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Pitton Rissardo J, Fornari Caprara AL. Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review. Brain Sci 2023; 13:1471. [PMID: 37891838 PMCID: PMC10605004 DOI: 10.3390/brainsci13101471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/29/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Cardiac sympathetic denervation, as documented on 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, is relatively sensitive and specific for distinguishing Parkinson's disease (PD) from other neurodegenerative causes of parkinsonism. The present study aims to comprehensively review the literature regarding the use of cardiac MIBG in PD. MIBG is an analog to norepinephrine. They share the same uptake, storage, and release mechanisms. An abnormal result in the cardiac MIBG uptake in individuals with parkinsonism can be an additional criterion for diagnosing PD. However, a normal result of cardiac MIBG in individuals with suspicious parkinsonian syndrome does not exclude the diagnosis of PD. The findings of cardiac MIBG studies contributed to elucidating the pathophysiology of PD. We investigated the sensitivity and specificity of cardiac MIBG scintigraphy in PD. A total of 54 studies with 3114 individuals diagnosed with PD were included. The data were described as means with a Hoehn and Yahr stage of 2.5 and early and delayed registration H/M ratios of 1.70 and 1.51, respectively. The mean cutoff for the early and delayed phases were 1.89 and 1.86. The sensitivity for the early and delayed phases was 0.81 and 0.83, respectively. The specificity for the early and delayed phases were 0.86 and 0.80, respectively.
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Saunders-Pullman R, Ortega RA, Wang C, Raymond D, Elango S, Leaver K, Urval N, Katsnelson V, Gerber R, Swan M, Shanker V, Alcalay RN, Mirelman A, Brumm MC, Mejia-Santana H, Coffey CS, Marek K, Ozelius LJ, Giladi N, Marder KS, Bressman SB. Association of Olfactory Performance With Motor Decline and Age at Onset in People With Parkinson Disease and the LRRK2 G2019S Variant. Neurology 2022; 99:e814-e823. [PMID: 35995594 PMCID: PMC9484727 DOI: 10.1212/wnl.0000000000200737] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is clinical and phenotypic heterogeneity in LRRK2 G2019S Parkinson disease (PD), including loss of smell. Olfactory scores have defined subgroups of LRRK2 PD at baseline. We now extend this work longitudinally to better determine features associated with olfactory classes and to gain further insight into this heterogeneity. METHODS Evaluation of 162 patients with LRRK2 PD and 198 patients with idiopathic PD (IPD) from the LRRK2 Ashkenazi Jewish Consortium was performed, with follow-up available for 92 patients with LRRK2 PD and 74 patients with IPD. Olfaction (University of Pennsylvania Smell Identification Test [UPSIT]), motor function (Unified Parkinson Disease Rating Scale), and cognition (Montreal Cognitive Assessment), as well as sleep, nonmotor, and mood, were measured. Gaussian mixture models were applied on the UPSIT percentile score to determine subgroups based on olfactory performance. Linear mixed effects models, using PD duration as the time scale, assessed the relationship between UPSIT subgroup membership and motor/cognitive change. RESULTS Baseline olfaction was better in LRRK2 PD compared with IPD (mean UPSIT ± SD: 24.2 ± 8.8 vs 18.9 ± 7.6), with higher mean percentile scores (difference: 15.3 ± 11.6) (p < 0.001) and less frequent hyposmia (55.6% vs 85.4%; p < 0.001). Analysis suggested 3 classes among LRRK2 PD. Age at onset in LRRK2 PD was earlier in the worst olfaction group (group 1), compared with groups 2 and 3 (54.5 ± 11.1 vs 61.7 ± 9.3) (p = 0.012), and separately in the hyposmic group overall (55.0 ± 11.3 vs 61.7 ± 9.1) (p < 0.001). Longitudinal motor deterioration in LRRK2 PD was also significantly faster in the worst UPSIT group than the best UPSIT group (group 3 vs group 1: B = 0.31, SE = 0.35 vs B = 0.96, SE = 0.28) (rate difference = -0.65, SE = 0.29) (p = 0.03). However, olfactory group membership was not significantly associated with cognitive decline. DISCUSSION In this large LRRK2 cohort with longitudinal analysis, we extend prior work demonstrating subgroups defined by olfaction in LRRK2 G2019S PD and show that the worst olfaction group has earlier age at PD onset and more rapid motor decline. This supports a subgroup of LRRK2 PD that might show more rapid change in a clinical trial of LRRK2-related agents and highlights the need to integrate careful phenotyping into allocation schema in clinical trials of LRRK2-related agents. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that worse olfactory scores were associated with an earlier age at symptomatic onset and a faster rate of motor deterioration in patients with LRRK2 PD.
