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Thaler A, Livne V, Rubinstein E, Omer N, Faust-Socher A, Cohen B, Giladi N, Shirvan JC, Cedarbaum JM, Gana-Weisz M, Goldstein O, Orr-Urtreger A, Alcalay RN, Mirelman A. Mild cognitive impairment among LRRK2 and GBA1 patients with Parkinson's disease. Parkinsonism Relat Disord 2024; 123:106970. [PMID: 38691978 DOI: 10.1016/j.parkreldis.2024.106970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/18/2024] [Accepted: 04/07/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is common in Parkinson's disease (PD). We aimed to assess the incidence of MCI among patients with PD, carriers of mutations in LRRK2 and GBA1 genes, based on the movement disorder society (MDS) criteria for the diagnosis of MCI in early-stage PD. METHODS Patients with PD were included if they scored ≤2 on the Hoehn and Yahr and ≤6 years since motor symptom onset. A group of age and gender matched healthy adults served as controls. A neuropsychological cognitive battery was used covering five cognitive domains (executive functions, working memory, memory, visuospatial and language). MCI was explored while applying two methods (level I and II). Frequency of MCI was assessed in comparison between groups. RESULTS 70 patients with idiopathic PD (iPD) (68 % males), 42 patients with LRRK2-PD (61 % males), 83 patients with GBA1-PD (63 % males) and 132 age and gender matched controls (61 % males), participated in this study. PD groups were similar in clinical characteristics. Level I criteria were positive in 57.5 % of iPD, 43 % of LRRK2-PD and 63.4 % of the GBA1-PD (p = 0.071). Level II criteria was met by 39 % of iPD, 14 % LRRK2-PD and 41 % of GBA1-PD (p < 0.001), when using a 2 standard-deviation (SD) threshold. GBA1-PD and iPD showed impairments on multiple domains even in the more conservative 2 SD, reflecting MCI. CONCLUSIONS The majority of our PD cohort was classified as MCI when assessed with strict criteria. GBA1-PD and iPD showed a more widespread pattern of MCI compared with LRRK2-PD.
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Affiliation(s)
- Avner Thaler
- Faculty of Medicine, Tel-Aviv University, Israel; Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Israel; Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Israel; Sagol School of Neuroscience, Tel-Aviv University, Israel.
| | - Vered Livne
- Faculty of Medicine, Tel-Aviv University, Israel; Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Israel
| | | | - Nurit Omer
- Faculty of Medicine, Tel-Aviv University, Israel; Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Israel; Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Israel
| | - Achinoam Faust-Socher
- Faculty of Medicine, Tel-Aviv University, Israel; Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Israel
| | - Batsheva Cohen
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Israel
| | - Nir Giladi
- Faculty of Medicine, Tel-Aviv University, Israel; Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Israel; Sagol School of Neuroscience, Tel-Aviv University, Israel
| | | | | | - Mali Gana-Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Avi Orr-Urtreger
- Faculty of Medicine, Tel-Aviv University, Israel; Sagol School of Neuroscience, Tel-Aviv University, Israel; Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Roy N Alcalay
- Faculty of Medicine, Tel-Aviv University, Israel; Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Israel; Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Israel; Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Anat Mirelman
- Faculty of Medicine, Tel-Aviv University, Israel; Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Israel; Sagol School of Neuroscience, Tel-Aviv University, Israel
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Schejter-Margalit T, Binyamin NB, Thaler A, Maidan I, Cedarbaum JM, Orr-Urtreger A, Gana Weisz M, Goldstein O, Giladi N, Mirelman A, Kizony R. Validity of the Short Weekly Calendar Planning Activity in patients with Parkinson disease and nonmanifesting LRRK2 and GBA carriers. Eur J Neurol 2024:e16327. [PMID: 38743695 DOI: 10.1111/ene.16327] [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: 08/21/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Subtle executive dysfunction is common in people newly diagnosed with Parkinson disease (PD), even when general cognitive abilities are intact. This study examined the Short Weekly Calendar Planning Activity (WCPA-10)'s known-group construct validity, comparing persons with PD to healthy controls (HCs) and nonmanifesting carriers of LRRK2 and GBA gene mutations to HCs. Additionally, convergent and ecological validity was examined. METHODS The study included 73 participants: 22 with idiopathic PD (iPD) who do not carry any of the founder GBA mutations or LRRK2-G2019S, 29 nonmanifesting carriers of the G2019S-LRRK2 (n = 14) and GBA (n = 15) mutations, and 22 HCs. Known-group validity was determined using the WCPA-10, convergent validity by also using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT), and ecological validity by using the WCPA-10, Schwab and England Activities of Daily Living Scale (SE ADL), and Physical Activity Scale for the Elderly (PASE). RESULTS Known-group validity of the WCPA-10 was established for the iPD group only; they followed fewer rules (p = 0.020), were slower (p = 0.003) and less efficient (p = 0.001), used more strategies (p = 0.017) on the WCPA-10, and achieved significantly lower CTT scores (p < 0.001) than the HCs. The nonmanifesting carriers and HCs were similar on all cognitive tests. Convergent and ecological validity of the WCPA-10 were partially established, with few correlations between WCPA-10 outcome measures and the MoCA (r = 0.50, r = 0.41), CTT-2 (r = 0.43), SE ADL (r = 0.41), and PASE (r = 0.54, r = 0.46, r = 0.31). CONCLUSIONS This study affirms the known-group validity for most (four) WCPA-10 scores and partially confirms its convergent and ecological validity for PD.
