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Barker MS, Ceslis A, Argall R, McCombe P, Henderson RD, Robinson GA. Verbal and nonverbal fluency in amyotrophic lateral sclerosis. J Neuropsychol 2023. [PMID: 37997256 DOI: 10.1111/jnp.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disorder that commonly affects cognition and behaviour. Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (i.e., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (i.e., a 'drop off' pattern). Twenty-two ALS patients and 21 demographically-matched controls completed verbal and nonverbal fluency tasks (phonemic/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first 'initiation' and the remaining 'maintenance' time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (e.g., waving). On phonemic fluency, ALS patients showed a 'drop off' pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS.
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Affiliation(s)
- Megan S Barker
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rosemary Argall
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Pamela McCombe
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert D Henderson
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Wesley Medical Research, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Gail A Robinson
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Christidi F, Argyropoulos GD, Karavasilis E, Velonakis G, Zouvelou V, Kourtesis P, Pantoleon V, Tan EL, Daponte A, Aristeidou S, Xirou S, Ferentinos P, Evdokimidis I, Rentzos M, Seimenis I, Bede P. Hippocampal Metabolic Alterations in Amyotrophic Lateral Sclerosis: A Magnetic Resonance Spectroscopy Study. Life (Basel) 2023; 13. [PMID: 36836928 DOI: 10.3390/life13020571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Magnetic resonance spectroscopy (MRS) in amyotrophic lateral sclerosis (ALS) has been overwhelmingly applied to motor regions to date and our understanding of frontotemporal metabolic signatures is relatively limited. The association between metabolic alterations and cognitive performance in also poorly characterised. MATERIAL AND METHODS In a multimodal, prospective pilot study, the structural, metabolic, and diffusivity profile of the hippocampus was systematically evaluated in patients with ALS. Patients underwent careful clinical and neurocognitive assessments. All patients were non-demented and exhibited normal memory performance. 1H-MRS spectra of the right and left hippocampi were acquired at 3.0T to determine the concentration of a panel of metabolites. The imaging protocol also included high-resolution T1-weighted structural imaging for subsequent hippocampal grey matter (GM) analyses and diffusion tensor imaging (DTI) for the tractographic evaluation of the integrity of the hippocampal perforant pathway zone (PPZ). RESULTS ALS patients exhibited higher hippocampal tNAA, tNAA/tCr and tCho bilaterally, despite the absence of volumetric and PPZ diffusivity differences between the two groups. Furthermore, superior memory performance was associated with higher hippocampal tNAA/tCr bilaterally. Both longer symptom duration and greater functional disability correlated with higher tCho levels. CONCLUSION Hippocampal 1H-MRS may not only contribute to a better academic understanding of extra-motor disease burden in ALS, but given its sensitive correlations with validated clinical metrics, it may serve as practical biomarker for future clinical and clinical trial applications. Neuroimaging protocols in ALS should incorporate MRS in addition to standard structural, functional, and diffusion sequences.
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Abstract
Objective: The goal of this meta-analysis is to improve insight into the development of cognition over the course of ALS and to assess predictors of cognitive performance.Method: A literature search was conducted in Pubmed and Web of Science on 29 July 2019 and 16 March 2021. Data were screened in Endnote® Version X9 (London, UK). Meta-analyses and meta-regressions were calculated for cross-sectional data using Rstudio®. Studies were assigned to temporal and physical categories and Hedges' g was calculated for the respective categories to provide an estimate of a cognitive course based on cross-sectional data. Due to low numbers and heterogeneity in reporting, longitudinal studies were analyzed descriptively.Results: A total of N = 45 cross-sectional and N = 13 longitudinal studies were included. Impairments in all cognitive domains, except verbal IQ, were found in ALS patients (PALS). PALS showed stable cognitive performances in cross-sectional and in most longitudinal studies. PALS with symptoms for 18-24 months and PALS who had an ALSFRS-R score of 40-36 were the most frequently reported subgroup regarding neuropsychology. Age was related to visuospatial functioning, and depressiveness to attention. In longitudinal studies, impact of site of onset and cognitive status at baseline on cognitive course was found.Conclusion: Despite vast evidence for cognitive impairment at disease onset in different domains, evidence for evolution of these deficits is rather limited, suggesting that PALS present with cognitive impairment early in the course possibly in a sense of disease trait.
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Affiliation(s)
- Julia Finsel
- Department of Neurology, Ulm University, Ulm, Germany and
| | - Ingo Uttner
- Department of Neurology, Ulm University, Ulm, Germany and
| | | | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany and.,German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, Ulm University, Ulm, Germany and
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Ferraro PM, Gervino E, De Maria E, Meo G, Ponzano M, Pardini M, Signori A, Schenone A, Roccatagliata L, Caponnetto C. Mild behavioral impairment as a potential marker of predementia risk states in motor neuron diseases. Eur J Neurol 2023; 30:47-56. [PMID: 36148819 PMCID: PMC10091712 DOI: 10.1111/ene.15570] [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: 07/19/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Mild behavioral impairment (MBI) has been increasingly regarded as the neurobehavioral axis of predementia risk states, but a specific investigation of its detection as a potential marker of prodromal dementia in motor neuron diseases (MNDs) is still lacking. The aims of our study were therefore to explore MBI in MNDs both at onset and over the disease course, and to evaluate its relationship with baseline and longitudinal cognitive features. METHODS Sixty MND patients with cognitive/behavioral, mood, and motor examinations were recruited and followed longitudinally for up to 15 months. Associations between baseline MBI symptoms and clinical features were tested using the Spearman correlation coefficient. Based on longitudinal data, relative deltas of variation for each cognitive measure were generated, and linear regression models were then used to evaluate the role of baseline MBI symptoms in predicting longitudinal rates of cognitive decline. RESULTS At disease onset, the most impaired MBI domain was affective/emotional dysregulation, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms correlated with more severe baseline motor, cognitive/behavioral, and mood disturbances (p values from <0.001 to 0.05). Longitudinally, the greatest decline was observed in the affective/emotional dysregulation domain, followed by impulse dyscontrol, apathy, and social inappropriateness. Greater MBI symptoms at onset were significant predictors of more severe longitudinal cognitive decline in both amyotrophic lateral sclerosis (ALS)-specific and ALS-nonspecific functions (p values from <0.001 to 0.03). CONCLUSIONS MBI represents a valuable clinical marker of incident cognitive decline in MNDs, and its evaluation has good potential for detecting dementia in its preclinical/prodromal phase.
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Affiliation(s)
- Pilar M Ferraro
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ester Gervino
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emiliano De Maria
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Meo
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Angelo Schenone
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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McKenna MC, Corcia P, Couratier P, Siah WF, Pradat PF, Bede P. Frontotemporal Pathology in Motor Neuron Disease Phenotypes: Insights From Neuroimaging. Front Neurol 2021; 12:723450. [PMID: 34484106 PMCID: PMC8415268 DOI: 10.3389/fneur.2021.723450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 01/18/2023] Open
Abstract
Frontotemporal involvement has been extensively investigated in amyotrophic lateral sclerosis (ALS) but remains relatively poorly characterized in other motor neuron disease (MND) phenotypes such as primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), spinal muscular atrophy (SMA), spinal bulbar muscular atrophy (SBMA), post poliomyelitis syndrome (PPS), and hereditary spastic paraplegia (HSP). This review focuses on insights from structural, metabolic, and functional neuroimaging studies that have advanced our understanding of extra-motor disease burden in these phenotypes. The imaging literature is limited in the majority of these conditions and frontotemporal involvement has been primarily evaluated by neuropsychology and post mortem studies. Existing imaging studies reveal that frontotemporal degeneration can be readily detected in ALS and PLS, varying degree of frontotemporal pathology may be captured in PMA, SBMA, and HSP, SMA exhibits cerebral involvement without regional predilection, and there is limited evidence for cerebral changes in PPS. Our review confirms the heterogeneity extra-motor pathology across the spectrum of MNDs and highlights the role of neuroimaging in characterizing anatomical patterns of disease burden in vivo. Despite the contribution of neuroimaging to MND research, sample size limitations, inclusion bias, attrition rates in longitudinal studies, and methodological constraints need to be carefully considered. Frontotemporal involvement is a quintessential clinical facet of MND which has important implications for screening practices, individualized management strategies, participation in clinical trials, caregiver burden, and resource allocation. The academic relevance of imaging frontotemporal pathology in MND spans from the identification of genetic variants, through the ascertainment of presymptomatic changes to the design of future epidemiology studies.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Philippe Corcia
- Department of Neurology-Neurophysiology, CRMR ALS, Tours, France.,UMR 1253 iBrain, University of Tours, Tours, France.,LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France
| | - Philippe Couratier
- LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France.,ALS Centre, Limoges University Hospital (CHU de Limoges), Limoges, France
| | - We Fong Siah
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
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Ta D, Ishaque A, Srivastava O, Hanstock C, Seres P, Eurich DT, Luk C, Briemberg H, Frayne R, Genge AL, Graham SJ, Korngut L, Zinman L, Kalra S. Progressive Neurochemical Abnormalities in Cognitive and Motor Subgroups of Amyotrophic Lateral Sclerosis: A Prospective Multicenter Study. Neurology 2021; 97:e803-e813. [PMID: 34426551 PMCID: PMC8397589 DOI: 10.1212/wnl.0000000000012367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/13/2021] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate progressive cerebral degeneration in amyotrophic lateral sclerosis (ALS) by assessing alterations in N-acetylaspartate (NAA) ratios in the motor and prefrontal cortex within clinical subgroups of ALS. METHODS Seventy-six patients with ALS and 59 healthy controls were enrolled in a prospective, longitudinal, multicenter study in the Canadian ALS Neuroimaging Consortium. Participants underwent serial clinical evaluations and magnetic resonance spectroscopy at baseline and 4 and 8 months using a harmonized protocol across 5 centers. NAA ratios were quantified in the motor cortex and prefrontal cortex. Patients were stratified into subgroups based on disease progression rate, upper motor neuron (UMN) signs, and cognitive status. Linear mixed models were used for baseline and longitudinal comparisons of NAA metabolite ratios. RESULTS Patients with ALS had reduced NAA ratios in the motor cortex at baseline (p < 0.001). Ratios were lower in those with more rapid disease progression and greater UMN signs (p < 0.05). A longitudinal decline in NAA ratios was observed in the motor cortex in the rapidly progressing (p < 0.01) and high UMN burden (p < 0.01) cohorts. The severity of UMN signs did not change significantly over time. NAA ratios were reduced in the prefrontal cortex only in cognitively impaired patients (p < 0.05); prefrontal cortex metabolites did not change over time. CONCLUSIONS Progressive degeneration of the motor cortex in ALS is associated with more aggressive clinical presentations. These findings provide biological evidence of variable spatial and temporal cerebral degeneration linked to the disease heterogeneity of ALS. The use of standardized imaging protocols may have a role in clinical trials for patient selection or subgrouping. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that MRS NAA metabolite ratios of the motor cortex are associated with more rapid disease progression and greater UMN signs in patients with ALS. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02405182.