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Affiliation(s)
- Rachel Saunders-Pullman
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston.
| | - Roberto Angel Ortega
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Cuiling Wang
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Deborah Raymond
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Sonya Elango
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Katherine Leaver
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Nikita Urval
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Viktoriya Katsnelson
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Rachel Gerber
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Matthew Swan
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Vicki Shanker
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Roy N Alcalay
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Anat Mirelman
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Michael C Brumm
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Helen Mejia-Santana
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Christopher S Coffey
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Kenneth Marek
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Laurie J Ozelius
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Nir Giladi
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Karen S Marder
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Susan B Bressman
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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4
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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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5
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Nasri A, Kacem I, Farhat N, Gharbi A, Sakka S, Souissi A, Zidi S, Damak M, Bendjebara M, Gargouri A, Mhiri C, Gouider R. Heart rate variability and sympathetic skin response for the assessment of autonomic dysfunction in leucine-rich repeat kinase 2 associated Parkinson's disease. Neurophysiol Clin 2022; 52:81-93. [DOI: 10.1016/j.neucli.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/18/2022] Open
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6
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Alonso CCG, Silva FG, Costa LOP, Freitas SMSF. Smell tests can discriminate Parkinson's disease patients from healthy individuals: A meta-analysis. Clin Neurol Neurosurg 2021; 211:107024. [PMID: 34823156 DOI: 10.1016/j.clineuro.2021.107024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Olfactory impairment is common in Parkinson's disease (PD). The authors aimed to identify the clinical tests used to assess olfactory function and examine their ability to distinguish PD with different disease duration from healthy individuals with physiological aging. METHODS Cross-sectional studies published until May 2020 that assessed the olfaction of individuals with PD using search terms related to PD, olfactory function, and assessment were searched on PubMed, PsycInfo, Cinahl, and Web of Science databases. RESULTS Twelve smell tests were identified from the reviewed studies (n = 125) that assessed 8776 individuals with PD. Data of 6593 individuals with PD and 8731 healthy individuals were included in the meta-analyses. Individuals with PD presented worse performance than healthy individuals, regardless of the smell test used. The University of Pennsylvania Smell Identification Test (UPSIT) was used by most studies (n = 2310 individuals with PD) and presented smaller heterogeneity. When the studies were subclassified according to the years of PD duration, there were no significant differences. CONCLUSION All smell tests were able to discriminate the olfactory function of PD from that of healthy individuals, although the UPSIT was widely used. The abnormal olfaction was not related to the disease duration. Systematic review protocol registration (PROSPERO/2020-CRD42020160878).
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Affiliation(s)
- Cintia C G Alonso
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Fernanda G Silva
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Sandra M S F Freitas
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
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7
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Aasly JO. Inflammatory Diseases Among Norwegian LRRK2 Mutation Carriers. A 15-Years Follow-Up of a Cohort. Front Neurosci 2021; 15:634666. [PMID: 33584195 PMCID: PMC7876287 DOI: 10.3389/fnins.2021.634666] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
The first families with LRRK2 related Parkinson’s disease (PD) were presented around 15 years ago and numerous papers have described the characteristics of the LRRK2 phenotype. The prevalence of autosomal dominant PD varies around the world mainly depending on local founder effects. The highest prevalence of LRRK2 G2019S PD in Norway is located to the central part of the country and most families could be traced back to common ancestors. The typical Norwegian LRRK2 phenotype is not different from classical PD and similar to that seen in most other LRRK2 families. The discovery of LRRK2 PD has allowed us to follow-up multi-incident families and to study their phenotype longitudinally. In the Norwegian LRRK2 families there has been a significantly higher incidence of inflammatory diseases like multiple sclerosis and rheumatoid arthritis that seen in other PD populations. Recent studies in LRRK2 mechanisms have indicated that this protein may be crucial in initiating disease processes. In this short survey of 100 Norwegian mutation carriers followed through more than 15 years are presented. The prevalence of inflammatory diseases among these cases is highlighted. The role of LRRK2 in the conversion process from carrier status to PD phenotype is still unknown and disease generating mechanisms important for initiating LRRK2 PD are still to be identified.
