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Heikkinen AL, Tikkanen V, Hänninen T, Hublin C, Koivisto AM, Saari TT, Remes AM, Paajanen TI, Krüger J. Utility of the INECO Frontal Screening and the Frontal Assessment Battery in detecting executive dysfunction in early-onset cognitive impairment and dementia. J Int Neuropsychol Soc 2024; 30:339-349. [PMID: 37800312 DOI: 10.1017/s1355617723000619] [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] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The INECO Frontal Screening (IFS) and the Frontal Assessment Battery (FAB) are executive dysfunction (ED) screening tools that can distinguish patients with neurodegenerative disorders from healthy controls and, to some extent, between dementia subtypes. This paper aims to examine the suitability of these tests in assessing early-onset cognitive impairment and dementia patients. METHOD In a memory clinic patient cohort (age mean = 57.4 years) with symptom onset at ≤65 years, we analyzed the IFS and the FAB results of four groups: early-onset dementia (EOD, n = 49), mild cognitive impairment due to neurological causes (MCI-n, n = 34), MCI due to other causes such as depression (MCI-o, n = 99) and subjective cognitive decline (SCD, n = 14). Data were gathered at baseline and at 6 and 12 months. We also studied the tests' accuracy in distinguishing EOD from SCD patients and ED patients from those with intact executive functioning. Correlations with neuropsychological measures were also studied. RESULTS The EOD group had significantly (p < .05) lower IFS and FAB total scores than the MCI-o and SCD groups. Compared with the FAB, the IFS showed more statistically significant (p < .05) differences between diagnostic groups, greater accuracy (IFS AUC = .80, FAB AUC = .75, p = .036) in detecting ED and marginally stronger correlations with neuropsychological measures. We found no statistically significant differences in the EOD group scores from baseline up to 6- or 12-months follow-up. CONCLUSIONS While both tests can detect EOD among memory clinic patients, the IFS may be more reliable in detecting ED than the FAB.
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Affiliation(s)
- Anna-Leena Heikkinen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Veera Tikkanen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Tuomo Hänninen
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Christer Hublin
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne M Koivisto
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Toni T Saari
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Teemu I Paajanen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
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Tikkanen V, Krüger J, Heikkinen AL, Hänninen T, Hublin C, Koivisto AM, Virkkala J, Saari TT, Remes AM, Paajanen TI. A Novel Computerized Flexible Attention Test in Detecting Executive Dysfunction of Patients with Early-Onset Cognitive Impairment and Dementia. Arch Clin Neuropsychol 2024:acae026. [PMID: 38581151 DOI: 10.1093/arclin/acae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE The number of computer-based cognitive tests has increased in recent years, but there is a need for tests focusing on the assessment of executive function (EF), as it can be crucial for the identification of early-onset neurodegenerative disorders. This study aims to examine the ability of the Flexible Attention Test (FAT), a new computer-based test battery for detecting executive dysfunction of early-onset cognitive impairment and dementia patients. METHOD We analyzed the FAT subtask results in memory clinic patients with cognitive symptom onset at ≤65 years. The patients were divided into four groups: early onset dementia (EOD, n = 48), mild cognitive impairment due to neurological causes (MCI-n, n = 34), MCI due to other causes (MCI-o, n = 99), and subjective cognitive decline (SCD, n = 14). The test accuracy to distinguish EOD patients from other groups was examined, as well as correlations with pen-and-paper EF tests. We also reported the 12-months follow-up results. RESULTS The EOD and MCI-n patients performed significantly poorer (p ≤ .002) than those in the MCI-o and SCD groups in most of the FAT subtasks. The accuracies of the FAT subtasks to detect EOD from other causes were mainly moderate (0.34 ≤ area under the curve < 0.74). The FAT subtasks correlated logically with corresponding pen-and-paper EF tests (.15 ≤ r ≤ .75). No systematic learning effects were detected in the FAT performance at follow-up. CONCLUSIONS The FAT appears to be a promising method for the precise evaluation of EF and applicable distinguishing early-onset neurodegenerative disorders from patients with other causes of cognitive problems.
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Affiliation(s)
- Veera Tikkanen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Anna-Leena Heikkinen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuomo Hänninen
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Christer Hublin
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne M Koivisto
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Jussi Virkkala
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
- Clinical Neurophysiology and Clinical Neurosciences, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Toni T Saari
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Teemu I Paajanen
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
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Heikkinen AL, Paajanen TI, Hänninen T, Tikkanen V, Hublin C, Koivisto AM, Remes AM, Krüger J. Neuropsychological Profiles, Etiologies, and Medical Comorbidities in Early-Onset Dementia and Cognitive Impairment: A Memory Outpatient Clinic Cohort Study. J Alzheimers Dis 2024; 97:1765-1776. [PMID: 38306037 DOI: 10.3233/jad-230877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background Although early-onset dementia (EOD) is associated with diagnostic challenges that differ from those of related to late-onset dementia, only limited studies have addressed the neuropsychological and health characteristics or specified the diagnoses underlying early-onset cognitive impairment in a real-world clinical setting. Objective To investigate the neuropsychological profiles, etiologies, and comorbidities of an unselected cohort of memory clinic patients (≤65 years at symptom onset). Methods The patients' (n = 210) diagnoses were determined based on comprehensive diagnostic workup. Medical comorbidities and neuropsychological profiles were compared between clinically relevant patient groups, namely early-onset dementia (n = 55), mild cognitive impairment due to vascular or suspected neurodegenerative (MCI-n, n = 35) or non-neurodegenerative (MCI-o, n = 106) etiologies, and subjective cognitive decline (n = 14). Results The most prevalent diagnoses were Alzheimer's disease (AD, 14%) and depression (11%). Multiple prior medical conditions were common (67%); however, EOD patients had fewer other diagnoses (p = 0.008) than MCI-o patients. Compared to other groups, EOD patients had more severe deficits (p < 0.001) on immediate and delayed memory, processing speed, symptom awareness, and global cognition. AD patients had weaker memory retention ability but less behavioral symptoms than frontotemporal dementia (FTD) patients (p≤0.05). Depression was associated with better immediate memory, symptom awareness, and global cognition than AD and FTD (p < 0.05). Conclusions EOD is associated with more severe and widespread neuropsychological deficits but fewer prior medical diagnoses than nondegenerative etiologies of cognitive impairment. AD and depression are common etiologies and the neuropsychological profiles are partly overlapping; however, memory, symptom awareness and global cognitive impairment measures may help in the differential diagnosis.
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Affiliation(s)
- Anna-Leena Heikkinen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Teemu I Paajanen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuomo Hänninen
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Veera Tikkanen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Christer Hublin
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne M Koivisto
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
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Heikkinen AL, Hänninen T, Kuikka P, Akila R, Savolainen A, Valtonen T, Umer A, Lötjönen J, Hublin C, Remes AM, Paajanen T. The Cognitive Function at Work Questionnaire (CFWQ): A new scale for measuring cognitive complaints in occupational population. Appl Neuropsychol Adult 2023; 30:649-660. [PMID: 34482772 DOI: 10.1080/23279095.2021.1970553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive functioning is a relevant work and health related topic, however, validated methods to assess subjective cognitive complaints (SCC) at work are lacking. We introduce the Cognitive Function at Work Questionnaire (CFWQ) for measuring SCC in occupational settings. 1-year follow-up data of 418 employees from a Finnish public media service company was analyzed. Participants completed web-based CFWQ, cognitive tests and a broad set of questionnaires for evaluating depression, anxiety, insomnia, daytime sleepiness, burnout, stress, mental job burden, work ability, cognitive errors, and perceived health. The factor analysis yielded a model with the CFWQ subdomains: Memory, Language, Executive Function, Speed of Processing, Cognitive Control and Name Memory. The internal consistency (Cronbach's alpha = .87) and the test-retest constancy (ICC = .84) reflected good reliability. Correlation between the CFWQ and cognitive errors at work ranged from .25 to .64 indicating adequate concurrent validity. Employees with depression, insomnia and burnout symptoms had higher (p < .001) CFWQ scores than participants without these symptoms. Depression and burnout symptom severity as well as accumulation of mood, sleep, and psychosocial stressors were associated with higher CFWQ scores (p < .001 in all). The CFWQ appears psychometrically sound measure for the assessment of SCC in occupational population.