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Affiliation(s)
- Tamara Schejter-Margalit
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Occupational Therapy Department, University of Haifa, Haifa, Israel
| | | | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jesse M Cedarbaum
- Yale University School of Medicine and Coeruleus Clinical Sciences, Woodbridge, Connecticut, USA
| | - Avi Orr-Urtreger
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Genomic Research Laboratory for Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mali Gana Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Kizony
- Occupational Therapy Department, University of Haifa, Haifa, Israel
- Occupational Therapy, Sheba Medical Center, Tel Hashomer, Israel
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Droby A, Thaler A, Mirelman A. Imaging Markers in Genetic Forms of Parkinson's Disease. Brain Sci 2023; 13:1212. [PMID: 37626568 PMCID: PMC10452191 DOI: 10.3390/brainsci13081212] [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: 07/19/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Parkinson's disease (PD) is a complex neurodegenerative disorder characterized by motor symptoms such as bradykinesia, rigidity, and resting tremor. While the majority of PD cases are sporadic, approximately 15-20% of cases have a genetic component. Advances in neuroimaging techniques have provided valuable insights into the pathophysiology of PD, including the different genetic forms of the disease. This literature review aims to summarize the current state of knowledge regarding neuroimaging findings in genetic PD, focusing on the most prevalent known genetic forms: mutations in the GBA1, LRRK2, and Parkin genes. In this review, we will highlight the contributions of various neuroimaging modalities, including positron emission tomography (PET), single-photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI), in elucidating the underlying pathophysiological mechanisms and potentially identifying candidate biomarkers for genetic forms of PD.
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Affiliation(s)
- Amgad Droby
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6801298, Israel; (A.T.); (A.M.)
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 39040, Israel
| | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6801298, Israel; (A.T.); (A.M.)
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 39040, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6801298, Israel; (A.T.); (A.M.)
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 39040, Israel
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Taymans JM, Fell M, Greenamyre T, Hirst WD, Mamais A, Padmanabhan S, Peter I, Rideout H, Thaler A. Perspective on the current state of the LRRK2 field. NPJ Parkinsons Dis 2023; 9:104. [PMID: 37393318 PMCID: PMC10314919 DOI: 10.1038/s41531-023-00544-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/05/2023] [Indexed: 07/03/2023] Open
Abstract
Almost 2 decades after linking LRRK2 to Parkinson's disease, a vibrant research field has developed around the study of this gene and its protein product. Recent studies have begun to elucidate molecular structures of LRRK2 and its complexes, and our understanding of LRRK2 has continued to grow, affirming decisions made years ago to therapeutically target this enzyme for PD. Markers of LRRK2 activity, with potential to monitor disease progression or treatment efficacy, are also under development. Interestingly, there is a growing understanding of the role of LRRK2 outside of the central nervous system in peripheral tissues such as gut and immune cells that may also contribute to LRRK2 mediated pathology. In this perspective, our goal is to take stock of LRRK2 research by discussing the current state of knowledge and critical open questions in the field.