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Affiliation(s)
- Jan O Aasly
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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8
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Mantri S, Morley JF, Siderowf AD. The importance of preclinical diagnostics in Parkinson disease. Parkinsonism Relat Disord 2019; 64:20-28. [DOI: 10.1016/j.parkreldis.2018.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/02/2018] [Accepted: 09/08/2018] [Indexed: 01/21/2023]
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9
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Gabilondo I, Llorens V, Rodriguez T, Fernández M, Concha TP, Acera M, Tijero B, Murueta-Goyena A, del Pino R, Cortés J, Gómez-Esteban JC. Myocardial MIBG scintigraphy in genetic Parkinson’s disease as a model for Lewy body disorders. Eur J Nucl Med Mol Imaging 2018; 46:376-384. [DOI: 10.1007/s00259-018-4183-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
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10
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Rey NL, Wesson DW, Brundin P. The olfactory bulb as the entry site for prion-like propagation in neurodegenerative diseases. Neurobiol Dis 2018; 109:226-248. [PMID: 28011307 PMCID: PMC5972535 DOI: 10.1016/j.nbd.2016.12.013] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023] Open
Abstract
Olfactory deficits are present in numerous neurodegenerative disorders and are accompanied by pathology in related brain regions. In several of these disorders, olfactory disturbances appear early and are considered as prodromal symptoms of the disease. In addition, pathological protein aggregates affect olfactory regions prior to other regions, suggesting that the olfactory system might be particularly vulnerable to neurodegenerative diseases. Exposed to the external environment, the olfactory epithelium and olfactory bulb allow pathogen and toxin penetration into the brain, a process that has been proposed to play a role in neurodegenerative diseases. Determining whether the olfactory bulb could be a starting point of pathology and of pathology spread is crucial to understanding how neurodegenerative diseases evolve. We argue that pathological changes following environmental insults contribute to the initiation of protein aggregation in the olfactory bulb, which then triggers the spread of the pathology within the brain by a templating mechanism in a prion-like manner. We review the evidence for the early involvement of olfactory structures in neurodegenerative diseases and the relationship between neuropathology and olfactory function. We discuss the vulnerability and putative underlying mechanisms by which pathology could be initiated in the olfactory bulb, from the entry of pathogens (promoted by increased permeability of the olfactory epithelium with aging or inflammation) to the sensitivity of the olfactory system to oxidative stress and inflammation. Finally, we review changes in protein expression and neural excitability triggered by pathogenic proteins that can promote pathogenesis in the olfactory bulb and beyond.
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Affiliation(s)
- Nolwen L Rey
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI 49503, USA.
| | - Daniel W Wesson
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI 49503, USA
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11
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Pont-Sunyer C, Tolosa E, Caspell-Garcia C, Coffey C, Alcalay RN, Chan P, Duda JE, Facheris M, Fernández-Santiago R, Marek K, Lomeña F, Marras C, Mondragon E, Saunders-Pullman R, Waro B. The prodromal phase of leucine-rich repeat kinase 2-associated Parkinson disease: Clinical and imaging Studies. Mov Disord 2017; 32:726-738. [PMID: 28370517 DOI: 10.1002/mds.26964] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Asymptomatic, nonmanifesting carriers of leucine-rich repeat kinase 2 mutations are at increased risk of developing PD. Clinical and neuroimaging features may be associated with gene carriage and/or may demarcate individuals at greater risk for phenoconversion to PD. OBJECTIVES To investigate clinical and dopamine transporter single-photon emission computed tomography imaging characteristics of leucine-rich repeat kinase 2 asymptomatic carriers. METHODS A total of 342 carriers' and 259 noncarriers' relatives of G2019S leucine-rich repeat kinase 2/PD patients and 39 carriers' and 31 noncarriers' relatives of R1441G leucine-rich repeat kinase 2/PD patients were evaluated. Motor and nonmotor symptoms were assessed using specific scales and questionnaires. Neuroimaging quantitative data were obtained in 81 carriers and compared with 41 noncarriers. RESULTS G2019S carriers scored higher in motor scores and had lower radioligand uptake compared to noncarriers, but no differences in nonmotor symptoms scores were observed. R1441G carriers scored higher in motor scores, had lower radioligand uptake, and had higher scores in depression, dysautonomia, and Rapid Eye Movements Sleep Behavior Disorder Screening Questionnaire scores, but had better cognition scores than noncarriers. Among G2019S carriers, a group with "mild motor signs" was identified, and was significantly older, with worse olfaction and lower radioligand uptake. CONCLUSIONS G2019S and R1441G carriers differ from their noncarriers' relatives in higher motor scores and slightly lower radioligand uptake. Nonmotor symptoms were mild, and different nonmotor profiles were observed in G2019S carriers compared to R1441G carriers. A group of G2019S carriers with known prodromal features was identified. Longitudinal studies are required to determine whether such individuals are at short-term risk of developing overt parkinsonism. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Claustre Pont-Sunyer
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.,Neurology Unit, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
| | - Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Piu Chan
- Departments of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - John E Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz VA Medical Center and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurizio Facheris
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Rubén Fernández-Santiago
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Hospital Clínic of Barcelona, Institutd'InvestigacionsBiomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, and the Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders and Molecular NeuroImaging, New Haven, Connecticut, USA
| | - Francisco Lomeña
- Department of Nuclear Medicine, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Connie Marras
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University of Toronto, Toronto, Ontario, Canada
| | - Elisabet Mondragon
- Department of Neurology, Movement Disorders Unit. Hospital Universitario Donostia. Biodonostia Research Institute, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), San Sebastián, Guipúzcoa, Spain
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bjorg Waro
- Department of Neurology, Norwegian University of Science and Technology, Trondheim, Norway
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12
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Liu SY, Chan P, Stoessl AJ. The underlying mechanism of prodromal PD: insights from the parasympathetic nervous system and the olfactory system. Transl Neurodegener 2017; 6:4. [PMID: 28239455 DOI: 10.1186/s40035-017-0074-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/07/2017] [Indexed: 12/13/2022] Open
Abstract
Neurodegeneration of Parkinson's disease (PD) starts in an insidious manner, 30-50% of dopaminergic neurons have been lost in the substantia nigra before clinical diagnosis. Prodromal stage of the disease, during which the disease pathology has started but is insufficient to result in clinical manifestations, offers a valuable window for disease-modifying therapies. The most focused underlying mechanisms linking the pathological pattern and clinical characteristics of prodromal PD are the prion hypothesis of alpha-synuclein and the selective vulnerability of neurons. In this review, we consider the two potential portals, the vagus nerve and the olfactory bulb, through which abnormal alpha-synuclein can access the brain. We review the clinical, pathological and neuroimaging evidence of the parasympathetic nervous system and the olfactory system in the neurodegenerative process and using the two systems as models to discuss the internal homogeneity and heterogeneity of the prodromal stage of PD, including both the clustering and subtyping of symptoms and signs. Finally, we offer some suggestions on future directions for imaging studies in prodromal Parkinson's disease.
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13
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Visanji NP, Bhudhikanok GS, Mestre TA, Ghate T, Udupa K, AlDakheel A, Connolly BS, Gasca-Salas C, Kern DS, Jain J, Slow EJ, Faust-Socher A, Kim S, Azhu Valappil R, Kausar F, Rogaeva E, William Langston J, Tanner CM, Schüle B, Lang AE, Goldman SM, Marras C. Heart rate variability in leucine-rich repeat kinase 2-associated Parkinson's disease. Mov Disord 2017; 32:610-614. [PMID: 28071824 DOI: 10.1002/mds.26896] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/05/2016] [Revised: 11/15/2016] [Accepted: 11/20/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Heart rate variability is reduced in idiopathic PD, indicating cardiac autonomic dysfunction likely resulting from peripheral autonomic synucleinopathy. Little is known about heart rate variability in leucine-rich repeat kinase 2-associated PD. OBJECTIVES This study investigated heart rate variability in LRRK2-associated PD. METHODS Resting electrocardiograms were obtained from 20 individuals with LRRK2-associated PD, 37 nonmanifesting carriers, 48 related noncarriers, 26 idiopathic PD patients, and 32 controls. Linear regression modelling compared time and frequency domain values, adjusting for age, sex, heart rate, and disease duration. RESULTS Low-frequency power and the ratio of low-high frequency power were reduced in idiopathic PD versus controls (P < .008, P < .029 respectively). In contrast, individuals with LRRK2-associated PD were not statistically different from controls in any parameter measured. Furthermore, all parameters trended toward being higher in LRRK2-associated PD when compared with idiopathic PD. CONCLUSIONS Heart rate variability may remain intact in LRRK2-associated PD, adding to a growing literature supporting clinical-pathologic differences between LRRK2-associated and idiopathic PD. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Naomi P Visanji
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | | | - Tiago A Mestre
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Taneera Ghate
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Kaviraj Udupa
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Amaal AlDakheel
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Barbara S Connolly
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Carmen Gasca-Salas
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Drew S Kern
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Jennifer Jain
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Elizabeth J Slow
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Achinoam Faust-Socher
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Sam Kim
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | | | - Farah Kausar
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - J William Langston
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Caroline M Tanner
- University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Birgitt Schüle