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Affiliation(s)
- Anna-Leena Heikkinen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Tuomo Hänninen
- Neurology, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Kuikka
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ritva Akila
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aslak Savolainen
- Occupational Health Services, Finnish Broadcasting Company, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Teppo Valtonen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Adil Umer
- VTT Technical Research Centre of Finland Ltd, Tampere, Finland
| | | | - Christer Hublin
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Teemu Paajanen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
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Luostarinen M, Remes AM, Urpilainen P, Takala S, Venojärvi M. Correlation of fatigue with disability and accelerometer-measured daily physical activity in patients with relapsing-remitting MS. Mult Scler Relat Disord 2023; 78:104908. [PMID: 37517311 DOI: 10.1016/j.msard.2023.104908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Fatigue is one of the most common symptoms in patients with multiple sclerosis (MS). Furthermore, measuring its effects on patients in daily life is challenging. This study aimed to discover the association between relapsing-remitting MS (RRMS) patients' disability, fatigue, and accelerometer-measured physical activity. METHODS A total of 41 patients with RRMS with an Expanded Disability Status Scale (EDSS) level of 0-5.5 and 20 healthy controls completed the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) questionnaires. The EDSS was evaluated for all patients with RRMS, and all participants performed the MS Functional Composite (MSFC) test and six-min walk test and wore an accelerometer for seven days. RESULTS Patients with an EDSS level of 0-2.5 were found to have higher fatigue levels (p < 0.001) than healthy controls but lower levels than patients with an EDSS level of 3-5.5 (p < 0.001). A significant correlation was found to exist between fatigue and disability level measured by the EDSS (EDSS/FSS, r=0.750/p=0.001; EDSS/MFIS, r=0.661/p=0.001) and with the MSFC test in the patient group (MSFC/FSS, r = -0.350 p=0.025; MSFC/MFIS, r = -0.423/p=0.007). Total daily activity correlated with fatigue as measured by the FSS (MVPS/FSS r = -0.357/p=0.028, step count/FSS r = -0.463/p=0.003), but no correlation was found between the EDSS or the MSFC. CONCLUSION A lower disability rate, better physical condition, and higher daily-living activity were found to predict lower fatigue levels.
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Affiliation(s)
- Marko Luostarinen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland; Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Pirjo Urpilainen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Saara Takala
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
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Ahvenjärvi H, Niiranen M, Simula S, Hämäläinen P, Surcel HM, Remes AM, Ryytty M, Krüger J. Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS. Mult Scler Relat Disord 2023; 77:104861. [PMID: 37442075 DOI: 10.1016/j.msard.2023.104861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fatigue is a prominent and disabling symptom of multiple sclerosis (MS), impairing quality of life. The disease course of relapsing remitting MS (RRMS) is individual. OBJECTIVES We aimed to study the effects of demographic and clinical characteristics, as well as lifestyle risk factors on experienced fatigue and health-related quality of life (HRQoL) among RRMS patients, comparing benign and severe disease types. METHODS Altogether 198 Finnish RRMS patients were recruited for this real-life cross-sectional study. Self-reported questionnaires were used to evaluate fatigue and HRQoL by using Fatigue Scale for Motor and Cognitive Functions and 15D health-related quality of life questionnaires. Patients were categorized into subgroups based on the current disability status measured by the Expanded Disability Status Scale (EDSS) cut-off value of 4.5, and by retrospective clinical course divided into benign and aggressive RRMS. RESULTS All in all, 73% of the RRMS patients suffered from fatigue. Lower HRQoL had a strong correlation with more prominent fatigue (r = -0.719). Higher EDSS was associated with more prominent fatigue and lower HRQoL in the whole RRMS cohort. Older age at the disease onset was associated with more prominent fatigue and decreased HRQoL in the groups of aggressive RRMS and EDSS > 4.5. In the groups of EDSS ≤ 4.5 and benign RRMS, a higher number of used disease-modifying treatments (DMTs) was associated with more pronounced fatigue and reduced HRQoL. In addition, higher BMI was associated with lower HRQoL in patients with benign RRMS. Side effects (45 %) and lack of efficacy (26 %) were the most common reasons for discontinuing a DMT. Cessation due to side effects was the only reason that was significantly associated with more prominent fatigue and lower HRQoL. Use of nicotine products, gender, or disease duration were not associated with fatigue or HRQoL. CONCLUSIONS Individuals with severe RRMS and higher EDSS scores are more prone to experience fatigue and lower HRQoL. In addition, fatigue and lower HRQoL are more commonly observed among RRMS patients with older age at disease onset and in those with multiple DMT switches.
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Affiliation(s)
- Henrik Ahvenjärvi
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland
| | - Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sakari Simula
- Southern Savo Hospital District, Department of Neurology, Porrassalmenkatu 35-37, FI-50100 Mikkeli, Finland
| | - Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, Vaihemäentie 10, FI-21250 Masku, Finland; Department of Psychology, FI-20014 University of Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, P.O. Box 8000, FI-90014 University of Oulu, Finland; Biobank Borealis of Northern Finland, Northern Ostrobothnia Hospital District, P.O. Box 10, FI-90029 Oulu University Hospital, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Clinical Neurosciences, P.O. Box 4, Yliopistonkatu 3, FI-00014 University of Helsinki, Finland
| | - Mervi Ryytty
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland.
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Heikkinen AL, Paajanen TI, Hublin C, Valtonen T, Krüger J, Tikkanen V, Saari T, Koivisto AM, Hänninen T, Remes AM. The Cognitive Function at Work Questionnaire in memory clinic setting: a validation study. J Clin Exp Neuropsychol 2023; 45:365-376. [PMID: 37561064 DOI: 10.1080/13803395.2023.2239508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION As there is a trend toward more people seeking medical help due to cognitive symptoms, validated and targeted questionnaires are increasingly important in the clinical evaluation process. The Cognitive Function at Work Questionnaire (CFWQ) was developed to identify and rate subjective cognitive symptoms of individuals active in working life. However, its psychometric characteristics have not been previously studied in a memory clinic setting. METHOD The factorial structure, internal consistency, test-retest reliability, and convergent validity of the CFWQ were studied in a memory clinic setting (N = 113). We also investigated the instrument's ability to identify cognitive symptoms in a cohort of early-onset dementia (EOD, N = 22), mild cognitive impairment-neurological (MCI-n, N = 18), MCI due to mood, sleep, or other physical health problems (MCI-o, N = 59), and subjective cognitive decline (SCD, N = 14) patients. RESULTS Based on factor analysis, eight cognitive subscales were identified covering main cognitive domains: Memory, Language, Executive Function, Speed of Processing, Cognitive Control, Name Memory, Visuospatial/Praxis and Attention. The internal consistency (α = .93) and the test-retest reliability (ICC = .91) were high. Several correlations (r = .19 - .33, p < .05) were documented between neuropsychological impairment level and CFWQ scores. EOD, MCI-n, MCI-o, and SCD groups did not differ statistically significantly in the levels of cognitive symptoms as measured by the CFWQ Total score. EOD group scored higher (p = .009) than other patient groups on the Visuospatial/Praxis subscale, but the difference between EOD and MCI-o groups turned insignificant after correcting for multiple testing. CONCLUSIONS The results of the study support the validity and reliability characteristics of the CFWQ in a memory clinic setting. The instrument is easy-to-use and has clinical utility in capturing the subjective cognitive symptoms of patients active in working life and who need a referral to a more detailed evaluation.
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Affiliation(s)
- Anna-Leena Heikkinen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Teemu I Paajanen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Christer Hublin
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Teppo Valtonen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Veera Tikkanen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Toni Saari
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Tuomo Hänninen
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
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Heikkinen S, Huber N, Katisko K, Kokkola T, Hartikainen P, Krüger J, Leinonen V, Korhonen VE, Herukka SK, Remes AM, Borroni B, Alberici A, Libri I, Solje E, Haapasalo A. Serum Cathepsin S Levels Do Not Show Alterations in Different Clinical, Neuropathological, or Genetic Subtypes of Frontotemporal Dementia Patients nor in Comparison to Healthy Control Individuals. J Alzheimers Dis 2023; 93:395-401. [PMID: 37038815 DOI: 10.3233/jad-221060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Frontotemporal dementia (FTD) can manifest as diverse clinical phenotypes and is frequently caused by mutations in different genes, complicating differential diagnosis. This underlines the urgent need for valid biomarkers. Altered lysosomal and immune functions proposedly contribute to FTD pathogenesis. Cathepsins, including cathepsin S, are enzymes preferentially expressed in brain in microglia, which influence lysosomal and immune function. Here, we examined whether alterations in serum cathepsin S levels associate with specific clinical, genetic, or neuropathological FTD subgroups, but no such alterations were observed. However, further research on other lysosomal proteins may reveal new biologically relevant biomarkers in FTD.