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Affiliation(s)
- Daniel Ta
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada.
| | - Abdullah Ishaque
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Ojas Srivastava
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Chris Hanstock
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Peter Seres
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Dean T Eurich
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Collin Luk
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Hannah Briemberg
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Richard Frayne
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Angela L Genge
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Simon J Graham
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Lawrence Korngut
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Lorne Zinman
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Sanjay Kalra
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada.
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Shah JS, Pedraza O, Festic E, Oskarsson B. The relationship between ventilatory function and cognitive and behavioral impairment in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:62-67. [PMID: 34348534 DOI: 10.1080/21678421.2021.1924206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To study the association between ventilatory function and cognitive and behavioral impairment in ALS patients accounting for the effects of pertinent covariates. Methods: Four hundred and eighty-one patients were identified from the Mayo Clinic Florida ALS registry who had concurrent forced vital capacity (FVC) and cognitive and behavioral testing using the ALS Cognitive Behavioral Screen (ALS-CBS). Multiple linear regression analysis was used to study the effects of FVC and relevant covariates on the ALS-CBS cognition score, subscores, and caregiver behavioral inventory. Results: FVC was positively correlated to the cognitive and behavioral subscores on the ALS-CBS (p < 0.001), and the correlation was independent of the effects of site of ALS onset, age, and years of education. Conclusion: Cognitive and behavioral function may be adversely affected by ventilatory impairment in ALS. The presence of cognitive and behavioral impairment warrants a detailed assessment of ventilatory function.
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Affiliation(s)
| | - Otto Pedraza
- Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Emir Festic
- Allergy and Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA
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Rong P, Heidrick L. Spatiotemporal Control of Articulation During Speech and Speechlike Tasks in Amyotrophic Lateral Sclerosis. Am J Speech Lang Pathol 2021; 30:1382-1399. [PMID: 33630657 DOI: 10.1044/2020_ajslp-20-00136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study examined the articulatory control of speech and speechlike tasks in individuals with amyotrophic lateral sclerosis (ALS) and neurologically healthy individuals with the aim to identify the most useful set of articulatory features and tasks for assessing bulbar motor involvement in ALS. Method Tongue and jaw kinematics were recorded in 12 individuals with bulbar ALS and 10 healthy controls during a speech task and two speechlike tasks (i.e., alternating motion rate [AMR], sequential motion rate [SMR]). Eight articulatory features were derived for each participant per task, including the range, maximum speed, and acceleration time of tongue and jaw movements as well as the coupling and timing between tongue and jaw movements. The effects of task (i.e., AMR, SMR, speech) and group (i.e., ALS, control) on these articulatory features were evaluated. For each feature, the task that yielded the largest difference between the ALS and control groups was identified. The diagnostic efficacy of these task-specific features was assessed using the receiver operating characteristic analysis; the relation of these task-specific features to a well-established bulbar severity index-speaking rate-was determined using Spearman's rank correlation. Results Seven task-specific articulatory features were identified, including (a) tongue and jaw acceleration time during the AMR task, (b) tongue-jaw coupling during the SMR task, and (c) range of tongue movement, maximum tongue and jaw speed, and temporal lag between tongue and jaw movements during the speech task. Among these features, tongue and jaw acceleration time and their temporal lag showed relatively high accuracy (i.e., 0.83-0.95) in differentiating individuals with ALS from healthy controls. Range of tongue movement and maximum tongue and jaw speed showed significant correlations with speaking rate. Conclusion Findings provided preliminary evidence for the utility of task-specific articulatory measurements as a novel quantitative assessment to detect and predict bulbar motor involvement in ALS.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
| | - Lindsey Heidrick
- Department of Hearing and Speech, The University of Kansas Medical Center, Kansas City
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Consonni M, Dalla Bella E, Bersano E, Lauria G. Cognitive and behavioural impairment in amyotrophic lateral sclerosis: A landmark of the disease? A mini review of longitudinal studies. Neurosci Lett 2021; 754:135898. [PMID: 33862143 DOI: 10.1016/j.neulet.2021.135898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/26/2021] [Accepted: 04/08/2021] [Indexed: 01/02/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a heterogeneous neurodegenerative disease marked by progressive loss of motor abilities. Approximately half of patents with ALS experience cognitive (ALSci) or behavioural impairment (ALSbi) during the course of the disease, with a small percentage developing overt frontotemporal dementia (FTD). ALSci and/or ALSbi can occur simultaneously with motor neuron degeneration or develop in advanced stages of the disease, but it can even precede motor involvement in some cases, namely in ALS patients meeting criteria for FTD. Despite clear evidence that cognitive/behavioural impairment may appear early in the course of ALS, no prominent deterioration seems to occur with disease progression. Longitudinal studies have failed to reach conclusive results on the progression of cognitive and behavioural involvement in ALS. This may be due to some structural limitations of the studies, such as attrition rate, practice effect, short-time interval between neuropsychological assessments, but it can also be due to the heterogeneity of ALS phenotypes. The objective of this review is to provide a comprehensive and critical analysis of results of longitudinal studies highlighting cognitive and behavioural domains mainly affected by neurodegeneration pointing out the determinants that might be associate with the development and worsening of frontotemporal symptoms in ALS. At this regard, older age, rapidly progressing ALS, bulbar-onset, advanced disease stages are among factors mainly associated with cognitive and behavioural involvement. Moreover, the progression of cognitive and behavioural deficits seems to be not directly related to the slope of motor disability, thus suggesting the independence of neuropsychological and motor functional decline in ALS. Cognitive and motor involvement may indeed present with distinct trajectories suggesting a differential vulnerability of motor and non-motor cortical networks. In this scenario, determining the progression of extra-motor involvement in ALS may help refine understanding of the clinical implications of cognitive and behavioural abnormalities, and provide clues to the aetiology of the disease.
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Affiliation(s)
- Monica Consonni
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Enrica Bersano
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
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Castelnovo V, Canu E, Riva N, Poletti B, Cividini C, Fontana A, Solca F, Silani V, Filippi M, Agosta F. Progression of cognitive and behavioral disturbances in motor neuron diseases assessed using standard and computer-based batteries. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:223-236. [DOI: 10.1080/21678421.2020.1867179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, Milan, Italy
| | - Nilo Riva
- Neurology Unit and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Camilla Cividini
- Neuroimaging Research Unit, Division of Neuroscience, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milano, Italy, and
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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11
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Leigh N, Simpson J, Eccles FJR. Does a lack of social support and perceived stigma influence the relationship between motor neurone disease-related stress and psychological distress? Br J Health Psychol 2020; 26:289-306. [PMID: 33026136 DOI: 10.1111/bjhp.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/02/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to investigate the mechanisms through which social support and felt stigma influence the relationship between motor neurone disease (MND)-related stress and psychological distress for people with MND. Although a lack of social support has been identified as a significant predictor of psychological distress for individuals with MND, the mechanisms through which this relationship exists have not been assessed, nor have the predictive nature of stigma. Furthermore, the theoretical model specifying the effects of enacted stigma on self-stigma has not been tested in individuals with MND. DESIGN A cross-sectional design utilizing an online survey method was used. It was hypothesized that social support would moderate the relationship between MND-related stress (operationalized as enacted stigma or physical functioning) and psychological distress (operationalized as depression, anxiety, and stress). Furthermore, felt stigma would significantly mediate the relationship between MND-related stress (enacted stigma) and psychological distress. METHODS Individuals with a diagnosis of MND were recruited internationally through social media and through various organizations and support services. Seventy-seven participants completed the online survey. RESULTS Significant correlations were identified between social support, felt, and enacted stigma and psychological distress. Moderation analysis was not significant. However, the mediation analyses identified felt stigma as a significant mediator of the relationship between enacted stigma and psychological distress. A direct relationship between enacted stigma and stress (but not depression and anxiety) was also evident. CONCLUSIONS A comprehensive approach to tackling stigma is important in ameliorating psychological distress for people with MND. Limitations of the current study are discussed, along with implications for clinical practice.