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Affiliation(s)
- Jean-Marc Taymans
- Univ. Lille, Inserm, CHU Lille, UMR-S 1172-LilNCog-Lille Neuroscience & Cognition, F-59000, Lille, France.
| | - Matt Fell
- Merck & Co., Inc., 33 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Tim Greenamyre
- Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh, 3501 Fifth Avenue, Suite 7039, Pittsburgh, PA, 15260, USA
| | - Warren D Hirst
- Neurodegenerative Diseases Research Unit, Biogen, 115 Broadway, Cambridge, MA, 02142, USA
| | - Adamantios Mamais
- Center for Translational Research in Neurodegenerative Disease, Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Shalini Padmanabhan
- The Michael J. Fox Foundation for Parkinson's Research, Grand Central Station, P.O. Box 4777, New York, NY, 10120, USA
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY, 10029, USA
| | - Hardy Rideout
- Centre for Clinical, Experimental Surgery, and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Avner Thaler
- Movement Disorders Unit and Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Faculty of medicine, Tel-Aviv University, Tel-Aviv, Israel
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5
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DeBroff J, Omer N, Cohen B, Giladi N, Kestenbaum M, Shirvan JC, Cedarbaum JM, Gana‐Weisz M, Goldstein O, Orr‐Urtreger A, Mirelman A, Thaler A. The Influence of GBA and LRRK2 on Mood Disorders in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:606-616. [PMID: 37070047 PMCID: PMC10105114 DOI: 10.1002/mdc3.13722] [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: 09/20/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
Background Mood disorders have emerged as major non-motor comorbidities in Parkinson's disease (PD) even at the prodromal stage of the disease. Mutations in the LRRK2 and GBA genes are common among Ashkenazi Jews, with more severe phenotype reported for GBA-PD. Objective To explore the association between genetic status and mood related disorders before and after diagnosis of PD and the association between mood-related medications, phenotype, and genetic status. Methods Participants were genotyped for mutations in the LRRK2 and GBA genes. State of depression, anxiety and non-motor features were evaluated using validated questionnaires. History of mood disorders prior to diagnosis of PD and use of mood-related medications were assessed. Results The study included 105 idiopathic PD (iPD), 55 LRRK2-PD and 94 GBA-PD. Scores on mood related questionnaires and frequency of depression and anxiety before diagnosis were similar between the groups (p>0.05). However, more GBA-PD patients used mood related medications before PD diagnosis than LRRK2-PD and iPD (16.5% vs 7.1% and 8.2%, p=0.044). LRRK2-PD and GBA-PD receiving mood-related medications at time of assessment had worse motor and non-motor phenotype compared to those that did not (p<0.05). LRRK2-PD receiving mood related-medications at time of assessment, scored higher on mood-related questionnaires compared to LRRK2-PD not receiving such medications (p<0.04). Conclusions Prodromal GBA-PD are more frequently treated with mood related-medications despite equal rates of reported mood-related disorders, while LRRK2-PD with mood-related disorders experience high rates of anxiety and depression despite treatment, attesting to the need of more precise assessment and treatment of these genetic subgroups.
