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Pan X, Donaghy PC, Roberts G, Chouliaras L, O’Brien JT, Thomas AJ, Heslegrave AJ, Zetterberg H, McGuinness B, Passmore AP, Green BD, Kane JPM. Plasma metabolites distinguish dementia with Lewy bodies from Alzheimer's disease: a cross-sectional metabolomic analysis. Front Aging Neurosci 2024; 15:1326780. [PMID: 38239488 PMCID: PMC10794326 DOI: 10.3389/fnagi.2023.1326780] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Background In multifactorial diseases, alterations in the concentration of metabolites can identify novel pathological mechanisms at the intersection between genetic and environmental influences. This study aimed to profile the plasma metabolome of patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), two neurodegenerative disorders for which our understanding of the pathophysiology is incomplete. In the clinical setting, DLB is often mistaken for AD, highlighting a need for accurate diagnostic biomarkers. We therefore also aimed to determine the overlapping and differentiating metabolite patterns associated with each and establish whether identification of these patterns could be leveraged as biomarkers to support clinical diagnosis. Methods A panel of 630 metabolites (Biocrates MxP Quant 500) and a further 232 metabolism indicators (biologically informative sums and ratios calculated from measured metabolites, each indicative for a specific pathway or synthesis; MetaboINDICATOR) were analyzed in plasma from patients with probable DLB (n = 15; age 77.6 ± 8.2 years), probable AD (n = 15; 76.1 ± 6.4 years), and age-matched cognitively healthy controls (HC; n = 15; 75.2 ± 6.9 years). Metabolites were quantified using a reversed-phase ultra-performance liquid chromatography column and triple-quadrupole mass spectrometer in multiple reaction monitoring (MRM) mode, or by using flow injection analysis in MRM mode. Data underwent multivariate (PCA analysis), univariate and receiving operator characteristic (ROC) analysis. Metabolite data were also correlated (Spearman r) with the collected clinical neuroimaging and protein biomarker data. Results The PCA plot separated DLB, AD and HC groups (R2 = 0.518, Q2 = 0.348). Significant alterations in 17 detected metabolite parameters were identified (q ≤ 0.05), including neurotransmitters, amino acids and glycerophospholipids. Glutamine (Glu; q = 0.045) concentrations and indicators of sphingomyelin hydroxylation (q = 0.039) distinguished AD and DLB, and these significantly correlated with semi-quantitative measurement of cardiac sympathetic denervation. The most promising biomarker differentiating AD from DLB was Glu:lysophosphatidylcholine (lysoPC a 24:0) ratio (AUC = 0.92; 95%CI 0.809-0.996; sensitivity = 0.90; specificity = 0.90). Discussion Several plasma metabolomic aberrations are shared by both DLB and AD, but a rise in plasma glutamine was specific to DLB. When measured against plasma lysoPC a C24:0, glutamine could differentiate DLB from AD, and the reproducibility of this biomarker should be investigated in larger cohorts.
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Affiliation(s)
- Xiaobei Pan
- School of Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Paul C. Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Leonidas Chouliaras
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Alan J. Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amanda J. Heslegrave
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
- Dementia Research Institute, UCL, London, United Kingdom
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, United Kingdom
- Dementia Research Institute, UCL, London, United Kingdom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Kowloon, Hong Kong SAR, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Anthony P. Passmore
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Brian D. Green
- School of Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Joseph P. M. Kane
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Yamamoto R, Takenoshita N, Inagawa Y, Kato H, Kaneshiro K, Kamiya T, Inagawa S, Saisho A, Tsugawa A, Mastumoto Y, Yoshimura M, Saito K, Shimizu S, Sato T. Association between longitudinal changes in striatal dopamine transporter uptake and clinical features of dementia with Lewy bodies. Psychogeriatrics 2023; 23:1036-1042. [PMID: 37726104 DOI: 10.1111/psyg.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND It is widely known that there is low striatal 123 I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3- fluoropropyl) nortropane (123 I-FP-CIT) dopamine transporter single photon emission tomography (DaT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). No studies to date have analyzed the association between longitudinal changes of clinical features and DaT uptake in patients with Parkinson syndrome, particularly those with DLB. The aim of this study was to investigate the association between the longitudinal changes in DaT uptake and the severity of parkinsonism and cognitive function in DLB patients. METHODS A total of 35 outpatients with probable DLB who underwent DaT-SPECT twice (at the initial examination and the follow-up period) in the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study between April 2014 and September 2020. The correlation between annual changes in DaT uptake and clinical features (cognitive function decline and parkinsonism) of the patients was analyzed. RESULTS A significant correlation was detected between annual changes in parkinsonism symptom severity and DaT uptake in the left posterior putamen (r = -0.39, P = 0.03), and between Mini-Mental State Examination scores and DaT uptake in all regions except the right posterior putamen (P < 0.05) in patients with DLB. CONCLUSIONS Our results suggested that the pathway from the ventrolateral tier of the substantia nigra to the putamen might be more crucial for motor function than other pathways, not only in Parkinson's disease but also in DLB.
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Affiliation(s)
- Ryo Yamamoto
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Naoto Takenoshita
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuta Inagawa
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hikaru Kato
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kyoko Kaneshiro
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Tomoki Kamiya
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shoya Inagawa
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Aya Saisho
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Akito Tsugawa
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yukari Mastumoto
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mana Yoshimura
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Tomohiko Sato
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
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Choudhury P, Zhang N, Adler CH, Chen K, Belden C, Driver-Dunckley E, Mehta SH, Shprecher DR, Serrano G, Shill HA, Beach TG, Atri A. Longitudinal motor decline in dementia with Lewy bodies, Parkinson disease dementia, and Alzheimer's dementia in a community autopsy cohort. Alzheimers Dement 2023; 19:4377-4387. [PMID: 37422286 PMCID: PMC10592344 DOI: 10.1002/alz.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION We examined the progression of extrapyramidal symptoms and signs in autopsy-confirmed dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and Alzheimer's disease dementia (AD). METHODS Longitudinal data were obtained from Arizona Study of Aging and Neurodegenerative Disease, with PDD (n = 98), AD (n = 47) and DLB (n = 48) further sub-grouped as with or without parkinsonism (DLB+ and DLB-). Within-group Unified Parkinson's Disease Rating Scale (UPDRS) -II and UPDRS-III trajectories were analyzed using non-linear mixed effects models. RESULTS In DLB, 65.6% had parkinsonism. Baseline UPDRS-II and III scores (off-stage) were highest (P < 0.001) for PDD (mean ± SD 14.3 ± 7.8 and 27.4 ± 16.3), followed by DLB+ (6.0 ± 8.8 and 17.2 ± 17.1), DLB- (1.1 ± 1.3 and 3.3 ± 5.5) and AD (3.2 ± 6.1 and 8.2 ± 13.6). Compared to PDD, the DLB+ group had faster UPDRS-III progression over 8-years (Cohen's-d range 0.98 to 2.79, P < 0.001), driven by gait (P < 0.001) and limb bradykinesia (P = 0.02) subscales. DISCUSSION Motor deficits progress faster in DLB+ than PDD, providing insights about expected changes in motor function. HIGHLIGHTS Dementia with Lewy bodies has faster motor progression than Parkinson's disease dementia Linear and non-linear mixed modeling analysis of longitudinal data was utilized Findings have implications for clinical prognostication and trial design.
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Affiliation(s)
- Parichita Choudhury
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Scottsdale, Arizona, 85259, USA
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona, 85259, USA
| | - Kewei Chen
- Computational Imaging Lab, Banner Alzheimer’s Institute, Phoenix, Arizona, 85006, USA
| | - Christine Belden
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Erika Driver-Dunckley
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona, 85259, USA
| | - Shyamal H. Mehta
- Computational Imaging Lab, Banner Alzheimer’s Institute, Phoenix, Arizona, 85006, USA
| | - David R. Shprecher
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Geidy Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Holly A. Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, 85013, USA
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Alireza Atri
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
- Center for Brain/Mind Medicine & Department of Neurology, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Nelson RS, Abner EL, Jicha GA, Schmitt FA, Di J, Wilcock DM, Barber JM, Van Eldik LJ, Katsumata Y, Fardo DW, Nelson PT. Neurodegenerative pathologies associated with behavioral and psychological symptoms of dementia in a community-based autopsy cohort. Acta Neuropathol Commun 2023; 11:89. [PMID: 37269007 PMCID: PMC10236713 DOI: 10.1186/s40478-023-01576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 06/04/2023] Open
Abstract
In addition to the memory disorders and global cognitive impairment that accompany neurodegenerative diseases, behavioral and psychological symptoms of dementia (BPSD) commonly impair quality of life and complicate clinical management. To investigate clinical-pathological correlations of BPSD, we analyzed data from autopsied participants from the community-based University of Kentucky Alzheimer's Disease Research Center longitudinal cohort (n = 368 research volunteers met inclusion criteria, average age at death 85.4 years). Data assessing BPSD were obtained approximately annually, including parameters for agitation, anxiety, apathy, appetite problems, delusions, depression, disinhibition, hallucinations, motor disturbance, and irritability. Each BPSD was scored on a severity scale (0-3) via the Neuropsychiatric Inventory Questionnaire (NPI-Q). Further, Clinical Dementia Rating (CDR)-Global and -Language evaluations (also scored on 0-3 scales) were used to indicate the degree of global cognitive and language impairment. The NPI-Q and CDR ratings were correlated with neuropathology findings at autopsy: Alzheimer's disease neuropathological changes (ADNC), neocortical and amygdala-only Lewy bodies (LBs), limbic predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC), primary age-related tauopathy (PART), hippocampal sclerosis, and cerebrovascular pathologies. Combinations of pathologies included the quadruple misfolding proteinopathy (QMP) phenotype with co-occurring ADNC, neocortical LBs, and LATE-NC. Statistical models were used to estimate the associations between BPSD subtypes and pathologic patterns. Individuals with severe ADNC (particularly those with Braak NFT stage VI) had more BPSD, and the QMP phenotype was associated with the highest mean number of BPSD symptoms: > 8 different BPSD subtypes per individual. Disinhibition and language problems were common in persons with severe ADNC but were not specific to any pathology. "Pure" LATE-NC was associated with global cognitive impairment, apathy, and motor disturbance, but again, these were not specific associations. In summary, Braak NFT stage VI ADNC was strongly associated with BPSD, but no tested BPSD subtype was a robust indicator of any particular "pure" or mixed pathological combination.
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Affiliation(s)
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Jing Di
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Justin M Barber
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA.
- University of Kentucky, Rm 575 Todd Building, Lexington, KY, 40536, USA.
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Sensi SL, Russo M, Tiraboschi P. Biomarkers of diagnosis, prognosis, pathogenesis, response to therapy: Convergence or divergence? Lessons from Alzheimer's disease and synucleinopathies. Handb Clin Neurol 2023; 192:187-218. [PMID: 36796942 DOI: 10.1016/b978-0-323-85538-9.00015-8] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Alzheimer's disease (AD) is the most common disorder associated with cognitive impairment. Recent observations emphasize the pathogenic role of multiple factors inside and outside the central nervous system, supporting the notion that AD is a syndrome of many etiologies rather than a "heterogeneous" but ultimately unifying disease entity. Moreover, the defining pathology of amyloid and tau coexists with many others, such as α-synuclein, TDP-43, and others, as a rule, not an exception. Thus, an effort to shift our AD paradigm as an amyloidopathy must be reconsidered. Along with amyloid accumulation in its insoluble state, β-amyloid is becoming depleted in its soluble, normal states, as a result of biological, toxic, and infectious triggers, requiring a shift from convergence to divergence in our approach to neurodegeneration. These aspects are reflected-in vivo-by biomarkers, which have become increasingly strategic in dementia. Similarly, synucleinopathies are primarily characterized by abnormal deposition of misfolded α-synuclein in neurons and glial cells and, in the process, depleting the levels of the normal, soluble α-synuclein that the brain needs for many physiological functions. The soluble to insoluble conversion also affects other normal brain proteins, such as TDP-43 and tau, accumulating in their insoluble states in both AD and dementia with Lewy bodies (DLB). The two diseases have been distinguished by the differential burden and distribution of insoluble proteins, with neocortical phosphorylated tau deposition more typical of AD and neocortical α-synuclein deposition peculiar to DLB. We propose a reappraisal of the diagnostic approach to cognitive impairment from convergence (based on clinicopathologic criteria) to divergence (based on what differs across individuals affected) as a necessary step for the launch of precision medicine.
