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Novakova L, Gajdos M, Barton M, Brabenec L, Zeleznikova Z, Moravkova I, Rektorova I. Striato-cortical functional connectivity changes in mild cognitive impairment with Lewy bodies. Parkinsonism Relat Disord 2024; 121:106031. [PMID: 38364623 DOI: 10.1016/j.parkreldis.2024.106031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Functional connectivity changes in clinically overt neurodegenerative diseases such as dementia with Lewy bodies have been described, but studies on connectivity changes in the pre-dementia phase are scarce. OBJECTIVES We concentrated on evaluating striato-cortical functional connectivity differences between patients with Mild Cognitive Impairment with Lewy bodies and healthy controls and on assessing the relation to cognition. METHODS Altogether, we enrolled 77 participants (47 patients, of which 35 met all the inclusion criteria for the final analysis, and 30 age- and gender-matched healthy controls, of which 28 met all the inclusion criteria for the final analysis) to study the seed-based connectivity of the dorsal, middle, and ventral striatum. We assessed correlations between functional connectivity in the regions of between-group differences and neuropsychological scores of interest (visuospatial and executive domains z-scores). RESULTS Subjects with Mild Cognitive Impairment with Lewy Bodies, as compared to healthy controls, showed increased connectivity from the dorsal part of the striatum particularly to the bilateral anterior part of the temporal cortex with an association with executive functions. CONCLUSIONS We were able to capture early abnormal connectivity within cholinergic and noradrenergic pathways that correlated with cognitive functions known to be linked to cholinergic/noradrenergic deficits. The knowledge of specific alterations may improve our understanding of early neural changes in pre-dementia stages and enhance research of disease modifying therapy.
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Affiliation(s)
- Lubomira Novakova
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic
| | - Martin Gajdos
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic
| | - Marek Barton
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic
| | - Lubos Brabenec
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic
| | - Zaneta Zeleznikova
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivona Moravkova
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Irena Rektorova
- Brain and Mind Research Program, CEITEC, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Leitner C, D'Este G, Verga L, Rahayel S, Mombelli S, Sforza M, Casoni F, Zucconi M, Ferini-Strambi L, Galbiati A. Neuropsychological Changes in Isolated REM Sleep Behavior Disorder: A Systematic Review and Meta-analysis of Cross-sectional and Longitudinal Studies. Neuropsychol Rev 2024; 34:41-66. [PMID: 36588140 DOI: 10.1007/s11065-022-09572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
The aim of this meta-analysis is twofold: (a) to assess cognitive impairments in isolated rapid eye movement (REM) sleep behavior disorder (iRBD) patients compared to healthy controls (HC); (b) to quantitatively estimate the risk of developing a neurodegenerative disease in iRBD patients according to baseline cognitive assessment. To address the first aim, cross-sectional studies including polysomnography-confirmed iRBD patients, HC, and reporting neuropsychological testing were included. To address the second aim, longitudinal studies including polysomnography-confirmed iRBD patients, reporting baseline neuropsychological testing for converted and still isolated patients separately were included. The literature search was conducted based on PRISMA guidelines and the protocol was registered at PROSPERO (CRD42021253427). Cross-sectional and longitudinal studies were searched from PubMed, Web of Science, Scopus, and Embase databases. Publication bias and statistical heterogeneity were assessed respectively by funnel plot asymmetry and using I2. Finally, a random-effect model was performed to pool the included studies. 75 cross-sectional (2,398 HC and 2,460 iRBD patients) and 11 longitudinal (495 iRBD patients) studies were selected. Cross-sectional studies showed that iRBD patients performed significantly worse in cognitive screening scores (random-effects (RE) model = -0.69), memory (RE model = -0.64), and executive function (RE model = -0.50) domains compared to HC. The survival analyses conducted for longitudinal studies revealed that lower executive function and language performance, as well as the presence of mild cognitive impairment (MCI), at baseline were associated with an increased risk of conversion at follow-up. Our study underlines the importance of a comprehensive neuropsychological assessment in the context of iRBD.
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Affiliation(s)
- Caterina Leitner
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Giada D'Este
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Laura Verga
- Comparative Bioacoustics Group, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Faculty of Psychology and Neuroscience, Department NP&PP, Maastricht University, Maastricht, The Netherlands
| | - Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Marco Sforza
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy.
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy.
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Mala C, Havlík F, Mana J, Nepožitek J, Dostálová S, Růžička E, Šonka K, Keller J, Jech R, Dušek P, Bezdicek O, Krupička R. Cortical and subcortical morphometric changes and their relation to cognitive impairment in isolated REM sleep behavior disorder. Neurol Sci 2024; 45:613-627. [PMID: 37670125 PMCID: PMC10791856 DOI: 10.1007/s10072-023-07040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To date, very few studies have focused on structural changes and their association with cognitive performance in isolated REM sleep behaviour disorder (iRBD). Moreover, the results of these studies are inconclusive. This study aims to evaluate differences in the associations between brain morphology and cognitive tests in iRBD and healthy controls. METHODS Sixty-three patients with iRBD and thirty-six controls underwent MRI with a 3 T scanner. The cognitive performance was assessed by a comprehensive neuropsychological battery. Based on performance, the iRBD group was divided into two subgroups with (iRBD-MCI) and without mild cognitive impairment (iRBD-NC). The high-resolution T1-weighted images were analysed using an automated atlas segmentation tool, voxel-based (VBM) and deformation-based (DBM) morphometry to identify between-group differences and correlations with cognitive performance. RESULTS VBM, DBM and the comparison of ROI volumes yielded no significant differences between iRBD and controls. In the iRBD group, significant correlations in VBM were found between several cortical and subcortical structures primarily located in the temporal, parietal, occipital lobe, cerebellum, and basal ganglia and three cognitive tests assessing psychomotor speed and one memory test. Between-group analysis of cognition revealed a significant difference between iRBD-MCI and iRBD-NC in tests including a processing speed component. CONCLUSIONS iRBD shows deficits in several cognitive tests that correlate with morphological changes, the most prominent of which is in psychomotor speed and visual attention as measured by the TMT-A and associated with the volume of striatum, insula, cerebellum, temporal lobe, pallidum and amygdala.