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Affiliation(s)
- Sami Heikkinen
- Institute of Clinical Medicine – Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine – Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kokkola
- Institute of Clinical Medicine – Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Ville Leinonen
- Neuro Center, Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine –Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Ville E. Korhonen
- Institute of Clinical Medicine – Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine – Neurology, University of Eastern Finland, Kuopio, Finland
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Barbara Borroni
- Department of Neurological Sciences, University of Brescia, Brescia, Italy
| | - Antonella Alberici
- Department of Neurological Sciences, University of Brescia, Brescia, Italy
| | - Ilenia Libri
- Department of Neurological Sciences, University of Brescia, Brescia, Italy
| | - Eino Solje
- Institute of Clinical Medicine – Neurology, University of Eastern Finland, Kuopio, Finland
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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9
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Bussy A, Levy JP, Best T, Patel R, Cupo L, Van Langenhove T, Nielsen JE, Pijnenburg Y, Waldö ML, Remes AM, Schroeter ML, Santana I, Pasquier F, Otto M, Danek A, Levin J, Le Ber I, Vandenberghe R, Synofzik M, Moreno F, de Mendonça A, Sanchez-Valle R, Laforce R, Langheinrich T, Gerhard A, Graff C, Butler CR, Sorbi S, Jiskoot L, Seelaar H, van Swieten JC, Finger E, Tartaglia MC, Masellis M, Tiraboschi P, Galimberti D, Borroni B, Rowe JB, Bocchetta M, Rohrer JD, Devenyi GA, Chakravarty MM, Ducharme S. Cerebellar and subcortical atrophy contribute to psychiatric symptoms in frontotemporal dementia. Hum Brain Mapp 2023; 44:2684-2700. [PMID: 36895129 PMCID: PMC10089095 DOI: 10.1002/hbm.26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 03/11/2023] Open
Abstract
Recent studies have reported early cerebellar and subcortical impact in the disease progression of genetic frontotemporal dementia (FTD) due to microtubule-associated protein tau (MAPT), progranulin (GRN) and chromosome 9 open reading frame 72 (C9orf72). However, the cerebello-subcortical circuitry in FTD has been understudied despite its essential role in cognition and behaviors related to FTD symptomatology. The present study aims to investigate the association between cerebellar and subcortical atrophy, and neuropsychiatric symptoms across genetic mutations. Our study included 983 participants from the Genetic Frontotemporal dementia Initiative including mutation carriers and noncarrier first-degree relatives of known symptomatic carriers. Voxel-wise analysis of the thalamus, striatum, globus pallidus, amygdala, and the cerebellum was performed, and partial least squares analyses (PLS) were used to link morphometry and behavior. In presymptomatic C9orf72 expansion carriers, thalamic atrophy was found compared to noncarriers, suggesting the importance of this structure in FTD prodromes. PLS analyses demonstrated that the cerebello-subcortical circuitry is related to neuropsychiatric symptoms, with significant overlap in brain/behavior patterns, but also specificity for each genetic mutation group. The largest differences were in the cerebellar atrophy (larger extent in C9orf72 expansion group) and more prominent amygdalar volume reduction in the MAPT group. Brain scores in the C9orf72 expansion carriers and MAPT carriers demonstrated covariation patterns concordant with atrophy patterns detectable up to 20 years before expected symptom onset. Overall, these results demonstrated the important role of the subcortical structures in genetic FTD symptom expression, particularly the cerebellum in C9orf72 and the amygdala in MAPT carriers.
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Affiliation(s)
- Aurélie Bussy
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | - Jake P Levy
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Tristin Best
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | - Raihaan Patel
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Lani Cupo
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | | | - Jørgen E Nielsen
- Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria Landqvist Waldö
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Matthias L Schroeter
- Clinic for Cognitive Neurology, University Clinic Leipzig, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University Clinic Leipzig, Leipzig, Germany
| | - Isabel Santana
- University Hospital of Coimbra (HUC), Neurology Service, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Florence Pasquier
- Universite de Lille, Lille, France
- Inserm 1172, Lille, France
- CHU, CNR-MAJ, Labex Distalz, Lille, France
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute-Institut du Cerveau-ICM, Inserm U1127, Paris, France
- Centre de référence des démences rares ou précoces, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
- Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, Leuven, Belgium
- Neurology Service, University Hospitals Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Fermin Moreno
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Spain
- Cognitive Disorders Unit, Department of Neurology, Donostia University Hospital, San Sebastian, Gipuzkoa, Spain
| | | | - Raquel Sanchez-Valle
- Alzheimer's disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Quebec, Canada
| | - Tobias Langheinrich
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Alexander Gerhard
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg, Essen, Germany
| | - Caroline Graff
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Bioclinicum, Karolinska Institutet, Solna, Sweden
- Unit for Hereditary Dementias, Theme Inflammation and Aging, Karolinska University Hospital, Solna, Sweden
| | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Sandro Sorbi
- Department of Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Lize Jiskoot
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Harro Seelaar
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | | | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | | | - Gabriel A Devenyi
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - M Mallar Chakravarty
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Simon Ducharme
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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10
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Logroscino G, Piccininni M, Graff C, Hardiman O, Ludolph AC, Moreno F, Otto M, Remes AM, Rowe JB, Seelaar H, Solje E, Stefanova E, Traykov L, Jelic V, Rydell MT, Pender N, Anderl-Straub S, Barandiaran M, Gabilondo A, Krüger J, Murley AG, Rittman T, van der Ende EL, van Swieten JC, Hartikainen P, Stojmenović GM, Mehrabian S, Benussi L, Alberici A, Dell’Abate MT, Zecca C, Borroni B. Incidence of Syndromes Associated With Frontotemporal Lobar Degeneration in 9 European Countries. JAMA Neurol 2023; 80:279-286. [PMID: 36716024 PMCID: PMC9887528 DOI: 10.1001/jamaneurol.2022.5128] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/01/2022] [Indexed: 01/31/2023]
Abstract
Importance Diagnostic incidence data for syndromes associated with frontotemporal lobar degeneration (FTLD) in multinational studies are urgent in light of upcoming therapeutic approaches. Objective To assess the incidence of FTLD across Europe. Design, Setting, and Participants The Frontotemporal Dementia Incidence European Research Study (FRONTIERS) was a retrospective cohort study conducted from June 1, 2018, to May 31, 2019, using a population-based registry from 13 tertiary FTLD research clinics from the UK, the Netherlands, Finland, Sweden, Spain, Bulgaria, Serbia, Germany, and Italy and including all new FTLD-associated cases during the study period, with a combined catchment population of 11 023 643 person-years. Included patients fulfilled criteria for the behavioral variant of frontotemporal dementia (BVFTD), the nonfluent variant or semantic variant of primary progressive aphasia (PPA), unspecified PPA, progressive supranuclear palsy, corticobasal syndrome, or frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS). Data were analyzed from July 19 to December 7, 2021. Main Outcomes and Measures Random-intercept Poisson models were used to obtain estimates of the European FTLD incidence rate accounting for geographic heterogeneity. Results Based on 267 identified cases (mean [SD] patient age, 66.70 [9.02] years; 156 males [58.43%]), the estimated annual incidence rate for FTLD in Europe was 2.36 cases per 100 000 person-years (95% CI, 1.59-3.51 cases per 100 000 person-years). There was a progressive increase in FTLD incidence across age, reaching its peak at the age of 71 years, with 13.09 cases per 100 000 person-years (95% CI, 8.46-18.93 cases per 100 000 person-years) among men and 7.88 cases per 100 000 person-years (95% CI, 5.39-11.60 cases per 100 000 person-years) among women. Overall, the incidence was higher among men (2.84 cases per 100 000 person-years; 95% CI, 1.88-4.27 cases per 100 000 person-years) than among women (1.91 cases per 100 000 person-years; 95% CI, 1.26-2.91 cases per 100 000 person-years). BVFTD was the most common phenotype (107 cases [40.07%]), followed by PPA (76 [28.46%]) and extrapyramidal phenotypes (69 [25.84%]). FTD-ALS was the rarest phenotype (15 cases [5.62%]). A total of 95 patients with FTLD (35.58%) had a family history of dementia. The estimated number of new FTLD cases per year in Europe was 12 057. Conclusions and Relevance The findings suggest that FTLD-associated syndromes are more common than previously recognized, and diagnosis should be considered at any age. Improved knowledge of FTLD incidence may contribute to appropriate health and social care planning and in the design of future clinical trials.
