mortem diagnosis of sporadic Creutzfeldt-Jakob disease. Updated criteria for the diagnosis of sporadic Creutzfeldt-Jakob disease, including application of RT-QuIC, should improve early clinical confirmation, surveillance, assessment of PrPSc seeding activity in different tissues, and trial monitoring. Moreover, emerging blood-based, prognostic, and potentially pre-symptomatic biomarker candidates are under investigation.
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Affiliation(s)
- Peter Hermann
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Brian Appleby
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH, USA; Departments of Neurology, Psychiatry, and Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jean-Philippe Brandel
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Steven Collins
- Australian National Creutzfeldt-Jakob disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | - Alison Green
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephane Haïk
- Cellule Nationale de Référence des Maladies de Creutzfeldt-Jakob, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Franc Llorens
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Network Center For Biomedical Research Of Neurodegenerative Diseases, Institute Carlos III, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Simon Mead
- National Prion Clinic, University College London Hospitals NHS Foundation Trust, London, UK; Medical Research Council Prion Unit at University College London, Institute of Prion Diseases, London, UK
| | - Noriyuki Nishida
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Suvankar Pal
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Piero Parchi
- Istituto di Ricovero e Cura e Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Katsuya Satoh
- Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Inga Zerr
- National Reference Center for Transmissible Spongiform Encephalopathies, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; German Center for Neurodegenerative Diseases, Göttingen, Germany
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9
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Horimoto Y, Sato C, Inagaki A, Tajima T, Hibino H, Kabasawa H, Inagaki H. Prion diseases reported in the "Annual of the Pathological Autopsy Cases in Japan". J Neurol Sci 2020; 420:117215. [PMID: 33183777 DOI: 10.1016/j.jns.2020.117215] [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: 09/16/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND For surveillance projects to be successful, it is important to accurately diagnose all patients, without overlooking any cases. Here, we investigated the present clinical diagnostic accuracy for prion diseases in Japan. METHODS We analyzed volumes of the "Annual of the Pathological Autopsy Cases in Japan", which reported details on 130,105 autopsies conducted from 2007 to 2016 throughout Japan. RESULTS The clinical diagnosis of patients with prion disease had a specificity of 91.3% and a sensitivity of 96.3%. The autopsy rates were estimated as 17.8% for patients with clinically suspected prion disease and as 1.8% for the entire population. CONCLUSIONS Despite the good accuracy of clinical diagnoses of prion diseases, a calculated 78.4 patients with prion disease were expected to have gone undiagnosed during the 10-year study period. However, autopsy is estimated to reveal a maximum of only 13.8 of these clinically undiagnosed patients because of the low autopsy rate. The overall autopsy rate, irrespective of any specific disorder, must increase for effective surveillance projects of disease incidence to be conducted.
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Affiliation(s)
| | - Chikako Sato
- Department of Neurology, Nagoya City Rehabilitation Center, Japan
| | - Aki Inagaki
- Department of Neurology, Nagoya City Rehabilitation Center, Japan
| | - Toshihisa Tajima
- Department of Neurology, Nagoya City Rehabilitation Center, Japan
| | - Hiroaki Hibino
- Department of Neurology, Nagoya City Rehabilitation Center, Japan
| | | | - Hiroshi Inagaki
- Department of Anatomic Pathology and Molecular Diagnostics, Nagoya City University, Japan
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10
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Ehrenberg AJ, Khatun A, Coomans E, Betts MJ, Capraro F, Thijssen EH, Senkevich K, Bharucha T, Jafarpour M, Young PNE, Jagust W, Carter SF, Lashley T, Grinberg LT, Pereira JB, Mattsson-Carlgren N, Ashton NJ, Hanrieder J, Zetterberg H, Schöll M, Paterson RW. Relevance of biomarkers across different neurodegenerative diseases. ALZHEIMERS RESEARCH & THERAPY 2020; 12:56. [PMID: 32404143 PMCID: PMC7222479 DOI: 10.1186/s13195-020-00601-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/16/2020] [Indexed: 01/11/2023]
Abstract
Background The panel of fluid- and imaging-based biomarkers available for neurodegenerative disease research is growing and has the potential to close important gaps in research and the clinic. With this growth and increasing use, appropriate implementation and interpretation are paramount. Various biomarkers feature nuanced differences in strengths, limitations, and biases that must be considered when investigating disease etiology and clinical utility. For example, neuropathological investigations of Alzheimer’s disease pathogenesis can fall in disagreement with conclusions reached by biomarker-based investigations. Considering the varied strengths, limitations, and biases of different research methodologies and approaches may help harmonize disciplines within the neurodegenerative disease field. Purpose of review Along with separate review articles covering fluid and imaging biomarkers in this issue of Alzheimer’s Research and Therapy, we present the result of a discussion from the 2019 Biomarkers in Neurodegenerative Diseases course at the University College London. Here, we discuss themes of biomarker use in neurodegenerative disease research, commenting on appropriate use, interpretation, and considerations for implementation across different neurodegenerative diseases. We also draw attention to areas where biomarker use can be combined with other disciplines to understand issues of pathophysiology and etiology underlying dementia. Lastly, we highlight novel modalities that have been proposed in the landscape of neurodegenerative disease research and care.