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Affiliation(s)
- Christiane Mala
- Department of Biomedical Informatics, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Filip Havlík
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiří Nepožitek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Radim Krupička
- Department of Biomedical Informatics, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Rahayel S, Postuma R, Baril AA, Misic B, Pelletier A, Soucy JP, Montplaisir J, Dagher A, Gagnon JF. 99mTc-HMPAO SPECT Perfusion Signatures Associated With Clinical Progression in Patients With Isolated REM Sleep Behavior Disorder. Neurology 2024; 102:e208015. [PMID: 38315966 PMCID: PMC10890831 DOI: 10.1212/wnl.0000000000208015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/03/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Idiopathic/isolated REM sleep behavior disorder (iRBD) is associated with dementia with Lewy bodies and Parkinson disease. Despite evidence of abnormal cerebral perfusion in iRBD, there is currently no pattern that can predict whether an individual will develop dementia with Lewy bodies or Parkinson disease. The objective was to identify a perfusion signature associated with conversion to dementia with Lewy bodies in iRBD. METHODS Patients with iRBD underwent video-polysomnography, neurologic and neuropsychological assessments, and baseline 99mTc-HMPAO SPECT to assess relative cerebral blood flow. Partial least squares correlation was used to identify latent variables that maximized covariance between 27 clinical features and relative gray matter perfusion. Patient-specific scores on the latent variables were used to test the association with conversion to dementia with Lewy bodies compared with that with Parkinson disease. The signature's expression was also assessed in 24 patients with iRBD who underwent a second perfusion scan, 22 healthy controls, and 19 individuals with Parkinson disease. RESULTS Of the 137 participants, 93 underwent SPECT processing, namely 52 patients with iRBD (67.9 years, 73% men), 19 patients with Parkinson disease (67.3 years, 37% men), and 22 controls (67.0 years, 73% men). Of the 47 patients with iRBD followed up longitudinally (4.5 years), 12 (26%) developed a manifest synucleinopathy (4 dementia with Lewy bodies and 8 Parkinson disease). Analysis revealed 2 latent variables between relative blood flow and clinical features: the first was associated with a broad set of features that included motor, cognitive, and perceptual variables, age, and sex; the second was mostly associated with cognitive features and RBD duration. When brought back into the patient's space, the expression of the first variable was associated with conversion to a manifest synucleinopathy, whereas the second was associated with conversion to dementia with Lewy bodies. The expression of the patterns changed over time and was associated with worse motor features. DISCUSSION This study identified a brain perfusion signature associated with cognitive impairment in iRBD and transition to dementia with Lewy bodies. This signature, which can be derived from individual scans, has the potential to be developed into a biomarker that predicts dementia with Lewy bodies in at-risk individuals.
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Affiliation(s)
- Shady Rahayel
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Ronald Postuma
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Andrée-Ann Baril
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Bratislav Misic
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Amélie Pelletier
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jean-Paul Soucy
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jacques Montplaisir
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Alain Dagher
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
| | - Jean-François Gagnon
- From the Department of Medicine (S.R., A.-A.B.), University of Montreal; Centre for Advanced Research in Sleep Medicine (S.R., R.P., A.-A.B., A.P., J.M., J.-F.G.), CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal; Department of Neurology (R.P., A.P.), Montreal General Hospital; The Neuro (Montreal Neurological Institute-Hospital) (B.M., J.-P.S., A.D.), McGill University; Department of Psychiatry (J.M.), University of Montreal; and Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada
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Joza S, Hu MT, Jung K, Kunz D, Arnaldi D, Lee J, Ferini‐Strambi L, Antelmi E, Sixel‐Döring F, De Cock VC, Montplaisir JY, Welch J, Kim H, Bes F, Mattioli P, Woo KA, Marelli S, Plazzi G, Mollenhauer B, Pelletier A, Razzaque J, Sunwoo J, Girtler N, Trenkwalder C, Gagnon J, Postuma RB. Prodromal dementia with Lewy bodies in REM sleep behavior disorder: A multicenter study. Alzheimers Dement 2024; 20:91-102. [PMID: 37461299 PMCID: PMC10917000 DOI: 10.1002/alz.13386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/12/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) is a powerful early predictor of dementia with Lewy bodies (DLB) and Parkinson's disease (PD). This provides an opportunity to directly observe the evolution of prodromal DLB and to identify which cognitive variables are the strongest predictors of evolving dementia. METHODS IRBD participants (n = 754) from 10 centers of the International RBD Study Group underwent annual neuropsychological assessment. Competing risk regression analysis determined optimal predictors of dementia. Linear mixed-effect models determined the annual progression of neuropsychological testing. RESULTS Reduced attention and executive function, particularly performance on the Trail Making Test Part B, were the strongest identifiers of early DLB. In phenoconverters, the onset of cognitive decline began up to 10 years prior to phenoconversion. Changes in verbal memory best differentiated between DLB and PD subtypes. DISCUSSION In iRBD, attention and executive dysfunction strongly predict dementia and begin declining several years prior to phenoconversion. HIGHLIGHTS Cognitive decline in iRBD begins up to 10 years prior to phenoconversion. Attention and executive dysfunction are the strongest predictors of dementia in iRBD. Decline in episodic memory best distinguished dementia-first from parkinsonism-first phenoconversion.