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Affiliation(s)
- Natalie Leigh
- Division of Health Research, Lancaster University, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, UK
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12
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Ceslis A, Argall R, Henderson RD, McCombe PA, Robinson GA. The spectrum of language impairments in amyotrophic lateral sclerosis. Cortex 2020; 132:349-360. [PMID: 33031977 DOI: 10.1016/j.cortex.2020.09.003] [Citation(s) in RCA: 4] [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: 01/13/2020] [Revised: 05/31/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
Language disorders are increasingly recognised in Amyotrophic lateral sclerosis (ALS), supporting the view of ALS as a multi-system disorder, impacting cognitive and motor function. However, the language impairments are heterogeneous and recent focus has been on determining the language profile across the ALS spectrum with little focus on spontaneous speech. The current study systematically investigated a wide range of language abilities in an unselected ALS sample (N = 22), including spontaneous speech. We analysed the ALS patients' performance as a group, compared to age-, education- and IQ-matched healthy controls (N = 21), and as a case series to identify dementia and specific language profiles. The ALS group was impaired on measures of spontaneous speech, word fluency and action naming. By contrast, object naming, semantic memory (object and actions), sentence comprehension and repetition (word and sentences) were comparable to healthy controls. In line with recent suggestions, our ALS patients' action naming (but not action semantic) deficit does not support the notion that action processing may be selectively impaired in ALS. The case series demonstrated that 14% of patients had probable dementia, 31% showed significant cognitive and/or language impairment and 55% were unimpaired, consistent with the spectrum of cognitive and language impairments reported in the literature. In addition, 36% of ALS patients produced significantly fewer words per minute on a spontaneous speech task than the control group, with this difference remaining when the ALS patients with frontotemporal dementia were excluded from the analysis. This pattern was observed across the ALS spectrum and in both limb and bulbar onset patients. The pattern of performance observed in the present study suggests that spontaneous speech is reduced across the ALS spectrum even in those with intact core language abilities.
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Affiliation(s)
- Amelia Ceslis
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia.
| | - Rosemary Argall
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia; Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia.
| | - Robert D Henderson
- Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Brisbane, Australia; Wesley Medical Research, The Wesley Hospital, Auchenflower, Brisbane, Australia.
| | - Pamela A McCombe
- Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Brisbane, Australia; Wesley Medical Research, The Wesley Hospital, Auchenflower, Brisbane, Australia.
| | - Gail A Robinson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia; Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia; Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia.
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13
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Huynh W, Ahmed R, Mahoney CJ, Nguyen C, Tu S, Caga J, Loh P, Lin CSY, Kiernan MC. The impact of cognitive and behavioral impairment in amyotrophic lateral sclerosis. Expert Rev Neurother 2020; 20:281-293. [DOI: 10.1080/14737175.2020.1727740] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- William Huynh
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Rebekah Ahmed
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Colin J. Mahoney
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Chilan Nguyen
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Sicong Tu
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Jashelle Caga
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Patricia Loh
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Cindy S-Y Lin
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Matthew C. Kiernan
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
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Benbrika S, Desgranges B, Eustache F, Viader F. Cognitive, Emotional and Psychological Manifestations in Amyotrophic Lateral Sclerosis at Baseline and Overtime: A Review. Front Neurosci 2019; 13:951. [PMID: 31551700 PMCID: PMC6746914 DOI: 10.3389/fnins.2019.00951] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022] Open
Abstract
It is now well recognized that, in addition to motor impairment, amyotrophic lateral sclerosis (ALS) may cause extra-motor clinical signs and symptoms. These can include the alteration of certain cognitive functions, impaired social cognition, and changes in the perception and processing of emotions. Where these extra-motor manifestations occur in ALS, they usually do so from disease onset. In about 10% of cases, the cognitive and behavioral changes meet the diagnostic criteria for frontotemporal dementia. The timecourse of behavioral and cognitive involvement in ALS is unclear. Whereas longitudinal studies have failed to show cognitive decline over time, some cross-sectional studies have demonstrated poorer cognitive performances in the advanced stages of the disease. Neuroimaging studies show that in ALS, extra-motor signs and symptoms are associated with specific brain lesions, but little is known about how they change over time. Finally, patients with ALS appear less depressed than might be expected, given the prognosis. Moreover, many patients achieve satisfactory psychosocial adjustment throughout the course of the disease, regardless of their degree of motor disability. There are scant longitudinal data on extra-motor impairment in ALS, and to our knowledge, no systematic review on this subject has yet been published. Even so, a better understanding of patients' clinical trajectory is essential if they are to be provided with tailored care and given the best possible support. We therefore undertook to review the evidence for extra-motor changes and their time course in ALS, in both the cognitive, emotional and psychological domains, with a view to identifying mechanisms that may help these patients cope with their disease.
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Affiliation(s)
| | - Béatrice Desgranges
- Neuropsychology and Imaging of Human Memory, Normandy University-PSL Research University-EPHE-INSERM U1077, Caen University Hospital, Caen, France
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15
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Srivastava O, Hanstock C, Chenji S, Mah D, Eurich D, Ta D, Seres P, Luk C, Zinman L, Abrahao A, Graham SJ, Genge A, Korngut L, Frayne R, Kalra S. Cerebral degeneration in amyotrophic lateral sclerosis: A prospective multicenter magnetic resonance spectroscopy study. Neurol Clin Pract 2019; 9:400-407. [PMID: 31750025 DOI: 10.1212/cpj.0000000000000674] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
Background We investigated cerebral degeneration and neurochemistry in patients with amyotrophic lateral sclerosis (ALS) using magnetic resonance spectroscopy (MRS). Methods We prospectively studied 65 patients and 43 age-matched healthy controls. Participants were recruited from 4 centers as part of a study in the Canadian ALS Neuroimaging Consortium. All participants underwent single-voxel proton MRS using a protocol standardized across all sites. Metabolites reflecting neuronal integrity (total N-acetyl aspartyl moieties [tNAA]) and gliosis (myo-inositol [Ino]), as well as creatine (Cr) and choline (Cho), were quantified in the midline motor cortex and midline prefrontal cortex. Comparisons were made between patients with ALS and healthy controls. Metabolites were correlated with clinical measures of upper motor neuron dysfunction, disease progression rate, and cognitive performance. Results In the motor cortex, tNAA/Cr, tNAA/Cho, and tNAA/Ino ratios were reduced in the ALS group compared with controls. Group differences in tNAA/Cr and tNAA/Cho in the prefrontal cortex displayed reduced ratios in ALS patients; however, these were not statistically significant. Reduced motor cortex ratios were associated with slower foot tapping rate, whereas only motor tNAA/Ino was associated with finger tapping rate. Disease progression rate was associated with motor tNAA/Cho. Verbal fluency, semantic fluency, and digit span forwards and backwards were associated with prefrontal tNAA/Cr. Conclusions This study demonstrates that cerebral degeneration in ALS is more pronounced in the motor than prefrontal cortex, that multicenter MRS studies are feasible, and that motor tNAA/Ino shows promise as a potential biomarker.