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Affiliation(s)
- Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology Unit, Center for Advanced Studies and Technology-CAST and ITAB Institute for Advanced Biotechnology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology Unit, Center for Advanced Studies and Technology-CAST and ITAB Institute for Advanced Biotechnology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Pietro Tiraboschi
- Division of Neurology V-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Sherwin PF. Correcting Diagnostic Test Sensitivity and Specificity for Patient Misclassifications Resulting from Use of an Imperfect Reference Standard. Diagnostics (Basel) 2022; 13. [PMID: 36611381 DOI: 10.3390/diagnostics13010090] [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: 12/01/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Investigational diagnostic tests are validated by using a reference standard (RS). If the RS is imperfect (i.e., it has sensitivity [Se] and/or specificity [Sp] < 1), incorrect values for the investigational test’s Se and Sp may result because of patient misclassification by the RS. Formulas were derived to correct a test’s Se and Sp that were determined by using an imperfect RS. The following derived formulas correct for misclassification and give the true numbers of disease-positive [nDP] and disease-negative patients [nDN] from the apparent number of disease-positive and disease-negative patients (anDP and anDN), and the Se and Sp of the RS (SeR, SpR): nDP = (anDP × SpR + anDN × SpR − anDN)/JR; nDN = (anDP × SeR + anDN × SeR − anDP)/JR, where JR is Youden’s Index for the RS (JR = SeR + SpR − 1). The following derived formulas give the correct Se and Sp of an investigational test (SeI and SpI): SeI = (anTPI × SpR − nDP × SeR × SpR + nDP × JR + nDN × SpR2 − nDN × SpR − SpR × anTNI + anTNI)/(nDP × JR); SpI = (anTPI − anTPI × SeR + nDP × SeR2 − nDP × SeR − SeR × nDN × SpR + nDN × JR + SeR × anTNI)/(nDN × JR), where anTPI is the apparent number of true-positive test results, and anTNI is the apparent number of true-negative test results. The derived formulas correct for patient misclassification by an imperfect RS and give the correct values of a diagnostic test’s Se and Sp.
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Ciafone J, Thomas A, Durcan R, Donaghy PC, Hamilton CA, Lawley S, Roberts G, Colloby S, Firbank MJ, Allan L, Petrides G, Taylor JP, O'Brien JT, Gallagher P. Neuropsychological Impairments and Their Cognitive Architecture in Mild Cognitive Impairment (MCI) with Lewy Bodies and MCI-Alzheimer's Disease. J Int Neuropsychol Soc 2022; 28:963-73. [PMID: 34666864 DOI: 10.1017/S1355617721001181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study aimed to clarify the neuropsychological profile of the emergent diagnostic category of Mild Cognitive Impairment with Lewy bodies (MCI-LB) and determine whether domain-specific impairments such as in memory were related to deficits in domain-general cognitive processes (executive function or processing speed). METHOD Patients (n = 83) and healthy age- and sex-matched controls (n = 34) underwent clinical and imaging assessments. Probable MCI-LB (n = 44) and MCI-Alzheimer's disease (AD) (n = 39) were diagnosed following National Institute on Aging-Alzheimer's Association (NIA-AA) and dementia with Lewy bodies (DLB) consortium criteria. Neuropsychological measures included cognitive and psychomotor speed, executive function, working memory, and verbal and visuospatial recall. RESULTS MCI-LB scored significantly lower than MCI-AD on processing speed [Trail Making Test B: p = .03, g = .45; Digit Symbol Substitution Test (DSST): p = .04, g = .47; DSST Error Check: p < .001, g = .68] and executive function [Trail Making Test Ratio (A/B): p = .04, g = .52] tasks. MCI-AD performed worse than MCI-LB on memory tasks, specifically visuospatial (Modified Taylor Complex Figure: p = .01, g = .46) and verbal (Rey Auditory Verbal Learning Test: p = .04, g = .42) delayed recall measures. Stepwise discriminant analysis correctly classified the subtype in 65.1% of MCI patients (72.7% specificity, 56.4% sensitivity). Processing speed accounted for more group-associated variance in visuospatial and verbal memory in both MCI subtypes than executive function, while no significant relationships between measures were observed in controls (all ps > .05). CONCLUSIONS MCI-LB was characterized by executive dysfunction and slowed processing speed but did not show the visuospatial dysfunction expected, while MCI-AD displayed an amnestic profile. However, there was considerable neuropsychological profile overlap and processing speed mediated performance in both MCI subtypes.
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Cavalli A, Lelli D, Pedone C, Boccardi V, Mecocci P, Antonelli Incalzi R. Attention, Praxis, and Reasoning Are Associated with Risk of Undernutrition in Older People with Cognitive Impairment. J Alzheimers Dis 2022; 89:1017-1024. [PMID: 35964176 DOI: 10.3233/jad-215732] [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: 11/15/2022]
Abstract
BACKGROUND Dementia is a risk factor for undernutrition. However, it is not clear if specific cognitive deficits have a higher risk of undernutrition and how much appetite/nutritional problems and caregiver stress mediate this association. OBJECTIVE To evaluate the relationship between nutritional status and severity of global and function-specific scores of cognitive dysfunctions, and to which extent this association is mediated by appetite/nutritional problems and caregiver stress. METHODS Cross-sectional analysis of the ReGAl study data, including 761 older adults attending a Memory Clinic. Nutritional status was evaluated with Mini Nutritional Assessment (MNA). The relationship between scores at neuro-cognitive tests and risk of undernutrition was evaluated using logistic regression models adjusted for potential confounders. To allow comparison between different tests, all scores were standardized. Mediation analysis was used to evaluate how much appetite/nutritional problems and caregiver stress mediate this association. RESULTS Mean age was 77 years (SD: 9), 37.3% were women. Exploring different cognitive domains, a stronger association was documented for attentive matrices (OR:0.49, 95% CI: 0.34-0.72), the figure copy test (OR:0.63, 95% CI: 0.45-0.88), and the verbal judgement test (OR:0.61, 95% CI: 0.42-0.91). The proportion of the effect of cognition (MMSE) on nutritional status mediated by caregiver distress was 9.5% (95% CI: 0.002-0.27), the proportion mediated by appetite/nutritional problems was 11% (95% CI: -4.8-3.18). CONCLUSION Risk of undernutrition is associated to cognitive decline; a stronger association was observed for attention, praxis, and reasoning. Caregiver distress is a mediator of this association. This information should be considered in the management plans of this population.
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Affiliation(s)
- Andrea Cavalli
- Unit of Geriatrics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Diana Lelli
- Unit of Geriatrics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Claudio Pedone
- Unit of Geriatrics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia-SantaMaria della Misericordia Hospital, Perugia, Italy
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia-SantaMaria della Misericordia Hospital, Perugia, Italy
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Yoon EJ, Lee JY, Kim H, Yoo D, Shin JH, Nam H, Jeon B, Kim YK. Brain Metabolism Related to Mild Cognitive Impairment and Phenoconversion in Patients With Isolated REM Sleep Behavior Disorder. Neurology 2022; 98:e2413-e2424. [PMID: 35437260 PMCID: PMC9231839 DOI: 10.1212/wnl.0000000000200326] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Mild cognitive impairment (MCI) in isolated REM sleep behavior disorder (iRBD) is a risk factor for subsequent neurodegeneration. We aimed to identify brain metabolism and functional connectivity changes related to MCI in patients with iRBD and the neuroimaging markers' predictive value for phenoconversion. Methods This is a prospective cohort study of patients with iRBD with a mean follow-up of 4.2 ± 2.6 years. At baseline, patients with iRBD and age- and sex-matched healthy controls (HCs) underwent 18F-fluorodeoxyglucose (FDG)–PET and resting-state fMRI scans and a comprehensive neuropsychological test battery. Voxel-wise group comparisons for FDG-PET data were performed using a general linear model. Seed-based connectivity maps were computed using brain regions showing significant hypometabolism associated with MCI in patients with iRBD and compared between groups. A Cox regression analysis was applied to investigate the association between brain metabolism and risk of phenoconversion. Results Forty patients with iRBD, including 21 with MCI (iRBD-MCI) and 19 with normal cognition (iRBD-NC), and 24 HCs were included in the study. The iRBD-MCI group revealed relative hypometabolism in the inferior parietal lobule, lateral and medial occipital, and middle and inferior temporal cortex bilaterally compared with HC and the iRBD-NC group. In seed-based connectivity analyses, the iRBD-MCI group exhibited decreased functional connectivity of the left angular gyrus with the occipital cortex. Of 40 patients with iRBD, 12 patients converted to Parkinson disease (PD) or dementia with Lewy bodies (DLB). Hypometabolism of the occipital pole (hazard ratio [95% CI] 6.652 [1.387–31.987]), medial occipital (4.450 [1.143–17.327]), and precuneus (3.635 [1.009–13.093]) was associated with higher phenoconversion rate to PD/DLB. Discussion MCI in iRBD is related to functional and metabolic changes in broad brain areas, particularly the occipital and parietal areas. Moreover, hypometabolism in these brain regions was a predictor of phenoconversion to PD or DLB. Evaluation of cognitive function and neuroimaging characteristics could be useful for risk stratification in patients with iRBD.
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Affiliation(s)
- Eun Jin Yoon
- Memory Network Medical Research Center, Seoul National University, Seoul, Korea, Republic of.,Department of Nuclear Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Jee-Young Lee
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Heejung Kim
- Department of Nuclear Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea, Republic of
| | - Dallah Yoo
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of.,Department of Neurology, Kyung Hee University Hospital, Seoul, Korea, Republic of
| | - Jung Hwan Shin
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Hyunwoo Nam
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea, Republic of
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10
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Roberts G, Lloyd JJ, Jefferson E, Kane JPM, Durcan R, Lawley S, Petrides GS, Howe K, Haq I, O'Brien JT, Thomas AJ. Uniformity of cardiac 123I-MIBG uptake on SPECT images in older adults with normal cognition and patients with dementia. J Nucl Cardiol 2021; 28:2151-2163. [PMID: 31820410 PMCID: PMC8648658 DOI: 10.1007/s12350-019-01977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Some studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls. We aimed to evaluate regional cardiac MIBG uptake patterns in healthy older adults and patients with dementia. METHODS 31 older adults with normal cognition, 15 Alzheimer's disease (AD), and 17 Dementia with Lewy bodies (DLB) patients were recruited. 5 individuals had previous myocardial infarction. Participants with sufficient cardiac uptake for regional SPECT analysis (29/31 controls, 15/15 AD, 5/17 DLB) had relative uptake pattern recorded. Controls were assessed for risk of future cardiovascular events using QRISK2, a validated online tool. RESULTS In controls uptake was reduced in the inferior wall (85%), apex (23%), septum (15%), and lateral wall (8%). AD and DLB showed similar patterns to controls. Lung or liver interference was present in 61% of cases. Myocardial infarction cases showed regional reductions in uptake, but normal/borderline planar uptake. In controls, there was no relationship between cardiovascular risk score and uptake pattern. CONCLUSIONS Significant variability of regional cardiac 123I-MIBG uptake is common in cases with normal planar cardiac uptake. Heterogeneity of regional uptake appears non-specific and unlikely to aid in the diagnosis of Lewy body disease.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK.
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Jim J Lloyd
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Elizabeth Jefferson
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Rory Durcan
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - Sarah Lawley
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - George S Petrides
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Kim Howe
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Iftikhar Haq
- Cardiology Department, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
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O’Brien JT, Taylor JP, Thomas A, Bamford C, Vale L, Hill S, Allan L, Finch T, McNally R, Hayes L, Surendranathan A, Kane J, Chrysos AE, Bentley A, Barker S, Mason J, Burn D, McKeith I. Improving the diagnosis and management of Lewy body dementia: the DIAMOND-Lewy research programme including pilot cluster RCT. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09070] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Background
Lewy body dementia, comprising both dementia with Lewy bodies and Parkinson’s disease dementia, is the second commonest cause of neurodegenerative dementia. Existing evidence suggests that it is underdiagnosed and without a consistent approach to management.
Objectives
To improve the diagnosis and management of Lewy body dementia by (1) understanding current diagnostic practice for dementia with Lewy bodies and Parkinson’s disease dementia; (2) identifying barriers to and facilitators of diagnosis and management; (3) developing evidence-based assessment toolkits to improve diagnosis of dementia with Lewy bodies and Parkinson’s disease dementia; (4) producing a management toolkit to facilitate management; and (5) undertaking a pilot cluster randomised clinical trial.
Design
Work package 1 assessed clinical diagnostic rates from case notes for dementia with Lewy bodies and Parkinson’s disease dementia before and after (work package 1 repeated) introduction of an assessment toolkit. In work package 2, we developed a management toolkit for Lewy body dementia. In work package 3, we developed assessment toolkits for dementia with Lewy bodies and Parkinson’s disease dementia and piloted these and the management toolkit in a clinical service. In work package 4, we undertook a pilot study of 23 services in nine NHS trusts that were cluster randomised to receiving and using the management toolkit or standard care. Work package 5 comprised a series of qualitative studies, examining barriers to and facilitators of diagnosis and management.
Setting
Secondary care memory assessment and movement disorder services in England.
Interventions
Assessment toolkits for Lewy body dementia consisted of questions for diagnostic symptoms, and management toolkits comprised 161 guidance statements grouped under five symptom domains.
Review methods
The systematic reviews of pharmacological and non-pharmacological management were based on published literature, with meta-analysis when possible, following a search of several electronic databases and the grey literature using terms related to Lewy body dementia, without restriction on time or language.
Participants
Participants aged ≥ 50 years diagnosed with dementia with Lewy bodies or Parkinson’s disease dementia and, for work package 1 and work package 1 repeated, non-dementia with Lewy bodies and non-Parkinson’s disease dementia controls. The qualitative studies included people with Lewy body dementia, carers and professionals.