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Affiliation(s)
- Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari-Aldo Moro, Bari at Pia Fondazione Cardinale Giovanni Panico, Tricase, Lecce, Italy
| | - Marco Piccininni
- Institute of Public Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Caroline Graff
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Unit for Hereditary Dementia, Theme Aging, Karolinska University Hospital–Solna, Stockholm, Sweden
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Albert C. Ludolph
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Ulm, Germany
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Hospital Universitario Donostia, San Sebastian, Spain
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- Department of Neurology, Martin Luther University, University Hospital, Halle (Saale), Germany
| | - Anne M. Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - James B. Rowe
- Department of Clinical Neurosciences, MRC Cognition and Brain Sciences Unit, and Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, United Kingdom
| | - Harro Seelaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Eino Solje
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
- NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Elka Stefanova
- Faculty of Medicine, Neurology Clinic, University Clinical Center, University of Belgrade, Serbia
| | - Latchezar Traykov
- Alexandrovska University Hospital, Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | - Vesna Jelic
- Theme Inflammation and Aging, Medical Unit Aging Brain, Karolinska University Hospital Huddinge, Solna, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Melissa Taheri Rydell
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | | | - Myriam Barandiaran
- Cognitive Disorders Unit, Department of Neurology, Hospital Universitario Donostia, San Sebastian, Spain
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Alazne Gabilondo
- Cognitive Disorders Unit, Department of Neurology, Hospital Universitario Donostia, San Sebastian, Spain
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Alexander G. Murley
- Department of Clinical Neurosciences, MRC Cognition and Brain Sciences Unit, and Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, MRC Cognition and Brain Sciences Unit, and Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, United Kingdom
| | - Emma L. van der Ende
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - John C. van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | | | - Shima Mehrabian
- Alexandrovska University Hospital, Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | - Luisa Benussi
- Molecular Markers Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonella Alberici
- Centre for Neurodegenerative Disorders, Neurology Unit, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia and University of Brescia, Brescia, Italy
| | - Maria Teresa Dell’Abate
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari-Aldo Moro, Bari at Pia Fondazione Cardinale Giovanni Panico, Tricase, Lecce, Italy
| | - Chiara Zecca
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari-Aldo Moro, Bari at Pia Fondazione Cardinale Giovanni Panico, Tricase, Lecce, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia and University of Brescia, Brescia, Italy
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11
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Soppela H, Krüger J, Hartikainen P, Koivisto A, Haapasalo A, Borroni B, Remes AM, Katisko K, Solje E. Traumatic Brain Injury Associates with an Earlier Onset in Sporadic Frontotemporal Dementia. J Alzheimers Dis 2023; 91:225-232. [PMID: 36373318 DOI: 10.3233/jad-220545] [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: 11/13/2022]
Abstract
BACKGROUND Currently, there are few studies considering possible modifiable risk factors of frontotemporal dementia (FTD). OBJECTIVE In this retrospective case-control study, we evaluated whether a history of traumatic brain injury (TBI) associates with a diagnosis of FTD or modulates the clinical phenotype or onset age in FTD patients. METHODS We compared the prevalence of prior TBI between individuals with FTD (N = 218) and age and sex-matched AD patients (N = 214) or healthy controls (HC; N = 100). Based on the patient records, an individual was categorized to the TBI+ group if they were reported to have suffered from TBI during lifetime. The possible associations of TBI with age of onset and disease duration were also evaluated in the whole FTD patient group or separately in the sporadic and genetic FTD groups. RESULTS The prevalence of previous TBI was the highest in the FTD group (19.3%) when compared to the AD group (13.1%, p = 0.050) or HC group (12%, p = 0.108, not significant). Preceding TBI was more often associated with the sporadic FTD cases than the C9orf72 repeat expansion-carrying FTD cases (p = 0.003). Furthermore, comparison of the TBI+ and TBI- FTD groups indicated that previous TBI was associated with an earlier onset age in the FTD patients (B = 3.066, p = 0.010). CONCLUSION A preceding TBI associates especially with sporadic FTD and with earlier onset of symptoms. The results of this study suggest that TBI may be a triggering factor for the neurodegenerative processes in FTD. However, understanding the precise underlying mechanisms still needs further studies.
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Affiliation(s)
- Helmi Soppela
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland.,Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Päivi Hartikainen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne Koivisto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.,Neuro Center, Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Annakaisa Haapasalo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy.,Neurology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland.,Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
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12
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Katisko K, Krüger J, Soppela H, Hartikainen P, Haapasalo A, Remes AM, Solje E. Psychopharmacological Medication Use in Frontotemporal Dementia at the Time of Diagnosis: Comparison with Alzheimer's Disease. J Alzheimers Dis 2023; 95:677-685. [PMID: 37574738 DOI: 10.3233/jad-230494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Due to the significant presence of neuropsychiatric symptoms in patients with frontotemporal dementia (FTD) spectrum disorders, psychiatric misdiagnoses, diagnostic delay, and use of psychiatric treatments are common prior to the FTD diagnosis. Furthermore, treatment of diagnosed FTD patients mainly relies on off-label psychopharmacological approaches. Currently, limited real-world data are available regarding the actual use of psychopharmacological medications in FTD. OBJECTIVE To evaluate psychopharmacological medication use at the time of FTD diagnosis. METHODS Psychopharmacological medication use was evaluated in a Finnish FTD cohort containing 222 FTD patients, including the major clinical disease phenotypes (behavioral, language, and motor variants) and genetic patients carrying the C9orf72 repeat expansion. A cohort of 214 Alzheimer's disease (AD) patients was used as a neurodegenerative disease reference group. RESULTS Active use of psychopharmacological medications at the time of diagnosis was significantly more common in FTD compared to AD, especially in the case of antidepressants (26.1% versus 15.0%, OR = 2.01, p = 0.008), antipsychotics (23.9% versus 9.3%, OR = 3.15, p < 0.001), and mood-stabilizers (6.3% versus 1.9%, OR = 2.93, p = 0.085; not statistically significant), whereas the use of cholinesterase inhibitors or memantine was nearly nonexistent in FTD patients. Female gender and behavioral variant of FTD phenotype alongside with depressive and psychotic symptoms were the most prominent factors associating with the use of these medications among the FTD spectrum patients. CONCLUSION Use of off-label psychopharmacological medication and polypharmacy is substantially common at the time of FTD diagnosis. This likely reflects the challenges in using symptom-driven treatment approaches, especially prior to the eventual diagnosis.
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Affiliation(s)
- Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Helmi Soppela
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences - University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
- Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland
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13
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Katisko K, Huber N, Kokkola T, Hartikainen P, Krüger J, Heikkinen AL, Paananen V, Leinonen V, Korhonen VE, Helisalmi S, Herukka SK, Cantoni V, Gadola Y, Archetti S, Remes AM, Haapasalo A, Borroni B, Solje E. Serum total TDP-43 levels are decreased in frontotemporal dementia patients with C9orf72 repeat expansion or concomitant motoneuron disease phenotype. Alzheimers Res Ther 2022; 14:151. [PMID: 36217158 PMCID: PMC9552448 DOI: 10.1186/s13195-022-01091-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Frontotemporal dementia (FTD) covers a spectrum of neurodegenerative disorders with various clinical and neuropathological subtypes. The two major pathological proteins accumulating in the brains of FTD patients, depending on their genetic background, are TDP-43 and tau. We aimed to evaluate whether total TDP-43 levels measured from the serum associate with the genotype or clinical phenotype of the FTD patients and whether serum TDP-43 provides prognostic or diagnostic value in the FTD spectrum disorders. METHODS The study cohort included 254 participants with a clinical diagnosis of FTD (including all major genotypes and clinical phenotypes) and 105 cognitively healthy controls. Serum total TDP-43 levels measured with a single-molecule array (Simoa) were compared within the FTD group according to the genotype, clinical phenotype, and predicted neuropathological subtype of the patients. We also evaluated the associations between the TDP-43 levels and disease severity or survival in FTD. RESULTS Total TDP-43 levels in the serum were significantly lower in the FTD group as compared to the healthy control group (275.3 pg/mL vs. 361.8 pg/mL, B = 0.181, 95%CI = 0.014-0.348, p = 0.034). The lowest TDP-43 levels were observed in the subgroup of FTD patients harboring predicted TDP-43 brain pathology (FTD-TDP, 241.4 pg/mL). The low levels in the FTD-TDP group were especially driven by C9orf72 repeat expansion carriers (169.2 pg/mL) and FTD patients with concomitant motoneuron disease (FTD-MND, 113.3 pg/mL), whereas GRN mutation carriers did not show decreased TDP-43 levels (328.6 pg/mL). Serum TDP-43 levels showed no correlation with disease severity nor progression in FTD. CONCLUSIONS Our results indicate that the total levels of TDP-43 in the serum are decreased especially in FTD patients with the C9orf72 repeat expansion or FTD-MND phenotype, both subtypes strongly associated with TDP-43 type B brain pathology. Serum-based measurement of TDP-43 could represent a useful tool in indicating C9orf72 repeat expansion and FTD-MND-related TDP-43 neuropathology for future diagnostics and intervention studies.