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Affiliation(s)
- Stephen Joza
- Department of NeurologyMontreal Neurological InstituteMontrealCanada
| | - Michele T. Hu
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - Ki‐Young Jung
- Department of Neurology, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Dieter Kunz
- Clinic for Sleep & ChronomedicineSt. Hedwig‐KrankenhausBerlinGermany
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical NeurologyUniversity of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Jee‐Young Lee
- Department of NeurologySeoul National University College of MedicineSeoul Metropolitan Government‐Seoul National University Boramae Medical CenterSeoulSouth Korea
| | | | - Elena Antelmi
- DIMI Department of Engineering and Medicine of InnovationUniversity of VeronaVeronaItaly
| | - Friederike Sixel‐Döring
- Department of Neurology and Section on Clinical NeurosciencePhilipps University MarburgMarburgGermany
- Paracelsus Elena KlinikCentre for Movement DisordersKasselGermany
| | - Valérie Cochen De Cock
- EuroMov Digital Health in MotionUniversity of MontpellierIMT Mines AlesMontpellierFrance
- Department of Neurology and SleepBeau Soleil ClinicMontpellierFrance
| | - Jacques Y. Montplaisir
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontréalQuebecCanada
| | - Jessica Welch
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - Han‐Joon Kim
- Department of Neurology, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Frederik Bes
- Clinic for Sleep & ChronomedicineSt. Hedwig‐KrankenhausBerlinGermany
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical NeurologyUniversity of GenoaGenoaItaly
| | - Kyung Ah Woo
- Department of NeurologySeoul National University College of MedicineSeoul Metropolitan Government‐Seoul National University Boramae Medical CenterSeoulSouth Korea
| | - Sara Marelli
- Sleep Disorders CenterVita‐Salute San Raffaele UniversityMilanItaly
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio‐EmiliaModenaItaly
| | - Brit Mollenhauer
- Department of Neurology and Section on Clinical NeurosciencePhilipps University MarburgMarburgGermany
- Paracelsus Elena KlinikCentre for Movement DisordersKasselGermany
| | - Amelie Pelletier
- Department of NeurologyMontreal Neurological InstituteMontrealCanada
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
| | - Jamil Razzaque
- Nuffield Department of Clinical Neurosciences, Division of Neurology and Oxford Parkinson's Disease CentreUniversity of OxfordOxfordUK
| | - Jun‐Sang Sunwoo
- Department of NeurologyKangbuk Samsung HospitalSeoulRepublic of Korea
| | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Clinical NeurologyUniversity of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Claudia Trenkwalder
- Paracelsus Elena KlinikCentre for Movement DisordersKasselGermany
- Department of NeurosurgeryUniversity Medical Center GoettingenGöttingenGermany
| | - Jean‐François Gagnon
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontréalQuebecCanada
| | - Ronald B. Postuma
- Department of NeurologyMontreal Neurological InstituteMontrealCanada
- Centre d’Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontréalQuebecCanada
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Grimaldi S, Guye M, Bianciardi M, Eusebio A. Brain MRI Biomarkers in Isolated Rapid Eye Movement Sleep Behavior Disorder: Where Are We? A Systematic Review. Brain Sci 2023; 13:1398. [PMID: 37891767 PMCID: PMC10604962 DOI: 10.3390/brainsci13101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
The increasing number of MRI studies focused on prodromal Parkinson's Disease (PD) demonstrates a strong interest in identifying early biomarkers capable of monitoring neurodegeneration. In this systematic review, we present the latest information regarding the most promising MRI markers of neurodegeneration in relation to the most specific prodromal symptoms of PD, namely isolated rapid eye movement (REM) sleep behavior disorder (iRBD). We reviewed structural, diffusion, functional, iron-sensitive, neuro-melanin-sensitive MRI, and proton magnetic resonance spectroscopy studies conducted between 2000 and 2023, which yielded a total of 77 relevant papers. Among these markers, iron and neuromelanin emerged as the most robust and promising indicators for early neurodegenerative processes in iRBD. Atrophy was observed in several regions, including the frontal and temporal cortices, limbic cortices, and basal ganglia, suggesting that neurodegenerative processes had been underway for some time. Diffusion and functional MRI produced heterogeneous yet intriguing results. Additionally, reduced glymphatic clearance function was reported. Technological advancements, such as the development of ultra-high field MRI, have enabled the exploration of minute anatomical structures and the detection of previously undetectable anomalies. The race to achieve early detection of neurodegeneration is well underway.
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Affiliation(s)
- Stephan Grimaldi
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 265 rue Saint-Pierre, 13005 Marseille, France
- Centre d’Exploration Métabolique par Résonnance Magnétique, Assistance Publique des Hôpitaux de Marseille, Hôpital Universitaire Timone, 265 rue Saint-Pierre, 13005 Marseille, France
- Center for Magnetic Resonance in Biology and Medicine, Aix Marseille University, Centre National de la Recherche Scientifique, 27 Bd Jean Moulin, 13385 Marseille, France
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, 149 13th St., Charlestown, MA 02129, USA
| | - Maxime Guye
- Centre d’Exploration Métabolique par Résonnance Magnétique, Assistance Publique des Hôpitaux de Marseille, Hôpital Universitaire Timone, 265 rue Saint-Pierre, 13005 Marseille, France
- Center for Magnetic Resonance in Biology and Medicine, Aix Marseille University, Centre National de la Recherche Scientifique, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Marta Bianciardi
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, 149 13th St., Charlestown, MA 02129, USA
- Division of Sleep Medicine, Harvard University, Boston, MA 02114, USA
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 265 rue Saint-Pierre, 13005 Marseille, France
- Institut de Neurosciences de la Timone, Aix Marseille University, Centre National de la Recherche Scientifique, 27 Bd Jean Moulin, 13385 Marseille, France
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7
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Rahayel S, Tremblay C, Vo A, Misic B, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Gagnon JF, Postuma RB, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Hansen AK, Monchi O, Gan-Or Z, Dagher A. Mitochondrial function-associated genes underlie cortical atrophy in prodromal synucleinopathies. Brain 2023; 146:3301-3318. [PMID: 36826230 PMCID: PMC10393413 DOI: 10.1093/brain/awad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Isolated rapid eye movement sleep behaviour disorder (iRBD) is a sleep disorder characterized by the loss of rapid eye movement sleep muscle atonia and the appearance of abnormal movements and vocalizations during rapid eye movement sleep. It is a strong marker of incipient synucleinopathy such as dementia with Lewy bodies and Parkinson's disease. Patients with iRBD already show brain changes that are reminiscent of manifest synucleinopathies including brain atrophy. However, the mechanisms underlying the development of this atrophy remain poorly understood. In this study, we performed cutting-edge imaging transcriptomics and comprehensive spatial mapping analyses in a multicentric cohort of 171 polysomnography-confirmed iRBD patients [67.7 ± 6.6 (49-87) years; 83% men] and 238 healthy controls [66.6 ± 7.9 (41-88) years; 77% men] with T1-weighted MRI to investigate the gene expression and connectivity patterns associated with changes in cortical thickness and surface area in iRBD. Partial least squares regression was performed to identify the gene expression patterns underlying cortical changes in iRBD. Gene set enrichment analysis and virtual histology were then done to assess the biological processes, cellular components, human disease gene terms, and cell types enriched in these gene expression patterns. We then used structural and functional neighbourhood analyses to assess whether the atrophy patterns in iRBD were constrained by the brain's structural and functional connectome. Moreover, we used comprehensive spatial mapping analyses to assess the specific neurotransmitter systems, functional networks, cytoarchitectonic classes, and cognitive brain systems associated with cortical changes in iRBD. All comparisons were tested against null models that preserved spatial autocorrelation between brain regions and compared to Alzheimer's disease to assess the specificity of findings to synucleinopathies. We found that genes involved in mitochondrial function and macroautophagy were the strongest contributors to the cortical thinning occurring in iRBD. Moreover, we demonstrated that cortical thinning was constrained by the brain's structural and functional connectome and that it mapped onto specific networks involved in motor and planning functions. In contrast with cortical thickness, changes in cortical surface area were related to distinct genes, namely genes involved in the inflammatory response, and to different spatial mapping patterns. The gene expression and connectivity patterns associated with iRBD were all distinct from those observed in Alzheimer's disease. In summary, this study demonstrates that the development of brain atrophy in synucleinopathies is constrained by specific genes and networks.
