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van de Burgt N, van Doesum W, Grevink M, van Niele S, de Koning T, Leibold N, Martinez-Martinez P, van Amelsvoort T, Cath D. Psychiatric manifestations of inborn errors of metabolism: A systematic review. Neurosci Biobehav Rev 2023; 144:104970. [PMID: 36436739 DOI: 10.1016/j.neubiorev.2022.104970] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Inborn errors of metabolism (IEMs) are characterized by deficits in metabolic enzymes as a result of an inherited disease, leading to the accumulation or decreased excretion of proteins, carbohydrates and lipids. Although IEMs are often diagnosed during childhood, adolescent and adult onset variants may be accompanied by less somatic and more psychiatric manifestations, which often hampers recognition by psychiatrists of the distinction between a primary and secondary psychiatric disorder. To help clinicians in the diagnostic process, we aimed to provide an overview of psychiatric manifestations in IEMs. Our literature search yielded 4380 records in total, of which 88 studies were included in the qualitative synthesis. Reported psychiatric disorders in adolescent and adult IEMs included depression, anxiety disorder, psychosis, attention deficit hyperactivity disorder, autism spectrum disorder, bipolar disorder and obsessive-compulsive disorder as assessed by semi-structured diagnostic interviews and validated questionnaires. A diagnostic screener and multidisciplinary IEM clinics are proposed to help clinicians during the diagnostic process, to prevent diagnostic delay and to raise awareness of the psychiatric manifestations among IEMs.
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Affiliation(s)
- Nikita van de Burgt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands.
| | - Willem van Doesum
- Department of Psychiatry, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Department of Specialized Training, GGZ Drenthe Mental Health Institute, Assen, the Netherlands
| | - Mirjam Grevink
- Department of Specialized Training, GGZ Drenthe Mental Health Institute, Assen, the Netherlands
| | - Stephanie van Niele
- Department of Specialized Training, GGZ Drenthe Mental Health Institute, Assen, the Netherlands
| | - Tom de Koning
- Department of Specialized Training, GGZ Drenthe Mental Health Institute, Assen, the Netherlands; Department of Neurology and Genetics, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Department of Pediatrics, Lund University, Lund, Sweden
| | - Nicole Leibold
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Pilar Martinez-Martinez
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Danielle Cath
- Department of Psychiatry, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Department of Specialized Training, GGZ Drenthe Mental Health Institute, Assen, the Netherlands
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2
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Kelly DM, Rothwell PM. Disentangling the Relationship Between Chronic Kidney Disease and Cognitive Disorders. Front Neurol 2022; 13:830064. [PMID: 35280286 PMCID: PMC8914950 DOI: 10.3389/fneur.2022.830064] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a rapidly rising global health burden that affects nearly 40% of older adults. Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia, and thus represent a vulnerable population. It is currently unknown to what extent this risk may be attributable to a clustering of traditional risk factors such as hypertension and diabetes mellitus leading to a high prevalence of both symptomatic and subclinical ischaemic cerebrovascular lesions, or whether other potential mechanisms, including direct neuronal injury by uraemic toxins or dialysis-specific factors could also be involved. These knowledge gaps may lead to suboptimal prevention and treatment strategies being implemented in this group. In this review, we explore the mechanisms of susceptibility and risk in the relationship between CKD and cognitive disorders.