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Affiliation(s)
| | - Nurit Omer
- Sackler School of MedicineTel‐Aviv University
- Movement Disorders UnitNeurological Institute, Tel‐Aviv Medical Center
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
| | - Batsheva Cohen
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
| | - Nir Giladi
- Sackler School of MedicineTel‐Aviv University
- Movement Disorders UnitNeurological Institute, Tel‐Aviv Medical Center
- Sagol School of NeuroscienceTel‐Aviv University
| | - Meir Kestenbaum
- Sackler School of MedicineTel‐Aviv University
- Neurology departmentMeir HospitalKfar‐SabaIsrael
| | | | | | - Mali Gana‐Weisz
- Genomic Research Laboratory for NeurodegenerationTel‐Aviv Medical CenterTel‐AvivIsrael
| | - Orly Goldstein
- Genomic Research Laboratory for NeurodegenerationTel‐Aviv Medical CenterTel‐AvivIsrael
| | - Avi Orr‐Urtreger
- Sackler School of MedicineTel‐Aviv University
- Sagol School of NeuroscienceTel‐Aviv University
- Genomic Research Laboratory for NeurodegenerationTel‐Aviv Medical CenterTel‐AvivIsrael
| | - Anat Mirelman
- Sackler School of MedicineTel‐Aviv University
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
- Sagol School of NeuroscienceTel‐Aviv University
| | - Avner Thaler
- Sackler School of MedicineTel‐Aviv University
- Movement Disorders UnitNeurological Institute, Tel‐Aviv Medical Center
- Laboratory of Early Markers of NeurodegenerationNeurological Institute, Tel‐Aviv Medical Center
- Sagol School of NeuroscienceTel‐Aviv University
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The emerging postural instability phenotype in idiopathic Parkinson disease. NPJ Parkinsons Dis 2022; 8:28. [PMID: 35304493 PMCID: PMC8933561 DOI: 10.1038/s41531-022-00287-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/01/2022] [Indexed: 01/15/2023] Open
Abstract
Identification of individuals at high risk for rapid progression of motor and cognitive signs in Parkinson disease (PD) is clinically significant. Postural instability and gait dysfunction (PIGD) are associated with greater motor and cognitive deterioration. We examined the relationship between baseline clinical factors and the development of postural instability using 5-year longitudinal de-novo idiopathic data (n = 301) from the Parkinson’s Progressive Markers Initiative (PPMI). Logistic regression analysis revealed baseline features associated with future postural instability, and we designated this cohort the emerging postural instability (ePI) phenotype. We evaluated the resulting ePI phenotype rating scale validity in two held-out populations which showed a significantly higher risk of postural instability. Emerging PI phenotype was identified before onset of postural instability in 289 of 301 paired comparisons, with a median progression time of 972 days. Baseline cognitive performance was similar but declined more rapidly in ePI phenotype. We provide an ePI phenotype rating scale (ePIRS) for evaluation of individual risk at baseline for progression to postural instability.
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Omer N, Giladi N, Gurevich T, Bar-Shira A, Gana-Weisz M, Glinka T, Goldstein O, Kestenbaum M, Cedarbaum JM, Mabrouk OS, Fraser KB, Shirvan JC, Orr-Urtreger A, Mirelman A, Thaler A. Glucocerebrosidase Activity Is Not Associated with Parkinson's Disease Risk or Severity. Mov Disord 2022; 37:651-652. [PMID: 35064687 DOI: 10.1002/mds.28929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nurit Omer
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Bar-Shira
- Genetic Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Mali Gana-Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Tal Glinka
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Meir Kestenbaum
- Neurology Department, Meir Medical Center, Kfar-Saba, Israel
| | - Jesse M Cedarbaum
- Biogen Inc, Cambridge, Massachusetts, USA.,Coeruleus Clinical Sciences LLC, Woodbridge, Connecticut, USA
| | | | | | | | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Anat Mirelman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Avner Thaler
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Nasri A, Kacem I, Farhat N, Gharbi A, Sakka S, Souissi A, Zidi S, Damak M, Bendjebara M, Gargouri A, Mhiri C, Gouider R. Heart rate variability and sympathetic skin response for the assessment of autonomic dysfunction in leucine-rich repeat kinase 2 associated Parkinson's disease. Neurophysiol Clin 2022; 52:81-93. [DOI: 10.1016/j.neucli.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/18/2022] Open
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Genetic factors affecting dopaminergic deterioration during the premotor stage of Parkinson disease. NPJ Parkinsons Dis 2021; 7:104. [PMID: 34836969 PMCID: PMC8626486 DOI: 10.1038/s41531-021-00250-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022] Open
Abstract
To estimate dopaminergic dysfunction in patients with Parkinson disease (PD) during the premotor stage and to investigate the effect of genetic factors on the trajectories. Using longitudinal dopamine transporter single-photon emission computed tomography data from 367 sporadic PD (sPD), 72 LRRK2 (G2019S), and 39 GBA (N370S) PD patients in the Parkinson's Progression Markers Initiative (PPMI) study, we estimated the temporal trajectories of putaminal-specific binding ratios using an integrating function between baseline values and their annual change rates. In order to test reproducibility, we computed another trajectory for sPD using positron emission tomography data of 38 sPD patients at Gangnam Severance Hospital (GSH). Temporal trajectories of sPD were compared between the groups separated by age at onset (AAO) and polygenic load for common PD risk variants, and also compared with genetic PD. sPD patients in both the PPMI and GSH cohorts showed similar onset of dopaminergic degeneration around 10 years before motor onset. Early-onset PD patients exhibited later onset of degeneration and a faster decline in dopaminergic activity during the premotor period than late-onset patients. sPD patients with high polygenic load were associated with earlier onset and slower progression of dopaminergic dysfunction. Compared to the sPD and LRRK2 PD groups, GBA PD patients exhibited faster deterioration of dopaminergic function during the premotor stage. Dopaminergic dysfunction in PD appears to start about 10 years before motor onset. Genetic factors may be contributing to the heterogeneity of dopaminergic deterioration during the premotor stage.