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Samuel M Goldman
- University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
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14
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Abstract
LRRK2 mutations are present in 1% of all sporadic Parkinson's disease (PD) cases and 5% of all familial PD cases. Several mutations in the LRRK2 gene are associated with PD, the most common of which is the Gly2019Ser mutation. In the following review, we summarize the demographics and motor and non-motor symptoms of LRRK2 carriers with PD, as well as symptoms in non-manifesting carriers. The clinical features of LRRK2-associated PD are often indistinguishable from those of idiopathic PD on an individual basis. However, LRRK2 PD patients are likely to have less non-motor symptoms compared to idiopathic PD patients, including less olfactory and cognitive impairment. LRRK2-associated PD patients are less likely to report REM sleep behavior disorder (RBD) than noncarriers. In addition, it is possible that carriers are more prone to cancer than noncarriers with PD, but larger studies are required to confirm this observation. Development of more sensitive biomarkers to identify mutation carriers at risk of developing PD, as well as biomarkers of disease progression among LRRK2 carriers with PD, is required. Such biomarkers would help evaluate interventions, which may prevent PD among non-manifesting carriers, or slow down disease progression among carriers with PD.
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15
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Marras C, Alcalay RN, Caspell-Garcia C, Coffey C, Chan P, Duda JE, Facheris MF, Fernández-Santiago R, Ruíz-Martínez J, Mestre T, Saunders-Pullman R, Pont-Sunyer C, Tolosa E, Waro B. Motor and nonmotor heterogeneity of LRRK2-related and idiopathic Parkinson's disease. Mov Disord 2016; 31:1192-202. [PMID: 27091104 DOI: 10.1002/mds.26614] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 10/21/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) associated with LRRK2 mutations has been described as similar to idiopathic PD with minor clinical differences. No study has compared the clinical features of LRRK2-associated PD due to different mutations. The objective of this study was to compare LRRK2-associated PD due to G2019S and G2385R mutations and to compare each to idiopathic PD. METHODS Sites within the international LRRK2 Cohort Consortium undertook family-based, community-based, or clinic-based studies to gather clinical data on manifesting carriers and patients with idiopathic PD. RESULTS Five hundred sixteen PD patients with the G2019S mutation, 199 with the G2385R mutation, and 790 patients with idiopathic PD were included in the data set. Adjusted for age, sex, disease duration, and levodopa-equivalent daily dose, mean MDS-UPDRS part II or III scores and the frequency of motor fluctuations were higher in the G2385R mutation carriers than in either the G2019S mutation carriers or idiopathic PD patients. G2019S mutation carriers had significantly lower UPDRS part III scores than idiopathic PD patients. Both G2019S and G2385R mutation carriers had a higher proportion of the postural instability gait disorder phenotype compared with idiopathic PD patients. LRRK2 G2019S PD patients had better UPSIT scores and lower Geriatric Depression Scale scores than idiopathic PD patients in adjusted analyses. CONCLUSIONS G2385R and G2019S PD appear to have motor differences that may be explained by contrasting local treatment or measurement practices or differences in the biology of the disease. Longitudinal studies should evaluate whether progression is faster in G2385R mutation carriers compared with G2019S PD or idiopathic PD. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Connie Marras
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University of Toronto, Toronto, Ontario, Canada
| | - Roy N Alcalay
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Piu Chan
- Departments of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, China
| | - John E Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz VA Medical Center and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurizio F Facheris
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Rubén Fernández-Santiago
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, and the Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Javier Ruíz-Martínez
- Department of Neurology (Movement Disorders Unit), Hospital Universitario Donostia. Biodonostia Research Institute, Neurosciences area. San Sebastián, Guipúzcoa, Spain, and CIBERNED, Carlos III Health Institute, Madrid, Spain
| | - Tiago Mestre
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University of Toronto, Toronto, Ontario, Canada.,Parkinson's Disease and Movement Disorder Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claustre Pont-Sunyer
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institutd'InvestigacionsBiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institutd'InvestigacionsBiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Bjorg Waro
- Department of Neurology, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
We herein report the case of a 43-year-old man with a 4-year history of resting tremor and akinesia. His resting tremor and rigidity were more prominent on the left side. He also presented retropulsion. His symptoms responded to the administration of levodopa. The patient also had a cleft lip and palate, cavum vergae, and hypoparathyroidism. A chromosome analysis disclosed a hemizygous deletion in 22q11.2, and he was diagnosed with early-onset Parkinson's disease associated with 22q11.2 deletion syndrome. However, the patient lacked autonomic nerve dysfunction, and his cardiac uptake of (123)I-metaiodobenzylguanidine was normal, indicating an underlying pathological mechanism that differed to that of sporadic Parkinson's disease.