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Affiliation(s)
- Dearbhla M. Kelly
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter M. Rothwell
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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3
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Mroczek M, Maniscalco I, Sendel M, Baron R, Seifritz E, Nowak A. Neuropsychiatric Symptoms and Their Association With Sex, Age, and Enzyme Replacement Therapy in Fabry Disease: A Systematic Review. Front Psychiatry 2022; 13:829128. [PMID: 35370863 PMCID: PMC8967288 DOI: 10.3389/fpsyt.2022.829128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from Fabry disease (FD) have an increased risk of developing neuropsychiatric symptoms (NPS), mostly impairment in cognitive performance and depression. Single cases of psychosis have been reported, however, their association with FD can be coincidental. Furthermore, deficits in social functioning and adaptation as well as specific coping styles in FD patients were observed. Recent studies focused on a longitudinal course of the disease and identified risk factors associated with specific NPS. Since 2001, enzyme replacement therapy (ERT) has been available and in preliminary studies seems to improve cognitive impairment and adaptive skills. In this systematic review, we analyze the available literature on the NPS in FD and investigate if there are any differences in their distribution between males and females, children/adolescents and adults, and individuals treated with ERT and untreated. We discuss the role of the psychological, environmental, and molecular alterations and their correlation to psychiatric manifestations in FD. Finally, we would like to increase awareness of the spectrum of NPS in FD.
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Affiliation(s)
- Magdalena Mroczek
- Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ignazio Maniscalco
- Department of Geriatric Psychiatry, Psychiatric Hospital of University of Zurich, Zurich, Switzerland
| | - Manon Sendel
- Department of Neurology, Division of Neurological Pain Research and Therapy, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Ralf Baron
- Department of Neurology, Division of Neurological Pain Research and Therapy, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of University of Zurich, Zurich, Switzerland
| | - Albina Nowak
- Department of Internal Medicine, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.,Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
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4
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Sigurdardottir S, Bjerkely B, Jenssen TG, Mathisen P, von der Lippe C, Ørstavik K, Heimdal K, Dahle DO, Weedon-Fekjær MS, Solberg O, Pihlstrøm HK. The impact of demographic and clinical characteristics on the trajectories of health-related quality of life among patients with Fabry disease. Orphanet J Rare Dis 2021; 16:427. [PMID: 34641933 PMCID: PMC8506470 DOI: 10.1186/s13023-021-02066-y] [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: 03/12/2021] [Accepted: 09/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background Fabry disease (FD) is an X-linked lysosomal storage disorder characterized by multiorgan dysfunction. Since individuals with FD usually experience progressive clinical disease manifestations, their health-related quality of life (HRQOL) is expected to change over time. However, there is limited longitudinal research examining HRQOL outcomes in individuals with FD. We aimed to: assess longitudinal outcomes in HRQOL in adults with FD; examine the physical- and mental HRQOL trajectories at the initial registration (baseline), 3–5 year, and 7–13 year follow-ups; and evaluate the possible associations of age, sex and medical complications with the physical- and mental HRQOL trajectories. Methods Forty-three individuals with FD (53% female) who were aged 18 to 81 years at baseline attended clinical follow-up visits between 2006 and 2020. Medical records were extracted retrospectively. Demographics and the 36-item Short-Form Health Survey (SF-36) were recorded at scheduled visits, except for the last data collection which was prospectively obtained in 2020. The physical (PCS) and mental (MCS) composite scores (SF-36) were chosen as outcome measures. Results The eight SF-36 domain scores were stable over a span of 13 years, and only physical- and social functioning domains worsened clinically over this follow-up period. Mean baseline SF-36 domain scores were all significantly lower (decreased HRQOL) in the FD sample compared with Norwegian population norms. Two hierarchical linear models were run to examine whether demographics and medical complications (measured at the last clinical visit) predicted physical and mental HRQOL trajectories. Age above 47 years (p < 0.001), male sex (p = 0.027), small fibre neuropathy (p < 0.001), renal dysfunction (p < 0.001), and cerebrovascular events (p = 0.003) were associated with lower HRQOL over time. No significant interactions were found between the time of follow up and the abovementioned predictors of HRQOL. Conclusions Overall HRQOL trajectories remained stable between baseline, 3–5 year, and 7–13 year follow-ups, with the majority of individuals reporting decreased physical and mental HRQOL. Medical complications in combination with older age and male sex are important predictors of lower HRQOL in FD. Awareness of this relationship is valuable both for health care providers and for patients. The findings provide indicators that can guide treatment decisions to improve physical and mental HRQOL outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02066-y.