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Affiliation(s)
- Ojas Srivastava
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Chris Hanstock
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sneha Chenji
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Dennell Mah
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Dean Eurich
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Daniel Ta
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Peter Seres
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Collin Luk
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Lorne Zinman
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Agessandro Abrahao
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simon J Graham
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Angela Genge
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Lawrence Korngut
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Richard Frayne
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sanjay Kalra
- Faculty of Science (OS); Department of Biomedical Engineering (CH, PS, SK); Neuroscience and Mental Health Institute (SC, DT, SK); Divison of Neurology (DM, CL, SK), Department of Medicine; School of Public Health (DE); University of Alberta, Edmonton, Alberta; Sunnybrook Health Sciences Centre (LZ, AA, SJG), University of Toronto, Toronto, Ontario; Montreal Neurological Institute and Hospital (AG), McGill University, Montreal, Quebec; Departments of Radiology and Clinical Neurosciences (LK, RF), Hotchkiss Brain Institute, University of Calgary; and Seaman Family MR Research Centre (LK, RF), Foothills Medical Centre, Calgary, Alberta, Canada
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Shellikeri S, Myers M, Black SE, Abrahao A, Zinman L, Yunusova Y. Speech network regional involvement in bulbar ALS: a multimodal structural MRI study. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:385-395. [PMID: 31088163 DOI: 10.1080/21678421.2019.1612920] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To examine gray (GM) and white matter (WM) structural changes in regions of the speech network (SpN) in ALS patients with varying degree of bulbar disease. Methods: T1 and DTI images were obtained for 19 ALS participants and 13 neurologically-intact controls. Surface-based, volumetric, and DTI metrics were obtained for 6 regions-of-interest (ROIs) including the primary motor cortex (PMC), pars triangularis (parsT), pars opercularis (ParsO), posterior superior temporal gyrus (pSTG), and transverse temporal (TT). Disease-effects and brain-behavioral correlates between neuroanatomy and clinical measures of bulbar, limb, and overall disability were examined using linear models. Results: Structural changes were observed in the right oral and limb PMC and left ParsT, TT, and pSTG in ALS. Bulbar motor dysfunction was associated with WM abnormalities in the right oral PMC and left pSTG, and GM changes in bilateral TT. In contrast, symptom progression rate predicted GM and WM changes in bilateral pars opercularis (part of Broca's area). Grip strength and disease duration models were non-significant. Conclusions: The findings suggested that regions of the left-dominant SpN may be implicated in ALS and degeneration of these areas are related to bulbar disease severity. Involvement of regions that overlap across multiple connectomes such as Broca's area, however, may be dependent on the rate of disease progression. The work contributes to our understanding of bulbar ALS subtype, which is crucial for predicting disease progression, delivering targeted clinical care, and appropriate recruitment into clinical trials.
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Affiliation(s)
- Sanjana Shellikeri
- a Department of Speech Language Pathology , University of Toronto , Ontario , Canada.,b Hurvitz Brain Sciences Program , Sunnybrook Research Institute , Ontario , Canada
| | - Matthew Myers
- b Hurvitz Brain Sciences Program , Sunnybrook Research Institute , Ontario , Canada
| | - Sandra E Black
- b Hurvitz Brain Sciences Program , Sunnybrook Research Institute , Ontario , Canada.,c L.C. Campbell Cognitive Neurology Research Unit , Sunnybrook Research Institute, University of Toronto , Toronto , Canada.,d Department of Medicine, Division of Neurology , Sunnybrook Health Sciences Centre , Toronto , Canada.,e Rotman Research Institute, Baycrest , Toronto , Canada , and
| | - Agessandro Abrahao
- b Hurvitz Brain Sciences Program , Sunnybrook Research Institute , Ontario , Canada.,d Department of Medicine, Division of Neurology , Sunnybrook Health Sciences Centre , Toronto , Canada
| | - Lorne Zinman
- b Hurvitz Brain Sciences Program , Sunnybrook Research Institute , Ontario , Canada.,c L.C. Campbell Cognitive Neurology Research Unit , Sunnybrook Research Institute, University of Toronto , Toronto , Canada.,d Department of Medicine, Division of Neurology , Sunnybrook Health Sciences Centre , Toronto , Canada
| | - Yana Yunusova
- a Department of Speech Language Pathology , University of Toronto , Ontario , Canada.,b Hurvitz Brain Sciences Program , Sunnybrook Research Institute , Ontario , Canada.,f University Health Network, Toronto Rehabilitation Institute , Ontario , Canada
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Abstract
Proton magnetic resonance spectroscopy (MRS) provides a means of measuring cerebral metabolites relevant to neurodegeneration in vivo. In amyotrophic lateral sclerosis (ALS), neurochemical changes reflecting neuronal loss or dysfunction (decreased N-actylaspartate [NAA]) is most significant in the motor cortex and corticospinal tracts. Other neurochemical changes observed include increased myo-inositol (mIns), a putative marker of gliosis. MRS confirmation of involvement of non-motor regions such as the frontal lobes, thalamus, basal ganglia, and cingulum are consistent with the multi-system facet of motor neuron disease with ALS being part of a MND-FTD spectrum. MRS-derived markers exhibit an encouraging discriminatory ability to identify patients from healthy controls, however more data is needed to determine its ability to assist with the diagnosis in early stages when upper motor neuron signs are limited, and in distinguishing from disease mimics. Longitudinal change of NAA and mIns do not appear to be reliable in monitoring disease progression. Technological advances in hardware and high field scanning are increasing the number of accessible metabolites available for interrogation.
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Affiliation(s)
- Sanjay Kalra
- Division of Neurology, Department of Medicine, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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18
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Christidi F, Karavasilis E, Riederer F, Zalonis I, Ferentinos P, Velonakis G, Xirou S, Rentzos M, Argiropoulos G, Zouvelou V, Zambelis T, Athanasakos A, Toulas P, Vadikolias K, Efstathopoulos E, Kollias S, Karandreas N, Kelekis N, Evdokimidis I. Gray matter and white matter changes in non-demented amyotrophic lateral sclerosis patients with or without cognitive impairment: A combined voxel-based morphometry and tract-based spatial statistics whole-brain analysis. Brain Imaging Behav 2019; 12:547-563. [PMID: 28425061 DOI: 10.1007/s11682-017-9722-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The phenotypic heterogeneity in amyotrophic lateral sclerosis (ALS) implies that patients show structural changes within but also beyond the motor cortex and corticospinal tract and furthermore outside the frontal lobes, even if frank dementia is not detected. The aim of the present study was to investigate both gray matter (GM) and white matter (WM) changes in non-demented amyotrophic lateral sclerosis (ALS) patients with or without cognitive impairment (ALS-motor and ALS-plus, respectively). Nineteen ALS-motor, 31 ALS-plus and 25 healthy controls (HC) underwent 3D-T1-weighted and 30-directional diffusion-weighted imaging on a 3 T MRI scanner. Voxel-based morphometry and tract-based spatial-statistics analysis were performed to examine GM volume (GMV) changes and WM differences in fractional anisotropy (FA), axial and radial diffusivity (AD, RD, respectively). Compared to HC, ALS-motor patients showed decreased GMV in frontal and cerebellar areas and increased GMV in right supplementary motor area, while ALS-plus patients showed diffuse GMV reduction in primary motor cortex bilaterally, frontotemporal areas, cerebellum and basal ganglia. ALS-motor patients had increased GMV in left precuneus compared to ALS-plus patients. We also found decreased FA and increased RD in the corticospinal tract bilaterally, the corpus callosum and extra-motor tracts in ALS-motor patients, and decreased FA and increased AD and RD in motor and several WM tracts in ALS-plus patients, compared to HC. Multimodal neuroimaging confirms motor and extra-motor GM and WM abnormalities in non-demented cognitively-impaired ALS patients (ALS-plus) and identifies early extra-motor brain pathology in ALS patients without cognitive impairment (ALS-motor).
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece.
| | - Efstratios Karavasilis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Franz Riederer
- Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Ioannis Zalonis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, Attikon University Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Sophia Xirou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Michalis Rentzos
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Georgios Argiropoulos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Thomas Zambelis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Athanasios Athanasakos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Panagiotis Toulas
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | | | - Efstathios Efstathopoulos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Spyros Kollias
- Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Nikolaos Karandreas
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
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Bueno APA, Pinaya WHL, Rebello K, de Souza LC, Hornberger M, Sato JR. Regional Dynamics of the Resting Brain in Amyotrophic Lateral Sclerosis Using Fractional Amplitude of Low-Frequency Fluctuations and Regional Homogeneity Analyses. Brain Connect 2019; 9:356-364. [PMID: 30793923 DOI: 10.1089/brain.2019.0663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Resting-state functional magnetic resonance imaging has been playing an important role in the study of amyotrophic lateral sclerosis (ALS). Although functional connectivity is widely studied, the patterns of spontaneous neural activity of the resting brain are important mechanisms that have been used recently to study a variety of conditions but remain less explored in ALS. Here we have used fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) to study the regional dynamics of the resting brain of nondemented ALS patients compared with healthy controls. As expected, we found the sensorimotor network with changes in fALFF and ReHo, and also found the default mode network (DMN), frontoparietal network (FPN), and salience network (SN) altered and the cerebellum, although no structural changes between ALS patients and controls were reported in the regions with fALFF and ReHo changes. We show an altered pattern in the spontaneous low-frequency oscillations that is not confined to the motor areas and reveal a more widespread involvement of nonmotor regions, including those responsible for cognition.