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Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
| | - Christina Tremblay
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Andrew Vo
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Bratislav Misic
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Stéphane Lehéricy
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Isabelle Arnulf
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Marie Vidailhet
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Jean-Christophe Corvol
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal H2X 3P2, Canada
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Neurology, Montreal General Hospital, Montreal H3G 1A4, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Psychiatry, University of Montreal, Montreal H3T 1J4, Canada
| | - Simon Lewis
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Elie Matar
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
- Department of Kinesiology, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
- Department of Radiology, Radio-Oncology, and Nuclear Medicine, University of Montreal, Montreal H3T 1A4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
- Department of Human Genetics, McGill University, Montreal H3A 0C7, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
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8
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Shin JH, Kim H, Kim YK, Yoon EJ, Nam H, Jeon B, Lee JY. Longitudinal evolution of cortical thickness signature reflecting Lewy body dementia in isolated REM sleep behavior disorder: a prospective cohort study. Transl Neurodegener 2023; 12:27. [PMID: 37217951 DOI: 10.1186/s40035-023-00356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/13/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The isolated rapid-eye-movement sleep behavior disorder (iRBD) is a prodromal condition of Lewy body disease including Parkinson's disease and dementia with Lewy bodies (DLB). We aim to investigate the longitudinal evolution of DLB-related cortical thickness signature in a prospective iRBD cohort and evaluate the possible predictive value of the cortical signature index in predicting dementia-first phenoconversion in individuals with iRBD. METHODS We enrolled 22 DLB patients, 44 healthy controls, and 50 video polysomnography-proven iRBD patients. Participants underwent 3-T magnetic resonance imaging (MRI) and clinical/neuropsychological evaluations. We characterized DLB-related whole-brain cortical thickness spatial covariance pattern (DLB-pattern) using scaled subprofile model of principal components analysis that best differentiated DLB patients from age-matched controls. We analyzed clinical and neuropsychological correlates of the DLB-pattern expression scores and the mean values of the whole-brain cortical thickness in DLB and iRBD patients. With repeated MRI data during the follow-up in our prospective iRBD cohort, we investigated the longitudinal evolution of the cortical thickness signature toward Lewy body dementia. Finally, we analyzed the potential predictive value of cortical thickness signature as a biomarker of phenoconversion in iRBD cohort. RESULTS The DLB-pattern was characterized by thinning of the temporal, orbitofrontal, and insular cortices and relative preservation of the precentral and inferior parietal cortices. The DLB-pattern expression scores correlated with attentional and frontal executive dysfunction (Trail Making Test-A and B: R = - 0.55, P = 0.024 and R = - 0.56, P = 0.036, respectively) as well as visuospatial impairment (Rey-figure copy test: R = - 0.54, P = 0.0047). The longitudinal trajectory of DLB-pattern revealed an increasing pattern above the cut-off in the dementia-first phenoconverters (Pearson's correlation, R = 0.74, P = 6.8 × 10-4) but no significant change in parkinsonism-first phenoconverters (R = 0.0063, P = 0.98). The mean value of the whole-brain cortical thickness predicted phenoconversion in iRBD patients with hazard ratio of 9.33 [1.16-74.12]. The increase in DLB-pattern expression score discriminated dementia-first from parkinsonism-first phenoconversions with 88.2% accuracy. CONCLUSION Cortical thickness signature can effectively reflect the longitudinal evolution of Lewy body dementia in the iRBD population. Replication studies would further validate the utility of this imaging marker in iRBD.
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Affiliation(s)
- Jung Hwan Shin
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Heejung Kim
- Department of Nuclear Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea.
| | - Eun Jin Yoon
- Department of Nuclear Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea.
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9
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Figorilli M, Meloni M, Lanza G, Casaglia E, Lecca R, Saibene FL, Congiu P, Puligheddu M. Considering REM Sleep Behavior Disorder in the Management of Parkinson's Disease. Nat Sci Sleep 2023; 15:333-352. [PMID: 37180094 PMCID: PMC10167974 DOI: 10.2147/nss.s266071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is the result of the loss of physiological inhibition of muscle tone during REM sleep, characterized by dream-enacting behavior and widely recognized as a prodromal manifestation of alpha-synucleinopathies. Indeed, patients with isolated RBD (iRBD) have an extremely high estimated risk to develop a neurodegenerative disease after a long follow up. Nevertheless, in comparison with PD patients without RBD (PDnoRBD), the occurrence of RBD in the context of PD (PDRBD) seems to identify a unique, more malignant phenotype, characterized by a more severe burden of disease in terms of both motor and non-motor symptoms and increased risk for cognitive decline. However, while some medications (eg, melatonin, clonazepam, etc.) and non-pharmacological options have been found to have some therapeutic benefits on RBD there is no available treatment able to modify the disease course or, at least, slow down the neurodegenerative process underlying phenoconversion. In this scenario, the long prodromal phase may allow an early therapeutic window and, therefore, the identification of multimodal biomarkers of disease onset and progression is becoming increasingly crucial. To date, several clinical (motor, cognitive, olfactory, visual, and autonomic features) neurophysiological, neuroimaging, biological (biofluids or tissue biopsy), and genetic biomarkers have been identified and proposed, also in combination, as possible diagnostic or prognostic markers, along with a potential role for some of them as outcome measures and index of treatment response. In this review, we provide an insight into the present knowledge on both existing and future biomarkers of iRBD and highlight the difference with PDRBD and PDnoRBD, including currently available treatment options.