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Affiliation(s)
- Solrun Sigurdardottir
- Centre for Rare Disorders, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | - Birgitte Bjerkely
- Centre for Rare Disorders, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Trond G Jenssen
- Department of Surgery, Inflammation Medicine and Transplantation, Section of Nephrology, Oslo University Hospital, Rikshospitalet HF, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per Mathisen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet HF, Oslo, Norway
| | - Charlotte von der Lippe
- Centre for Rare Disorders, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Kristin Ørstavik
- Department of Neurology, Section for Rare Neuromuscular Disorders, Oslo University Hospital, Rikshospitalet HF, Oslo, Norway
| | - Ketil Heimdal
- Department of Medical Genetics, Oslo University Hospital, Rikshospitalet HF, Oslo, Norway
| | - Dag Olav Dahle
- Department of Surgery, Inflammation Medicine and Transplantation, Section of Nephrology, Oslo University Hospital, Rikshospitalet HF, Oslo, Norway
| | | | - Olga Solberg
- Centre for Rare Disorders, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Hege K Pihlstrøm
- Department of Surgery, Inflammation Medicine and Transplantation, Section of Nephrology, Oslo University Hospital, Rikshospitalet HF, Oslo, Norway
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5
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Roy A, Umar H, Ochoa-Ferraro A, Warfield A, Lewis N, Geberhiwot T, Steeds R. Atherosclerosis in Fabry Disease-A Contemporary Review. J Clin Med 2021; 10:4422. [PMID: 34640440 DOI: 10.3390/jcm10194422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Fabry disease (FD) is a lysosomal storage disorder characterised by a deficiency in the enzyme α-galactosidase A resulting in sphingolipid deposition which causes progressive cardiac, renal, and cerebral manifestations. The case illustrates a patient with FD who died suddenly, and medical examination demonstrated myocardial scarring and prior infarction. Angina is a frequent symptom in FD. Our own data are consistent with registry data indicating a high prevalence of risk factors for coronary artery disease (CAD) in FD that may accelerate conventional atherosclerosis. Patients with FD also have a higher high-density lipoprotein (HDL)/total cholesterol (T-Chol) ratio which may further accelerate atherosclerosis through expression of early atherosclerotic markers. Patients with FD may develop CAD both via classical atherosclerosis and through formation of thickened fibrocellular intima containing fibroblasts with storage of sphingolipids. Both mechanisms occurring together may accelerate coronary stenosis, as well as alter myocardial blood flow. Our data supports limited data that, although coronary flow may be reduced, the prevalence of epicardial coronary stenosis is low in FD. Microvascular dysfunction and arterial wall stress from sphingolipid deposition may form reactive oxygen species (ROS) and myeloperoxidase (MPO), key atherosclerotic mediators. Reduced myocardial blood flow in FD has also been demonstrated using numerous imaging modalities suggesting perfusion mismatch. This review describes the above mechanisms in detail, highlighting the importance of modifying cardiovascular risk factors in FD patients who likely develop accelerated atherosclerosis compared to the general population.
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6
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Ali N, Caceres A, Hall EW, Laney D. Attention Deficits and ADHD Symptoms in Adults with Fabry Disease-A Pilot Investigation. J Clin Med 2021; 10:jcm10153367. [PMID: 34362157 PMCID: PMC8347978 DOI: 10.3390/jcm10153367] [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] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
The present pilot study examines subjective reported symptoms of attention-deficit/hyperactivity (AD/H) in adults with Fabry disease (FD) in comparison with existing normative control data. Existing data from 69 adults with FD via the Achenbach System of Empirically Based Assessment Adult Self-Report questionnaire were analyzed. The results demonstrated a higher prevalence of AD/H symptoms in adults with FD than in the general United States population, with a roughly equal endorsement of Inattention/Attention Deficit symptoms (AD), Hyperactivity-Impulsivity (H-I) symptoms, and Combined Inattention/hyperactivity-impulsivity (C) symptoms. No gender differences were observed. While all subjects endorsing H-I symptoms fell into the symptomatic range on the AD/H scale, only two-thirds of subjects endorsing AD did so. This suggests that attention difficulties with FD are not solely explained by ADHD. Adults with FD who endorsed the AD, H-I, and C symptoms were also more likely to report mean adaptive functioning difficulties. These findings support the growing literature regarding attention difficulties in adults with FD, as well as suggesting a previously unrecognized risk of AD/H symptoms. Future research involving the objective assessment of ADHD in adults with FD is recommended. When serving adults with FD clinically, healthcare professionals should address multiple areas of care, including physical, psychological, and cognitive arenas.