Main outcome measures
For work packages 1 and 1 repeated, diagnostic rates for dementia with Lewy bodies and Parkinson’s disease dementia as a proportion of all dementia or Parkinson’s disease. For work packages 2 and 3, the production of diagnostic and management toolkits. For work package 4, feasibility of undertaking a cluster randomised trial of the toolkits, measured by number of participants recruited and use of the toolkits, assessed qualitatively.
Results
Work package 1 – 4.6% of dementia cases in secondary care received a dementia with Lewy bodies diagnosis (with significant differences in diagnostic rates between services) and 9.7% of those with Parkinson’s disease had a diagnosis of Parkinson’s disease dementia. There was evidence of delays in diagnosis for both dementia with Lewy bodies and Parkinson’s disease dementia compared with control patients, and the costs of dementia with Lewy bodies and Parkinson’s disease dementia were also greater than those for matched controls (p < 0.01 for both). Work package 2 – we produced 252 statements regarding Lewy body dementia management and, following a Delphi process, 161 statements were included in a management toolkit. Work package 3 – piloting indicated that separate assessment toolkits for use in memory clinic and movement disorder services were preferred, but a single toolkit for Lewy body dementia management was suitable. Work package 4 – we were able to recruit Lewy body dementia patients to target and recruited 131 patients within 6 months (target n = 120), of whom > 80% were retained in the study at 6 months. Work package 5 – barriers to diagnosis and management of Lewy body dementia were complex. Managing Lewy body dementia often requires input from a range of specialties and, therefore, care pathways may be fragmented. Positive attitudes to diagnosing Lewy body dementia, working with a team with expertise in Lewy body dementia and opportunities for cross-specialty discussion of patients with complex needs facilitated diagnosis and management. The toolkits were generally well received, particularly the management toolkit. Implementation, however, varied, reflecting differences in attitudes, skills, time and local leadership. Work package 1 repeated – following introduction of the assessment toolkit, we found that 9.7% of dementia cases had dementia with Lewy bodies (a significant increase from baseline; p = 0.0019), but Parkinson’s disease dementia rates were similar (8.2%) to baseline.
Limitations
We included only two geographical regions and evidence informing the management toolkit was limited. Work package 4 was a pilot study and, therefore, we did not set out to assess the extent to which use of the management toolkit altered outcomes at the individual patient level. We noted implementation of the toolkits was variable. The increase in diagnostic rates in dementia with Lewy bodies following introduction of the assessment toolkits cannot be necessarily causally attributed to them.
Conclusions
Dementia with Lewy bodies and Parkinson’s disease dementia were diagnosed in secondary care NHS services, with a lower frequency (around half) than that expected from known prevalence rates. The introduction of assessment toolkits for dementia with Lewy bodies and Parkinson’s disease dementia was associated with increased diagnostic rates of dementia with Lewy bodies, but not Parkinson’s disease dementia. Qualitative studies indicated inherent complexities of the disease itself, with treatment requiring input from different specialties and the potential for fragmented services, a workforce with variable training and confidence in Lewy body dementia, and negative attitudes towards diagnosis. The cluster randomised pilot trial demonstrated that patients could be successfully recruited, and provided preliminary evidence that the toolkits could be implemented in clinical services.
Future work
The evidence base informing the management of Lewy body dementia is limited, especially for non-pharmacological interventions. More well-designed randomised controlled trials for both cognitive and non-cognitive symptoms are needed.
Trial registration
Current Controlled Trials ISRCTN11083027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allan
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Richard McNally
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joseph Kane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandros E Chrysos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Allison Bentley
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Burn
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Roberts G, Donaghy PC, Lloyd J, Durcan R, Petrides G, Colloby SJ, Lawley S, Ciafone J, Hamilton CA, Firbank M, Allan L, Barnett N, Barker S, Olsen K, Howe K, Ali T, Taylor JP, O'Brien J, Thomas AJ. Accuracy of dopaminergic imaging as a biomarker for mild cognitive impairment with Lewy bodies. Br J Psychiatry 2021; 218:276-282. [PMID: 33355065 DOI: 10.1192/bjp.2020.234] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain. AIMS To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies. METHOD We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard. RESULTS At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52-77%), specificity 88% (76-95%) and accuracy 76% (68-84%), with positive likelihood ratio 5.3. CONCLUSIONS It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
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Affiliation(s)
- Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; and Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Jim Lloyd
- Translational and Clinical Research Institute, Newcastle University, UK; and Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kim Howe
- Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - Tamir Ali
- Nuclear Medicine Department, Royal Victoria Infirmary, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
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13
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Roberts G, Durcan R, Donaghy PC, Lawley S, Ciafone J, Hamilton CA, Colloby SJ, Firbank MJ, Allan L, Barnett N, Barker S, Howe K, Ali T, Petrides GS, Lloyd J, Taylor JP, O'Brien J, Thomas AJ. Accuracy of Cardiac Innervation Scintigraphy for Mild Cognitive Impairment With Lewy Bodies. Neurology 2021; 96:e2801-e2811. [PMID: 33883238 PMCID: PMC8205462 DOI: 10.1212/wnl.0000000000012060] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To provide evidence that cardiac I-123-metaiodobenzylguanidine sympathetic innervation imaging (MIBG) scintigraphy differentiates probable mild cognitive impairment with Lewy bodies (MCI-LB) from mild cognitive impairment due to Alzheimer disease (MCI-AD), we scanned patients with MCI and obtained consensus clinical diagnoses of their MCI subtype. We also performed baseline FP-CIT scans to compare the accuracy of MIBG and FP-CIT. Methods We conducted a prospective cohort study into the accuracy of cardiac MIBG scintigraphy in the diagnosis of MCI-LB. Follow-up clinical assessment was used to diagnose MCI-AD (no core features of MCI-LB and normal FP-CIT), probable MCI-LB (2 or more core features, or 1 core feature with abnormal FP-CIT), or possible MCI-LB (1 core feature or abnormal FP-CIT). For the comparison between MIBG and FP-CIT, only core clinical features were used for diagnosis. Results We recruited 95 people with mild cognitive impairment. Cardiac MIBG was abnormal in 22/37 probable and 2/15 possible MCI-LB cases and normal in 38/43 MCI-AD cases. The sensitivity in probable MCI-LB was 59% (95% confidence interval [CI], 42%–75%), specificity 88% (75%–96%), and accuracy 75% (64%–84%). The positive likelihood ratio was 5.1 and negative likelihood ratio 0.46. With symptom-only diagnoses, the accuracies were 79% for MIBG (95% CI, 68%–87%) and 76% for FP-CIT (95% CI, 65%–85%). Conclusions Cardiac MIBG appears useful in early disease, with an abnormal scan highly suggestive of MCI-LB. Validation in a multicenter setting is justified. Classification of Evidence This study provides Class I evidence that cardiac MIBG distinguishes MCI-LB from MCI-AD.
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Affiliation(s)
- Gemma Roberts
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK.
| | - Rory Durcan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Paul C Donaghy
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sarah Lawley
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Joanna Ciafone
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Calum A Hamilton
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sean J Colloby
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Michael J Firbank
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Louise Allan
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Nicola Barnett
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Sally Barker
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Kim Howe
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Tamir Ali
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - George S Petrides
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Jim Lloyd
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John-Paul Taylor
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - John O'Brien
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
| | - Alan J Thomas
- From the Translational and Clinical Research Institute (G.R., R.D., P.C.D., S.L., J.C., C.A.H., S.J.C., M.J.F., N.B., S.B., J.L., J.-P.T., A.J.T.), Newcastle University; Nuclear Medicine Department (G.R., K.H., T.A., G.S.P., J.L.), Royal Victoria Infirmary, Newcastle upon Tyne; University of Exeter Medical School (L.A.); and Department of Psychiatry (J.O.), University of Cambridge School of Clinical Medicine, UK
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Chen CL, Hsu MH, Hung CH, Chiu PY, Liu CH. Prevalence and Associated Factors of Visual Hallucinations in Patients with Vascular Cognitive Impairment. Behav Neurol 2021; 2021:8866763. [PMID: 33505534 DOI: 10.1155/2021/8866763] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Visual hallucinations (VHs) are striking features for dementia, especially dementia with Lewy bodies (DLB). We aimed to study the frequency and associated factors of VH in vascular cognitive impairment (VCI) and investigate the feasibility of clinically diagnosing the mixed pathology of VCI with DLB. This is a multicentre registration study. A consecutive series of VCI patients with and without dementia were enrolled. Frequency of VH and associated factors, including age, gender, education, disease severity, DLB clinical features, vascular risk factors, cognitive function, and neuropsychiatric symptoms, were compared between VCI with VH (VH+) and without VH (VH-). Among the 1281 patients analysed, 155 (12.1%) had VH. The VH+ group was older (t = 5.07; p < 0.001), was more likely to be female (χ 2 = 13.46; p < 0.001), and has a higher clinical dementia rating (χ 2 = 70.51; p < 0.001). After adjusting for age, gender, and disease severity, the VH+ group had poorer cognition and more severe neuropsychiatric symptoms. The VH+ group was more associated with DLB features in fluctuating cognition (OR = 2.48; p < 0.001), parkinsonism (OR = 1.85; p = 0.001), rapid eye movement (REM) behavioral disorder (OR = 4.56; p < 0.001), and ≧2 DLB core features (OR = 26.01; p < 0.001). VCI patients with VH tend to have more severe dementia, neuropsychiatric symptoms, and poorer cognitive function. Additionally, highly associated with clinical DLB features in VCI with VH raised the possibility of mixed pathology with DLB in this group. More than two core features in VCI might help in diagnosing a mixed pathology with DLB.
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Cersosimo MG, Benarroch EE, Raina GB. Lewy bodies in the olfactory system and the hypothalamus. The Human Hypothalamus: Neuropsychiatric Disorders 2021; 182:235-244. [DOI: 10.1016/b978-0-12-819973-2.00016-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Bousiges O, Philippi N, Lavaux T, Perret-Liaudet A, Lachmann I, Schaeffer-Agalède C, Anthony P, Botzung A, Rauch L, Jung B, de Sousa PL, Demuynck C, Martin-Hunyadi C, Cretin B, Blanc F. Differential diagnostic value of total alpha-synuclein assay in the cerebrospinal fluid between Alzheimer's disease and dementia with Lewy bodies from the prodromal stage. Alzheimers Res Ther 2020; 12:120. [PMID: 32993772 PMCID: PMC7523311 DOI: 10.1186/s13195-020-00684-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
Background Several studies have investigated the value of alpha-synuclein assay in the cerebrospinal fluid (CSF) of Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) patients in the differential diagnosis of these two pathologies. However, very few studies have focused on this assay in AD and DLB patients at the MCI stage. Methods All patients were enrolled under a hospital clinical research protocol from the tertiary Memory Clinic (CM2R) of Alsace, France, by an experienced team of clinicians. A total of 166 patients were included in this study: 21 control subjects (CS), 51 patients with DLB at the prodromal stage (pro-DLB), 16 patients with DLB at the demented stage (DLB-d), 33 AD patients at the prodromal stage (pro-AD), 32 AD patients at the demented stage (AD-d), and 13 patients with mixed pathology (AD+DLB). CSF levels of total alpha-synuclein were assessed using a commercial enzyme-linked immunosorbent assay (ELISA) for alpha-synuclein (AJ Roboscreen). Alzheimer’s biomarkers (t-Tau, P-Tau, Aβ42, and Aβ40) were also measured. Results The alpha-synuclein assays showed a significant difference between the AD and DLB groups. Total alpha-synuclein levels were significantly higher in AD patients than in DLB patients. However, the ROC curves show a moderate discriminating power between AD and DLB (AUC = 0.78) which does not improve the discriminating power of the combination of Alzheimer biomarkers (AUC = 0.95 with or without alpha-synuclein). Interestingly, the levels appeared to be altered from the prodromal stage in both AD and DLB. Conclusions The modification of total alpha-synuclein levels in the CSF of patients occurs early, from the prodromal stage. The adding of alpha-synuclein total to the combination of Alzheimer’s biomarker does not improve the differential diagnosis between AD and DLB. Trial registration ClinicalTrials.gov, NCT01876459 (AlphaLewyMa)
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Affiliation(s)
- Olivier Bousiges
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000, Strasbourg, France. .,Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), University of Strasbourg, 67000, Strasbourg, France. .,CNRS UMR7364, 67000, Strasbourg, France. .,CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.