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Schejter-Margalit T, Kizony R, Shirvan J, Cedarbaum JM, Bregman N, Thaler A, Giladi N, Mirelman A. Quantitative digital clock drawing test as a sensitive tool to detect subtle cognitive impairments in early stage Parkinson's disease. Parkinsonism Relat Disord 2021; 90:84-89. [PMID: 34416663 DOI: 10.1016/j.parkreldis.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The prevalence of subtle cognitive decline in the early stages of Parkinson's Disease (PD) is common and is thought to be even greater in patients carrying genetic mutations in the GBA gene. Current cognitive tests often lack sensitivity to identify subtle impairments. Technological advancements may offer greater precision. We explored the utility of a digitized cognitive clock-drawing test to assess cognition in patients with PD compared to healthy controls (HC) and its sensitivity compared to that of standardized neuropsychological tests. Further, we investigated the existence of a cognitive profile based on genotype. METHODS The study included 75 early stage PD patients (24 with GBA-PD, 23 LRRK2-PD, 28 idiopathic PD cases) and 59 HC. Participants underwent a cognitive assessment which included the Montreal Cognitive Assessment (MoCA), the Color Trails Test (CTT) and a digital clock drawing test (DCTclock). RESULTS Patients with PD presented lower scores than HC on all cognitive tests. The DCTclock best discriminated PD from HC (AUC: 0.807) compared to the MoCA (0.590) and CTT (0.636 and 0.717 for CTT-1 and CTT-2 respectively). In-depth quantitative analysis of the DCTclock revealed that LRRK2-PD showed better performance than other PD sub-groups. CONCLUSION The use of quantitative digital cognitive assessment showed greater sensitivity in identifying subtle cognitive decline than the current standardized tests. Differences in cognitive profiles were observed based on genotype. The identification of early cognitive decline may improve the clinical management of PD patients and be useful for cognitive related clinical trials.
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Affiliation(s)
- Tamara Schejter-Margalit
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Occupational Therapy Department, University of Haifa, Haifa, Israel.
| | - Rachel Kizony
- Occupational Therapy Department, University of Haifa, Haifa, Israel; Occupational Therapy, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Jesse M Cedarbaum
- Coeruleus Clinical Sciences and Yale University School of Medicine, CT USA
| | - Noa Bregman
- Memory and Cognitive Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel
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11
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Thaler A, Omer N, Giladi N, Gurevich T, Bar-Shira A, Gana-Weisz M, Goldstein O, Kestenbaum M, Shirvan JC, Cedarbaum JM, Orr-Urtreger A, Regev K, Shenhar-Tsarfaty S, Mirelman A. Mutations in GBA and LRRK2 Are Not Associated with Increased Inflammatory Markers. JOURNAL OF PARKINSONS DISEASE 2021; 11:1285-1296. [PMID: 33998549 PMCID: PMC8461659 DOI: 10.3233/jpd-212624] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Inflammation is an integral part of neurodegeneration including in Parkinson’s disease (PD). Ashkenazi Jews have high rates of genetic PD with divergent phenotypes among GBA-PD and LRRK2-PD. The role of inflammation in the prodromal phase of PD and the association with disease phenotype has yet to be elucidated. Objective: To assess central and peripheral cytokines among PD patients with mutations in the LRRK2 and GBA genes and among non-manifesting carriers (NMC) of these mutations in order to determine the role of inflammation in genetic PD. Methods: The following cytokines were assessed from peripheral blood and cerebrospinal fluid (CSF): TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10 and INF- γ. A comprehensive intake including general medical conditions, use of anti-inflammatory treatments, motor and cognitive assessments and additional laboratory measures were recorded, enabling the construction of the MDS probable prodromal score. Results: Data from 362 participants was collected: 31 idiopathic PD (iPD), 30 LRRK2-PD, 77 GBA-PD, 3 homozygote GBA-PD, 3 GBA-LRRK2-PD, 67 LRRK2-NMC, 105 GBA-NMC, 14 LRRK2-GBA-NMC, and 32 healthy controls. No between-group differences in peripheral or CSF cytokines were detected. No correlation between disease characteristics or risk for prodromal PD could be associated with any inflammatory measure. Conclusion: In this study, we could not detect any evidence on dysregulated immune response among GBA and LRRK2 PD patients and non-manifesting mutation carriers.