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Affiliation(s)
- Alexander J Ehrenberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA. .,Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA. .,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA.
| | - Ayesha Khatun
- Dementia Research Centre, University College London Institute of Neurology, London, UK
| | - Emma Coomans
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Matthew J Betts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Institute of Cognitive Neurology and Dementia Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Federica Capraro
- The Francis Crick Institute, London, UK.,Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology, London, UK
| | - Elisabeth H Thijssen
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Clinical Chemistry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Konstantin Senkevich
- Petersburg Nuclear Physics Institute names by B.P. Konstantinov of National Research Center, Kurchatov Institute, St. Petersburg, Russia.,First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Tehmina Bharucha
- Oxford Glycobiology Institute, Department of Biochemistry , University of Oxford, Oxford, UK
| | - Mehrsa Jafarpour
- Department of Neurodegenerative Disease, UCL Queen Square, Institute of Neurology, University College London, London, UK
| | - Peter N E Young
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Center for Molecular and Translational Medicine, Lund University, Lund, Sweden
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA.,Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Tammaryn Lashley
- Department of Neurodegenerative Disease, UCL Queen Square, Institute of Neurology, University College London, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Lea T Grinberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,University of São Paulo Medical School, São Paulo, Brazil.,Global Brain Health Institute, San Francisco, CA, USA
| | - Joana B Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Center for Molecular and Translational Medicine, Lund University, Lund, Sweden
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Center for Molecular and Translational Medicine, Lund University, Lund, Sweden.,King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, UK.,NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK
| | - Jörg Hanrieder
- Department of Neurodegenerative Disease, UCL Queen Square, Institute of Neurology, University College London, London, UK.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square, Institute of Neurology, University College London, London, UK.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at University College London, London, UK
| | - Michael Schöll
- Department of Neurodegenerative Disease, UCL Queen Square, Institute of Neurology, University College London, London, UK.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ross W Paterson
- Dementia Research Centre, University College London Institute of Neurology, London, UK
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11
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Detection of Pathognomonic Biomarker PrP Sc and the Contribution of Cell Free-Amplification Techniques to the Diagnosis of Prion Diseases. Biomolecules 2020; 10:biom10030469. [PMID: 32204429 PMCID: PMC7175149 DOI: 10.3390/biom10030469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
Transmissible spongiform encephalopathies or prion diseases are rapidly progressive neurodegenerative diseases, the clinical manifestation of which can resemble other promptly evolving neurological maladies. Therefore, the unequivocal ante-mortem diagnosis is highly challenging and was only possible by histopathological and immunohistochemical analysis of the brain at necropsy. Although surrogate biomarkers of neurological damage have become invaluable to complement clinical data and provide more accurate diagnostics at early stages, other neurodegenerative diseases show similar alterations hindering the differential diagnosis. To solve that, the detection of the pathognomonic biomarker of disease, PrPSc, the aberrantly folded isoform of the prion protein, could be used. However, the amounts in easily accessible tissues or body fluids at pre-clinical or early clinical stages are extremely low for the standard detection methods. The solution comes from the recent development of in vitro prion propagation techniques, such as Protein Misfolding Cyclic Amplification (PMCA) and Real Time-Quaking Induced Conversion (RT-QuIC), which have been already applied to detect minute amounts of PrPSc in different matrixes and make early diagnosis of prion diseases feasible in a near future. Herein, the most relevant tissues and body fluids in which PrPSc has been detected in animals and humans are being reviewed, especially those in which cell-free prion propagation systems have been used with diagnostic purposes.