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Affiliation(s)
- Ana Paula Arantes Bueno
- 1 Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil.,2 Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Walter Hugo Lopez Pinaya
- 1 Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil.,3 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Keila Rebello
- 1 Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - Leonardo Cruz de Souza
- 4 Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michael Hornberger
- 2 Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,5 Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom
| | - João Ricardo Sato
- 1 Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
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20
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Ye S, Rosenbohm A, Böhm S, Uttner I, Ji Y, Ludolph AC, Lulé D, Fan D. Cognitive and behavioral impairments in German and Chinese ALS populations - a post-hoc comparison of national study data. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:28-36. [PMID: 30472897 DOI: 10.1080/21678421.2018.1542535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study aimed to clarify whether differences between German and Chinese studies using the standardized Edinburgh Cognitive and Behavioural ALS Screen (ECAS), might be explained by differences in translated versions of ECAS, by patient demographic or clinical characteristics or by population-specific factors. Comparisons were performed on data from two previous studies in Germany and China. We found except for spelling task (p = 0.05), no differences between control groups of two countries were detected after adjusting for demographics. In contrast, differences were observed in scores on total ECAS, ALS-specific function such as different executive functions (all p < 0.01) and language (p = 0.02), even after correcting for demographic and clinical variables. Chinese ALS cohort performed worse in executive subfunction scores for sentence completion, alternation, social cognition, digit span and language comprehension; they performed better in spelling. Chinese ALS cohort more frequently exhibited disinhibition (p = 0.02), whereas German cohort more frequently exhibited loss of sympathy (p = 0.01) and stereotyped behavior (p = 0.03). Chinese and German ALS cohorts showed a distinctly different pattern in executive and language function. Most of the differences might be related to distinct differences between populations as only spelling might be affected by different language versions of ECAS. Socio-cultural factors might explain behavioral profile differences.
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Affiliation(s)
- Shan Ye
- a Department of Neurology , Peking University Third Hospital , Beijing , China
| | | | - Sarah Böhm
- b Department of Neurology , University of Ulm , Ulm , Germany
| | - Ingo Uttner
- b Department of Neurology , University of Ulm , Ulm , Germany
| | - Ying Ji
- a Department of Neurology , Peking University Third Hospital , Beijing , China
| | | | - Dorothée Lulé
- b Department of Neurology , University of Ulm , Ulm , Germany
| | - Dongsheng Fan
- a Department of Neurology , Peking University Third Hospital , Beijing , China.,c Key Laboratory for Neuroscience, Ministry of Education/National Health & Commission , Peking University , Beijing , China
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21
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Christidi F, Karavasilis E, Rentzos M, Kelekis N, Evdokimidis I, Bede P. Clinical and Radiological Markers of Extra-Motor Deficits in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:1005. [PMID: 30524366 PMCID: PMC6262087 DOI: 10.3389/fneur.2018.01005] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is now universally recognized as a complex multisystem disorder with considerable extra-motor involvement. The neuropsychological manifestations of frontotemporal, parietal, and basal ganglia involvement in ALS have important implications for compliance with assistive devices, survival, participation in clinical trials, caregiver burden, and the management of individual care needs. Recent advances in neuroimaging have been instrumental in characterizing the biological substrate of heterogeneous cognitive and behavioral deficits in ALS. In this review we discuss the clinical and radiological aspects of cognitive and behavioral impairment in ALS focusing on the recognition, assessment, and monitoring of these symptoms.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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22
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Christidi F, Karavasilis E, Velonakis G, Ferentinos P, Rentzos M, Kelekis N, Evdokimidis I, Bede P. The Clinical and Radiological Spectrum of Hippocampal Pathology in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:523. [PMID: 30018591 PMCID: PMC6037820 DOI: 10.3389/fneur.2018.00523] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 05/09/2018] [Accepted: 06/13/2018] [Indexed: 12/29/2022] Open
Abstract
Hippocampal pathology in Amyotrophic Lateral Sclerosis (ALS) remains surprisingly under recognized despite compelling evidence from neuropsychology, neuroimaging and neuropathology studies. Hippocampal dysfunction contributes significantly to the clinical heterogeneity of ALS and requires structure-specific cognitive and neuroimaging tools for accurate in vivo evaluation. Recent imaging studies have generated unprecedented insights into the presymptomatic and longitudinal processes affecting this structure and have contributed to the characterisation of both focal and network-level changes. Emerging neuropsychology data suggest that memory deficits in ALS may be independent from executive dysfunction. In the era of precision medicine, where the development of individualized care strategies and patient stratification for clinical trials are key priorities, the comprehensive review of hippocampal dysfunction in ALS is particularly timely.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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23
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Poletti B, Solca F, Carelli L, Faini A, Madotto F, Lafronza A, Monti A, Zago S, Ciammola A, Ratti A, Ticozzi N, Abrahams S, Silani V. Cognitive-behavioral longitudinal assessment in ALS: the Italian Edinburgh Cognitive and Behavioral ALS screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:387-395. [DOI: 10.1080/21678421.2018.1473443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Federica Solca
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Fabiana Madotto
- Department of Medicine and Surgery, Research Centre on Public Health, University of Milano-Bicocca, Monza, Italy,
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy,
| | - Stefano Zago
- Department of Neuroscience and Mental Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy and
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Sharon Abrahams
- PPLS, Department of Psychology, Euan MacDonald Centre for Motor Neurone Disease Research, Human Cognitive Neuroscience-Psychology, University of Edinburgh, Edinburgh, UK
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
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24
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Pinto-Grau M, Hardiman O, Pender N. The Study of Language in the Amyotrophic Lateral Sclerosis - Frontotemporal Spectrum Disorder: a Systematic Review of Findings and New Perspectives. Neuropsychol Rev 2018; 28:251-268. [DOI: 10.1007/s11065-018-9375-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
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25
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Moszczynski AJ, Hintermayer MA, Strong MJ. Phosphorylation of Threonine 175 Tau in the Induction of Tau Pathology in Amyotrophic Lateral Sclerosis-Frontotemporal Spectrum Disorder (ALS-FTSD). A Review. Front Neurosci 2018; 12:259. [PMID: 29731706 PMCID: PMC5919950 DOI: 10.3389/fnins.2018.00259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022] Open
Abstract
Approximately 50–60% of all patients with amyotrophic lateral sclerosis (ALS) will develop a deficit of frontotemporal function, ranging from frontotemporal dementia (FTD) to one or more deficits of neuropsychological, speech or language function which are collectively known as the frontotemporal spectrum disorders of ALS (ALS-FTSD). While the neuropathology underlying these disorders is most consistent with a widespread alteration in the metabolism of transactive response DNA-binding protein 43 (TDP-43), in both ALS with cognitive impairment (ALSci) and ALS with FTD (ALS-FTD; also known as MND-FTD) there is evidence for alterations in the metabolism of the microtubule associated protein tau. This alteration in tau metabolism is characterized by pathological phosphorylation at residue Thr175 (pThr175 tau) which in vitro is associated with activation of GSK3β (pTyr216GSK3β), phosphorylation of Thr231tau, and the formation of cytoplasmic inclusions with increased rates of cell death. This putative pathway of pThr175 induction of pThr231 and the formation of pathogenic tau inclusions has been recently shown to span a broad range of tauopathies, including chronic traumatic encephalopathy (CTE) and CTE in association with ALS (CTE-ALS). This pathway can be experimentally triggered through a moderate traumatic brain injury, suggesting that it is a primary neuropathological event and not secondary to a more widespread neuronal dysfunction. In this review, we discuss the neuropathological underpinnings of the postulate that ALS is associated with a tauopathy which manifests as a FTSD, and examine possible mechanisms by which phosphorylation at Thr175tau is induced. We hypothesize that this might lead to an unfolding of the hairpin structure of tau, activation of GSK3β and pathological tau fibril formation through the induction of cis-Thr231 tau conformers. A potential role of TDP-43 acting synergistically with pathological tau metabolism is proposed.
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Affiliation(s)
- Alexander J Moszczynski
- Molecular Medicine Research Group, Schulich School of Medicine & Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Matthew A Hintermayer
- Molecular Medicine Research Group, Schulich School of Medicine & Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Michael J Strong
- Molecular Medicine Research Group, Schulich School of Medicine & Dentistry, Robarts Research Institute, Western University, London, ON, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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26
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Bock M, Duong YN, Kim A, Allen I, Murphy J, Lomen-Hoerth C. Progression and effect of cognitive-behavioral changes in patients with amyotrophic lateral sclerosis. Neurol Clin Pract 2017; 7:488-498. [PMID: 29431172 DOI: 10.1212/cpj.0000000000000397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background To prospectively evaluate the progression of cognitive-behavioral function in amyotrophic lateral sclerosis (ALS) and examine the association of cognitive-behavioral deficits with disease progression, patient quality of life (QOL), and caregiver burden. Methods We evaluated cognitive-behavioral function using the Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen at enrollment and after 7 months in a cohort of patients with ALS. Paired t tests were used to evaluate the change in the 2 assessments. Linear regression and Kruskal-Wallis tests were applied to investigate how initial cognitive or behavioral status related to outcomes. Results The mean test-retest interval was 6.8 months (SD 1.6). Cognitive status of the study population (n = 49) overall did not change over the study period (p = 0.06) despite progression of motor weakness (p < 0.001), though small subsets of the sample demonstrate cognitive change. Patients initially classified as behaviorally normal showed increased behavioral problems over time (t = -2.8, p = 0.009). Decline in cognitive (β = -1.3, p = 0.03) and behavioral (β = -0.76, p = 0.002) status predicted increasing caregiver burden. Behavioral abnormalities predicted decline in forced vital capacity and ALS Functional Rating Scale-Revised score (p = 0.008, 0.012) in the study population and patient QOL in the most severely affected group (t = 4.3, p = 0.003). Conclusions Cognitive-behavioral change is a key aspect of disease heterogeneity in ALS. Executive function in ALS overall remains stable over 7 months as detected by an administered screening tool. However, patients may develop caregiver-reported behavioral symptoms in that time period. Screening for caregiver-reported symptoms has a particular utility in predicting future clinical decline, increased caregiver burden, and worsening patient QOL.