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Affiliation(s)
- Avner Thaler
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Nurit Omer
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Bar-Shira
- Genetic Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Mali Gana-Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Meir Kestenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Neurology Department, Meir Hospital, Kfar-Saba, Israel
| | | | - Jesse M Cedarbaum
- Biogen Inc, Cambridge, MA, USA.,Coeruleus Clinical Sciences LLC, Woodbridge, CT, USA
| | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Keren Regev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Neuroimmunology Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Internal Medicine "C", "D", and "E", Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Anat Mirelman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
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12
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Oliveira LMA, Gasser T, Edwards R, Zweckstetter M, Melki R, Stefanis L, Lashuel HA, Sulzer D, Vekrellis K, Halliday GM, Tomlinson JJ, Schlossmacher M, Jensen PH, Schulze-Hentrich J, Riess O, Hirst WD, El-Agnaf O, Mollenhauer B, Lansbury P, Outeiro TF. Alpha-synuclein research: defining strategic moves in the battle against Parkinson's disease. NPJ Parkinsons Dis 2021; 7:65. [PMID: 34312398 PMCID: PMC8313662 DOI: 10.1038/s41531-021-00203-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
With the advent of the genetic era in Parkinson's disease (PD) research in 1997, α-synuclein was identified as an important player in a complex neurodegenerative disease that affects >10 million people worldwide. PD has been estimated to have an economic impact of $51.9 billion in the US alone. Since the initial association with PD, hundreds of researchers have contributed to elucidating the functions of α-synuclein in normal and pathological states, and these remain critical areas for continued research. With this position paper the authors strive to achieve two goals: first, to succinctly summarize the critical features that define α-synuclein's varied roles, as they are known today; and second, to identify the most pressing knowledge gaps and delineate a multipronged strategy for future research with the goal of enabling therapies to stop or slow disease progression in PD.
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Affiliation(s)
- Luis M A Oliveira
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA.
| | - Thomas Gasser
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Robert Edwards
- Departments of Neurology and Physiology, UCSF School of Medicine, San Francisco, CA, USA
| | - Markus Zweckstetter
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department for NMR-based Structural Biology, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - Ronald Melki
- Institut François Jacob, MIRCen, CEA and Laboratory of Neurodegenerative Diseases, CNRS, Fontenay-aux-Roses, France
| | - Leonidas Stefanis
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- First Department of Neurology, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Hilal A Lashuel
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Brain Mind Institute, Faculty of Life Sciences, EPFL, Lausanne, Switzerland
| | - David Sulzer
- Department of Psychiatry, Neurology, Molecular Pharmacology and Therapeutics, Columbia University, New York, NY, USA
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Kostas Vekrellis
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Glenda M Halliday
- University of Sydney, Brain and Mind Centre and Faculty of Medicine and Health, School of Medical Sciences, Sydney, NSW, Australia
| | - Julianna J Tomlinson
- Neuroscience Program, The Ottawa Hospital, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Michael Schlossmacher
- Neuroscience Program, The Ottawa Hospital, Ottawa, ON, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Poul Henning Jensen
- Aarhus University, Department of Biomedicine & DANDRITE, Danish Research Institute of Translational Neuroscience, Aarhus, Denmark
| | - Julia Schulze-Hentrich
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Warren D Hirst
- Neurodegenerative Diseases Research Unit, Biogen, Cambridge, MA, USA
| | - Omar El-Agnaf
- Neurological Disorder Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation, Doha, Qatar
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Paracelsus-Elena-Klinik, Kassel, Germany
| | | | - Tiago F Outeiro
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany.