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Affiliation(s)
- Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Meloni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Elisa Casaglia
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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10
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Mombelli S, Leitner C, D'Este G, Sforza M, Marelli S, Castelnuovo A, Zucconi M, Casoni F, Fantini ML, Novellino F, Salsone M, Ferini-Strambi L, Galbiati A. A data-driven approach to neuropsychological features in isolated REM behaviour disorder: A latent class analysis. J Neuropsychol 2023; 17:161-179. [PMID: 36192363 DOI: 10.1111/jnp.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
Recent evidence demonstrated that neuropsychological assessment may be considered a valid marker of neurodegeneration in idiopathic REM sleep behaviour disorder (iRBD). However, little is known about the possible neuropsychological heterogeneity within the iRBD population. This retrospective study aimed to identify and describe different neuropsychological phenotypes in iRBD patients by means of a data-driven approach using latent class analysis. A total of 289 iRBD patients underwent a neuropsychological assessment evaluating cognitive domains: global cognition, language, short- and long-term memory, executive functions and visuospatial abilities. The presence of mild cognitive impairment (MCI) was also assessed. Latent class analysis was carried out to identify iRBD subtypes according to neuropsychological scores. The most parsimonious model identified three latent classes. Groups were labelled as follows: Class 2 "severely impaired" (n = 83/289): mean pathological scores in different tests, a high percentage of MCI multiple-domain and impairment in all neuropsychological domains. Class 1 "moderately impaired" (n = 44/289): mean neuropsychological score within the normal value, a high percentage of MCI (high risk to phenoconversion) and great impairment in the visuospatial domain. Class 3 "slightly impaired" (n = 162/289): no deficit worthy of attention except for short- and long-term memory. Our results suggest three different clinical phenotypes within the iRBD population. These findings may be relevant in the future for predicting the clinical trajectories of phenoconversion in iRBD.
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Affiliation(s)
- Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Leitner
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Giada D'Este
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Livia Fantini
- Sleep and EEG, Neurophysiology Unit, Clermont-Ferrand University Hospital and UMR 6602 - Université Clermont Auvergne, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council, Catanzaro, Italy.,Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Neuroquímica (IUINQ-UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
| | - Maria Salsone
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy.,Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
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11
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Wang J, Sun L, Chen L, Sun J, Xie Y, Tian D, Gao L, Zhang D, Xia M, Wu T. Common and distinct roles of amygdala subregional functional connectivity in non-motor symptoms of Parkinson's disease. NPJ Parkinsons Dis 2023; 9:28. [PMID: 36806219 PMCID: PMC9938150 DOI: 10.1038/s41531-023-00469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Neuroimaging studies suggest a pivotal role of amygdala dysfunction in non-motor symptoms (NMS) of Parkinson's disease (PD). However, the relationship between amygdala subregions (the centromedial (CMA), basolateral (BLA) and superficial amygdala (SFA)) and NMS has not been delineated. We used resting-state functional MRI to examine the PD-related alterations in functional connectivity for amygdala subregions. The left three subregions and right BLA exhibited between-group differences, and were commonly hypo-connected with the frontal, temporal, insular cortex, and putamen in PD. Each subregion displayed distinct hypoconnectivity with the limbic systems. Partial least-squares analysis revealed distinct amygdala subregional involvement in diverse NMS. Hypo-connectivity of all four subregions was associated with emotion, pain, olfaction, and cognition. Hypo-connectivity of the left SFA was associated with sleepiness. Our findings highlight the hypofunction of the amygdala subregions in PD and their preliminary associations with NMS, providing new insights into the pathogenesis of NMS.
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Affiliation(s)
- Junling Wang
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Lianglong Sun
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091 China
| | - Lili Chen
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Junyan Sun
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Yapei Xie
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091 China
| | - Dezheng Tian
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091 China
| | - Linlin Gao
- grid.417031.00000 0004 1799 2675Department of General Medicine, Tianjin Union Medical Center, Tianjin, 300122 China
| | - Dongling Zhang
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Mingrui Xia
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091, China. .,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091, China. .,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091, China.
| | - Tao Wu
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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12
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Ma LY, Feng T, He C, Li M, Ren K, Tu J. A progression analysis of motor features in Parkinson's disease based on the mapper algorithm. Front Aging Neurosci 2023; 15:1047017. [PMID: 36896420 PMCID: PMC9989279 DOI: 10.3389/fnagi.2023.1047017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disease with a broad spectrum of motor and non-motor symptoms. The great heterogeneity of clinical symptoms, biomarkers, and neuroimaging and lack of reliable progression markers present a significant challenge in predicting disease progression and prognoses. Methods We propose a new approach to disease progression analysis based on the mapper algorithm, a tool from topological data analysis. In this paper, we apply this method to the data from the Parkinson's Progression Markers Initiative (PPMI). We then construct a Markov chain on the mapper output graphs. Results The resulting progression model yields a quantitative comparison of patients' disease progression under different usage of medications. We also obtain an algorithm to predict patients' UPDRS III scores. Conclusions By using mapper algorithm and routinely gathered clinical assessments, we developed a new dynamic models to predict the following year's motor progression in the early stage of PD. The use of this model can predict motor evaluations at the individual level, assisting clinicians to adjust intervention strategy for each patient and identifying at-risk patients for future disease-modifying therapy clinical trials.