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12
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Takahashi-Iwata I, Yabe I, Kudo A, Eguchi K, Wakita M, Shirai S, Matsushima M, Toyoshima T, Chiba S, Tanikawa S, Tanaka S, Satoh K, Kitamoto T, Sasaki H. MM2 cortical form of sporadic Creutzfeldt-Jakob disease without progressive dementia and akinetic mutism: A case deviating from current diagnostic criteria. J Neurol Sci 2020; 412:116759. [PMID: 32114028 DOI: 10.1016/j.jns.2020.116759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/16/2020] [Accepted: 02/23/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ikuko Takahashi-Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Akihiko Kudo
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Katsuya Eguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Masahiro Wakita
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Takanobu Toyoshima
- Department of Neurology, Nishimaruyama Hospital, 7-25, 4 chou-me, Maruyama Nishimachi, Chuou-ku, Sapporo 064-8557, Japan
| | - Susumu Chiba
- Department of Neurology, Nishimaruyama Hospital, 7-25, 4 chou-me, Maruyama Nishimachi, Chuou-ku, Sapporo 064-8557, Japan
| | - Satoshi Tanikawa
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Shinya Tanaka
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Katsuya Satoh
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Science, 7-1, 1 chou-me, Sakamoto, Nagasaki 852-8501, Japan
| | - Tetsuyuki Kitamoto
- Department of Neurological Science, Tohoku University Graduate School of Medicine, 2-1, seiryouchou, Aoba-ku, Sendai 980-8575, Japan
| | - Hidenao Sasaki
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
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13
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Seilhean D. Neuropathology in Pitié-Salpêtrière hospital: Past, present and prospect. Neuropathology 2019; 40:3-13. [PMID: 31802544 DOI: 10.1111/neup.12616] [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: 09/21/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
Pitié and La Salpêtrière, both founded in the17th century, were for long two distinct hospitals until they merged in 1964. The name La Salpêtrière is inherited from the initial purpose of the buildings designed to produce saltpeter for gun powder. But the place was soon transformed into an asylum to shelter the poor and the insane. From the care of this underprivileged population, alienists such as Pinel have paved the way for modern medicine for the mentally ill at the time of the French Revolution. In the second half of the 19th century, Jean-Martin Charcot and his students laid the foundations of modern neurology from the observation of the large population hosted in La Salpêtrière, mostly women with severe chronic diseases. Charcot led clinicopathological studies in almost all the fields of nervous system disorders. His successors (including Raymond, Dejerine, Pierre Marie) maintained the same close relationship between clinical neurology and neuropathology. In parallel with the development of neurosurgery at Pitié hospital, neuropathology first spread through small laboratories attached to clinical departments. The merger of the two hospitals in the early '60s coincided with the creation of a large university hospital in which the care and study of diseases of the nervous system were preponderant. An independent laboratory of neuropathology was created, led by Raymond Escourolle. This period was on the eve of important developments in neuroscience around the world. Today, the Pitié-Salpêtrière neuropathology laboratory still plays a central role between neurology and neurosurgery clinics and major research institutes such as the Brain Institute, callled Institut du Cerveau et de la Moelle (ICM), and the Institute of Myology.