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Affiliation(s)
- Mitsuaki Oki
- Department of Neurology, Kansai Medical University, Japan
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Pont-Sunyer C, Iranzo A, Gaig C, Fernández-Arcos A, Vilas D, Valldeoriola F, Compta Y, Fernández-Santiago R, Fernández M, Bayés A, Calopa M, Casquero P, de Fàbregues O, Jaumà S, Puente V, Salamero M, José Martí M, Santamaría J, Tolosa E. Sleep Disorders in Parkinsonian and Nonparkinsonian LRRK2 Mutation Carriers. PLoS One 2015; 10:e0132368. [PMID: 26177462 PMCID: PMC4503402 DOI: 10.1371/journal.pone.0132368] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/14/2015] [Indexed: 12/21/2022] Open
Abstract
Objective In idiopathic Parkinson disease (IPD) sleep disorders are common and may antedate the onset of parkinsonism. Based on the clinical similarities between IPD and Parkinson disease associated with LRRK2 gene mutations (LRRK2-PD), we aimed to characterize sleep in parkinsonian and nonmanifesting LRRK2 mutation carriers (NMC). Methods A comprehensive interview conducted by sleep specialists, validated sleep scales and questionnaires, and video-polysomnography followed by multiple sleep latency test (MSLT) assessed sleep in 18 LRRK2-PD (17 carrying G2019S and one R1441G mutations), 17 NMC (11 G2019S, three R1441G, three R1441C), 14 non-manifesting non-carriers (NMNC) and 19 unrelated IPD. Results Sleep complaints were frequent in LRRK2-PD patients; 78% reported poor sleep quality, 33% sleep onset insomnia, 56% sleep fragmentation and 39% early awakening. Sleep onset insomnia correlated with depressive symptoms and poor sleep quality. In LRRK2-PD, excessive daytime sleepiness (EDS) was a complaint in 33% patients and short sleep latencies on the MSLT, which are indicative of objective EDS, were found in 71%. Sleep attacks occurred in three LRRK2-PD patients and a narcoleptic phenotype was not observed. REM sleep behavior disorder (RBD) was diagnosed in three LRRK2-PD. EDS and RBD were always reported to start after the onset of parkinsonism in LRRK2-PD. In NMC, EDS was rarely reported and RBD was absent. When compared to IPD, sleep onset insomnia was more significantly frequent, EDS was similar, and RBD was less significantly frequent and less severe in LRRK2-PD. In NMC, RBD was not detected and sleep complaints were much less frequent than in LRRK2-PD. No differences were observed in sleep between NMC and NMNC. Conclusions Sleep complaints are frequent in LRRK2-PDand show a pattern that when compared to IPD is characterized by more frequent sleep onset insomnia, similar EDS and less prominent RBD. Unlike in IPD, RBD and EDS seem to be not markers of the prodromal stage of LRRK2-PD.