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Affiliation(s)
- Ling-Yan Ma
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, China National Clinical Research Center for Neurological Disease, Beijing, China.,Parkinson's Disease Center, Beijing Institute for Brain Disorders, Beijing, China
| | - Chengzhang He
- Institute of Mathematical Sciences, ShanghaiTech University, Shanghai, China
| | - Mujing Li
- Institute of Mathematical Sciences, ShanghaiTech University, Shanghai, China
| | - Kang Ren
- GYENNO Science Co., LTD., Shenzhen, China.,Department of Neurology, HUST-GYENNO Central Neural System Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Junwu Tu
- Institute of Mathematical Sciences, ShanghaiTech University, Shanghai, China
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13
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Sumi Y, Masuda F, Kadotani H, Ozeki Y. The prevalence of depression in isolated/idiopathic rapid eye movement sleep behavior disorder: A systematic review and meta-analysis. Sleep Med Rev 2022; 65:101684. [DOI: 10.1016/j.smrv.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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14
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Valli M, Uribe C, Mihaescu A, Strafella AP. Neuroimaging of rapid eye movement sleep behavior disorder and its relation to Parkinson's disease. J Neurosci Res 2022; 100:1815-1833. [DOI: 10.1002/jnr.25099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/10/2022] [Accepted: 06/08/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Mikaeel Valli
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Brain Institute, UHN University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
| | - Carme Uribe
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience University of Barcelona Barcelona Spain
| | - Alexander Mihaescu
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Brain Institute, UHN University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
| | - Antonio P. Strafella
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Brain Institute, UHN University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
- Edmond J. Safra Parkinson Disease Program & Morton and Gloria Shulman Movement Disorder Unit, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN University of Toronto Toronto Ontario Canada
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15
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Rahayel S, Tremblay C, Vo A, Zheng YQ, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Gagnon JF, Postuma RB, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Hansen A, Monchi O, Misic B, Dagher A. Brain atrophy in prodromal synucleinopathy is shaped by structural connectivity and gene expression. Brain 2022; 145:3162-3178. [PMID: 35594873 DOI: 10.1093/brain/awac187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
Isolated REM sleep behaviour disorder (iRBD) is a synucleinopathy characterized by abnormal behaviours and vocalizations during REM sleep. Most iRBD patients develop dementia with Lewy bodies, Parkinson's disease, or multiple system atrophy over time. Patients with iRBD exhibit brain atrophy patterns that are reminiscent of those observed in overt synucleinopathies. However, the mechanisms linking brain atrophy to the underlying alpha-synuclein pathophysiology are poorly understood. Our objective was to investigate how the prion-like and regional vulnerability hypotheses of alpha-synuclein might explain brain atrophy in iRBD. Using a multicentric cohort of 182 polysomnography-confirmed iRBD patients who underwent T1-weighted MRI, we performed vertex-based cortical surface and deformation-based morphometry analyses to quantify brain atrophy in patients (67.8 years, 84% men) and 261 healthy controls (66.2 years, 75%) and investigated the morphological correlates of motor and cognitive functioning in iRBD. Next, we applied the agent-based Susceptible-Infected-Removed model (i.e., a computational model that simulates in silico the spread of pathologic alpha-synuclein based on structural connectivity and gene expression) and tested if it recreated atrophy in iRBD by statistically comparing simulated regional brain atrophy to the atrophy observed in patients. The impact of SNCA and GBA gene expression and brain connectivity was then evaluated by comparing the model fit to the one obtained in null models where either gene expression or connectivity was randomized. The results showed that iRBD patients present with cortical thinning and tissue deformation, which correlated with motor and cognitive functioning. Next, we found that the computational model recreated cortical thinning (r = 0.51, p = 0.0007) and tissue deformation (r = 0.52, p = 0.0005) in patients, and that the connectome's architecture along with SNCA and GBA gene expression contributed to shaping atrophy in iRBD. We further demonstrated that the full agent-based model performed better than network measures or gene expression alone in recreating the atrophy pattern in iRBD. In summary, atrophy in iRBD is extensive, correlates with motor and cognitive function, and can be recreated using the dynamics of agent-based modelling, structural connectivity, and gene expression. These findings support the concepts that both prion-like spread and regional susceptibility account for the atrophy observed in prodromal synucleinopathies. Therefore, the agent-based Susceptible-Infected-Removed model may be a useful tool for testing hypotheses underlying neurodegenerative diseases and new therapies aimed at slowing or stopping the spread of alpha-synuclein pathology.
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Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada
| | - Christina Tremblay
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Andrew Vo
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Ying-Qiu Zheng
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Stéphane Lehéricy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Isabelle Arnulf
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Marie Vidailhet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | | | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal H2X 3P2, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Neurology, Montreal General Hospital, Montreal H3G 1A4, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Psychiatry, Université de Montréal, Montreal H3 T 1J4, Canada
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Elie Matar
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia.,Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Allan Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada.,Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary T2N 4N1, Canada
| | - Bratislav Misic
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
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16
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Abstract
One characteristic of Parkinson's disease (PD) is a prodromal phase, lasting many years during which both pre-clinical motor and non-motor symptoms occur. Around one-fifth of patients with PD manifest mild cognitive impairment at time of clinical diagnosis. Thus, important challenges are to define the time of onset of cognitive dysfunction in the prodromal phase of PD, and to define its co-occurrence with other specific characteristics. Evidence for cognitive change in prodromal PD comes from various study designs, including both longitudinal and cross-sectional approaches with different target groups. These studies support the concept that changes in global cognitive function and alterations in executive functions occur, and that these changes may be present up to 6 years before clinical PD diagnosis. Notably, this evidence led to including global cognitive impairment as an independent prodromal marker in the recently updated research criteria of the Movement Disorder Society for prodromal PD. Knowledge in this field, however, is still at its beginning, and evidence is sparse about many aspects of this topic. Further longitudinal studies including standardized assessments of global and domain-specific cognitive functions are needed to gain further knowledge about the first appearance, the course, and the interaction of cognitive deficits with other non-motor symptoms in prodromal stage PD. Treatment approaches, including non-pharmacological interventions, in individuals with prodromal PD might help to prevent or delay cognitive dysfunction in early PD.