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Affiliation(s)
- Danielle Seilhean
- Raymond Escourolle Department of Neuropathology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
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14
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Tilley BS, Smith C, Pavese N, Attems J. Rare histotype of sporadic Creutzfeldt-Jakob disease, clinically suspected as corticobasal degeneration. BMJ Case Rep 2019; 12:e228305. [PMID: 30850568 PMCID: PMC6424260 DOI: 10.1136/bcr-2018-228305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/04/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare neurodegenerative disease that can mimic other neurological disorders. We present a case of sCJD in a 64-year-old man that presented with corticobasal syndrome and survived for 3 years. He presented initially with dementia, hemiparkinsonism and alien limb phenomenon and was diagnosed with corticobasal degeneration, ultimately progressing to immobility and akinetic mutism. With a normal MRI 1 year before onset, his neuroimaging 1 year later revealed abnormal DaTscan, cortical and hippocampal atrophy with ventricular dilatation on MRI, and diffusion-weighted cortical ribboning and thalamic hyperintensity. Postmortem, the patient's brain was collected by the Parkinson's UK Tissue Bank. Prion protein immunohistochemistry revealed widespread diffuse microvacuolar staining without kuru-type plaques. Hyperphosphorylated tau was only found in the entorhinal cortex and hippocampus. This case highlights the clinical heterogeneity of sCJD presentation and the important inclusion of CJD in the differential diagnosis of atypical presentations of neurodegenerative disease.
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Affiliation(s)
| | - Colin Smith
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - Nicola Pavese
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
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15
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A network analysis based approach to characterizing periodic sharp wave complexes in electroencephalograms of patients with sporadic CJD. Int J Med Inform 2018; 121:19-29. [PMID: 30545486 DOI: 10.1016/j.ijmedinf.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/12/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022]
Abstract
Creutzfeldt-Jacob disease (CJD) is a rapidly progressive, uniformly fatal transmissible spongiform encephalopathy. Sporadic CJD (sCJD) is the most common form of CJD. Electroencephalography (EEG) is one of the main methods to perform clinical diagnosis of CJD, mainly because of periodic sharp wave complexes (PSWCs). In this paper, we propose a network analysis based approach to characterizing PSWCs in EEGs of patients with sCJD. Our approach associates a network with each EEG at disposal and defines a new numerical coefficient and some network motifs, which characterize the presence of PSWCs in an EEG tracing. The new coefficient, called connection coefficient, and the detected network motifs are capable of characterizing the EEG tracing segments with PSWCs. Furthermore, network motifs are able to detect what are the most active and/or connected brain areas in the tracing segments with PSWCs. The results obtained show that, analogously to what happens for other neurological diseases, network analysis can be successfully exploited to investigate sCJD.
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16
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Sipilä JOT, Rissanen E, Korpela J, Päivärinta M. Steroid-responsive encephalopathy with a peculiar CSF biomarker profile in an 89-year-old man. Oxf Med Case Reports 2018; 2018:omy073. [PMID: 30263128 PMCID: PMC6151313 DOI: 10.1093/omcr/omy073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022] Open
Abstract
Being treatable, steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), or Hashimoto's encephalopathy, should be distinguished from untreatable conditions. Our patient was a previously healthy 89-year-old man, who presented with cognitive and balance deterioration over several months. His cerebrospinal fluid (CSF) examination was positive for protein 14-3-3 but no other test suggested Creutzfeldt-Jacob disease. His condition improved markedly, although not fully, with intravenous corticosteroids. In control CSF sampling, protein 14-3-3 was negative but a biomarker signature consistent with Alzheimer's disease was observed. SREAT should be considered also in the very elderly in case of subacute encephalopathy.