| | - Nathalie Philippi
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
| | - Thomas Lavaux
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Armand Perret-Liaudet
- Neurochemistry Laboratory, Biochemistry Department, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, 59 bd Pinel, 69677, Bron, France.,BIORAN Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028, Université de Lyon - Université Claude Bernard, 95 bd Pinel, 69675, Bron, France.,Center for Memory Resources and Research, Hospices Civils de Lyon, Charpennes Hospital, Lyon 1 University, 69100, Villeurbanne, France
| | - Ingolf Lachmann
- AJ Roboscreen GmbH, Hohmannstraße 7, 04129, Leipzig, Germany
| | - Caroline Schaeffer-Agalède
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Pierre Anthony
- Geriatrics Department, General Hospital Centre, CM2R, Geriatric Day Hospital, Colmar, France
| | - Anne Botzung
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Lucie Rauch
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Barbara Jung
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Benjamin Cretin
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
| | - Frédéric Blanc
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France.,University of Strasbourg and CNRS, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg, France
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Tanprasertsuk J, Johnson EJ, Johnson MA, Poon LW, Nelson PT, Davey A, Martin P, Barbey AK, Barger K, Wang XD, Scott TM. Clinico-Neuropathological Findings in the Oldest Old from the Georgia Centenarian Study. J Alzheimers Dis 2020; 70:35-49. [PMID: 31177211 DOI: 10.3233/jad-181110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/15/2022]
Abstract
BACKGROUND Centenarian studies are important sources for understanding of factors that contribute to longevity and healthy aging. Clinico-neuropathological finding is a key in identifying pathology and factors contributing to age-related cognitive decline and dementia in the oldest old. OBJECTIVE To characterize the cross-sectional relationship between neuropathologies and measures of premortem cognitive performance in centenarians. METHODS Data were acquired from 49 centenarians (≥98 years) from the Georgia Centenarian Study. Cognitive assessment from the time point closest to mortality was used (<1 year for all subjects) and scores for cognitive domains were established. Neuropathologies [cerebral atrophy, ventricular dilation, atherosclerosis, cerebral amyloid angiopathy (CAA), Lewy bodies, hippocampal sclerosis (HS), hippocampal TDP-43 proteinopathy, neuritic plaque (NP) and neurofibrillary tangle (NFT) counts, Braak staging, and National Institute on Aging-Reagan Institute (NIARI) criteria for the neuropathological diagnosis of Alzheimer's disease (AD)] were compared among subjects with different ratings of dementia. Linear regression was applied to evaluate the association between cognitive domain scores and neuropathologies. RESULTS Wide ranges of AD-type neuropathological changes were observed in both non-demented and demented subjects. Neocortical NFT and Braak staging were related to clinical dementia rating. Neocortical NFT and NP, Braak and NIARI staging, cerebral and ventricular atrophy, HS, CAA, and TDP-43 proteinopathy were differentially associated with poor performance in multiple cognitive domains and activities of daily living. CONCLUSION AD-type pathology was associated with severe dementia and poor cognition but was not the only variable that explained cognitive impairment, indicating the complexity and heterogeneity of pathophysiology of dementia in the oldest old.
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Affiliation(s)
- Jirayu Tanprasertsuk
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Elizabeth J Johnson
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Mary Ann Johnson
- Department of Nutrition and Health Sciences, University of Nebraska Lincoln, Lincoln, NE, USA
| | - Leonard W Poon
- Institute of Gerontology, University of Georgia, Athens, GA, USA
| | - Peter T Nelson
- Department of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, USA
| | - Adam Davey
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Peter Martin
- Human Development & Family Studies, Iowa State University, Ames, IA, USA
| | - Aron K Barbey
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kathryn Barger
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Xiang-Dong Wang
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Tammy M Scott
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Inagawa Y, Kanetaka H, Tsugawa A, Sakurai S, Serisawa S, Shimizu S, Sakurai H, Hanyu H. Efficacy of Olfactory and Pareidolia Tests Compared With That of Indicative Biomarkers in Diagnosis of Dementia With Lewy Bodies. Front Neurol 2020; 11:540291. [PMID: 33041991 PMCID: PMC7517047 DOI: 10.3389/fneur.2020.540291] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Although olfactory decline and visual hallucinations are useful in distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) in a clinical setting, neither is easy to evaluate objectively. The pareidolia test is used to assess susceptibility to visual hallucinations, while in Japan, the Odor Stick Identification Test for the Japanese (OSIT-J) is used to objectively quantify olfactory decline. The present study investigated the efficacy of these olfactory and pareidolia tests in differentiating AD from DLB. Their usefulness was then compared with that of the indicative biomarkers in neuroimaging for a clinical diagnosis of DLB listed in the Fourth Consensus Report of the Dementia with Lewy Bodies Consortium. Methods: A total of 24 probable DLB and 22 probable AD patients were enrolled. All underwent 4 diagnostic procedures: uptake of dopamine transporter in single photon emission computed tomography (DaT-SPECT) and meta-iodobenzylguanidine (MIBG) in myocardial scintigraphy, the pareidolia test, and OSIT-J. The sensitivity, specificity, and accuracy of these methods in differentiating DLB from AD were compared. Results: Sensitivity and specificity in differentiating DLB from AD were 86 and 100% by the heart-to-mediastinum ratio of MIBG uptake; 82 and 96% by the specific binding ratio on DaT-SPECT; 77 and 67% by the combination of OSIT-J and pareidolia test scores; 73 and 62% by the pareidolia test scores; and 77 and 58% by the OSIT-J scores, respectively. Conclusions: The present results suggest that the pareidolia and OSIT-J tests may be considered before resorting to nuclear neuroimaging in the diagnosis of DLB.
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Gmitterová K, Gawinecka J, Llorens F, Varges D, Valkovič P, Zerr I. Cerebrospinal fluid markers analysis in the differential diagnosis of dementia with Lewy bodies and Parkinson's disease dementia. Eur Arch Psychiatry Clin Neurosci 2020; 270:461-470. [PMID: 30083957 DOI: 10.1007/s00406-018-0928-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/16/2018] [Indexed: 01/18/2023]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) share a couple of clinical similarities that is often a source of diagnostic pitfalls. We evaluated the discriminatory potential of brain-derived CSF markers [tau, p-tau (181P), Aβ1-42, NSE and S100B] across the spectrum of Lewy body disorders and assessed whether particular markers are associated with cognitive status in investigated patients. The tau CSF level, amyloid β1-42 and p-tau/tau ratio were helpful in the distinction between DLB and PDD (p = 0.04, p = 0.002 and p = 0.02, respectively) as well as from PD patients (p < 0.001, p = 0.001 and p = 0.002, respectively). Furthermore, the p-tau/tau ratio enabled the differentiation of DLB with mild dementia from PDD patients (p = 0.02). The CSF tau and p-tau levels in DLB and CSF tau and p-tau/tau ratio in PDD patients reflected the severity of dementia. Rapid disease course was associated with the decrease of Aβ1-42 in DLB but not in PDD. Elevation of S100B in DLB (p < 0.0001) as well as in PDD patients (p = 0.002) in comparison to controls was estimated. Hence, with the appropriate clinical context; the CSF marker profile could be helpful in distinguishing DLB from PDD patients even in early stages of dementia.
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Affiliation(s)
- Karin Gmitterová
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
- Second Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Joanna Gawinecka
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Franc Llorens
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
| | - Daniela Varges
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
| | - Peter Valkovič
- Second Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany.
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Hirose D, Shimizu S, Hirao K, Ogawa Y, Sato T, Kaneko Y, Takenoshita N, Namioka N, Fukasawa R, Umahara T, Sakurai H, Watanabe R, Hanyu H. Neuroimaging Characteristics of Frailty Status in Patients with Alzheimer's Disease. J Alzheimers Dis 2020; 67:1201-1208. [PMID: 30689570 DOI: 10.3233/jad-180701] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVE Although frailty is closely linked to dementia, particularly Alzheimer's disease (AD), underlying pathophysiology of frailty associated with AD remains uncertain. This study aimed to investigate differences in structural and functional brain imaging abnormalities between AD with and without frailty. METHODS A total of 191 outpatients with probable AD (men: 91; women: 100; age: 80.7±6.3 years) who underwent both magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) were enrolled in this study. Frailty was determined in accordance with the Obu study Health Promotion for the Elderly. We compared numbers of small infarctions in the subcortical gray and white matter and severity of white matter abnormalities (periventricular hyperintensity [PVH] and deep white matter hyperintensity [DWMH]) on MRI, and regional cerebral blood flow (rCBF) changes on SPECT between AD with and without frailty. RESULTS The prevalence of frailty was 43.4% in patients with AD. PVH and DWMH scores were significantly higher in AD with frailty compared to those without frailty. AD with frailty had a trend of decreased rCBF in the bilateral anterior cingulate gyrus, whereas those without frailty tend to have decreased rCBF in the left dominant parietal lobe and precuneus. CONCLUSION Our MRI and SPECT imaging studies suggest different underlying pathophysiology in the brain between AD with frailty and without frailty.
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Affiliation(s)
- Daisuke Hirose
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kentaro Hirao
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Ogawa
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomohiko Sato
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshitsugu Kaneko
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoto Takenoshita
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Nayuta Namioka
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Raita Fukasawa
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takahiko Umahara
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirofumi Sakurai
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ryo Watanabe
- Kanagawa University of Human Services, Yokosuka City, Kanagawa Prefecture, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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Chabran E, Noblet V, Loureiro de Sousa P, Demuynck C, Philippi N, Mutter C, Anthony P, Martin-Hunyadi C, Cretin B, Blanc F. Changes in gray matter volume and functional connectivity in dementia with Lewy bodies compared to Alzheimer's disease and normal aging: implications for fluctuations. Alzheimers Res Ther 2020; 12:9. [PMID: 31907068 PMCID: PMC6945518 DOI: 10.1186/s13195-019-0575-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Fluctuations are one of the core clinical features characterizing dementia with Lewy bodies (DLB). They represent a determining factor for its diagnosis and strongly impact the quality of life of patients and their caregivers. However, the neural correlates of this complex symptom remain poorly understood. This study aimed to investigate the structural and functional changes in DLB patients, compared to Alzheimer's disease (AD) patients and healthy elderly subjects, and their potential links with fluctuations. METHODS Structural and resting-state functional MRI data were collected from 92 DLB patients, 70 AD patients, and 22 control subjects, who also underwent a detailed clinical examination including the Mayo Clinic Fluctuation Scale. Gray matter volume changes were analyzed using whole-brain voxel-based morphometry, and resting-state functional connectivity was investigated using a seed-based analysis, with regions of interest corresponding to the main nodes of the salience network (SN), frontoparietal network (FPN), dorsal attention network (DAN), and default mode network (DMN). RESULTS At the structural level, fluctuation scores in DLB patients did not relate to the atrophy of insular, temporal, and frontal regions typically found in this pathology, but instead showed a weak correlation with more subtle volume reductions in different regions of the cholinergic system. At the functional level, the DLB group was characterized by a decreased connectivity within the SN and attentional networks, while the AD group showed decreases within the SN and DMN. In addition, higher fluctuation scores in DLB patients were correlated to a greater connectivity of the SN with the DAN and left thalamus, along with a decreased connectivity between the SN and DMN, and between the right thalamus and both the FPN and DMN. CONCLUSIONS Functional connectivity changes, rather than significant gray matter loss, could play an important role in the emergence of fluctuations in DLB. Notably, fluctuations in DLB patients appeared to be related to a disturbed external functional connectivity of the SN, which may lead to less relevant transitions between different cognitive states in response to internal and environmental stimuli. Our results also suggest that the thalamus could be a key region for the occurrence of this symptom.
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Affiliation(s)
- Eléna Chabran
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Vincent Noblet
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Nathalie Philippi
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Catherine Mutter
- INSERM Centre d’Investigation Clinique 1434, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Anthony
- General Hospital Centre, Geriatrics Department, CM2R, Geriatric Day Hospital, Colmar, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Benjamin Cretin
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
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Roberts G, Kane JPM, Lloyd JJ, Petrides GS, Howe K, O'Brien JT, Thomas AJ. A comparison of visual and semiquantitative analysis methods for planar cardiac 123I-MIBG scintigraphy in dementia with Lewy bodies. Nucl Med Commun 2019; 40:734-743. [PMID: 31058746 DOI: 10.1097/mnm.0000000000001024] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cardiac I-MIBG imaging is an established technique for the diagnosis of dementia with Lewy bodies but various analysis methods are reported in the literature. We assessed different methods in the same cohort of patients to inform best practice. PATIENTS AND METHODS Seventeen patients with dementia with Lewy bodies, 15 with Alzheimer's disease and 16 controls were included. Planar images were acquired 20 min and 4 h after injection. Nine operators produced heart-to-mediastinum ratios (HMRs) using freehand and 6, 7 and 8 cm diameter circular cardiac regions. Interoperator variation was measured using the coefficient of variation. HMR differences between methods were assessed using analysis of variance. Seven raters assessed the images visually. Accuracy was compared using receiver operating characteristic analysis. RESULTS There were significant differences in HMR between region methods (P=0.006). However, with optimised cut-offs there was no significant difference in accuracy (P=0.2-1.0). The sensitivity was 65-71% and specificity 100% for all HMR methods. Variation was lower with fixed regions than freehand (P<0.001). Visual rating sensitivity and specificity were 65 and 77% on early images and 76 and 71% on delayed images. There was no significant difference in HMR between early and delayed images (P=0.4-0.7) although a greater separation between means was seen on delayed images (0.73 vs. 0.95). CONCLUSION HMR analysis using a suitable cut-off is more accurate than visual rating. Accuracy is similar for all methods, but freehand regions are more variable and 6 cm circles easiest to place. We recommend calculating HMR using a 6 cm circular cardiac region of interest on delayed images.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University.,Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | | | - Jim J Lloyd
- Institute of Neuroscience, Newcastle University.,Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | - George S Petrides
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | - Kim Howe
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Esmaeeli S, Murphy K, Swords GM, Ibrahim BA, Brown JW, Llano DA. Visual hallucinations, thalamocortical physiology and Lewy body disease: A review. Neurosci Biobehav Rev 2019; 103:337-351. [PMID: 31195000 DOI: 10.1016/j.neubiorev.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 12/22/2022]
Abstract
One of the core diagnostic criteria for Dementia with Lewy Bodies (DLB) is the presence of visual hallucinations. The presence of hallucinations, along with fluctuations in the level of arousal and sleep disturbance, point to potential pathological mechanisms at the level of the thalamus. However, the potential role of thalamic dysfunction in DLB, particularly as it relates to the presence of formed visual hallucinations is not known. Here, we review the literature on the pathophysiology of DLB with respect to modern theories of thalamocortical function and attempt to derive an understanding of how such hallucinations arise. Based on the available literature, we propose that combined thalamic-thalamic reticular nucleus and thalamocortical pathology may explain the phenomenology of visual hallucinations in DLB. In particular, diminished α7 cholinergic activity in the thalamic reticular nucleus may critically disinhibit thalamocortical activity. Further, concentrated pathological changes within the posterior regions of the thalamus may explain the predilection for the hallucinations to be visual in nature.