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Affiliation(s)
- Nadia Ali
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Correspondence:
| | | | - Eric W. Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Dawn Laney
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA;
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7
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Körver S, Geurtsen GJ, Hollak CEM, van Schaik IN, Longo MGF, Lima MR, Dijkgraaf MGW, Langeveld M. Cognitive functioning and depressive symptoms in Fabry disease: A follow-up study. J Inherit Metab Dis 2020; 43:1070-1081. [PMID: 32510623 PMCID: PMC7540266 DOI: 10.1002/jimd.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Patients with Fabry disease (FD) have a high prevalence of depressive symptoms and can suffer from cognitive impairment, negatively affecting their life. The course of cognitive functioning and depressive symptoms in FD is unknown. The aim of this prospective cohort study was to describe changes in cognitive functioning and depressive symptoms and to identify related variables in patients with FD over 1 year. Assessments were conducted twice, using a neuropsychological test battery and the Centre of Epidemiological Studies Depression scale (CESD). Eighty-one patients were included of which 76 patients (94%) completed both assessments (age: 44 years, 34% men, 75% classical phenotype). A significant decrease in cognitive functioning was found in four patients (5%), with patients regressing from excellent to average/good. Changes were not related to sex, phenotype, stroke, IQ or CESD scores. CESD scores ≥16 were present in 29 patients (38%) at baseline. Using the reliable change index a decrease in CESD scores was found in six patients (8%). Decreased CESD scores were independently related to employing a positive and problem solving coping style and increased CESD scores to an avoiding and brooding coping style and worsening health perception. We found no major changes in cognitive functioning in patients with FD during 1 year follow-up making it an unsuitable outcome in FD treatment trials. Considering the high prevalence of persistent depressive symptoms, assessment of depressive symptoms should be part of routine follow-up. Altering coping styles and health perception may improve psychological well-being in FD.
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Affiliation(s)
- Simon Körver
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Gert J. Geurtsen
- Department of Medical PsychologyAmsterdam UMC, Location AMC, University of Amsterdam, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Ivo N. van Schaik
- Department of Neurology, Amsterdam UMC, Location AMCUniversity of AmsterdamAmsterdamThe Netherlands
- Spaarne GasthuisHaarlemThe Netherlands
| | - Maria G. F. Longo
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Marjana R. Lima
- Department of RadiologyHospital Moinhos de VentoPorto AlegreBrazil
| | - Marcel G. W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
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8
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Körver S, Longo MGF, Lima MR, Hollak CEM, El Sayed M, van Schaik IN, Vedolin L, Dijkgraaf MGW, Langeveld M. Determinants of cerebral radiological progression in Fabry disease. J Neurol Neurosurg Psychiatry 2020; 91:756-763. [PMID: 32317398 DOI: 10.1136/jnnp-2019-322268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 11/08/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM It is unclear which patients with Fabry disease (FD) are at risk for progression of white matter lesions (WMLs) and brain infarctions and whether enzyme replacement therapy (ERT) changes this risk. The aim of this study was to determine the effect of ERT and clinical characteristics on progression of WMLs and infarctions on MRI in patients with FD. METHODS MRIs were assessed for WMLs (Fazekas scale), infarctions and basilar artery diameter (BAD). The effect of clinical characteristics (renal and cardiac involvement, cardiovascular risk factors, cardiac complications, BAD) and ERT on WML and infarction progression was evaluated using mixed models. RESULTS One hundred forty-nine patients were included (median age: 39 years, 38% men, 79% classical phenotype). Median follow-up time was 7 years (range: 0-13 years) with a median number of MRIs per patient of 5 (range: 1-14), resulting in a total of 852 scans. Variables independently associated with WML and infarction progression were age, male sex and a classical phenotype. Progression of WMLs and infarctions was not affected by adding ERT to the model, neither for the whole group, nor for early treated patients. Progression was highly variable among patients which could not be explained by other known variables such as hypertension, cholesterol, atrial fibrillation and changes in kidney function, left ventricular mass or BAD. CONCLUSION Progression of WMLs and cerebral infarctions in FD is mainly related to age, sex and phenotype. Additional effects of established cardiovascular risk factors, organ involvement and treatment with ERT are probably small to negligible.