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Affiliation(s)
- Meredith Bock
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Y-Nhy Duong
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Anthony Kim
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Isabel Allen
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Jennifer Murphy
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Catherine Lomen-Hoerth
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
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27
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Ohta Y, Sato K, Takemoto M, Takahashi Y, Morihara R, Nakano Y, Tsunoda K, Nomura E, Hishikawa N, Yamashita T, Abe K. Behavioral and affective features of amyotrophic lateral sclerosis patients. J Neurol Sci 2017; 381:119-125. [DOI: 10.1016/j.jns.2017.08.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022]
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28
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Abstract
Amyotrophic lateral sclerosis (ALS) is primarily characterized by progressive loss of motor neurons, although there is marked phenotypic heterogeneity between cases. Typical, or "classical," ALS is associated with simultaneous upper motor neuron (UMN) and lower motor neuron (LMN) involvement at disease onset, whereas atypical forms, such as primary lateral sclerosis and progressive muscular atrophy, have early and predominant involvement in the UMN and LMN, respectively. The varying phenotypes can be so distinctive that they would seem to have differing biology. Because the same phenotypes can have multiple causes, including different gene mutations, there may be multiple molecular mechanisms causing ALS, implying that the disease is a syndrome. Conversely, multiple phenotypes can be caused by a single gene mutation; thus, a single molecular mechanism could be compatible with clinical heterogeneity. The pathogenic mechanism(s) in ALS remain unknown, but active propagation of the pathology neuroanatomically is likely a primary component.
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Affiliation(s)
- Leslie I Grad
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal H3A 2B4, Canada
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
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29
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Abstract
CaMK2N1 and CaMK2N2 are endogenous inhibitors of calcium/calmodulin-dependent protein kinase II (CaMKII), a key synaptic signaling molecule for learning and memory. Here, we investigated the learning and memory function of CaMK2N1 by knocking-down its expression in dorsal hippocampus of mice. We found that reduced CaMK2N1 expression does not affect contextual fear long-term memory (LTM) formation. However, we show that it impairs maintenance of established LTM, but only if retrieval occurs. CaMK2N1 knockdown prevents a decrease of threonine-286 (T286) autophosphorylation of αCaMKII and increases GluA1 levels in hippocampal synapses after retrieval of contextual fear LTM. CaMK2N1 knockdown can also increase CaMK2N2 expression, but we show that such increased expression does not affect LTM after retrieval. We also found that substantial overexpression of CaMK2N2 in dorsal hippocampus impairs LTM formation, but not LTM maintenance, suggesting that CaMKII activity is not required for LTM storage. Taken together, we propose a specific function for CaMK2N1; enabling LTM maintenance after retrieval by inhibiting T286 autophosphorylation of αCaMKII.
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Affiliation(s)
- Fabio Antonio Vigil
- Department of Basic and Clinical Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, United Kingdom
| | - Keiko Mizuno
- Department of Basic and Clinical Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, United Kingdom
| | - Walter Lucchesi
- Department of Basic and Clinical Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, United Kingdom
| | - Victoria Valls-Comamala
- Department of Basic and Clinical Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, United Kingdom
| | - Karl Peter Giese
- Department of Basic and Clinical Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, United Kingdom.
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Tard C, Defebvre L, Moreau C, Devos D, Danel-Brunaud V. Clinical features of amyotrophic lateral sclerosis and their prognostic value. Rev Neurol (Paris) 2017; 173:263-272. [DOI: 10.1016/j.neurol.2017.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/27/2017] [Indexed: 12/29/2022]
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Xu Z, Alruwaili ARS, Henderson RD, McCombe PA. Screening for cognitive and behavioural impairment in amyotrophic lateral sclerosis: Frequency of abnormality and effect on survival. J Neurol Sci 2017; 376:16-23. [PMID: 28431606 DOI: 10.1016/j.jns.2017.02.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 11/15/2016] [Revised: 02/01/2017] [Accepted: 02/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To screen for cognitive and behavioural impairment in people with amyotrophic lateral sclerosis (ALS) and controls with neuromuscular disease and to correlate these with clinical features. METHODS 108 people with ALS and 60 controls with other neuromuscular diseases were recruited and assessed with the Addenbrooke's cognitive examination-III (ACE-III), the frontal assessment battery (FAB), and the executive function component of the Edinburgh cognitive and behavioural ALS screen (ECAS). The Amyotrophic lateral sclerosis-Frontotemporal dementia questionnaire (ALS-FTD-Q) and the Motor Neuron Disease Behavioural instrument (MiND-B) were administered to the caregivers of people with ALS. The prevalence of abnormalities was determined and correlated with clinical features and survival. In 37 people with ALS, serial studies were performed. RESULTS The frequencies of cognitive impairment based on the ACE-III and FAB were 30.0% and 14.0%, in ALS and 11.7% and 3.3% in controls, respectively. Age and years of education influence the results of the ACE-III and ECAS executive function. In ALS, the frequencies of behavioural impairment based on ALS-FTD-Q and MiND-B were 32.1% and 39.4%, respectively. There is significant correlation of ALS-FTD-Q and MiND-B with the ALSFRS-R score. ALS participants with cognitive impairment measured with ACE-III had significantly shorter survival time than those without. ALS participants with behavioural impairment measured with ALS-FTD-Q had worse prognosis than those without. No significant difference was found between the first two serial cognitive tests based on ACE-III and FAB by using generalized estimating equation. CONCLUSION There is a greater frequency of cognitive impairment in people with ALS than in patients with other neuromuscular diseases. The cognitive and behavioural tests are potential biomarkers of the prognosis of ALS. The results of cognitive tests are stable over 6months and possibly longer.
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Affiliation(s)
- Zhouwei Xu
- The University of Queensland, Brisbane, Centre for Clinical Research, Queensland, Australia.
| | | | - Robert David Henderson
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Pamela Ann McCombe
- The University of Queensland, Brisbane, Centre for Clinical Research, Queensland, Australia
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Burkhardt C, Neuwirth C, Weber M. Longitudinal assessment of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS): lack of practice effect in ALS patients? Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:202-209. [PMID: 28165766 DOI: 10.1080/21678421.2017.1283418] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The study objective was to assess whether controls and ALS patients show a practice effect in the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) on repeated longitudinal testing and if the ECAS detects progression of cognitive or behavioural changes over time. METHODS The ECAS was administered serially to ALS patients (n = 24 after six months, n = 10 after 12-18 months) and controls (n = 21 after six months). The ECAS was fully performed by all participants. For comparison purposes the Frontal Assessment Battery (FAB) was administered to a subgroup of 14 patients and 14 controls. RESULTS After six months controls showed a significantly higher overall score (p < 0.001) and significantly higher scores in all subdomains of the ECAS, except for visuospatial function and fluency. ALS patients showed no significant difference in any score of the ECAS after six months and up to18 months. Behavioural changes were increasingly, but not statistically, significant, noted by patient carers. The FAB was no longer applicable due to progressive motor deficits in 20% of ALS patients. CONCLUSIONS In conclusion, in contrast to healthy controls, ALS patients show no practice effects. This could reflect 'pre-symptomatic' cognitive decline and progressive behavioural symptoms.
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Affiliation(s)
- Christian Burkhardt
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
| | - Christoph Neuwirth
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
| | - Markus Weber
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
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Shellikeri S, Karthikeyan V, Martino R, Black SE, Zinman L, Keith J, Yunusova Y. The neuropathological signature of bulbar-onset ALS: A systematic review. Neurosci Biobehav Rev 2017; 75:378-392. [PMID: 28163193 DOI: 10.1016/j.neubiorev.2017.01.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 11/04/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
ALS is a multisystem disorder affecting motor and cognitive functions. Bulbar-onset ALS (bALS) may be preferentially associated with cognitive and language impairments, compared with spinal-onset ALS (sALS), stemming from a potentially unique neuropathology. The objective of this systematic review was to compare neuropathology findings reported for bALS and sALS subtypes in studies of cadaveric brains. Using Cochrane guidelines, we reviewed articles in MEDLINE, Embase, and PsycINFO databases using standardized search terms for ALS and neuropathology, from inception until July 16th 2016. 17 studies were accepted for analysis. The analysis revealed that both subtypes presented with involvement in motor and frontotemporal cortices, deep cortical structures, and cerebellum and were characterized by neuronal loss, spongiosis, myelin pallor, and ubiquitin+ and TDP43+ inclusion bodies. Changes in Broca and Wernicke areas - regions associated with speech and language processing - were noted exclusively in bALS. Further, some bALS cases presented with atypical pathology such as neurofibrillary tangles and basophilic inclusions, which were not found in sALS cases. Given the limited number of studies, all with methodological biases, further work is required to better understand neuropathology of ALS subtypes.