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Affiliation(s)
- Shooka Esmaeeli
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Kathleen Murphy
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Gabriel M Swords
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Baher A Ibrahim
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jeffrey W Brown
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Daniel A Llano
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Carle Neuroscience Institute, Urbana, IL, United States.
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24
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de Heus RAA, Donders R, Santoso AMM, Olde Rikkert MGM, Lawlor BA, Claassen JAHR. Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension. J Am Heart Assoc 2019; 8:e011938. [PMID: 31088188 PMCID: PMC6585342 DOI: 10.1161/jaha.119.011938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 01/28/2019] [Accepted: 04/16/2019] [Indexed: 12/23/2022]
Abstract
Background Hypertension is common among patients with Alzheimer disease. Because this group has been excluded from hypertension trials, evidence regarding safety of treatment is lacking. This secondary analysis of a randomized controlled trial assessed whether antihypertensive treatment increases the prevalence of orthostatic hypotension (OH) in patients with Alzheimer disease. Methods and Results Four hundred seventy-seven patients with mild-to-moderate Alzheimer disease were randomized to the calcium-channel blocker nilvadipine 8 mg/day or placebo for 78 weeks. Presence of OH (blood pressure drop ≥20/≥10 mm Hg after 1 minute of standing) and OH-related adverse events (dizziness, syncope, falls, and fractures) was determined at 7 follow-up visits. Mean age of the study population was 72.2±8.2 years and mean Mini-Mental State Examination score was 20.4±3.8. Baseline blood pressure was 137.8±14.0/77.0±8.6 mm Hg. Grade I hypertension was present in 53.4% (n=255). After 13 weeks, blood pressure had fallen by -7.8/-3.9 mm Hg for nilvadipine and by -0.4/-0.8 mm Hg for placebo ( P<0.001). Across the 78-week intervention period, there was no difference between groups in the proportion of patients with OH at a study visit (odds ratio [95% CI]=1.1 [0.8-1.5], P=0.62), nor in the proportion of visits where a patient met criteria for OH, corrected for number of visits (7.7±13.8% versus 7.3±11.6%). OH-related adverse events were not more often reported in the intervention group compared with placebo. Results were similar for those with baseline hypertension. Conclusions This study suggests that initiation of a low dose of antihypertensive treatment does not significantly increase the risk of OH in patients with mild-to-moderate Alzheimer disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A. A. de Heus
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Rogier Donders
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Angelina M. M. Santoso
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Brian A. Lawlor
- Mercer's Institute for Research on AgeingSt. James's HospitalDublinIreland
- Department of Medical GerontologyTrinity College Institute of NeuroscienceDublinIreland
| | - Jurgen A. H. R. Claassen
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
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25
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Schumacher J, Peraza LR, Firbank M, Thomas AJ, Kaiser M, Gallagher P, O'Brien JT, Blamire AM, Taylor JP. Dynamic functional connectivity changes in dementia with Lewy bodies and Alzheimer's disease. Neuroimage Clin 2019; 22:101812. [PMID: 30991620 PMCID: PMC6462776 DOI: 10.1016/j.nicl.2019.101812] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 01/22/2023]
Abstract
We studied the dynamic functional connectivity profile of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) compared to controls, how it differs between the two dementia subtypes, and a possible relation between dynamic connectivity alterations and temporally transient clinical symptoms in DLB. Resting state fMRI data from 31 DLB, 29 AD, and 31 healthy control participants were analyzed using dual regression to determine between-network functional connectivity. Subsequently, we used a sliding window approach followed by k-means clustering and dynamic network analyses to study dynamic functional connectivity. Dynamic connectivity measures that showed significant group differences were tested for correlations with clinical symptom severity. Our results show that AD and DLB patients spent more time than controls in sparse connectivity configurations with absence of strong positive and negative connections and a relative isolation of motor networks from other networks. Additionally, DLB patients spent less time in a more strongly connected state and the variability of global brain network efficiency was reduced in DLB compared to controls. There were no significant correlations between dynamic connectivity measures and clinical symptom severity. An inability to switch out of states of low inter-network connectivity into more highly and specifically connected network configurations might be related to the presence of dementia in general as it was observed in both AD and DLB. In contrast, the loss of global efficiency variability in DLB might indicate the presence of an abnormally rigid brain network and the lack of economical dynamics, factors which could contribute to cognitive slowing and an inability to respond appropriately to situational demands.
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Affiliation(s)
- Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom; Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, United Kingdom
| | - Michael Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, United Kingdom; Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge CB2 0SP, United Kingdom
| | - Andrew M Blamire
- Institute of Cellular Medicine & Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
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26
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Roberts G, Lloyd JJ, Petrides GS, Donaghy PC, Kane JPM, Durcan R, Lawley S, Howe K, Sims AJ, Taylor JP, O'Brien JT, Thomas AJ. 123I-FP-CIT striatal binding ratios do not decrease significantly with age in older adults. Ann Nucl Med 2019; 33:434-443. [PMID: 30900103 DOI: 10.1007/s12149-019-01352-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/22/2019] [Accepted: 03/14/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE I-123-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane (FP-CIT) imaging is an established biomarker used in the diagnosis of Lewy body disease. Images are often reported with the aid of striatal binding ratios (SBRs), comparing uptake to a normal database via Z scores. It is well known that SBRs are age dependent. However, previous studies cover wide age ranges between 20 and 80 years, rather than focusing on older adults. Typically a linear relationship is reported, but some authors have suggested that SBRs do not decline as rapidly in old age. Commercial software packages usually adjust the SBR Z score to attempt to compensate for age-related decline, but the model used varies. Ensuring age correction is appropriate for older adults is important, given that the majority of patients referred for FP-CIT scans are aged over 60 years. We examined the relationship of SBR with age in older adults and the effect of age correction using research scans from 123 adults over 60 years of age. METHODS Twenty-nine healthy older adults and twenty-three with MCI due to Alzheimer's disease were included as controls, i.e. individuals with no evidence of Lewy body disease. Their ages ranged from 60 to 92 years (mean 76; SD 7.9). SBRs and Z scores were calculated using BRASS (Hermes Medical) and DaTQUANT (GE Healthcare). SBRs were plotted against age and linear mixed effect models applied. We tested the effect of removing age correction in BRASS using an independent dataset of 71 older adults with dementia or mild cognitive impairment. RESULTS The slopes of the linear fits between SBR and age per year were - 0.007 (p = 0.30) with BRASS and - 0.004 (p = 0.35) with DaTQUANT. The slopes are smaller than reported in the literature and show no statistically significant difference from zero. Switching age correction off in BRASS in the test subjects reduced Z scores by approximately 1 standard deviation at 80 years of age. CONCLUSION We found no statistically significant age-related decline in SBR in adults over 60 years of age without Lewy body disease. Commercial software packages that apply a fixed rate of age correction may be overcorrecting for age in older adults, which could contribute to misdiagnosis.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK. .,Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE1 4LP, UK.
| | - James J Lloyd
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - George S Petrides
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Paul C Donaghy
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Joseph P M Kane
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Rory Durcan
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Sarah Lawley
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Kim Howe
- Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Andrew J Sims
- Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE7 7DN, UK.,Institute of Cellular Medicine, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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27
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Thomas AJ, Donaghy P, Roberts G, Colloby SJ, Barnett NA, Petrides G, Lloyd J, Olsen K, Taylor JP, McKeith I, O'Brien JT. Diagnostic accuracy of dopaminergic imaging in prodromal dementia with Lewy bodies. Psychol Med 2019; 49:396-402. [PMID: 29692275 PMCID: PMC6331684 DOI: 10.1017/s0033291718000995] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Dopaminergic imaging has high diagnostic accuracy for dementia with Lewy bodies (DLB) at the dementia stage. We report the first investigation of dopaminergic imaging at the prodromal stage. METHODS We recruited 75 patients over 60 with mild cognitive impairment (MCI), 33 with probable MCI with Lewy body disease (MCI-LB), 15 with possible MCI-LB and 27 with MCI with Alzheimer's disease. All underwent detailed clinical, neurological and neuropsychological assessments and FP-CIT [123I-N-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)] dopaminergic imaging. FP-CIT scans were blindly rated by a consensus panel and classified as normal or abnormal. RESULTS The sensitivity of visually rated FP-CIT imaging to detect combined possible or probable MCI-LB was 54.2% [95% confidence interval (CI) 39.2-68.6], with a specificity of 89.0% (95% CI 70.8-97.6) and a likelihood ratio for MCI-LB of 4.9, indicating that FP-CIT may be a clinically important test in MCI where any characteristic symptoms of Lewy body (LB) disease are present. The sensitivity in probable MCI-LB was 61.0% (95% CI 42.5-77.4) and in possible MCI-LB was 40.0% (95% CI 16.4-67.7). CONCLUSIONS Dopaminergic imaging had high specificity at the pre-dementia stage and gave a clinically important increase in diagnostic confidence and so should be considered in all patients with MCI who have any of the diagnostic symptoms of DLB. As expected, the sensitivity was lower in MCI-LB than in established DLB, although over 50% still had an abnormal scan. Accurate diagnosis of LB disease is important to enable early optimal treatment for LB symptoms.
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Affiliation(s)
- Alan J. Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Paul Donaghy
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Gemma Roberts
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, UK
| | - Sean J. Colloby
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Nicky A. Barnett
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - George Petrides
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, UK
| | - Kirsty Olsen
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - John T. O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
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28
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Kane JPM, Roberts G, Petrides GS, Lloyd JJ, O'Brien JT, Thomas AJ. 123I-MIBG scintigraphy utility and cut-off value in a clinically representative dementia cohort. Parkinsonism Relat Disord 2019; 62:79-84. [PMID: 30709778 DOI: 10.1016/j.parkreldis.2019.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/20/2018] [Accepted: 01/25/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the utility of 123I-metaiodobenzylguanidine cardiac scintigraphy (MIBG), and optimum heart: mediastinum ratio (HMR) for differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) in a clinically representative population, comparing findings with those of 123I-2β -carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) SPECT. METHODS We recruited subjects with probable DLB (n = 17) and probable AD (n = 16) from clinical services. Each participant underwent clinical examination, cardiac MIBG scintigraphy and FP-CIT SPECT. Diagnosis was made on the basis of clinical symptoms using validated criteria. Cardiac MIBG uptake was measured by the planar HMR, blind to clinical diagnosis, with values below a cut-off taken from a previous study (<2.2 at four hours) defining scans as abnormal. FP-CIT scans were blindly rated according to a visual rating scale. RESULTS MIBG had a sensitivity, specificity and overall accuracy of 71%, 81% and 76% for distinguishing DLB from AD. FP-CIT demonstrated a sensitivity, specificity and accuracy of 82%, 88% and 85%. Using a lower HMR cut-off to distinguish between abnormal and normal MIBG scans improved the accuracy of MIBG, raising specificity (100%) and overall accuracy (85%) without compromising sensitivity (71%). Neither prescription of potentially interfering medications, nor a history of myocardial infarction (MI), had a significant effect on HMR. CONCLUSION We found that MIBG did not demonstrate superior sensitivity and overall accuracy to FP-CIT. HMR cut-off influences biomarker utility, and clinical and Caucasian populations may require a lower cut-off than those reported elsewhere. Future MIBG studies should include clinically representative cohorts as neither medications nor previous MI appear to influence HMR.