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Affiliation(s)
- Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany; IB-Hochschule, Stuttgart, Germany.
| | - Anja Ophey
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
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17
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van der Zee S, Kanel P, Gerritsen MJJ, Boertien JM, Slomp AC, Müller MLTM, Bohnen NI, Spikman JM, van Laar T. Altered Cholinergic Innervation in De Novo Parkinson's Disease with and without Cognitive Impairment. Mov Disord 2022; 37:713-723. [PMID: 35037719 PMCID: PMC9306739 DOI: 10.1002/mds.28913] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
Background Altered cholinergic innervation plays a putative role in cognitive impairment in Parkinson's disease (PD) at least in advanced stages. Identification of the relationship between cognitive impairment and cholinergic innervation early in the disease will provide better insight into disease prognosis and possible early intervention. Objective The aim was to assess regional cholinergic innervation status in de novo patients with PD, with and without cognitive impairment. Methods Fifty‐seven newly diagnosed, treatment‐naive, PD patients (32 men, mean age 64.6 ± 8.2 years) and 10 healthy controls (5 men, mean age 54.6 ± 6.0 years) were included. All participants underwent cholinergic [18F]fluoroethoxybenzovesamicol positron emission tomography and detailed neuropsychological assessment. PD patients were classified as either cognitively normal (PD‐NC) or mild cognitive impairment (PD‐MCI). Whole brain voxel‐based group comparisons were performed. Results Results show bidirectional cholinergic innervation changes in PD. Both PD‐NC and PD‐MCI groups showed significant cortical cholinergic denervation compared to controls (P < 0.05, false discovery rate corrected), primarily in the posterior cortical regions. Higher‐than‐normal binding was most prominent in PD‐NC in both cortical and subcortical regions, including the cerebellum, cingulate cortex, putamen, gyrus rectus, hippocampus, and amygdala. Conclusion Altered cholinergic innervation is already present in de novo patients with PD. Posterior cortical cholinergic losses were present in all patients independent of cognitive status. Higher‐than‐normal binding in cerebellar, frontal, and subcortical regions in cognitively intact patients may reflect compensatory cholinergic upregulation in early‐stage PD. Limited or failing cholinergic upregulation may play an important role in early, clinically evident cognitive impairment in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Sygrid van der Zee
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Division of Clinical Neuropsychology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marleen J J Gerritsen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Division of Clinical Neuropsychology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Jeffrey M Boertien
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne C Slomp
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Division of Clinical Neuropsychology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,University of Michigan Parkinson's Foundation Center of Excellent, Ann Arbor, Michigan, USA
| | - Jacoba M Spikman
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Division of Clinical Neuropsychology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Horsager J, Knudsen K, Sommerauer M. Clinical and imaging evidence of brain-first and body-first Parkinson's disease. Neurobiol Dis 2022; 164:105626. [PMID: 35031485 DOI: 10.1016/j.nbd.2022.105626] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Braak's hypothesis has been extremely influential over the last two decades. However, neuropathological and clinical evidence suggest that the model does not conform to all patients with Parkinson's disease (PD). To resolve this controversy, a new model was recently proposed; in brain-first PD, the initial α-synuclein pathology arise inside the central nervous system, likely rostral to the substantia nigra pars compacta, and spread via interconnected structures - eventually affecting the autonomic nervous system; in body-first PD, the initial pathological α-synuclein originates in the enteric nervous system with subsequent caudo-rostral propagation to the autonomic and central nervous system. By using REM-sleep behavior disorder (RBD) as a clinical identifier to distinguish between body-first PD (RBD-positive at motor symptom onset) and brain-first PD (RBD-negative at motor symptom onset), we explored the literature to evaluate clinical and imaging differences between these proposed subtypes. Body-first PD patients display: 1) a larger burden of autonomic symptoms - in particular orthostatic hypotension and constipation, 2) more frequent pathological α-synuclein in peripheral tissues, 3) more brainstem and autonomic nervous system involvement in imaging studies, 4) more symmetric striatal dopaminergic loss and motor symptoms, and 5) slightly more olfactory dysfunction. In contrast, only minor cortical metabolic alterations emerge before motor symptoms in body-first. Brain-first PD is characterized by the opposite clinical and imaging patterns. Patients with pathological LRRK2 genetic variants mostly resemble a brain-first PD profile whereas patients with GBA variants typically conform to a body-first profile. SNCA-variant carriers are equally distributed between both subtypes. Overall, the literature indicates that body-first and brain-first PD might be two distinguishable entities on some clinical and imaging markers.
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Affiliation(s)
- Jacob Horsager
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sommerauer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Köln, Germany; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
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19
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Jeong E, Cha KS, Shin HR, Kim EY, Jun JS, Kim TJ, Byun JI, Shin JW, Sunwoo JS, Jung KY. Alerting network alteration in isolated rapid eye movement sleep behavior disorder patients with mild cognitive impairment. Sleep Med 2021; 89:10-18. [PMID: 34864507 DOI: 10.1016/j.sleep.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) was found in 30-50% of the isolated REM sleep behavior disorder (iRBD) patients. Furthermore, it is known that patients with Parkinson's disease have attention network defects. Given that iRBD is known to be the prodromal disease of α-synucleinopathies, our aim was to investigate whether there are attention network dysfunctions in iRBD patients following the presence of MCI. METHODS 14 healthy controls, 48 iRBD patients, 24 with MCI and 24 without MCI, were included in this study. Attention network task (ANT) was used to assess alerting, orienting, and executive control networks. Event-related potentials (ERPs) and behavioral performances were recorded during the ANT. Parietal N1 and P3 components were analyzed to find effects of the three attention networks. RESULTS IRBD patients without MCI showed neuropsychological, behavioral, and ERP results similar to those of healthy controls. On the other hand, iRBD patients with MCI showed a general decline in cognitive domains with no alerting effect (controls, p = 0.043; iRBD-noMCI, p = 0.014; iRBD-MCI, p = 0.130) while preserving orienting and executive control effect. Furthermore, iRBD patients with MCI had impairments in executive function and verbal memory domains, compared to iRBD patients without MCI. CONCLUSIONS Our findings indicate that when cognition is reduced to MCI levels in iRBD patients, the attention network, especially the alerting component, is impaired. The attention network and cognition, on the other hand, can be preserved in iRBD patients due to the compensatory mechanism.