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Affiliation(s)
- Kasper Katisko
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), FI-70211 Kuopio, Finland
| | - Nadine Huber
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kokkola
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), FI-70211 Kuopio, Finland
| | - Päivi Hartikainen
- grid.410705.70000 0004 0628 207XNeuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Krüger
- grid.10858.340000 0001 0941 4873Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917MRC, Oulu University Hospital, Oulu, Finland ,grid.412326.00000 0004 4685 4917Neurology, Neurocenter, Oulu University Hospital, Oulu, Finland
| | - Anna-Leena Heikkinen
- grid.10858.340000 0001 0941 4873Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917MRC, Oulu University Hospital, Oulu, Finland ,grid.412326.00000 0004 4685 4917Neurology, Neurocenter, Oulu University Hospital, Oulu, Finland ,grid.6975.d0000 0004 0410 5926Finnish Institute of Occupational Health, Work Ability and Working Careers, Helsinki, Finland
| | - Veera Paananen
- grid.10858.340000 0001 0941 4873Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917MRC, Oulu University Hospital, Oulu, Finland ,grid.412326.00000 0004 4685 4917Neurology, Neurocenter, Oulu University Hospital, Oulu, Finland
| | - Ville Leinonen
- grid.410705.70000 0004 0628 207XNeuro Center, Neurosurgery, Kuopio University Hospital, 70029 Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, 70211 Kuopio, Finland
| | - Ville E. Korhonen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), FI-70211 Kuopio, Finland ,grid.410705.70000 0004 0628 207XNeuro Center, Neurosurgery, Kuopio University Hospital, 70029 Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, 70211 Kuopio, Finland
| | - Seppo Helisalmi
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), FI-70211 Kuopio, Finland ,grid.410705.70000 0004 0628 207XNeuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Valentina Cantoni
- grid.7637.50000000417571846Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Yasmine Gadola
- grid.7637.50000000417571846Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Anne M. Remes
- grid.10858.340000 0001 0941 4873Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Annakaisa Haapasalo
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Barbara Borroni
- grid.7637.50000000417571846Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy ,grid.412725.7ASST Spedali Civili, Brescia, Italy
| | - Eino Solje
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine – Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), FI-70211 Kuopio, Finland ,grid.410705.70000 0004 0628 207XNeuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
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Korpioja A, Krüger J, Hurme-Niiranen A, Solje E, Katisko K, Lipponen J, Lehtilahti M, Remes AM, Majamaa K, Kytövuori L. Cognitive impairment is not uncommon in patients with biallelic RFC1 AAGGG repeat expansion, but the expansion is rare in patients with cognitive disease. Parkinsonism Relat Disord 2022; 103:98-101. [PMID: 36088850 DOI: 10.1016/j.parkreldis.2022.08.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The biallelic repeat expansion (AAGGG)exp in RFC1 causes cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS). Recently, cognitive impairment has been reported in patients with CANVAS and a broader neurodegenerative process associated with RFC1 has been suggested. Furthermore, rare cases of multiple system atrophy, Parkinson's disease, amyotrophic lateral sclerosis or CANVAS with features of dementia with Lewy bodies have been found. OBJECTIVE We hypothesized that the biallelic (AAGGG)exp is associated with neurodegeneration manifested as cognitive symptoms and that atypical RFC1 disease may be found among patients with cognitive disorder. METHODS Clinical data on nine patients with biallelic (AAGGG)exp were reviewed and 564 patients with Alzheimer's disease or frontotemporal dementia (FTD) were investigated for biallelic RFC1 (AAGGG)exp. RESULTS Five patients with biallelic (AAGGG)exp were found with a cognitive impairment and in four of them the phenotype resembled FTD. However, biallelic (AAGGG)exp was not detected among patients with Alzheimer's disease or FTD. CONCLUSION Cognitive impairment is a feature in patients with the biallelic (AAGGG)exp, but the pathogenic expansion seems to be rare in patients with dementia. Studies on patients with diverse phenotypes would be useful to further explore the involvement of RFC1 in neuronal degeneration and to identify atypical phenotypes, which should be taken into account in clinical practice.
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Affiliation(s)
- Anita Korpioja
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland; OUH Neurocenter, Neurology, Oulu University Hospital, FI-90029, Oulu, Finland
| | - Anri Hurme-Niiranen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eino Solje
- KUH NeuroCenter, Neurology, Kuopio University Hospital, P.O. Box 100, 70029, KYS, Kuopio, Finland; Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Joonas Lipponen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria Lehtilahti
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland; Clinical Neurosciences, University of Helsinki, Biomedicum, P.O. Box 63, 00014, Helsinki, Finland
| | - Kari Majamaa
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland; OUH Neurocenter, Neurology, Oulu University Hospital, FI-90029, Oulu, Finland
| | - Laura Kytövuori
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland; OUH Neurocenter, Neurology, Oulu University Hospital, FI-90029, Oulu, Finland.
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15
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Niiranen M, Koikkalainen J, Lötjönen J, Selander T, Cajanus A, Hartikainen P, Simula S, Vanninen R, Remes AM. Grey matter atrophy in patients with benign multiple sclerosis. Brain Behav 2022; 12:e2679. [PMID: 35765699 PMCID: PMC9304852 DOI: 10.1002/brb3.2679] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/22/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brain atrophy appears during the progression of multiple sclerosis (MS) and is associated with the disability caused by the disease. METHODS We investigated global and regional grey matter (GM) and white matter (WM) volumes, WM lesion load, and corpus callosum index (CCI), in benign relapsing-remitting MS (BRRMS, n = 35) with and without any treatment and compared those to aggressive relapsing-remitting MS (ARRMS, n = 46). Structures were analyzed by using an automated MRI quantification tool (cNeuro®). RESULTS The total brain and cerebral WM volumes were larger in BRRMS than in ARRMS (p = .014, p = .017 respectively). In BRRMS, total brain volumes, regional GM volumes, and CCI were found similar whether or not disease-modifying treatment (DMT) was used. The total (p = .033), as well as subcortical (p = .046) and deep WM (p = .041) lesion load volumes were larger in BRRMS patients without DMT. Cortical GM volumes did not differ between BRRMS and ARRMS, but the volumes of total brain tissue (p = .014) and thalami (p = .003) were larger in patients with BRRMS compared to ARRMS. A positive correlation was found between CCI and whole-brain volume in both BRRMS (r = .73, p < .001) and ARRMS (r = .80, p < .01). CONCLUSIONS Thalamic volume is the most prominent measure to differentiate BRRMS and ARRMS. Validation of automated quantification of CCI provides an additional applicable MRI biomarker to detect brain atrophy in MS.
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Affiliation(s)
- Marja Niiranen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine - Radiology, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
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Soppela H, Katisko K, Gadola Y, Krüger J, Hartikainen P, Alberici A, Benussi A, Koivisto A, Haapasalo A, Remes AM, Borroni B, Solje E. Modifiable potential risk factors in familial and sporadic frontotemporal dementia. Ann Clin Transl Neurol 2022; 9:1195-1205. [PMID: 35767471 PMCID: PMC9380159 DOI: 10.1002/acn3.51619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Only a few studies have evaluated modifiable risk factors for frontotemporal dementia (FTD). Here, we evaluated several modifiable factors and their association with disease phenotype, genotype, and prognosis in a large study population including Finnish and Italian patients with FTD and control groups. Methods In this case–control study, we compared the presence of several cardiovascular and other lifestyle‐related diseases and education between Finnish and Italian patients with familial (n = 376) and sporadic (n = 654) FTD, between different phenotypes of FTD, and between a subgroup of Finnish FTD patients (n = 221) and matched Finnish patients with Alzheimer's disease (AD) (n = 214) and cognitively healthy controls (HC) (n = 100). Results Patients with sporadic FTD were less educated (p = 0.042, B = ‐0.560, 95% CI −1.101 to −0.019) and had more heart diseases (p < 0.001, OR = 2.265, 95% CI 1.502–3.417) compared to patients with familial FTD. Finnish FTD patients were less educated (p = 0.032, B = 0.755, 95% CI 0.064–1.466) compared with AD patients. The Finnish FTD group showed lower prevalence of hypertension than the HC group (p = 0.003, OR = 2.162, 95% CI 1.304–3.583) and lower prevalence of hypercholesterolemia than in the HC group (p < 0.001, OR = 2.648, 95%CI 1.548–4.531) or in the AD group (p < 0.001, OR = 1.995, 95% CI 1.333–2.986). Within the FTD group, clinical phenotypes also differed regarding education and lifestyle‐related factors. Interpretation Our study suggests distinct profiles of several modifiable factors in the FTD group depending on the phenotype and familial inheritance history and that especially sporadic FTD may be associated with modifiable risk factors.