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29
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Komatsu J, Samuraki M, Nakajima K, Arai H, Arai H, Arai T, Asada T, Fujishiro H, Hanyu H, Iizuka O, Iseki E, Kashihara K, Kosaka K, Maruno H, Mizukami K, Mizuno Y, Mori E, Nakamura H, Nakano S, Nakashima K, Nishio Y, Orimo S, Takahashi A, Taki J, Tokuda T, Urakami K, Utsumi K, Wada K, Washimi Y, Yamashina S, Yamasaki J, Yoshita M, Yamada M. 123I-MIBG myocardial scintigraphy for the diagnosis of DLB: a multicentre 3-year follow-up study. J Neurol Neurosurg Psychiatry 2018; 89:1167-1173. [PMID: 29853532 DOI: 10.1136/jnnp-2017-317398] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/26/2018] [Accepted: 05/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE We previously reported the usefulness of iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy for differentiation of dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) in a cross-sectional multicentre study. The aim of this study was, by using reassessed diagnosis after 3-year follow-up, to evaluate the diagnostic accuracy of 123I-MIBG scintigraphy in differentiation of probable DLB from probable AD. METHODS We undertook 3-year follow-up of 133 patients with probable or possible DLB or probable AD who had undergone 123I-MIBG myocardial scintigraphy at baseline. An independent consensus panel made final diagnosis at 3-year follow-up. Based on the final diagnosis, we re-evaluated the diagnostic accuracy of 123I-MIBG scintigraphy performed at baseline. RESULTS Sixty-five patients completed 3-year follow-up assessment. The final diagnoses were probable DLB (n=30), possible DLB (n=3) and probably AD (n=31), and depression (n=1). With a receiver operating characteristic curve analysis of heart-to-mediastinum (H/M) ratios for differentiating probable DLB from probable AD, the sensitivity/specificity were 0.77/0.94 for early images using 2.51 as the threshold of early H/M ratio, and 0.77/0.97 for delayed images using 2.20 as the threshold of delayed H/M ratio. Five of six patients who were diagnosed with possible DLB at baseline and with probable DLB at follow-up had low H/M ratio at baseline. CONCLUSIONS Our follow-up study confirmed high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy at baseline and the clinical diagnosis of probable DLB at 3-year follow-up. Its diagnostic usefulness in early stage of DLB was suggested. TRIAL REGISTRATION NUMBER UMIN00003419.
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Affiliation(s)
- Junji Komatsu
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Miharu Samuraki
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Heii Arai
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Arai
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tetsuaki Arai
- Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Asada
- Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshige Fujishiro
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Osamu Iizuka
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eizo Iseki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Kenji Kosaka
- Department of Neurology, Medical Care Court Clinic, Yokohama, Japan
| | | | - Katsuyoshi Mizukami
- Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yoshikuni Mizuno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seigo Nakano
- Center for Treatment, Care and Research of Dementia, Medical Co. LTA, Tokyo, Japan
| | - Kenji Nakashima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yoshiyuki Nishio
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | | | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Takahiko Tokuda
- Department of Molecular Pathobiology of Brain Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuya Urakami
- Department of Biological Regulation, Faculty of Medicine, School of Health Science, Tottori University, Tottori, Japan
| | - Kumiko Utsumi
- Department of Neuropsychiatry, Sunagawa City Medical Center, Sunagawa, Japan
| | - Kenji Wada
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yukihiko Washimi
- Department for Cognitive Disorders, Hospital of National Center for Geriatrics and Gerontology, Toyota, Japan
| | - Shouhei Yamashina
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Tokyo, Japan
| | - Junichi Yamasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Yoshita
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.,Department of Neurology, Hokuriku National Hospital, Toyama, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Cromarty RA, Schumacher J, Graziadio S, Gallagher P, Killen A, Firbank MJ, Blamire A, Kaiser M, Thomas AJ, O’Brien JT, Peraza LR, Taylor JP. Structural Brain Correlates of Attention Dysfunction in Lewy Body Dementias and Alzheimer's Disease. Front Aging Neurosci 2018; 10:347. [PMID: 30519184 PMCID: PMC6251343 DOI: 10.3389/fnagi.2018.00347] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/15/2018] [Indexed: 12/04/2022] Open
Abstract
Lewy body dementia (LBD) and Alzheimer's disease (AD) are common forms of dementia that have different clinical profiles but are both commonly associated with attentional deficits. The aim of this study was to investigate efficiency of different attentional systems in LBD and AD and its association with brain structural abnormalities. We studied reaction time (RT) data from 45 LBD, 31 AD patients and 22 healthy controls (HCs) using the Attention Network Test (ANT) to assess the efficiency of three different attentional systems: alerting, orienting and executive conflict. Voxel-based morphometry (VBM) was used to investigate relations between different attention components and cortical volume. Both dementia groups showed slower overall RTs than controls, with additional slowing in LBD relative to AD. There was a significant alerting effect in controls which was absent in the dementia groups, the executive conflict effect was greater in both dementia groups compared to controls, but the orienting effect did not differ between groups. Mean RT in AD was negatively correlated with occipital gray matter (GM) volume and in LBD orienting efficiency was negatively related to occipital white matter (WM) volume. Given that previous studies in less impaired patients suggest a maintenance of the alerting effect, the absent alerting effect in our study suggests a loss of alerting efficiency with dementia progression. While orienting was largely preserved, it might be related to occipital structural abnormalities in LBD. Executive function was markedly impaired in both dementia groups, however, the absence of relations to brain volume suggests that it might be more related to functional rather than macrostructural pathophysiological changes.
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Affiliation(s)
- Ruth A. Cromarty
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Julia Schumacher
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sara Graziadio
- NIHR In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison Killen
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael J. Firbank
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Blamire
- Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marcus Kaiser
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
- Interdisciplinary Computing and Complex BioSystems (ICOS) Research Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alan J. Thomas
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, United Kingdom
| | - Luis R. Peraza
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
- Interdisciplinary Computing and Complex BioSystems (ICOS) Research Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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Rizzo G, Arcuti S, Copetti M, Alessandria M, Savica R, Fontana A, Liguori R, Logroscino G. Accuracy of clinical diagnosis of dementia with Lewy bodies: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2018; 89:358-366. [PMID: 29030419 DOI: 10.1136/jnnp-2017-316844] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/12/2017] [Accepted: 09/28/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND The diagnosis of dementia with Lewy bodies (DLB) is based on diagnostic clinical criteria, which were updated over the years. OBJECTIVE To evaluate, through a systematic review, accuracy of the diagnostic criteria, testing a possible improvement over time. METHODS We searched on MEDLINE and SCOPUS databases for studies reporting diagnostic parameters regarding the clinical diagnosis of DLB until October 2016. We performed meta-analysis, using a Bayesian approach, on those using pathological examination as gold standard, subclassified based on the different diagnostic criteria used. RESULTS We selected 22 studies on 1585 patients. Pooled sensitivity, specificity and accuracy were 60.2%, 93.8%, 79.7%, respectively, for criteria antecedents to McKeith 1996. For McKeith 1996-possible, pooled sensitivity, specificity and accuracy were 65.6%, 80.6%, 77.9% in early stages and 72.3%, 64.3%, 66% in late stages, respectively. For McKeith 1996-probable, pooled sensitivity, specificity and accuracy were 19.4%, 95.1%, 77.7% in early stages and 48.6%, 88%, 79.2% in late stages, respectively. McKeith criteria 2005 were evaluated only in late stages: pooled sensitivity, specificity and accuracy were 91.3%, 66.7% and 81.6%, respectively, for possible diagnosis (only one study) and 88.3%, 80.8%, 90.7% for probable diagnosis, decreasing to 85.6%, 77.1% and 81.7% if only considering clinical settings focused on dementia diagnosis and care. CONCLUSIONS AND RELEVANCE Diagnostic criteria have become more sensitive and less specific over time, without substantial change in the accuracy. Based on current data, about 20% of DLB diagnosis are incorrect. Future studies are needed to evaluate if the recently released revised consensus criteria will improve the diagnostic accuracy of DLB.
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Affiliation(s)
- Giovanni Rizzo
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Unit of Neurology, University of Bologna, Bologna, Italy
| | - Simona Arcuti
- Department of Clinical Research in Neurology, University of Bari, Tricase, Italy.,Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Alessandria
- Department of Clinical Research in Neurology, University of Bari, Tricase, Italy
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Rocco Liguori
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Unit of Neurology, University of Bologna, Bologna, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, University of Bari, Tricase, Italy.,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
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Park KW, Hong YJ, Park JH, Park H, Cheon SM, Kim JW, Kim BC, Jeong YJ, Yoon HJ, Kang DY. Pattern of cerebral hypoperfusion according to the clinical staging in dementia with Lewy bodies. Neurocase 2018; 24:83-89. [PMID: 29508646 DOI: 10.1080/13554794.2018.1447133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed to detect different patterns of cerebral hypoperfusion in DLB according to clinical staging. Thirty-three patients with DLB were recruited by clinical dementia rating (CDR) stage. Compared with control, cerebral hypoperfusion was mainly observed in the lingual gyrus, the cuneus, the occipital gyrus in CDR 0.5 group; the fusiform gyrus, the middle temporal gyrus, and the posterior cingulate in CDR 1; and the lingual gyrus, the cuneus, the hippocampus, the fusiform gyrus, and the inferior frontal gyrus in CDR 2. Our findings suggest that cerebral hypoperfusion spreads to the frontal cortex and temporal lobes as disease progresses.
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Affiliation(s)
- Kyung Won Park
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea.,b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea
| | - Yun Jeong Hong
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea.,c Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Jong Hwan Park
- b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea
| | - Hyuntae Park
- b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea.,d Department of Health Care Science , Dong-A University , Busan , Korea
| | - Sang Myung Cheon
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea
| | - Jae Woo Kim
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea
| | - Byeong C Kim
- e Department of Neurology , Chonnam National University Medical School , Gwangju , Korea
| | - Young Jin Jeong
- f Department of Nuclear Medicine, College of Medicine , Dong-A University , Busan , Korea
| | - Hyun Jin Yoon
- f Department of Nuclear Medicine, College of Medicine , Dong-A University , Busan , Korea
| | - Do-Young Kang
- b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea.,f Department of Nuclear Medicine, College of Medicine , Dong-A University , Busan , Korea
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Kane JPM, Surendranathan A, Bentley A, Barker SAH, Taylor JP, Thomas AJ, Allan LM, McNally RJ, James PW, McKeith IG, Burn DJ, O'Brien JT. Clinical prevalence of Lewy body dementia. Alzheimers Res Ther 2018; 10:19. [PMID: 29448953 PMCID: PMC5815202 DOI: 10.1186/s13195-018-0350-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022]
Abstract
Background The prevalence of dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) in routine clinical practice is unclear. Prevalence rates observed in clinical and population-based cohorts and neuropathological studies vary greatly. Small sample sizes and methodological factors in these studies limit generalisability to clinical practice. Methods We investigated prevalence in a case series across nine secondary care services over an 18-month period, to determine how commonly DLB and PDD cases are diagnosed and reviewed within two regions of the UK. Results Patients with DLB comprised 4.6% (95% CI 4.0–5.2%) of all dementia cases. DLB was represented in a significantly higher proportion of dementia cases in services in the North East (5.6%) than those in East Anglia (3.3%; χ2 = 13.6, p < 0.01). DLB prevalence in individual services ranged from 2.4 to 5.9%. PDD comprised 9.7% (95% CI 8.3–11.1%) of Parkinson’s disease cases. No significant variation in PDD prevalence was observed between regions or between services. Conclusions We found that the frequency of clinical diagnosis of DLB varied between geographical regions in the UK, and that the prevalence of both DLB and PDD was much lower than would be expected in this case series, suggesting considerable under-diagnosis of both disorders. The significant variation in DLB diagnostic rates between these two regions may reflect true differences in disease prevalence, but more likely differences in diagnostic practice. The systematic introduction of more standardised diagnostic practice could improve the rates of diagnosis of both conditions.
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Affiliation(s)
- Joseph P M Kane
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ajenthan Surendranathan
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Allison Bentley
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Sally A H Barker
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Richard J McNally
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Peter W James
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Ian G McKeith
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - David J Burn
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. .,Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
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Groveman BR, Orrù CD, Hughson AG, Raymond LD, Zanusso G, Ghetti B, Campbell KJ, Safar J, Galasko D, Caughey B. Rapid and ultra-sensitive quantitation of disease-associated α-synuclein seeds in brain and cerebrospinal fluid by αSyn RT-QuIC. Acta Neuropathol Commun 2018; 6:7. [PMID: 29422107 PMCID: PMC5806364 DOI: 10.1186/s40478-018-0508-2] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/25/2022] Open
Abstract
The diagnosis and treatment of synucleinopathies such as Parkinson disease and dementia with Lewy bodies would be aided by the availability of assays for the pathogenic disease-associated forms of α-synuclein (αSynD) that are sufficiently sensitive, specific, and practical for analysis of accessible diagnostic specimens. Two recent αSynD seed amplification tests have provided the first prototypes for ultrasensitive and specific detection of αSynD in patients' cerebrospinal fluid. These prototypic assays require 5-13 days to perform. Here, we describe an improved α-synuclein real time quaking-induced conversion (αSyn RT-QuIC) assay that has similar sensitivity and specificity to the prior assays, but can be performed in 1-2 days with quantitation. Blinded analysis of cerebrospinal fluid from 29 synucleinopathy cases [12 Parkinson's and 17 dementia with Lewy bodies] and 31 non-synucleinopathy controls, including 16 Alzheimer's cases, yielded 93% diagnostic sensitivity and 100% specificity for this test so far. End-point dilution analyses allowed quantitation of relative amounts of αSynD seeding activity in cerebrospinal fluid samples, and detection in as little as 0.2 μL. These results confirm that αSynD seeding activity is present in cerebrospinal fluid. We also demonstrate that it can be rapidly detected, and quantitated, even in early symptomatic stages of synucleinopathy.