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany.
- Max Planck Institute for Experimental Medicine, Göttingen, Germany.
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.
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13
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Thaler A, Omer N, Giladi N, Gurevich T, Bar-Shira A, Gana-Weisz M, Goldstein O, Kestenbaum M, Cedarbaum JM, Orr-Urtreger A, Shenhar-Tsarfaty S, Mirelman A. Biochemical markers for severity and risk in GBA and LRRK2 Parkinson's disease. J Neurol 2021; 268:1517-1525. [PMID: 33388928 DOI: 10.1007/s00415-020-10325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The phenotype of Parkinson's disease (PD) is variable with mutations in genes such as LRRK2 and GBA explaining part of this heterogeneity. Additional genetic and environmental factors contribute to disease variability. OBJECTIVE To assess the association between biochemical markers, PD severity and probability score for prodromal PD, among GBA and LRRK2 mutation carriers. METHODS Levels of uric acid, vitamin D, C-reactive protein, microalbumin/creatinine ratio (ACR), white blood count (WBC), hemoglobin, platelets, neutrophil/lymphocyte ratio and estimated glomerular filtration rate (eGFR) were assessed from patients with PD and non-manifesting carriers (NMC) of mutations in GBA and LRRK2, together with disease related questionnaires enabling the construction of the MDS prodromal probability score. RESULT A total of 241 patients with PD: 105 idiopathic PD (iPD), 49 LRRK2-PD and 87 GBA-PD and 412 non-manifesting subjects; 74 LRRK2-NMC, 118 GBA-NMC and 220 non-manifesting non-carriers (NMNC), participated in this study. No significant differences in biochemical measures were detected among patients with PD or non-manifesting carriers. Among GBA-PD patients, worse motor performance was associated with ACR (B = 4.68, 95% CI (1.779-7.559); p = 0.002). The probability score for prodromal PD among all non-manifesting participants was associated with eGFR; NMNC (B = - 0.531 95% CI (- 0.879 to - 0.182); p < 0.001, LRRK2-NMC (B = - 1.014 95% CI (- 1.663 to - 0.366); p < 0.001) and GBA-NMC (B = - 0.686 95% CI (1.300 to - 0.071); p = 0.029). CONCLUSION Sub-clinical renal impairment is associated with increased likelihood for prodromal PD regardless of genetic status. While the mechanism behind this finding needs further elucidation, it suggests that kidney function might play a role in PD pathogenesis.
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Affiliation(s)
- Avner Thaler
- Movement Disorder Unit, Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel.
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel Aviv, Israel.
| | - Nurit Omer
- Movement Disorder Unit, Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Movement Disorder Unit, Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorder Unit, Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Anat Bar-Shira
- Genetic Institute, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Mali Gana-Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Meir Kestenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Neurology Department, Meir Medical Center, Kfar Saba, Israel
| | - Jesse M Cedarbaum
- Biogen Inc., Cambridge, MA, USA
- Coeruleus Clinical Sciences LLC, Woodbridge, CT, USA
| | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Internal Medicine "C", "D", and "E", Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Anat Mirelman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
- Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel Aviv, Israel
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14
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Omer N, Giladi N, Gurevich T, Bar-Shira A, Gana-Weisz M, Goldstein O, Kestenbaum M, Cedarbaum JM, Orr-Urtreger A, Mirelman A, Thaler A. A Possible Modifying Effect of the G2019S Mutation in the LRRK2 Gene on GBA Parkinson's Disease. Mov Disord 2020; 35:1249-1253. [PMID: 32353202 DOI: 10.1002/mds.28066] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The phenotype of Parkinson's disease (PD) is milder among patients with LRRK2-PD and more severe among patients with GBA-PD; however, whether an additive phenotypical effect occurs among dual-mutation carriers requires validation. OBJECTIVE The objective of this study was to explore the phenotypic expression of patients with PD who carry mutations in both genes compared with a single-mutation presentation. METHODS Patients with PD were genotyped for the G2019S-LRRK2 mutation and 9 mutations in the GBA gene. Subjects were classified into 5 groups: idiopathic PD, mild GBA-PD, severe GBA-PD, LRRK2-PD, and LRRK2+GBA-PD. Clinical symptoms were evaluated using performance-based measures. RESULTS A total of 1090 patients with idiopathic PD, 155 patients with LRRK2-PD, 155 patients with mild GBA-PD, 56 patients with severe GBA-PD, and 27 patients with LRRK2+GBA-PD participated in this study. The patients with LRRK2-PD and LRRK2+GBA-PD exhibited lower scores on total Unified Parkinson's Disease Rating Scale (P < 0.01) and better olfaction (P < 0.01) compared with GBA-PD. CONCLUSIONS Patients with LRRK2+GBA-PD were symptomatically similar to patients with LRRK2-PD, suggesting a dominant effect of LRRK2 over GBA in the phenotypic presentation. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nurit Omer