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Affiliation(s)
- Helmi Soppela
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Yasmine Gadola
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience - Neurology, University of Oulu, Oulu, Finland.,MRC - Oulu University Hospital, Oulu, Finland
| | - Päivi Hartikainen
- Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland
| | | | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Anne Koivisto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland.,Neuro Center, Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience - Neurology, University of Oulu, Oulu, Finland.,MRC - Oulu University Hospital, Oulu, Finland
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center - Neurology, Kuopio University Hospital, Kuopio, Finland
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Heikkinen S, Cajanus A, Katisko K, Hartikainen P, Vanninen R, Haapasalo A, Krüger J, Remes AM, Solje E. Brainstem atrophy is linked to extrapyramidal symptoms in frontotemporal dementia. J Neurol 2022; 269:4488-4497. [PMID: 35377014 PMCID: PMC9294011 DOI: 10.1007/s00415-022-11095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
AbstractExtrapyramidal (EP) symptoms are a known feature in a subpopulation of patients with behavioral variant frontotemporal dementia (bvFTD). Concomitant EP symptoms with FTD-like neuropsychiatric symptoms are also core features in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). This complicates the early diagnosis of these disorders. Our retrospective register study aimed to discover imaging (MRI and FDG-PET) biomarkers to differentiate PSP, CBD, and bvFTD patients with extrapyramidal symptoms (EP +) from bvFTD patients without EP symptoms (EP-). The records of 2751 patients were screened for the diagnoses and presence of EP symptoms. A total of 222 patients were submitted to imaging analysis and applicable imaging data were recovered from 139 patients. Neuroimaging data were analyzed using Freesurfer software. In the whole cohort, EP + patients showed lower volumes of gray matter compared to EP- patients in the putamen (p = 0.002), bilateral globus pallidum (p = 0.002, p = 0.042), ventral diencephalon (p = 0.002) and brain stem (p < 0.001). In the bvFTD subgroup, there was volumetric difference between EP + and EP− patients in the brain stem. FDG-PET scans in the bvFTD patient subgroup showed that EP + patients had comparative hypometabolism of the superior cerebellar peduncle (SCP) and the frontal lobes. We discovered that EP symptoms are linked to brainstem atrophy in bvFTD patients and the whole cohort. Also, evident hypometabolism in the SCP of bvFTD EP + patients was detected as compared to bvFTD EP− patients. This could indicate that the EP symptoms in these diseases have a more caudal origin in the brainstem than in Parkinson’s disease.
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Affiliation(s)
- Sami Heikkinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland
| | | | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine - Radiology, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland.
- Neuro Center, Kuopio University Hospital, Kuopio, Finland.
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Lukkarinen H, Jeppsson A, Wikkelsö C, Blennow K, Zetterberg H, Constantinescu R, Remes AM, Herukka SK, Hiltunen M, Rauramaa T, Nägga K, Leinonen V, Tullberg M. Cerebrospinal fluid biomarkers that reflect clinical symptoms in idiopathic normal pressure hydrocephalus patients. Fluids Barriers CNS 2022; 19:11. [PMID: 35123528 PMCID: PMC8817565 DOI: 10.1186/s12987-022-00309-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background The relationship between cerebrospinal fluid (CSF) biomarkers and the clinical features of idiopathic normal pressure hydrocephalus (iNPH) has been inconclusive. We aimed to evaluate CSF biomarkers reflecting Alzheimer’s disease (AD)-related amyloid β (Aβ) aggregation, tau pathology, neuroinflammation and axonal degeneration in relation to the clinical features of pre- and post-shunt surgery in iNPH patients. Methods Mini Mental State Examination (MMSE) scores and gait velocity were evaluated pre- and postoperatively in cohorts of 65 Finnish (FIN) and 82 Swedish (SWE) iNPH patients. Lumbar CSF samples were obtained prior to shunt surgery and analysed for soluble amyloid precursor protein alpha (sAPPα) and beta (sAPPβ); amyloid-β isoforms of 42, 40 and 38 (Aβ42, Aβ40, Aβ38); total tau (T-tau); phosphorylated tau (P-tau181); neurofilament light (NfL) and monocyte chemoattractant protein 1 (MCP1). Results Preoperative patient characteristics showed no significant differences between patients in the FIN and SWE cohorts. Patients in both cohorts had significantly improved gait velocity after shunt surgery (p < 0.0001). Low CSF T-tau and absence of apolipoprotein E ε4 predicted over 20% gait improvement postoperatively (p = 0.043 and p = 0.008). Preoperative CSF T-tau, P-tau181 and NfL correlated negatively with MMSE scores both pre- (p < 0.01) and post-surgery (p < 0.01). Furthermore, T-tau, NfL and Aβ42 correlated with MMSE outcomes (p < 0.05). Low preoperative CSF P-tau181 (p = 0.001) and T-tau with NfL (p < 0.001 and p = 0.049) best predicted pre- and postoperative MMSE scores greater than or equal to 26. Conclusions CSF biomarkers of neurodegeneration appeared to correlate with pre- and postoperative cognition, providing a window into neuropathological processes. In addition, preoperative CSF neurodegeneration biomarkers may have potential in the prediction of gait and cognitive outcomes after shunt surgery.
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Huttula S, Väyrynen H, Helisalmi S, Kytövuori L, Luukkainen L, Hiltunen M, Remes AM, Krüger J. NDUFA1 p.Gly32Arg variant in early-onset dementia. Neurobiol Aging 2022; 114:113-116. [DOI: 10.1016/j.neurobiolaging.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/14/2021] [Accepted: 09/25/2021] [Indexed: 01/23/2023]
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Huber N, Korhonen S, Hoffmann D, Leskelä S, Rostalski H, Remes AM, Honkakoski P, Solje E, Haapasalo A. Deficient neurotransmitter systems and synaptic function in frontotemporal lobar degeneration-Insights into disease mechanisms and current therapeutic approaches. Mol Psychiatry 2022; 27:1300-1309. [PMID: 34799692 PMCID: PMC9095474 DOI: 10.1038/s41380-021-01384-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) comprises a heterogenous group of fatal neurodegenerative diseases and, to date, no validated diagnostic or prognostic biomarkers or effective disease-modifying therapies exist for the different clinical or genetic subtypes of FTLD. Current treatment strategies rely on the off-label use of medications for symptomatic treatment. Changes in several neurotransmitter systems including the glutamatergic, GABAergic, dopaminergic, and serotonergic systems have been reported in FTLD spectrum disease patients. Many FTLD-related clinical and neuropsychiatric symptoms such as aggressive and compulsive behaviour, agitation, as well as altered eating habits and hyperorality can be explained by disturbances in these neurotransmitter systems, suggesting that their targeting might possibly offer new therapeutic options for treating patients with FTLD. This review summarizes the present knowledge on neurotransmitter system deficits and synaptic dysfunction in model systems and patients harbouring the most common genetic causes of FTLD, the hexanucleotide repeat expansion in C9orf72 and mutations in the granulin (GRN) and microtubule-associated protein tau (MAPT) genes. We also describe the current pharmacological treatment options for FLTD that target different neurotransmitter systems.
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Affiliation(s)
- Nadine Huber
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sonja Korhonen
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Dorit Hoffmann
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Stina Leskelä
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Hannah Rostalski
- grid.9668.10000 0001 0726 2490A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Anne M. Remes
- grid.10858.340000 0001 0941 4873Unit of Clinical Neuroscience, Neurology, University of Oulu, P. O. Box 8000, University of Oulu, FI-90014 Oulu, Finland ,grid.412326.00000 0004 4685 4917MRC Oulu, Oulu University Hospital, P. O. Box 8000, University of Oulu, FI-90014 Oulu, Finland
| | - Paavo Honkakoski
- grid.9668.10000 0001 0726 2490School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70210 Kuopio, Finland ,grid.10698.360000000122483208Department of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Eino Solje
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine—Neurology, University of Eastern Finland, P.O. Box 1627, FI-70210 Kuopio, Finland ,grid.410705.70000 0004 0628 207XNeuro Center, Neurology, Kuopio University Hospital, P.O. Box 100, KYS, FI-70029 Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
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21
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Huber N, Hoffmann D, Giniatullina R, Rostalski H, Leskelä S, Takalo M, Natunen T, Solje E, Remes AM, Giniatullin R, Hiltunen M, Haapasalo A. C9orf72 hexanucleotide repeat expansion leads to altered neuronal and dendritic spine morphology and synaptic dysfunction. Neurobiol Dis 2021; 162:105584. [PMID: 34915153 DOI: 10.1016/j.nbd.2021.105584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/26/2021] [Accepted: 12/11/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal lobar degeneration (FTLD) comprises a heterogenous group of progressive neurodegenerative syndromes. To date, no validated biomarkers or effective disease-modifying therapies exist for the different clinical or genetic subtypes of FTLD. The most common genetic cause underlying FTLD and amyotrophic lateral sclerosis (ALS) is a hexanucleotide repeat expansion in the C9orf72 gene (C9-HRE). FTLD is accompanied by changes in several neurotransmitter systems, including the glutamatergic, GABAergic, dopaminergic, and serotonergic systems and many clinical symptoms can be explained by disturbances in these systems. Here, we aimed to elucidate the effects of the C9-HRE on synaptic function, molecular composition of synapses, and dendritic spine morphology. We overexpressed the pathological C9-HRE in cultured E18 mouse primary hippocampal neurons and characterized the pathological, morphological, and functional changes by biochemical methods, confocal microscopy, and live cell calcium imaging. The C9-HRE-expressing neurons were confirmed to display the pathological RNA foci and DPR proteins. C9-HRE expression led to significant changes in dendritic spine morphologies, as indicated by decreased number of mushroom-type spines and increased number of stubby and thin spines, as well as diminished neuronal branching. These morphological changes were accompanied by concomitantly enhanced susceptibility of the neurons to glutamate-induced excitotoxicity as well as augmented and prolonged responses to excitatory stimuli by glutamate and depolarizing potassium chloride as compared to control neurons. Mechanistically, the hyperexcitation phenotype in the C9-HRE-expressing neurons was found to be underlain by increased activity of extrasynaptic GluN2B-containing N-methyl-d-aspartate (NMDA) receptors. Our results are in accordance with the idea suggesting that C9-HRE is associated with enhanced excitotoxicity and synaptic dysfunction. Thus, therapeutic interventions targeted to alleviate synaptic disturbances might offer efficient avenues for the treatment of patients with C9-HRE-associated FTLD.