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Affiliation(s)
- Bradley R Groveman
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Christina D Orrù
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Andrew G Hughson
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Lynne D Raymond
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Katrina J Campbell
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Jiri Safar
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California-San Diego, La Jolla, CA, USA.
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
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Russell G, Harper R, Allen H, Baldwin R, Burns A. Cognitive impairment and Charles Bonnet syndrome: a prospective study. Int J Geriatr Psychiatry 2018; 33:39-46. [PMID: 28117918 DOI: 10.1002/gps.4665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Charles Bonnet syndrome (CBS) is a common cause of visual hallucinations in older people. The relationship between CBS and cognitive impairment is unclear, but anecdotal reports exist of dementia emerging in patients diagnosed with CBS. This work set out to determine if there is an increased incidence of dementia, and increased severity of cognitive impairment, in people with CBS compared to controls from the same clinical setting. METHOD People over 65 attending low-vision and glaucoma clinics, and a cohort of age-matched controls, underwent a psychiatric assessment. The cohorts were followed up after one year. RESULTS Mild cognitive impairment was present in 2/12 CBS participants and 2/10 controls. Partial insight was seen in nine CBS participants. Two participants with CBS, and no controls, developed dementia at follow-up. No significant differences in performance on the ACE-R were found between the groups. Both participants who developed dementia had partial insight and hallucinations of familiar figures at diagnosis of CBS, and one had mild cognitive impairment. CONCLUSIONS Reassurance that CBS is universally benign may be misplaced. Some people given this diagnosis go on to develop dementia. Cognitive testing at the point of diagnosis was unable to identify those at risk of this outcome. Partial insight, the presence of Mild Cognitive Impairment, and hallucinations of familiar figures at diagnosis of CBS may confer an increased risk of subsequent dementia diagnosis. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Gregor Russell
- Horton Park Centre, Horton Park Avenue, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Robert Harper
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Harry Allen
- Manchester Mental Health and Social Care NHS Foundation Trust, Manchester, UK
| | - Robert Baldwin
- Manchester Mental Health and Social Care NHS Foundation Trust, Manchester, UK
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36
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Watson R, Colloby SJ, Blamire AM, Wesnes KA, Wood J, O'Brien JT. Does attentional dysfunction and thalamic atrophy predict decline in dementia with Lewy bodies? Parkinsonism Relat Disord 2017; 45:69-74. [DOI: 10.1016/j.parkreldis.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 11/25/2022]
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Cersosimo MG. Propagation of alpha-synuclein pathology from the olfactory bulb: possible role in the pathogenesis of dementia with Lewy bodies. Cell Tissue Res 2018; 373:233-43. [PMID: 29196808 DOI: 10.1007/s00441-017-2733-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
Olfactory limbic structures, like the amygdala, the entorhinal, and the piriform cortices, are closely involved in cognitive processes. Thus, besides olfactory dysfunctions, it is conceivable that the compromise of these structures can lead to cognitive impairment. The olfactory bulb is affected by alpha-synuclein pathology in almost all cases of both Parkinson's disease and dementia with Lewy bodies. The clinical distinction between these disorders relies on the timing in the appearance of dementia in relationship to motor symptoms. Typically, it occurs late in the course of Parkinson's disease, and within the first year in dementia with Lewy bodies. The close anatomical proximity of the olfactory bulb with limbic regions, together with the early occurrence of cognitive impairment that is observed in dementia with Lewy bodies, raise the question whether the propagation of alpha-synuclein pathology in this condition might originate in the olfactory bulb, spreading from there to other limbic structures, and thereby reaching the associative neocortex. This review will describe the anatomical basis of the olfactory system and discuss the evidence of potential spreading pathways from the olfactory bulb that could support the presence of early dementia in the setting of Lewy body disorders.
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Schumacher J, Peraza LR, Firbank M, Thomas AJ, Kaiser M, Gallagher P, O'Brien JT, Blamire AM, Taylor JP. Functional connectivity in dementia with Lewy bodies: A within- and between-network analysis. Hum Brain Mapp 2017; 39:1118-1129. [PMID: 29193464 PMCID: PMC5900719 DOI: 10.1002/hbm.23901] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 04/28/2017] [Revised: 10/28/2017] [Accepted: 11/20/2017] [Indexed: 01/07/2023] Open
Abstract
Dementia with Lewy bodies (DLB) is a common form of dementia and is characterized by cognitive fluctuations, visual hallucinations, and Parkinsonism. The phenotypic expression of the disease may, in part, relate to alterations in functional connectivity within and between brain networks. This resting‐state study sought to clarify this in DLB, how networks differed from Alzheimer's disease (AD), and whether they were related to clinical symptoms in DLB. Resting‐state networks were estimated using independent component analysis. We investigated functional connectivity changes in 31 DLB patients compared to 31 healthy controls and a disease comparator group of 29 AD patients using dual regression and FSLNets. Within‐network connectivity was generally decreased in DLB compared to controls, mainly in motor, temporal, and frontal networks. Between‐network connectivity was mainly intact; only the connection between a frontal and a temporal network showed increased connectivity in DLB. Differences between AD and DLB were subtle and we did not find any significant correlations with the severity of clinical symptoms in DLB. This study emphasizes the importance of reduced connectivity within motor, frontal, and temporal networks in DLB with relative sparing of the default mode network. The lack of significant correlations between connectivity measures and clinical scores indicates that the observed reduced connectivity within these networks might be related to the presence, but not to the severity of motor and cognitive impairment in DLB patients. Furthermore, our results suggest that AD and DLB may show more similarities than differences in patients with mild disease.
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Affiliation(s)
- Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, NE4 5TG, United Kingdom
| | - Michael Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, NE4 5TG, United Kingdom.,Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, United Kingdom
| | - Andrew M Blamire
- Institute of Cellular Medicine & Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
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Turcano P, Mielke MM, Josephs KA, Bower JH, Parisi JE, Boeve BF, Savica R. Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county: 1991-2010. Mov Disord 2017; 32:1439-1446. [PMID: 28843020 DOI: 10.1002/mds.27125] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. BACKGROUND The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. METHODS We used a defined population-based incidence cohort with clinical parkinsonism (n = 669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991-2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n = 60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. RESULTS Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer's disease without concomitant α-synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α-synuclein or Aβ- or tau-immunoreactive lesions at autopsy. CONCLUSIONS Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical-pathological discrepancies were documented in 13.3%. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology and Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology and Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
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Samudra N, Patel N, Womack KB, Khemani P, Chitnis S. Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management. Drugs Aging 2016; 33:855-63. [PMID: 27830568 DOI: 10.1007/s40266-016-0416-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Parkinson disease psychosis (PDP) is a common phenomenon in Parkinson disease (PD) patients treated with dopaminergic drugs, and is associated with high morbidity and mortality. It also correlates with depression and dementia, and can contribute to considerable caregiver stress and burnout. While symptoms can be relieved by decreasing doses or number of anti-PD medications, this may lead to an unacceptable worsening of motor function. When general medical or psychiatric conditions have been ruled out, and decreasing dopaminergic agents is not effective in treating psychosis, therapies include atypical antipsychotics, primarily clozapine and quetiapine. Of these, clozapine is effective but is associated with a poor side-effect profile and the necessity for frequent blood draws. Clinicians prefer quetiapine for its theoretically better safety profile, although there is no evidence for efficacy in treating psychosis. All atypical antipsychotics are associated with increased mortality in this patient population. Cholinesterase inhibitors can ameliorate psychosis symptoms. The serotonin 5-HT2A receptor inverse agonist pimavanserin was recently approved by the US FDA for the treatment of PDP and may prove to be a more targeted therapy without the downsides of atypical antipsychotics.
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Skogseth R, Hortobágyi T, Soennesyn H, Chwiszczuk L, Ffytche D, Rongve A, Ballard C, Aarsland D. Accuracy of Clinical Diagnosis of Dementia with Lewy Bodies versus Neuropathology. J Alzheimers Dis 2017; 59:1139-1152. [DOI: 10.3233/jad-170274] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Ragnhild Skogseth
- Haraldsplass Deaconess Hospital, Kavli Research Centre for Geriatrics and Dementia, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tibor Hortobágyi
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, Departments of Neurology & Neuropathology, University of Debrecen, Debrecen, Hungary
| | - Hogne Soennesyn
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Luiza Chwiszczuk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway
| | - Clive Ballard
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Blanc F, Mahmoudi R, Jonveaux T, Galmiche J, Chopard G, Cretin B, Demuynck C, Martin-Hunyadi C, Philippi N, Sellal F, Michel JM, Tio G, Stackfleth M, Vandel P, Magnin E, Novella JL, Kaltenbach G, Benetos A, Sauleau EA. Long-term cognitive outcome of Alzheimer's disease and dementia with Lewy bodies: dual disease is worse. Alzheimers Res Ther 2017; 9:47. [PMID: 28655337 PMCID: PMC5488368 DOI: 10.1186/s13195-017-0272-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022]
Abstract
Background Longitudinal studies of dementia with Lewy bodies (DLB) are rare. Clinically, DLB is usually considered to worsen into Alzheimer’s disease (AD). The aim of our study was to compare the rate of the cognitive decline in DLB, AD, and the association of the two diseases (AD + DLB). Methods Using the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment database, which includes all the patients seen at all memory clinics (medical consultation and day hospitals) in four French regions, and beta regression, we compared the longitudinal the Mini-Mental State Examination scores of 1159 patients with AD (n = 1000), DLB (n = 131) and AD + DLB (association of the two) (n = 28) during follow-up of at least 4 years. Results The mean follow-up of the patients was 5.88 years. Using beta regression without propensity scores, the comparison of the decline of patients with AD and patients with DLB did not show a significant difference, but the decline of patients with AD + DLB was worse than that of either patients with DLB (P = 0.006) or patients with AD (P < 0.001). Using beta regression weighted by a propensity score, comparison of patients with AD and patients with DLB showed a faster decline for patients with DLB (P < 0.001). The comparison of the decline of patients with AD + DLB with that of patients with DLB (P < 0.001) and patients with AD (P < 0.001) showed that the decline was clearly worse in the patients with dual disease. Conclusions Whatever the analysis, the rate of decline is faster in patients with AD + DLB dual disease. The identification of such patients is important to enable clinicians to optimise treatment and care and to better inform and help patients and caregivers.
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Affiliation(s)
- Frédéric Blanc
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France. .,University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Intégrative en Santé (IMIS)/Neurocrypto, Strasbourg, France. .,University of Strasbourg, Laboratory of Biostatistics and French National Centre for Scientific Research (CNRS), ICube Laboratory, Team Modèles, Images et Vision (MIV), Strasbourg, France.
| | - Rachid Mahmoudi
- Geriatrics Department, Centre Hospitalier Universitaire Reims, Memory Resource and Research Centre (CM2R) Champagne-Ardenne, Reims, France
| | - Thérèse Jonveaux
- Geriatrics Department, Centre Hospitalier Universitaire Nancy, Université de Lorraine, Memory Resource and Research Centre (CM2R) Lorraine, Nancy, France
| | - Jean Galmiche
- Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Gilles Chopard
- Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Benjamin Cretin
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France.,University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Intégrative en Santé (IMIS)/Neurocrypto, Strasbourg, France
| | - Catherine Demuynck
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Catherine Martin-Hunyadi
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Nathalie Philippi
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France.,University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Intégrative en Santé (IMIS)/Neurocrypto, Strasbourg, France
| | - François Sellal
- Geriatrics Department and Neurology Department, Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France.,Neurology Department,
- Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France
| | - Jean-Marc Michel
- Geriatrics Department and Neurology Department, Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France.,Neurology Department,
- Centre Hospitalier Général (CHG) de Colmar, Memory Resource and Research Centre (CM2R) Alsace, Colmar, France
| | - Gregory Tio
- Psychiatry Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Neurology Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Melanie Stackfleth
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Pierre Vandel
- Psychiatry Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Eloi Magnin
- Neurology Department, Centre Hospitalier Universitaire Besançon, Memory Resource and Research Centre (CM2R) Franche Comté, Besançon, France.,Association pour le Développement de la Neuropsychologie Appliquée (ADNA), Besançon, France
| | - Jean-Luc Novella
- Geriatrics Department, Centre Hospitalier Universitaire Reims, Memory Resource and Research Centre (CM2R) Champagne-Ardenne, Reims, France
| | - Georges Kaltenbach
- Memory Resource and Research Centre (CM2R), Geriatrics Day Hospital, Geriatrics Department, University Hospital of Strasbourg, 21 rue David Richard, 67091, Strasbourg Cedex, France
| | - Athanase Benetos
- Geriatrics Department, Centre Hospitalier Universitaire Nancy, Université de Lorraine, Memory Resource and Research Centre (CM2R) Lorraine, Nancy, France
| | - Erik A Sauleau
- University of Strasbourg, Laboratory of Biostatistics and French National Centre for Scientific Research (CNRS), ICube Laboratory, Team Modèles, Images et Vision (MIV), Strasbourg, France
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Shimizu S, Hirose D, Namioka N, Kanetaka H, Hirao K, Hatanaka H, Takenoshita N, Kaneko Y, Ogawa Y, Umahara T, Sakurai H, Hanyu H. Correlation between clinical symptoms and striatal DAT uptake in patients with DLB. Ann Nucl Med 2017; 31:390-398. [DOI: 10.1007/s12149-017-1166-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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Shimizu S, Namioka N, Hirose D, Kanetaka H, Hirao K, Hatanaka H, Takenoshita N, Kaneko Y, Ogawa Y, Tsugawa A, Umahara T, Sakurai H, Hanyu H. Comparison of diagnostic utility of semi-quantitative analysis for DAT-SPECT for distinguishing DLB from AD. J Neurol Sci 2017; 377:50-54. [PMID: 28477707 DOI: 10.1016/j.jns.2017.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE It is widely known that there is low striatal 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). However, a consistent quantitative evaluation method for DAT-SPECT has not yet been established. There are two semi-quantitative software packages for DAT-SPECT available in Japan, namely, DaTView and DaTQUANT. The aim of this study was to identify which of these is superior for distinguishing DLB from AD. Moreover, we aimed to identify which region of the striatum is more suitable for distinguishing DLB from AD. METHODS Patients with Alzheimer's disease (AD) (n=95) and patients with DLB (n=133) who underwent DAT-SPECT were enrolled. DaTView and DaTQUANT were used as semi-quantitative analysis tools for DAT-SPECT. RESULTS There were significant correlations in DAT uptake between DaTView and entire regions by DaTQUANT. There was no significant difference in diagnostic accuracy between DaTView and DaTQUANT except in the posterior putamen by DaTQUANT. CONCLUSIONS For distinguishing DLB from AD, both of DaTView and DaTQUANT software are useful. Moreover, assessing the DAT uptake in entire striatum by DaTView might be sufficient for distinguishing DLB from AD.