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Affiliation(s)
- Claustre Pont-Sunyer
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Alex Iranzo
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- * E-mail:
| | - Carles Gaig
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ana Fernández-Arcos
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Dolores Vilas
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Francesc Valldeoriola
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Yaroslau Compta
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ruben Fernández-Santiago
- Laboratory of Neurodegenerative Disorders, Department of Clinical and Experimental Neurology, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Manel Fernández
- Laboratory of Neurodegenerative Disorders, Department of Clinical and Experimental Neurology, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | | | - Matilde Calopa
- NeurologyService, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Oriol de Fàbregues
- Neurology Service, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Serge Jaumà
- NeurologyService, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Victor Puente
- Neurology Service, Hospital Del Mar, Barcelona, Spain
| | | | - Maria José Martí
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Joan Santamaría
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Eduard Tolosa
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
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19
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Saunders-Pullman R, Mirelman A, Wang C, Alcalay RN, San Luciano M, Ortega R, Raymond D, Mejia-Santana H, Ozelius L, Clark L, Orr-Utreger A, Marder K, Giladi N, Bressman SB. Olfactory identification in LRRK2 G2019S mutation carriers: a relevant marker? Ann Clin Transl Neurol 2014; 1:670-8. [PMID: 25493281 PMCID: PMC4241794 DOI: 10.1002/acn3.95] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 12/12/2022] Open
Abstract
Objective Olfactory impairment is a potential marker for impending phenoconversion to Parkinson disease (PD) that may precede the development of disease by several years. Because of low specificity, it may be of greater predictive value in those with genetic mutations and its potential as a marker for developing LRRK2 PD should be evaluated. Methods We examined olfactory identification in 126 LRRK2 G2019S mutation carriers with PD, 125 mutation carriers not manifesting PD, 126 noncarriers with idiopathic PD, 106 noncarrier family members without PD, and 35 unrelated controls. We compared olfactory performance and performed mixture modeling to identify possible subgroups of olfactory performance in LRRK2 PD and nonmanifesting carriers. Results Adjusting for sex, age, cognitive score, site, and smoking history, LRRK2 PD had better olfactory scores compared to idiopathic PD (mean olfaction difference: −3.7, P < 0.001), and both LRRK2 PD and idiopathic PD had worse olfaction than controls (−12.8, −9.1, both P < 0.001). LRRK2 PD were less likely to be hyposmic than idiopathic PD (54.8% vs. 80.2%, P < 0.001). Nonmanifesting carriers and noncarrier family members did not differ. Mixture model analysis identified three classes in the LRRK2 PD and nonmanifesting carriers, suggesting that there are subgroups with poor olfactory identification in both LRRK2 PD and nonmanifesting carriers. Interpretation Therefore, olfactory identification deficit is less likely to be an obligate feature in LRRK2 PD than idiopathic PD, and while a relevant marker in some, a subset of carriers who eventually phenoconvert may proceed directly to PD without prior impaired olfaction.
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Affiliation(s)
- Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel Medical Center New York City, New York ; Department of Neurology, Icahn School of Medicine at Mount Sinai New York City, New York ; Department of Neurology, Albert Einstein College of Medicine Bronx, New York
| | - Anat Mirelman
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University Tel-Aviv, Israel
| | - Cuiling Wang
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine Bronx, New York
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University New York City, New York ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University New York City, New York
| | - Marta San Luciano
- Department of Neurology, University of California San Francisco San Francisco, California
| | - Robert Ortega
- Department of Neurology, Mount Sinai Beth Israel Medical Center New York City, New York
| | - Deborah Raymond
- Department of Neurology, Mount Sinai Beth Israel Medical Center New York City, New York
| | - Helen Mejia-Santana
- Department of Neurology, College of Physicians and Surgeons, Columbia University New York City, New York ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University New York City, New York
| | - Laurie Ozelius
- Department of Neurology, Icahn School of Medicine at Mount Sinai New York City, New York ; Department of Genetics, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Lorraine Clark
- Department of Neurology, College of Physicians and Surgeons, Columbia University New York City, New York ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University New York City, New York
| | - Avi Orr-Utreger
- Genetic Institute, Tel-Aviv Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University Tel-Aviv, Israel
| | - Karen Marder
- Department of Neurology, College of Physicians and Surgeons, Columbia University New York City, New York ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University New York City, New York ; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University New York City, New York ; Department of Psychiatry, Columbia University Medical Center New York City, New York
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University Tel-Aviv, Israel
| | - Susan B Bressman
- Department of Neurology, Mount Sinai Beth Israel Medical Center New York City, New York ; Department of Neurology, Icahn School of Medicine at Mount Sinai New York City, New York
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Hao M, Pan N, Zhang Q, Wang X. Mutant of leucine-rich repeat kinase 2 is not associated with non-motor symptoms in Chinese Parkinson's disease patients. Int J Clin Exp Med 2014; 7:2253-2257. [PMID: 25232417 PMCID: PMC4161577] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/15/2014] [Indexed: 06/03/2023]
Abstract
Non-motor symptoms (NMS) are common in patients with Parkinson's disease (PD). However, little is known about NMS in patients with mutant of leucine-rich repeat kinase 2 (LRRK2). This study aimed to elucidate the relationship between NMS in Chinese PD patients and to ascertain if there were differences in NMS between PD patients and mutant of LRRK2. 200 sporadic PD (sPD) patients were recruited from a Provincial Hospital Affiliated to Shandong University. The Non-motor Symptom Questionnaire (NMSQ) was used to screen for the presence of NMS. A mean of 9.73 NMS (SD=4.53) was reported per patient. Forgetfulness, constipation and daytime sleepiness were found to be the most frequent NMS. No differences were found in 9 domains analysis between PD with and without LRRK2 variants. Non-motor symptoms in PD are too important to remain undetected. There are no Clinical characteristics of NMS tend to be similar between LRRK2 variants carriers and non-carriers in Chinese sPD patients.