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Bar-Shira
- Genetic Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Mali Gana-Weisz
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Orly Goldstein
- Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Meir Kestenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Neurology Department, Meir Hospital, Kfar-Saba, Israel
| | - Jesse M Cedarbaum
- Biogen Inc, Cambridge, Massachusetts, USA.,Coeruleus Clinical Sciences LLC, Woodbridge, Connecticut, USA
| | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Genomic Research Laboratory for Neurodegeneration, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Anat Mirelman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Avner Thaler
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
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15
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Simuni T, Brumm MC, Uribe L, Caspell-Garcia C, Coffey CS, Siderowf A, Alcalay RN, Trojanowski JQ, Shaw LM, Seibyl J, Singleton A, Toga AW, Galasko D, Foroud T, Nudelman K, Tosun-Turgut D, Poston K, Weintraub D, Mollenhauer B, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten S, Bressman S, Marek K. Clinical and Dopamine Transporter Imaging Characteristics of Leucine Rich Repeat Kinase 2 (LRRK2) and Glucosylceramidase Beta (GBA) Parkinson's Disease Participants in the Parkinson's Progression Markers Initiative: A Cross-Sectional Study. Mov Disord 2020; 35:833-844. [PMID: 32073681 DOI: 10.1002/mds.27989] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are limited data on the phenotypic and dopamine transporter (DAT) imaging characterization of the Parkinson's disease (PD) patients with leucine rich kinase 2 (LRRK2) and glucosylceramidase beta (GBA) mutations. OBJECTIVE The objective of this study was to examine baseline clinical and DAT imaging characteristics in GBA and LRRK2 mutation carriers with early PD compared with sporadic PD. METHODS The Parkinson's Progression Markers Initiative is an ongoing observational longitudinal study that enrolled participants with sporadic PD, LRRK2 and GBA PD carriers from 33 sites worldwide. All participants are assessed annually with a battery of motor and nonmotor scales, 123-I Ioflupane DAT imaging, and biologic variables. RESULTS We assessed 158 LRRK2 (89% G2019S), 80 GBA (89 %N370S), and 361 sporadic PD participants with the mean (standard deviation) disease duration of 2.9 (1.9), 3.1 (2.0), and 2.6 (0.6) years, respectively. When compared with sporadic PD, the GBA PD patients had no difference in any motor, cognitive, or autonomic features. The LRRK2 PD patients had less motor disability and lower rapid eye movement behavior disorder questionnaire scores, but no meaningful difference in cognitive or autonomic features. Both genetic cohorts had a higher score on the impulse control disorders scale when compared with sporadic PD, but no difference in other psychiatric features. Both genetic PD cohorts had less loss of dopamine transporter on DAT imaging when compared with sporadic PD. CONCLUSIONS We confirm previous reports of milder phenotype associated with LRRK2-PD. A previously reported more aggressive phenotype in GBA-PD is not evident early in the disease in N370s carriers. This observation identifies a window for potential disease-modifying interventions. Longitudinal data will be essential to define the slope of progression for both genetic cohorts. TRIAL REGISTRATION ClinicalTrials.gov (NCT01141023). © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael C Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy N Alcalay
- Department of Neurology, The Taub Institite for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - John Q Trojanowski
- Departments of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie M Shaw
- Departments of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda, Maryland, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, California, USA
| | - Doug Galasko
- Department of Neurology, University of California, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Kelly Nudelman
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Duygu Tosun-Turgut
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alyssa Reimer
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Samantha Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Susan Bressman
- Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
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