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Affiliation(s)
- Nadine Huber
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
| | - Dorit Hoffmann
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
| | - Raisa Giniatullina
- Molecular Pain Research group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
| | - Hannah Rostalski
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
| | - Stina Leskelä
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
| | - Mari Takalo
- Institute of Biomedicine, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland.
| | - Teemu Natunen
- Institute of Biomedicine, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland.
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Yliopistonranta 1 C, 70211 Kuopio, Finland; Neuro Center, Neurology, Kuopio University Hospital, P. O. Box 100, FI-70029 KYS, Finland.
| | - Anne M Remes
- Medical Research Center, Oulu University Hospital, P. O. Box 8000, FI-90014 University of Oulu, Finland; Unit of Clinical Neuroscience, Neurology, University of Oulu, P. O. Box 8000, FI-90014 University of Oulu, Finland.
| | - Rashid Giniatullin
- Molecular Pain Research group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland.
| | - Annakaisa Haapasalo
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland.
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22
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Katisko K, Cajanus A, Huber N, Jääskeläinen O, Kokkola T, Kärkkäinen V, Rostalski H, Hartikainen P, Koivisto AM, Hannonen S, Lehtola JM, Korhonen VE, Helisalmi S, Koivumaa-Honkanen H, Herukka SK, Remes AM, Solje E, Haapasalo A. GFAP as a biomarker in frontotemporal dementia and primary psychiatric disorders: diagnostic and prognostic performance. J Neurol Neurosurg Psychiatry 2021; 92:1305-1312. [PMID: 34187866 DOI: 10.1136/jnnp-2021-326487] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) and primary psychiatric disorders (PPD) are characterised by overlapping clinical features but different aetiologies. Here, we assessed for the first time the potential of blood glial fibrillar acidic protein (GFAP), marker of astrogliosis, as a discriminative and prognostic tool in FTLD and PPD. METHODS The levels of GFAP in serum (sGFAP) of patients with FTLD (N=107) and PPD (N=44) and GFAP in whole blood samples (bGFAP) from FTLD (N=10), PPD (N=10) and healthy controls (N=18) were measured. We evaluated whether the sGFAP levels associate with C9orf72 repeat expansion, survival of FTLD and PPD patients, and brain atrophy assessed cross-sectionally and longitudinally by structural T1W MRI. We also examined the correlation between sGFAP and bGFAP levels in a subset of patients. RESULTS sGFAP and bGFAP levels were elevated in the FTLD group compared with the PPD or control groups. Receiver operating characteristic analysis indicated an excellent diagnostic performance between FTLD and PPD (the area under the curve (AUC)=0.820, 95% CI 0.745 to 0.896). sGFAP and bGFAP levels showed a strong correlation and elevated sGFAP levels significantly associated with atrophy rate in the temporal cortex and predicted shorter survival time in patients with FTLD. No association with C9orf72 repeat expansion was detected. CONCLUSIONS sGFAP enabled differentiation of patients with FTLD and PPD and associated with shorter survival and more severe brain atrophy rate in patients with FTLD. These results suggest that blood-based GFAP represents a minimally invasive and useful biomarker in the differential diagnostics between patients with FTLD and PPD and in evaluating disease progression and astrogliosis in FTLD.
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Affiliation(s)
- Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli Jääskeläinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kokkola
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Neuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Hannah Rostalski
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paivi Hartikainen
- Neuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro center, Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Internal Medicine and Rehabilitation, Geriatrics, Helsinki University Hospital, Helsinki, Finland.,Department of Neurosciences, University of Helsinki, Helsinki, Finland
| | - Sanna Hannonen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Juha-Matti Lehtola
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ville E Korhonen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland .,Neuro center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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23
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Saracino D, Géraudie A, Remes AM, Ferrieux S, Noguès-Lassiaille M, Bottani S, Cipriano L, Houot M, Funkiewiez A, Camuzat A, Rinaldi D, Teichmann M, Pariente J, Couratier P, Boutoleau-Bretonnière C, Auriacombe S, Etcharry-Bouyx F, Levy R, Migliaccio R, Solje E, Le Ber I. Primary progressive aphasias associated with C9orf72 expansions: Another side of the story. Cortex 2021; 145:145-159. [PMID: 34717271 DOI: 10.1016/j.cortex.2021.09.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 12/13/2022]
Abstract
C9orf72 repeat expansions are rarely associated with primary progressive aphasias (PPA). In-depth characterization of the linguistic deficits, and the underlying patterns of grey-matter atrophy in PPA associated with the C9orf72 expansions (PPA-C9orf72) are currently lacking. In this study, we comprehensively analyzed a unique series of 16 patients affected by PPA-C9orf72. Eleven patients were issued from two independent French and Finnish cohorts, and five were identified by means of literature review. Voxel-based morphometry (VBM) studies were performed on three of them. This study depicts the spectrum of C9orf72-related aphasic phenotypes, and illustrates their linguistic presentation. The non-fluent/agrammatic variant was the most frequent phenotype in our series (9/16 patients, 56%), with apraxia of speech being the main defining feature. Left frontal lobe atrophy was present in these subjects, peaking in inferior frontal gyrus. Three patients (19%) showed the semantic variant, with progression of atrophy in temporo-polar regions, later involving orbitofrontal cortex. Anterior temporal lobe dysfunction was also particularly relevant in two patients (12.5%) with mixed forms of PPA. Lastly, two patients (12.5%) had unclassifiable PPA with predominating word-finding difficulties. No PPA-C9orf72 patients in our series fulfilled the criteria of the logopenic variant. Importantly, this study underlines the role of C9orf72 mutation in the disruption of the most anterior parts of the language network, including prefrontal and temporo-polar areas. It provides guidelines for C9orf72 testing in PPA patients, with important clinical impact as gene-specific therapies are upcoming.
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Affiliation(s)
- Dario Saracino
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Aramis Project Team, Inria Research Center of Paris, Paris, France
| | - Amandine Géraudie
- Department of Neurology, Toulouse University Hospital, Toulouse, France; ToNIC, Toulouse NeuroImaging Centre, Inserm, UPS, University of Toulouse, Toulouse, France
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; MRC Oulu, Oulu University Hospital, Oulu, Finland
| | - Sophie Ferrieux
- Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Marie Noguès-Lassiaille
- Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Simona Bottani
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Aramis Project Team, Inria Research Center of Paris, Paris, France
| | - Lorenzo Cipriano
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli" - Naples, Italy
| | - Marion Houot
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Center of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Aurélie Funkiewiez
- Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Paris Brain Institute - Institut Du Cerveau (ICM), FrontLab, Paris, France
| | - Agnès Camuzat
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; EPHE, PSL Research University, Paris, France
| | - Daisy Rinaldi
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Marc Teichmann
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Paris Brain Institute - Institut Du Cerveau (ICM), FrontLab, Paris, France
| | - Jérémie Pariente
- Department of Neurology, Toulouse University Hospital, Toulouse, France; ToNIC, Toulouse NeuroImaging Centre, Inserm, UPS, University of Toulouse, Toulouse, France
| | | | | | - Sophie Auriacombe
- CMRR Nouvelle Aquitaine / Institut des Maladies Neurodégénératives Clinique (IMNc), CHU de Bordeaux Hôpital Pellegrin, Bordeaux, France
| | | | - Richard Levy
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Paris Brain Institute - Institut Du Cerveau (ICM), FrontLab, Paris, France
| | - Raffaella Migliaccio
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Paris Brain Institute - Institut Du Cerveau (ICM), FrontLab, Paris, France
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland; Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute - Institut Du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Reference Centre for Rare or Early-Onset Dementias, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Paris Brain Institute - Institut Du Cerveau (ICM), FrontLab, Paris, France.