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Affiliation(s)
- Maolin Hao
- Department of Neurology, Provincial Hospital Affiliated to Shandong University Jinan 250022, Shandong, China
| | - Ning Pan
- Department of Neurology, Provincial Hospital Affiliated to Shandong University Jinan 250022, Shandong, China
| | - Qinghua Zhang
- Department of Neurology, Provincial Hospital Affiliated to Shandong University Jinan 250022, Shandong, China
| | - Xiaohong Wang
- Department of Neurology, Provincial Hospital Affiliated to Shandong University Jinan 250022, Shandong, China
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21
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Li DW, Gu Z, Wang C, Ma J, Tang BS, Chen SD, Chan P. Non-motor symptoms in Chinese Parkinson's disease patients with and without LRRK2 G2385R and R1628P variants. J Neural Transm (Vienna) 2014; 122:661-7. [PMID: 25062988 DOI: 10.1007/s00702-014-1281-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
Non-motor symptoms (NMS) are common among patients with Parkinson's disease (PD). However, reports on NMS in Chinese PD population are scarce. Little is known about NMS in patients with Asian specific leucine-rich repeat kinase 2 (LRRK2) variants in G2385R and R1628P. This study aimed to elucidate the clinical characteristics of NMS in Chinese PD patients and to ascertain if there were differences in NMS between PD patients with and without LRRK2 variants. A multicenter, observational study was conducted with 1,225 sporadic PD (sPD) patients recruited from a PD cohort of the Chinese National Consortium on neurodegenerative diseases, 163 participants had the LRRK2 variants. The Non-motor Symptom Questionnaire (NMSQ) was used to screen for the presence of NMS. This study found the majority of sPD patients (97.6 %) had at least one NMS. A mean of 8.72 NMS (SD = 5.43) was reported per patient. Forgetfulness, constipation and daytime sleepiness were found to be the most frequent NMS. Moreover, the number of NMS was positively correlated with the age, disease duration, Hoehn & Yahr stage and the motor scores of the unified Parkinson's disease rating scale. Although no discrepancy was found in the number of NMS between sPD patients with and without LRRK2 variants, nocturia was less common in LRRK2 variants carriers than in non-carriers (P = 0.045). NMS appear to be prevalent in Chinese sPD population. There are no differences in the NMS phenotype between LRRK2 and no LRRK2 patients.
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Affiliation(s)
- Da-Wei Li
- Department of Neurology, Neurobiology and Geriatrics, National GCP Clinical Trial Center on Neurodegenerative Disease, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, #45 Changchun Street, Beijing, 100053, China
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22
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Abstract
Olfactory dysfunction is an early 'pre-clinical' sign of Parkinson's disease (PD). The present review is a comprehensive and up-to-date assessment of such dysfunction in PD and related disorders. The olfactory bulb is implicated in the dysfunction, since only those syndromes with olfactory bulb pathology exhibit significant smell loss. The role of dopamine in the production of olfactory system pathology is enigmatic, as overexpression of dopaminergic cells within the bulb's glomerular layer is a common feature of PD and most animal models of PD. Damage to cholinergic, serotonergic, and noradrenergic systems is likely involved, since such damage is most marked in those diseases with the most smell loss. When compromised, these systems, which regulate microglial activity, can influence the induction of localized brain inflammation, oxidative damage, and cytosolic disruption of cellular processes. In monogenetic forms of PD, olfactory dysfunction is rarely observed in asymptomatic gene carriers, but is present in many of those that exhibit the motor phenotype. This suggests that such gene-related influences on olfaction, when present, take time to develop and depend upon additional factors, such as those from aging, other genes, formation of α-synuclein- and tau-related pathology, or lowered thresholds to oxidative stress from toxic insults. The limited data available suggest that the physiological determinants of the early changes in PD-related olfactory function are likely multifactorial and may include the same determinants as those responsible for a number of other non-motor symptoms of PD, such as dysautonomia and sleep disturbances.
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Affiliation(s)
- Richard L Doty
- Smell & Taste Center, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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