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Affiliation(s)
- S Shellikeri
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
| | - V Karthikeyan
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - R Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Health Care and Outcomes Research, Krembil Research Institute, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Department of Medicine, Neurology, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Department of Medicine, Neurology, University of Toronto, Toronto, Ontario, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - L Zinman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Neurology, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Department of Medicine, Neurology, University of Toronto, Toronto, Ontario, Canada
| | - J Keith
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Y Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease defined by the presence of muscle weakness. The motor features of disease are heterogeneous in site of onset and progression. There are also extra-motor features in some patients. The genetic basis for extra-motor features is uncertain. The heterogeneity of ALS is an issue for clinical trials. Areas covered: This paper reviews the range and prevalence of extra-motor features associated with ALS, and highlights the current information about genetic associations with extra-motor features. Expert commentary: There are extra-motor features of ALS, but these are not found in all patients. The most common is cognitive abnormality. More data is required to ascertain whether extra-motor features arise with progression of disease. Extra-motor features are reported in patients with a range of causative genetic mutations, but are not found in all patients with these mutations. Further studies are required of the heterogeneity of ALS, and genotype/phenotype correlations are required, taking note of extra-motor features.
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Affiliation(s)
- P A McCombe
- a The University of Queensland Centre for Clinical Research and Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - N R Wray
- b The University of Queensland Institute for Molecular Bioscience , Brisbane , Australia
| | - R D Henderson
- a The University of Queensland Centre for Clinical Research and Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia
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Gillingham SM, Yunusova Y, Ganda A, Rogaeva E, Black SE, Stuss DT, Zinman L. Assessing cognitive functioning in ALS: A focus on frontal lobe processes. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:182-192. [PMID: 27931119 DOI: 10.1080/21678421.2016.1248977] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE It is generally acknowledged that at least 50% of individuals with amyotrophic lateral sclerosis (ALS) will exhibit cognitive deficits outside of the characteristic motor neuron involvement. However, a specific cognitive profile has been difficult to ascertain due to disease-related testing barriers and limitations in the sensitivity and specificity of available assessment methods. This study assessed the level of functioning of extramotor frontal cognitive processes in ALS, and the amount of change in the functioning in these processes over time as disease progresses. METHODS Empirical tests validated for a model of frontal lobe functioning were modified into an assessment battery appropriate for individuals with ALS in a clinical setting (the ALS-CFB, Computerised Frontal Battery). Twenty ALS participants and 36 age- and education-matched neurologically healthy controls were tested, and a sub-sample of each group (11 ALS and 20 controls) re-tested after approximately nine months. RESULTS AND CONCLUSIONS Compared to standard neuropsychological screening tests that did not show a difference between ALS participants and healthy controls, the ALS-CFB illustrated a profile of extramotor frontal dysfunction involving energisation (preparing the neural system to respond) and executive functions, a profile that may be indicative of the nature of neurodegeneration in ALS.
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Affiliation(s)
- S M Gillingham
- a Rotman Research Institute at Baycrest , Toronto , Canada.,b Department of Psychology , University of Toronto , Toronto , Canada
| | - Y Yunusova
- c Department of Speech-Language Pathology , University of Toronto , Toronto , Canada.,d Hurvitz Brain Sciences Research Programme , and Sunnybrook Research Institute , Toronto , Canada
| | - A Ganda
- d Hurvitz Brain Sciences Research Programme , and Sunnybrook Research Institute , Toronto , Canada.,e Department of Medicine, (Neurology) , University of Toronto , Toronto , Canada
| | - E Rogaeva
- e Department of Medicine, (Neurology) , University of Toronto , Toronto , Canada.,f Tanz Centre for Research in Neurodegenerative Diseases , University of Toronto , Toronto , Canada
| | - S E Black
- a Rotman Research Institute at Baycrest , Toronto , Canada.,d Hurvitz Brain Sciences Research Programme , and Sunnybrook Research Institute , Toronto , Canada.,e Department of Medicine, (Neurology) , University of Toronto , Toronto , Canada.,g Department of Medicine (Neurology) , Sunnybrook Health Sciences Centre and.,h L.C. Campbell Cognitive Neurology Research Unit , Sunnybrook Research Institute, University of Toronto , Toronto , Canada
| | - D T Stuss
- a Rotman Research Institute at Baycrest , Toronto , Canada.,b Department of Psychology , University of Toronto , Toronto , Canada.,d Hurvitz Brain Sciences Research Programme , and Sunnybrook Research Institute , Toronto , Canada.,e Department of Medicine, (Neurology) , University of Toronto , Toronto , Canada.,g Department of Medicine (Neurology) , Sunnybrook Health Sciences Centre and
| | - L Zinman
- d Hurvitz Brain Sciences Research Programme , and Sunnybrook Research Institute , Toronto , Canada.,g Department of Medicine (Neurology) , Sunnybrook Health Sciences Centre and.,h L.C. Campbell Cognitive Neurology Research Unit , Sunnybrook Research Institute, University of Toronto , Toronto , Canada
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Flaherty C, Kraft J, Brothers A, Harrison M, Legro R, Manni A, Yang C, Simmons Z. The relationship between oestrogen and executive functioning in ALS females with emerging Frontotemporal Lobar Degeneration (FTLD) supports a neuroendocrine model of FTLD attenuation. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:74-85. [DOI: 10.1080/21678421.2016.1249487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- C. Flaherty
- Department of Neurology, Penn State College of Medicine, Hershey, PA, USA,
| | - J. Kraft
- Department of Psychology, Penn State University, Middletown, PA, USA,
| | - A. Brothers
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA,
| | - M. Harrison
- Department of Psychology, Penn State University, Middletown, PA, USA,
| | - R.S. Legro
- Department of OB/GYN, Penn State College of Medicine, Hershey, PA, USA,
| | - A. Manni
- Division of Endocrinology, Diabetes and Metabolism, Penn State College of Medicine, Hershey, PA, USA, and
| | - C. Yang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Z. Simmons
- Department of Neurology, Penn State College of Medicine, Hershey, PA, USA,
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Foley G, Neely F. Cognitive Impairment in Amyotrophic Lateral Sclerosis: A Consideration for Occupational Performance. Br J Occup Ther 2016. [DOI: 10.1177/030802260306600906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditionally, amyotrophic lateral sclerosis (ALS) has been viewed as a degenerative disease, selective to the motor system. Until recently, research into cognitive impairment in ALS was confined primarily to a small proportion of patients with overt and clinically evident frontotemporal dementia (ALS/FTD). However, evidence from contemporary neuropsychological analysis and functional imaging studies, as identified in this review, indicates that a significantly higher percentage of patients with ALS presents with milder cognitive impairment in frontotemporal function. These deficits are considered progressive in nature, with increasing disability. Disturbances within the supervisory attentional system or central executive are thought to be responsible. It would appear that patients diagnosed with ALS may not be equally susceptible to developing cognitive deficits. The relationship between bulbar-onset ALS and increased cognitive decline is noteworthy. In ALS, the impact of cognitive disturbance on occupational performance must be considered in addition to physical disability.
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van Groenestijn AC, Kruitwagen-van Reenen ET, Visser-Meily JMA, van den Berg LH, Schröder CD. Associations between psychological factors and health-related quality of life and global quality of life in patients with ALS: a systematic review. Health Qual Life Outcomes 2016; 14:107. [PMID: 27439463 PMCID: PMC4955215 DOI: 10.1186/s12955-016-0507-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 02/10/2016] [Accepted: 07/07/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To systematically identify and appraise evidence on associations between psychological factors (moods, beliefs, personality) and Health-related QoL (HRQoL) and/or global QoL in patients with Amyotrophic Lateral Sclerosis (ALS). METHODS A systematic review was conducted in several online databases (PsycINFO, EMBASE, PubMed and CINAHL) up to October 2015. Articles were included if they reported associations between psychological factors (moods, beliefs and personality) and HRQoL and/or global QoL in an ALS population. The search was limited to empirical studies, published in English, which provided quantitative data. The methodological quality of the included articles was assessed. RESULTS In total, 22 studies were included. Mood was investigated in 14 studies, beliefs in 11 studies and personality in one study. Fifteen different psychological factors were extracted and assessed using 24 different measures. Twelve different QoL measures were used in the selected studies, subdivided into seven different HRQoL measures and five different global QoL measures. Higher levels of anxiety and depression appeared to be related to a poorer HRQoL, whereas a higher level of religiosity seemed to be associated with better global QoL. No conclusive associations were found for confusion-bewilderment (mood), spirituality, mindfulness, coping styles, hopelessness, perception of burden, cognitive appraisal (beliefs), neuroticism, extraversion, openness, agreeableness and conscientiousness (personality), due to insufficient or inconsistent evidence. Religiosity and spirituality appeared to become more positively associated over time. CONCLUSIONS Our results suggest that higher levels of anxiety and depression are related to a poorer HRQoL, whereas higher levels of religiosity appeared to be related to better global QoL. Associations might change during the disease course. This review supports the importance of psychological factors with regard to ALS care. Further research is needed to supplement the available evidence and to investigate how psychological factors can be modified to improve QoL. REVIEW REGISTRATION NUMBER PROSPERO 2015:CRD42015027303.