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Affiliation(s)
- Jussi O T Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
- Department of Neurology, University of Turku, Turku, Finland
- Department of Neurology, Siun Sote North Karelia Central Hospital, Joensuu, Finland
| | - Eero Rissanen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
- Department of Neurology, University of Turku, Turku, Finland
| | - Jaana Korpela
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
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17
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Saraceno L, Ricigliano VAG, Cavalli M, Cagol A, Bosco G, Moda F, Caroppo P, Meola G. Sporadic MM-1 Type Creutzfeldt-Jakob Disease With Hemiballic Presentation and No Cognitive Impairment Until Death: How New NCJDRSU Diagnostic Criteria May Allow Early Diagnosis. Front Neurol 2018; 9:739. [PMID: 30233486 PMCID: PMC6134320 DOI: 10.3389/fneur.2018.00739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/14/2018] [Indexed: 12/05/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease is the most common human prion disorder. Although associated with heterogeneous clinical phenotypes, its distinctive feature is the presence of a rapidly progressive multidomain cognitive impairment. We describe the atypical case of a patient affected by sporadic Methionine/Methionine type 1 Creutzfeldt-Jakob disease (typically associated with early cognitive decline) who presented with an isolated hemiballic syndrome and no signs of cognitive involvement until death. We review sporadic Creutzfeldt-Jakob disease diagnostic criteria and their updates since their first formulation, highlighting their limitations in clinical diagnostic work-up. Finally, we discuss the recently introduced National Creutzfeldt-Jakob Disease Research and Surveillance Unit diagnostic criteria, suggesting how their application could support an early clinical diagnosis, even in atypical cases, such as the one presented.
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Affiliation(s)
- Lorenzo Saraceno
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Vito A G Ricigliano
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Michele Cavalli
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Alessandro Cagol
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Giovanna Bosco
- Department of Neurology, IRCCS Policlinico San Donato, Milan, Italy
| | - Fabio Moda
- Carlo Besta Neurological Institute, IRCCS Foundation, Milan, Italy
| | - Paola Caroppo
- Carlo Besta Neurological Institute, IRCCS Foundation, Milan, Italy
| | - Giovanni Meola
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.,Department of Neurology, IRCCS Policlinico San Donato, Milan, Italy
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18
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Gushue D, Herbst A, Sim V, McKenzie D, Aiken JM. 14-3-3 and enolase abundances in the CSF of Prion diseased rats. Prion 2018; 12:253-260. [PMID: 30149773 PMCID: PMC6277185 DOI: 10.1080/19336896.2018.1513317] [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] [Indexed: 10/28/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is characterized by an extended asymptomatic preclinical phase followed by rapid neurodegeneration. There are no effective treatments. CJD diagnosis is initially suspected based upon the clinical presentation of the disease and the exclusion of other etiologies. Neurologic symptoms are assessed in combination with results from cerebrospinal fluid (CSF) biomarker abundances, electroencephalography (EEG), magnetic resonance imaging (MRI), and in some countries, real-time quaking-induced conversion (RT-QuIC). Inconsistencies in sensitivities and specificities of prion disease biomarker abundance in CSF have been described, which can affect diagnostic certainty, but the utility of biomarkers for prognosis has not been fully explored. The clinical presentation of CJD is variable, and factors such as prion protein polymorphic variants, prion strain, and other genetic or environmental contributions may affect the disease progression, confounding the appearance or abundance of biomarkers in the CSF. These same factors may also affect the appearance or abundance of biomarkers, further confounding diagnosis. In this study, we controlled for many of these variables through the analysis of serial samples of CSF from prion-infected and control rats. Prion disease in laboratory rodents follows a defined disease course as the infection route and time, prion strain, genotype, and environmental conditions are all controlled. We measured the relative abundance of 14-3-3 and neuron-specific enolase (NSE) in CSF during the course of prion infection in rats. Even when disease-related, environmental and genetic variables were controlled, CSF 14-3-3 and NSE abundances were variable. Our study emphasizes the considerable diagnostic and prognostic limitations of these prion biomarkers.
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Affiliation(s)
- Danielle Gushue
- a Department of Agricultural, Food and Nutritional Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Allen Herbst
- a Department of Agricultural, Food and Nutritional Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Valerie Sim
- b Department of Medicine - Division of Neurology, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Debbie McKenzie
- c Department of Biological Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
| | - Judd M Aiken
- a Department of Agricultural, Food and Nutritional Sciences, Centre for Prions and Protein Folding Diseases , University of Alberta , Edmonton , Canada
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