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Affiliation(s)
- Simon Körver
- Endocrinology and Metabolism, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | - Maria G F Longo
- Department of Radiology, Massachusetts General Hospital Institute for Patient Care, Boston, Massachusetts, USA
| | - Marjana R Lima
- Department of Radiology, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carla E M Hollak
- Endocrinology and Metabolism, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | - Mohamed El Sayed
- Endocrinology and Metabolism, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam UMC-Locatie AMC, Amsterdam, North Holland, The Netherlands.,Spaarne Gasthuis, Haarlem, Noord-Holland, The Netherlands
| | - Leonardo Vedolin
- Imaging Director, Diagnosticos da America SA, Barueri, São Paulo, Brazil
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC-Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Mirjam Langeveld
- Endocrinology and Metabolism, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
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Viggiano D, Wagner CA, Martino G, Nedergaard M, Zoccali C, Unwin R, Capasso G. Mechanisms of cognitive dysfunction in CKD. Nat Rev Nephrol 2020; 16:452-469. [PMID: 32235904 DOI: 10.1038/s41581-020-0266-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is an increasingly recognized major cause of chronic disability and is commonly found in patients with chronic kidney disease (CKD). Knowledge of the relationship between kidney dysfunction and impaired cognition may improve our understanding of other forms of cognitive dysfunction. Patients with CKD are at an increased risk (compared with the general population) of both dementia and its prodrome, mild cognitive impairment (MCI), which are characterized by deficits in executive functions, memory and attention. Brain imaging in patients with CKD has revealed damage to white matter in the prefrontal cortex and, in animal models, in the subcortical monoaminergic and cholinergic systems, accompanied by widespread macrovascular and microvascular damage. Unfortunately, current interventions that target cardiovascular risk factors (such as anti-hypertensive drugs, anti-platelet agents and statins) seem to have little or no effect on CKD-associated MCI, suggesting that the accumulation of uraemic neurotoxins may be more important than disturbed haemodynamic factors or lipid metabolism in MCI pathogenesis. Experimental models show that the brain monoaminergic system is susceptible to uraemic neurotoxins and that this system is responsible for the altered sleep pattern commonly observed in patients with CKD. Neural progenitor cells and the glymphatic system, which are important in Alzheimer disease pathogenesis, may also be involved in CKD-associated MCI. More detailed study of CKD-associated MCI is needed to fully understand its clinical relevance, underlying pathophysiology, possible means of early diagnosis and prevention, and whether there may be novel approaches and potential therapies with wider application to this and other forms of cognitive decline.
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Affiliation(s)
- Davide Viggiano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Biogem Scarl, Ariano Irpino, Italy
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Gianvito Martino
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maiken Nedergaard
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
| | - Carmine Zoccali
- Institute of Clinical Physiology, National Research Council (CNR), Reggio Calabria Unit, Reggio Calabria, Italy
| | - Robert Unwin
- Department of Renal Medicine, University College London (UCL), Royal Free Campus, London, UK.,Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. .,Biogem Scarl, Ariano Irpino, Italy.