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Affiliation(s)
- Annerieke C van Groenestijn
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Esther T Kruitwagen-van Reenen
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carin D Schröder
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Karim AA, Hinterberger T, Richter J, Mellinger J, Neumann N, Flor H, Kübler A, Birbaumer N. Neural Internet: Web Surfing with Brain Potentials for the Completely Paralyzed. Neurorehabil Neural Repair 2016; 20:508-15. [PMID: 17082507 DOI: 10.1177/1545968306290661] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neural Internet is a new technological advancement in brain-computer interface research, which enables locked-in patients to operate a Web browser directly with their brain potentials. Neural Internet was successfully tested with a locked-in patient diagnosed with amyotrophic lateral sclerosis rendering him the first paralyzed person to surf the Internet solely by regulating his electrical brain activity. The functioning of Neural Internet and its clinical implications for motor-impaired patients are highlighted.
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Affiliation(s)
- Ahmed A Karim
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.
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Ma X, Zhang J, Zhang Y, Chen H, Li R, Long Z, Zheng J, Wang J, Chen H. Frequency-specific alterations in the fractional amplitude of low-frequency fluctuations in amyotrophic lateral sclerosis. Neurol Sci 2016; 37:1283-91. [DOI: 10.1007/s10072-016-2583-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
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Xiao S, MacNair L, McLean J, McGoldrick P, McKeever P, Soleimani S, Keith J, Zinman L, Rogaeva E, Robertson J. C9orf72 isoforms in Amyotrophic Lateral Sclerosis and Frontotemporal Lobar Degeneration. Brain Res 2016; 1647:43-49. [PMID: 27134035 DOI: 10.1016/j.brainres.2016.04.062] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 02/22/2016] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 12/11/2022]
Abstract
A hexanucleotide (G4C2) repeat expansion in the 5' non-coding region C9orf72 is the most common genetic cause of amyotrophic lateral sclerosis and frontotemporal lobar degeneration. Three modes of toxicity have been proposed: gain of function through formation of RNA foci and sequestration of RNA binding proteins; expression of dipeptide repeat proteins generated by repeat-associated non-ATG translation; and loss of function due to C9orf72 haploinsufficiency. Much is known about the proposed gain of function mechanisms, but there is little knowledge of the normal function of C9orf72 and the cellular consequences if its activity is perturbed. Here we will review what is known of C9orf72 at the transcript and protein levels and how changes in C9orf72 expression could contribute to disease pathogenesis. This article is part of a Special Issue entitled SI:RNA Metabolism in Disease.
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Affiliation(s)
- Shangxi Xiao
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada
| | - Laura MacNair
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - Jesse McLean
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada
| | - Phillip McGoldrick
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada
| | - Paul McKeever
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - Serena Soleimani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada
| | | | | | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada
| | - Janice Robertson
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.
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Spalloni A, Longone P. Cognitive impairment in amyotrophic lateral sclerosis, clues from the SOD1 mouse. Neurosci Biobehav Rev 2016; 60:12-25. [DOI: 10.1016/j.neubiorev.2015.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
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Nidos A, Kasselimis DS, Simos PG, Rentzos M, Alexakis T, Zalonis I, Zouvelou V, Potagas C, Evdokimidis I, Woolley SC. Frontotemporal Dysfunction in Amyotrophic Lateral Sclerosis: A Discriminant Function Analysis. NEURODEGENER DIS 2015; 16:140-6. [DOI: 10.1159/000381186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022] Open
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Abstract
The superimposed clinical features of motor neuron disease (MND) and
frontotemporal dementia (FTD) comprise a distinct, yet not fully understood,
neurological overlap syndrome whose clinicopathological basis has recently been
reviewed. Here, we present a review of the clinical, pathological and genetic
basis of MND-FTD and the role of MRI in its diagnosis. In doing so, we discuss
current techniques that depict the involvement of the selective corticospinal
tract (CST) and temporal lobe in MND-FTD.
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Kasper E, Zydatiss K, Schuster C, Machts J, Bittner D, Kaufmann J, Benecke R, Vielhaber S, Teipel S, Prudlo J. No Change in Executive Performance in ALS Patients: A Longitudinal Neuropsychological Study. NEURODEGENER DIS 2015; 16:184-91. [DOI: 10.1159/000440957] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 09/03/2015] [Indexed: 11/19/2022] Open
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Canosa A, Pagani M, Cistaro A, Montuschi A, Iazzolino B, Fania P, Cammarosano S, Ilardi A, Moglia C, Calvo A, Chiò A. 18F-FDG-PET correlates of cognitive impairment in ALS. Neurology 2015; 86:44-9. [DOI: 10.1212/wnl.0000000000002242] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/28/2015] [Indexed: 11/15/2022] Open
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Abstract
Although amyotrophic lateral sclerosis (ALS) is classically considered a disorder exclusively affecting motor neurons, there is substantial clinical, neuroimaging, and neuropathologic evidence that more than half of patients have an associated syndrome of frontotemporal dysfunction. These syndromes range from frontotemporal dementia to behavioral or cognitive syndromes. Neuroimaging and neuropathologic findings are consistent with frontotemporal lobar degeneration that underpins alterations in network connectivity. Future clinical trials need to be stratified based on the presence or absence of frontotemporal dysfunction on the disease course of ALS.
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Affiliation(s)
- Susan C Woolley
- Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, Suite 111, San Francisco, CA 94115, USA
| | - Michael J Strong
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Barulli MR, Fontana A, Panza F, Copetti M, Bruno S, Tursi M, Iurillo A, Tortelli R, Capozzo R, Simone IL, Logroscino G. Frontal assessment battery for detecting executive dysfunction in amyotrophic lateral sclerosis without dementia: a retrospective observational study. BMJ Open 2015; 5:e007069. [PMID: 26338835 PMCID: PMC4563243 DOI: 10.1136/bmjopen-2014-007069] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The frontal assessment battery (FAB) is a quick and reliable method of screening to evaluate frontal lobe dysfunction in amyotrophic lateral sclerosis (ALS). However, previous studies were generally conducted on small samples representing different stages of disease and severity. We assessed the diagnostic accuracy of the FAB in detecting executive functions and its association with demographic and clinical features in ALS without dementia. DESIGN Retrospective observational study. SETTING A multidisciplinary tertiary centre for motor neuron disease. PARTICIPANTS We enrolled 95 consecutive patients with ALS diagnosed with El Escorial criteria in the period between January 2006 and December 2010. MAIN OUTCOME MEASURES We screened the patients with ALS using the FAB. An Executive Index (EI) was also calculated by averaging the Z scores of analytic executive tests evaluating information-processing speed (Symbol Digit Modalities Test--Oral version), selective attention (Stroop test) and semantic memory (Verbal Fluency Test). RESULTS The FAB detected executive dysfunction in 13.7% of the patients with ALS. Moreover, using the EI standardised cut-off, 37.9% of the patients with ALS showed executive dysfunction. The receiver-operating characteristic curve showed that the optimal cut-off for the FAB in the whole sample was 16, with a sensitivity of 0.889 (95% CIs 0.545 to 1.000), a specificity of 0.593 (95% CI 0.450 to 0.907) and a moderate overall discriminatory power of 0.809. Different levels of respiratory function, duration of disease and depressive symptoms did not affect the FAB validity. CONCLUSIONS In patients with ALS without dementia, a high prevalence of executive dysfunction was present. The FAB showed good validity as a screening instrument to detect executive dysfunction in these patients and may be used when a complete neuropsychological assessment is not possible.
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Affiliation(s)
- Maria Rosaria Barulli
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Stefania Bruno
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Marianna Tursi
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Annalisa Iurillo
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Rosa Capozzo
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Isabella Laura Simone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Ma X, Zhang J, Zhang Y, Chen H, Li R, Wang J, Chen H. Altered cortical hubs in functional brain networks in amyotrophic lateral sclerosis. Neurol Sci 2015; 36:2097-104. [PMID: 26198762 DOI: 10.1007/s10072-015-2319-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cortical hubs are highly connected nodes in functional brain networks that play vital roles in the efficient transfer of information across brain regions. Although altered functional connectivity has been found in amyotrophic lateral sclerosis (ALS), the changing pattern in functional network hubs in ALS remains unknown. In this study, we applied a voxel-wise method to investigate the changing pattern of cortical hubs in ALS. Through resting-state fMRI, we constructed whole-brain voxel-wise functional networks by measuring the temporal correlations of each pair of brain voxels and identified hubs using the graph theory method. Specifically, a functional connectivity strength (FCS) map was derived from the data on 20 patients with ALS and 20 healthy controls. The brain regions with high FCS values were regarded as functional network hubs. Functional hubs were found mainly in the bilateral precuneus, parietal cortex, medial prefrontal cortex, and in several visual regions and temporal areas in both groups. Within the hub regions, the ALS patients exhibited higher FCS in the prefrontal cortex compared with the healthy controls. The FCS value in the significantly abnormal hub regions was correlated with clinical variables. Results indicated the presence of altered cortical hubs in the ALS patients and could therefore shed light on the pathophysiology mechanisms underlying ALS.
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