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Affiliation(s)
- Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Nayuta Namioka
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Daisuke Hirose
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hidekazu Kanetaka
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kentaro Hirao
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hirokuni Hatanaka
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Naoto Takenoshita
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yoshitsugu Kaneko
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yusuke Ogawa
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Akito Tsugawa
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Takahiko Umahara
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hirofumi Sakurai
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Ikonomovic MD, Buckley CJ, Heurling K, Sherwin P, Jones PA, Zanette M, Mathis CA, Klunk WE, Chakrabarty A, Ironside J, Ismail A, Smith C, Thal DR, Beach TG, Farrar G, Smith APL. Post-mortem histopathology underlying β-amyloid PET imaging following flutemetamol F 18 injection. Acta Neuropathol Commun 2016; 4:130. [PMID: 27955679 PMCID: PMC5154022 DOI: 10.1186/s40478-016-0399-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/29/2016] [Indexed: 01/19/2023] Open
Abstract
In vivo imaging of fibrillar β-amyloid deposits may assist clinical diagnosis of Alzheimer's disease (AD), aid treatment selection for patients, assist clinical trials of therapeutic drugs through subject selection, and be used as an outcome measure. A recent phase III trial of [18F]flutemetamol positron emission tomography (PET) imaging in 106 end-of-life subjects demonstrated the ability to identify fibrillar β-amyloid by comparing in vivo PET to post-mortem histopathology. Post-mortem analyses demonstrated a broad and continuous spectrum of β-amyloid pathology in AD and other dementing and non-dementing disease groups. The GE067-026 trial demonstrated 91% sensitivity and 90% specificity of [18F]flutemetamol PET by majority read for the presence of moderate or frequent plaques. The probability of an abnormal [18F]flutemetamol scan increased with neocortical plaque density and AD diagnosis. All dementia cases with non-AD neurodegenerative diseases and those without histopathological features of β-amyloid deposits were [18F]flutemetamol negative. Majority PET assessments accurately reflected the amyloid plaque burden in 90% of cases. However, ten cases demonstrated a mismatch between PET image interpretations and post-mortem findings. Although tracer retention was best associated with amyloid in neuritic plaques, amyloid in diffuse plaques and cerebral amyloid angiopathy best explain three [18F]flutemetamol positive cases with mismatched (sparse) neuritic plaque burden. Advanced cortical atrophy was associated with the seven false negative [18F]flutemetamol images. The interpretation of images from pathologically equivocal cases was associated with low reader confidence and inter-reader agreement. Our results support that amyloid in neuritic plaque burden is the primary form of β-amyloid pathology detectable with [18F]flutemetamol PET imaging. ClinicalTrials.gov NCT01165554. Registered June 21, 2010; NCT02090855. Registered March 11, 2014.
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McKeith I, Taylor JP, Thomas A, Donaghy P, Kane J. Revisiting DLB Diagnosis: A Consideration of Prodromal DLB and of the Diagnostic Overlap With Alzheimer Disease. J Geriatr Psychiatry Neurol 2016; 29:249-53. [PMID: 27502299 DOI: 10.1177/0891988716656083] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Efforts to clinically diagnose cases having dementia with Lewy bodies (DLB) identify those with a characteristic clinical syndrome (probable DLB) at the expense of missing an equal, if not greater, number of cases who have atypical presentations thought to be associated with coexisting Alzheimer pathologies. This article argues that further efforts should now be made to characterize this atypical group that constitutes cases previously identified postmortem as the Lewy body variant of Alzheimer disease (AD) or as AD with Lewy bodies. Since such fine distinction is unlikely to be achieved on clinical grounds alone, this new diagnostic category will require robust biomarker validation. Turning to a consideration of early/prodromal diagnosis of both typical and atypical DLB cases, it is suggested that there will be at least 3 prototypical forms-a mild cognitive impairment variant, associated with early visuoperceptual and attentional deficits; a delirium onset DLB with provoked or spontaneous delirium as the presenting features; and a psychiatric disorder DLB with its primary presentation as a late-onset affective disorder or psychosis.
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Affiliation(s)
- Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Paul Donaghy
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Joseph Kane
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
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Brønnick K, Breitve MH, Rongve A, Aarsland D. Neurocognitive Deficits Distinguishing Mild Dementia with Lewy Bodies from Mild Alzheimer’s Disease are Associated with Parkinsonism. J Alzheimers Dis 2016; 53:1277-85. [DOI: 10.3233/jad-160294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kolbørn Brønnick
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Monica H. Breitve
- Department of Research and Innovation, Helse-Fonna HF, Haugesund Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Arvid Rongve
- Department of Research and Innovation, Helse-Fonna HF, Haugesund Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Old age psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
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Tiraboschi P, Corso A, Guerra UP, Nobili F, Piccardo A, Calcagni ML, Volterrani D, Cecchin D, Tettamanti M, Antelmi L, Vidale S, Sacco L, Merello M, Stefanini S, Micheli A, Vai P, Capitanio S, Gabanelli SV, Riva R, Pinto P, Biffi AM, Muscio C. 123
I‐2β‐carbomethoxy‐3β‐(4‐iodophenyl)‐
N
‐(3‐fluoropropyl) nortropane single photon emission computed tomography and
123
I‐metaiodobenzylguanidine myocardial scintigraphy in differentiating dementia with lewy bodies from other dementias: A comparative study. Ann Neurol 2016; 80:368-78. [DOI: 10.1002/ana.24717] [Citation(s) in RCA: 36] [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] [Received: 04/01/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Pietro Tiraboschi
- Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation “Carlo Besta” Neurological InstituteMilan Italy
| | - Angelo Corso
- Department of Nuclear MedicineSant'Anna HospitalComo Italy
| | - Ugo Paolo Guerra
- Department of Nuclear MedicinePoliambulanza FoundationBrescia Italy
| | - Flavio Nobili
- Department of NeuroscienceUniversity of GenoaGenoa Italy
| | - Arnoldo Piccardo
- Nuclear Medicine Unit, Department of Diagnostic ImagingE. O. Galliera HospitalGenoa Italy
| | | | | | - Diego Cecchin
- Department of MedicineUniversity of PaduaPadua Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Institute of Hospitalization and Scientific Care Mario Negri Institute of Pharmacological ResearchMilan Italy
| | - Luigi Antelmi
- Health Department, Institute of Hospitalization and Scientific Care Foundation Carlo Besta Neurological InstituteMilan Italy
| | - Simone Vidale
- Department of Neurology and Stroke UnitSant'Anna HospitalComo Italy
| | - Leonardo Sacco
- Department of Neurology and Stroke UnitSant'Anna HospitalComo Italy
- Neurocenter of Southern SwitzerlandLugano Switzerland
| | - Maria Merello
- European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of GazzanigaBergamo Italy
| | - Stefano Stefanini
- European Foundation for Biomedical Research, Alzheimer Center of Excellence, Briolini Hospital of GazzanigaBergamo Italy
| | - Anna Micheli
- Neurology Unit, San Francesco ClinicBergamo Italy
| | - Paola Vai
- Department of Nuclear MedicinePapa Giovanni XXIII HospitalBergamo Italy
| | - Selene Capitanio
- Department of Nuclear MedicinePapa Giovanni XXIII HospitalBergamo Italy
| | | | - Riccardo Riva
- Department of NeurologyPapa Giovanni XXIII HospitalBergamo Italy
| | - Patrizia Pinto
- Department of NeurologyPapa Giovanni XXIII HospitalBergamo Italy
| | - Ave Maria Biffi
- Department of PsychologyPapa Giovanni XXIII HospitalBergamo Italy
| | - Cristina Muscio
- Division of Neurology V/Neuropathology, Scientific Institute for Research, Hospitalization, and Care (IRCCS), Foundation “Carlo Besta” Neurological InstituteMilan Italy
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Blanc F, Colloby SJ, Cretin B, de Sousa PL, Demuynck C, O'Brien JT, Martin-Hunyadi C, McKeith I, Philippi N, Taylor JP. Grey matter atrophy in prodromal stage of dementia with Lewy bodies and Alzheimer's disease. Alzheimers Res Ther 2016; 8:31. [PMID: 27484179 PMCID: PMC4970221 DOI: 10.1186/s13195-016-0198-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 06/29/2016] [Indexed: 01/28/2023]
Abstract
Background Little is known about the patterns of brain atrophy in prodromal dementia with Lewy bodies (pro-DLB). Methods In this study, we used SPM8 with diffeomorphic anatomical registration through exponentiated lie algebra to measure grey matter (GM) volume and investigate patterns of GM atrophy in pro-DLB (n = 28) and prodromal Alzheimer’s disease (pro-AD) (n = 27) and compared and contrasted them with those in elderly control subjects (n = 33) (P ≤ 0.05 corrected for family-wise error). Results Patients with pro-DLB showed diminished GM volumes of bilateral insulae and right anterior cingulate cortex compared with control subjects. Comparison of GM volume between patients with pro-AD and control subjects showed a more extensive pattern, with volume reductions in temporal (hippocampi and superior and middle gyri), parietal and frontal structures in the former. Direct comparison of prodromal groups suggested that more atrophy was evident in the parietal lobes of patients with pro-AD than patients with pro-DLB. In patients with pro-DLB, we found that visual hallucinations were associated with relative atrophy of the left cuneus. Conclusions Atrophy in pro-DLB involves the insulae and anterior cingulate cortex, regions rich in von Economo neurons, which we speculate may contribute to the early clinical phenotype of pro-DLB.
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Affiliation(s)
- Frederic Blanc
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France. .,Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France. .,Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK.
| | - Sean J Colloby
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Benjamin Cretin
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France
| | - John T O'Brien
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Catherine Martin-Hunyadi
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France
| | - Ian McKeith
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Nathalie Philippi
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Abdelnour C, van Steenoven I, Londos E, Blanc F, Auestad B, Kramberger MG, Zetterberg H, Mollenhauer B, Boada M, Aarsland D. Alzheimer's disease cerebrospinal fluid biomarkers predict cognitive decline in lewy body dementia. Mov Disord 2016; 31:1203-8. [DOI: 10.1002/mds.26668] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 01/13/2023] Open
Affiliation(s)
- Carla Abdelnour
- Fundació ACE, Alzheimer Research Center and Memory ClinicInstitut Català de Neurociències AplicadesBarcelona Spain
| | - Inger van Steenoven
- Alzheimer Center, Department of NeurologyVU Medical CenterAmsterdam The Netherlands
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical SciencesLund UniversityMalmö Sweden
| | - Frédéric Blanc
- Neuropsychology Unit and Geriatric Day Hospital (Strasbourg Resource and Research Memory Center, CMRR), University Hospital of Strasbourg and ICube laboratory, FMTSUniversity of Strasbourg and CNRSStrasbourg France
| | - Bjørn Auestad
- Research DepartmentStavanger University HospitalStavanger Norway
- Department of Mathematics and Natural SciencesUniversity of StavangerStavanger Norway
| | | | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistrythe Sahlgrenska Academy at the University of GothenburgMölndal Sweden
- Department of Molecular NeuroscienceUCL Institute of NeurologyLondon United Kingdom
| | - Brit Mollenhauer
- Paracelsus‐Elena‐Klinik, Kassel and University Medical Center, Department of Neurosurgery and Institute of NeuropathologyGöttingen Germany
| | - Mercè Boada
- Fundació ACE, Alzheimer Research Center and Memory ClinicInstitut Català de Neurociències AplicadesBarcelona Spain
| | - Dag Aarsland
- Research DepartmentStavanger University HospitalStavanger Norway
- Karolinska Institutet, Department of Neurobiology, Care sciences and Society (NVS)Center for Alzheimer Research Division for NeurogeriatricsStockholm Sweden
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