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Affiliation(s)
- El Jeong
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Kwang Su Cha
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye-Rim Shin
- Department of Neurology, Dankook University Hospital, Cheonan, South Korea
| | - Eun Young Kim
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jung-Won Shin
- Department of Neurology, CHA University, Bundang CHA Medical Center, Seongnam, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
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20
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Rémillard-Pelchat D, Rahayel S, Gaubert M, Postuma RB, Montplaisir J, Pelletier A, Monchi O, Brambati SM, Carrier J, Gagnon JF. Comprehensive Analysis of Brain Volume in REM Sleep Behavior Disorder with Mild Cognitive Impairment. J Parkinsons Dis 2021; 12:229-241. [PMID: 34690149 DOI: 10.3233/jpd-212691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rapid-eye-movement sleep behavior disorder (RBD) is a major risk factor for Parkinson's disease and dementia with Lewy bodies. More than a third of RBD patients have mild cognitive impairment (MCI), but their specific structural brain alterations remain poorly understood. OBJECTIVE This study aimed to investigate the local deformation and volume of gray and white matter tissue underlying MCI in RBD. METHODS Fifty-two idiopathic RBD patients, including 17 with MCI (33%), underwent polysomnography, neuropsychological, neurological, and magnetic resonance imaging assessments. MCI diagnosis was based on a subjective complaint, cognitive impairment on the neuropsychological battery, and preserved daily functioning. Forty-one controls were also included. Deformation-based morphometry (DBM), voxel-based morphometry (VBM), and regional volume analyses of the corpus callosum and basal forebrain cholinergic were performed. Multiple regressions models were also computed using anatomical, cognitive (composite z score), and motor parameters. RESULTS Globally, patients with MCI displayed a widespread pattern of local deformation and volume atrophy in the cortical (bilateral insula, cingulate cortex, precuneus, frontal and temporal regions, right angular gyrus, and mid-posterior segment of the corpus callosum) and subcortical (brainstem, corona radiata, basal ganglia, thalamus, amygdala, and right hippocampus) regions compared to patients without MCI (DBM) or controls (DBM and VBM). Moreover, brain deformation (DBM) in patients were associated with lower performance in attention and executive functions, visuospatial abilities, and higher motor symptoms severity. CONCLUSION The present study identified novel brain structural alterations in RBD patients with MCI which correlated with poorer cognitive performance. These results are consistent with those reported in patients with synucleinopathies-related cognitive impairment.
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Affiliation(s)
- David Rémillard-Pelchat
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Shady Rahayel
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Malo Gaubert
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Oury Monchi
- Department of Radiology, Radio-Oncology, and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada.,Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Simona Maria Brambati
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
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21
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Miglis MG, Adler CH, Antelmi E, Arnaldi D, Baldelli L, Boeve BF, Cesari M, Dall'Antonia I, Diederich NJ, Doppler K, Dušek P, Ferri R, Gagnon JF, Gan-Or Z, Hermann W, Högl B, Hu MT, Iranzo A, Janzen A, Kuzkina A, Lee JY, Leenders KL, Lewis SJG, Liguori C, Liu J, Lo C, Ehgoetz Martens KA, Nepozitek J, Plazzi G, Provini F, Puligheddu M, Rolinski M, Rusz J, Stefani A, Summers RLS, Yoo D, Zitser J, Oertel WH. Biomarkers of conversion to α-synucleinopathy in isolated rapid-eye-movement sleep behaviour disorder. Lancet Neurol 2021; 20:671-684. [PMID: 34302789 DOI: 10.1016/s1474-4422(21)00176-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/19/2022]
Abstract
Patients with isolated rapid-eye-movement sleep behaviour disorder (RBD) are commonly regarded as being in the early stages of a progressive neurodegenerative disease involving α-synuclein pathology, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy. Abnormal α-synuclein deposition occurs early in the neurodegenerative process across the central and peripheral nervous systems and might precede the appearance of motor symptoms and cognitive decline by several decades. These findings provide the rationale to develop reliable biomarkers that can better predict conversion to clinically manifest α-synucleinopathies. In addition, biomarkers of disease progression will be essential to monitor treatment response once disease-modifying therapies become available, and biomarkers of disease subtype will be essential to enable prediction of which subtype of α-synucleinopathy patients with isolated RBD might develop.
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Affiliation(s)
- Mitchell G Miglis
- Department of Neurology and Neurological Sciences and Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA.
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Bradley F Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irene Dall'Antonia
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Nico J Diederich
- Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | | | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal-Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Ziv Gan-Or
- The Neuro-Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, and Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE), Research Site Rostock, Rostock, Germany
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Annette Janzen
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany
| | | | - Jee-Young Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Klaus L Leenders
- Department of Nuclear Medicine and Biomedical Imaging, University Medical Center Groningen, Groningen, Netherlands
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Claudio Liguori
- Sleep Medicine Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Christine Lo
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kaylena A Ehgoetz Martens
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; UOC Clinica Neurologica Rete Metropolitana NEUROMET, Bellaria Hospital, Bologna, Italy
| | - Monica Puligheddu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Michal Rolinski
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jennifer Zitser
- Department of Neurology and Neurological Sciences, University of California, San Francisco, CA, USA; Department of Neurology, Tel Aviv Sourasky Medical Center, Affiliate of Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wolfgang H Oertel
- Department of Neurology and Section on Clinical Neuroscience, Philipps University Marburg, Marburg, Germany; Institute for Neurogenomics, Helmholtz Center for Health and Environment, München-Neuherberg, Germany
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22
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Aarsland D, Batzu L, Halliday GM, Geurtsen GJ, Ballard C, Ray Chaudhuri K, Weintraub D. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers 2021; 7:47. [PMID: 34210995 DOI: 10.1038/s41572-021-00280-3] [Citation(s) in RCA: 327] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder, affecting >1% of the population ≥65 years of age and with a prevalence set to double by 2030. In addition to the defining motor symptoms of PD, multiple non-motor symptoms occur; among them, cognitive impairment is common and can potentially occur at any disease stage. Cognitive decline is usually slow and insidious, but rapid in some cases. Recently, the focus has been on the early cognitive changes, where executive and visuospatial impairments are typical and can be accompanied by memory impairment, increasing the risk for early progression to dementia. Other risk factors for early progression to dementia include visual hallucinations, older age and biomarker changes such as cortical atrophy, as well as Alzheimer-type changes on functional imaging and in cerebrospinal fluid, and slowing and frequency variation on EEG. However, the mechanisms underlying cognitive decline in PD remain largely unclear. Cortical involvement of Lewy body and Alzheimer-type pathologies are key features, but multiple mechanisms are likely involved. Cholinesterase inhibition is the only high-level evidence-based treatment available, but other pharmacological and non-pharmacological strategies are being tested. Challenges include the identification of disease-modifying therapies as well as finding biomarkers to better predict cognitive decline and identify patients at high risk for early and rapid cognitive impairment.
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Affiliation(s)
- Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
| | - Lucia Batzu
- Parkinson's Foundation Centre of Excellence, King's College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Glenda M Halliday
- Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Gert J Geurtsen
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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