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10
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Körver S, Geurtsen GJ, Hollak CEM, van Schaik IN, Longo MGF, Lima MR, Vedolin L, Dijkgraaf MGW, Langeveld M. Depressive symptoms in Fabry disease: the importance of coping, subjective health perception and pain. Orphanet J Rare Dis 2020; 15:28. [PMID: 31992347 PMCID: PMC6986064 DOI: 10.1186/s13023-020-1307-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background Despite the high prevalence of depressive symptoms in Fabry disease (FD), it is unclear which patient characteristics are important in relation to these symptoms. Additionally, the impact of coping styles in relation to depressive symptoms in FD has been unexplored. Determining the impact of different factors relating to depressive symptoms in FD can guide both prevention and treatment of these symptoms. Methods Depressive symptoms (Center for Epidemiologic Studies Depression scale (CESD)) and coping styles (Utrecht Coping List) were assessed in a Dutch FD cohort. Other potentially important variables were identified from FD literature and assessed in this cohort. Relations were evaluated using multiple linear models. Results Potentially important variables in FD literature were: pain, unemployment, health perception, being single, comorbidities and stroke. Employed coping styles were “avoidance and brooding”, “positivity and problem solving” and “seeking social support”. Thirty-one of the 81 FD patients (38%) had depressive symptoms. CESD-scores were lower in patients with better health perception and more “positivity and problem solving” and higher in patients with more pain and “avoidance and brooding”. The best model explained 70% (95%CI: 54–76%) of observed variance of the CESD. Conclusions Depressive symptoms in FD are related to pain, negative health perception and use of specific coping styles. Psychological interventions could be employed to alter coping behavior and alleviate depressive symptoms.
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Affiliation(s)
- Simon Körver
- Department of Endocrinology and Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Carla E M Hollak
- Department of Endocrinology and Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Maria G F Longo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Marjana R Lima
- Department of Radiology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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Körver S, van de Schraaf SAJ, Geurtsen GJ, Hollak CEM, van Schaik IN, Langeveld M. The Mini Mental State Examination does not accurately screen for objective cognitive impairment in Fabry Disease. JIMD Rep 2019; 48:53-59. [PMID: 31392113 PMCID: PMC6606981 DOI: 10.1002/jmd2.12036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/25/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 01/31/2023] Open
Abstract
Fabry disease (FD) patients may suffer from objective cognitive impairment (OCI). This study assessed the accuracy of the Mini Mental State Examination (MMSE) to screen for OCI in FD patients. Presence or absence of OCI was established using a neuropsychological test battery. For different MMSE cutoffs sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and clinical utility index (CUI) to identify OCI were calculated. Eighty-one patients were included (mean age 44.5 ± 14.3, 35% men, 74% classical phenotype) of which 13 patients (16%) had OCI. The median MMSE score was 29 (range: 25-30). MMSE cutoffs ≤28 and ≤29 had the highest sensitivity and specificity, with higher specificity reached at cutoff ≤28 (sensitivity: .46, specificity: .73) and higher sensitivity at cutoff ≤29 (sensitivity: .92, specificity: .40). PPV was low for both cutoffs (PPV ≤28: .25, PPV ≤29: .23) resulting in a low positive CUI (case finding ability). The results of our study indicate that the MMSE does not accurately screen for OCI in FD, with poor sensitivity-specificity trade-off at all cutoffs. The low PPV shows that the majority of FD patients that score below the cutoffs do not suffer from OCI. Administering the MMSE as a screening test will lead to unnecessary referrals for neuropsychological testing, which is time consuming and burdensome. Screening tools designed to accurately detect mild (executive) impairment might prove more appropriate to screen for OCI in FD.
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Affiliation(s)
- Simon Körver
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Sara A. J. van de Schraaf
- Department of Medical PsychologyAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Gert J. Geurtsen
- Department of Medical PsychologyAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Ivo N. van Schaik
- Department of NeurologyAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
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