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24
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Niiranen M, Kontkanen A, Jääskeläinen O, Tertsunen HM, Selander T, Hartikainen P, Huber N, Solje E, Haapasalo A, Kokkola T, Lohioja T, Herukka SK, Simula S, Remes AM. Serum GFAP and NfL levels in benign relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2021; 56:103280. [PMID: 34627002 DOI: 10.1016/j.msard.2021.103280] [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] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to investigate serum glial fibrillary acidic protein (GFAP) and serum neurofilament light chain (NfL) levels as potential discriminative biomarkers between benign relapsing-remitting multiple sclerosis (BRRMS) and aggressive relapsing-remitting MS (ARRMS). METHODS Serum GFAP and NfL levels were analyzed in patients with BRRMS (n = 34), ARRMS (n = 29), and healthy controls (n = 14) by using Single Molecule Array (Simoa). Patients with ARRMS had been treated with highly effective disease-modifying treatments (DMT) (fingolimod or natalizumab). RESULTS Serum GFAP levels in both BRRMS (median 210.19 pg/ml, IQR 163.69-287.19) and in ARRMS (median 188.60 pg/ml, IQR39.23-244.93) were significantly higher (p = 0.035 and p = 0.034, respectively) compared to healthy controls (median 117.93 pg/ml, IQR 60.28-183.83). Serum GFAP levels did not differ between BRRMS and ARRMS. There were no statistical differences in NfL levels between BRRMS, ARRMS and healthy controls. GFAP level was significantly higher (p = 0.04) in BRRMS without DMT (median 216.04 pg/ml, IQR 188.60-274.79) than in those BRRMS patients who had used DMT (median 196.26 pg/ml, IQR 133.33-325.54). CONCLUSIONS We found elevated levels of serum GFAP in both BRRMS and ARRMS compared to healthy controls, reflecting astrocytic activation. Serum NfL did not differ between BRRMS and ARRMS, probably due to the stable inflammatory phase of the disease and effective DMT use in ARRMS. Single serum NfL and GFAP measurements cannot separate a patient with BRRMS from effectively treated ARRMS after a long history of the disease, thus consecutive samples are needed in the follow-up.
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Affiliation(s)
- Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland.
| | - Aleksi Kontkanen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Olli Jääskeläinen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Hanna-Mari Tertsunen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kokkola
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tarja Lohioja
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland
| | - Sanna-Kaisa Herukka
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
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25
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Rostalski H, Korhonen V, Kuulasmaa T, Solje E, Krüger J, Gen F, Kaivola K, Eide PK, Lambert JC, Julkunen V, Tienari PJ, Remes AM, Leinonen V, Hiltunen M, Haapasalo A. A Novel Genetic Marker for the C9orf72 Repeat Expansion in the Finnish Population. J Alzheimers Dis 2021; 83:1325-1332. [PMID: 34397416 DOI: 10.3233/jad-210599] [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 C9orf72 repeat expansion (C9exp) is the most common genetic cause underlying frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). However, detection of the C9exp requires elaborative methods. OBJECTIVE Identification of C9exp carriers from genotyped cohorts could be facilitated by using single nucleotide polymorphisms (SNPs) as markers for the C9exp. METHODS We elucidated the potential of the previously described Finnish risk haplotype, defined by the SNP rs3849942, to identify potential C9exp carriers among 218,792 Finns using the FinnGen database. The haplotype approach was first tested in an idiopathic normal pressure hydrocephalus (iNPH) patient cohort (European Alzheimer's Disease DNA BioBank) containing C9exp carriers by comparing intermediate (15-30) and full-length (> 60 repeats) C9exp carriers (n = 41) to C9exp negative patients (< 15 repeats, n = 801). RESULTS In this analysis, rs3849942 was associated with carriership of C9exp (OR 8.44, p < 2×10-15), while the strongest association was found with rs139185008 (OR 39.4, p < 5×10-18). Unbiased analysis of rs139185008 in FinnGen showed the strongest association with FTLD (OR 4.38, 3×10-15) and motor neuron disease ALS (OR 5.19, 3×10-21). rs139185008 was the top SNP in all diseases (iNPH, FTLD, ALS), and further showed a strong association with ALS in the UK Biobank (p = 9.0×10-8). CONCLUSION Our findings suggest that rs139185008 is a useful marker to identify potential C9exp carriers in the genotyped cohorts and biobanks originating from Finland.
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Affiliation(s)
- Hannah Rostalski
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ville Korhonen
- Neurocenter, Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Teemu Kuulasmaa
- Institute of Biomedicine, Yliopistonranta 1E, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center (MRC), Oulu University Hospital, Oulu, Finland
| | - Finn Gen
- Department of Neurology, Helsinki University Hospital and Translational Immunology Program, Biomedicum, University of Helsinki, Helsinki, Finland
| | - Karri Kaivola
- Department of Neurology, Helsinki University Hospital and Translational Immunology Program, Biomedicum, University of Helsinki, Helsinki, Finland
| | - Per Kristian Eide
- Oslo University Hospital-Rikshospitalet; and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Jean-Charles Lambert
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE facteurs de risque et déterminants moléculaires des maladies liés au vieillissement, Lille, France
| | - Valtteri Julkunen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Pentti J Tienari
- Department of Neurology, Helsinki University Hospital and Translational Immunology Program, Biomedicum, University of Helsinki, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center (MRC), Oulu University Hospital, Oulu, Finland
| | - Ville Leinonen
- Neurocenter, Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, Yliopistonranta 1E, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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26
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Borroni B, Graff C, Hardiman O, Ludolph AC, Moreno F, Otto M, Piccininni M, Remes AM, Rowe JB, Seelaar H, Stefanova E, Traykov L, Logroscino G. FRONTotemporal dementia Incidence European Research Study-FRONTIERS: Rationale and design. Alzheimers Dement 2021; 18:498-506. [PMID: 34338439 PMCID: PMC9291221 DOI: 10.1002/alz.12414] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/22/2021] [Accepted: 06/09/2021] [Indexed: 01/26/2023]
Abstract
Introduction The incidence of Frontotemporal Lobar Degeneration (FTLD)–related disorders and their characteristics are not well known. The “FRONTotemporal dementia Incidence European Research Study” (FRONTIERS) is designed to fill this gap. Methods FRONTIERS is a European prospective, observational population study based on multinational registries. FRONTIERS comprises 11 tertiary referral centers across Europe with long‐lasting experience in FTLD‐related disorders and comprehensive regional referral networks, enabling incidence estimation over well‐defined geographical areas. Endpoints The primary endpoints are (1) the incidence of FTLD‐related disorders across Europe; (2) geographic trends of FTLD‐related disorders; (3) the distribution of FTLD phenotypes in different populations and ethnicities in Europe; (4) inheritance of FTLD‐related disorders, including the frequencies of monogenic FTLD as compared to overall disease burden; and (5) implementation of data banking for clinical and biological material. Expected impacts FRONTIERS will improve the understanding of FTLD‐related disorders and their epidemiology, promoting appropriate public health service policies and treatment strategies.
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Affiliation(s)
- Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, ASST Spedali Civili Brescia and University of Brescia, Brescia, Italy
| | - Caroline Graff
- Department NVS, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Unit for Hereditary Dementia, Theme Aging, Karolinska University Hospital-Solna, Stockholm, Sweden
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Albert C Ludolph
- Department of Neurology, University Hospital Ulm, Ulm, Germany.,Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Ulm, Germany
| | - Fermin Moreno
- Department of Neurology, Cognitive Disorders Unit, Hospital Universitario Donostia, San Sebastian, Spain.,Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - James B Rowe
- Department of Clinical Neurosciences, MRC Cognition and Brain Sciences Unit, and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Harro Seelaar
- Department of Neurology and Alzheimer center, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elka Stefanova
- Faculty of Medicine, Neurology Clinic, University of Belgrade, University Clinical Center Serbia, Serbia
| | - Latchezar Traykov
- Department of Neurology, UH "Alexandrovska", Medical University Sofia, Sofia, Bulgaria
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione di Culto e Religione, Cardinale Giovanni Panico, University of Bari-Aldo Moro, Bari, Italy
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Leskelä S, Hoffmann D, Rostalski H, Huber N, Wittrahm R, Hartikainen P, Korhonen V, Leinonen V, Hiltunen M, Solje E, Remes AM, Haapasalo A. FTLD Patient-Derived Fibroblasts Show Defective Mitochondrial Function and Accumulation of p62. Mol Neurobiol 2021; 58:5438-5458. [PMID: 34328616 PMCID: PMC8599259 DOI: 10.1007/s12035-021-02475-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022]
Abstract
Frontotemporal lobar degeneration (FTLD) is a clinically, genetically, and neuropathologically heterogeneous group of neurodegenerative syndromes, leading to progressive cognitive dysfunction and frontal and temporal atrophy. C9orf72 hexanucleotide repeat expansion (C9-HRE) is the most common genetic cause of FTLD, but pathogenic mechanisms underlying FTLD are not fully understood. Here, we compared cellular features and functional properties, especially related to protein degradation pathways and mitochondrial function, of FTLD patient–derived skin fibroblasts from C9-HRE carriers and non-carriers and healthy donors. Fibroblasts from C9-HRE carriers were found to produce RNA foci, but no dipeptide repeat proteins, and they showed unchanged levels of C9orf72 mRNA transcripts. The main protein degradation pathways, the ubiquitin–proteasome system and autophagy, did not show alterations between the fibroblasts from C9-HRE-carrying and non-carrying FTLD patients and compared to healthy controls. An increase in the number and size of p62-positive puncta was evident in fibroblasts from both C9-HRE carriers and non-carriers. In addition, several parameters of mitochondrial function, namely, basal and maximal respiration and respiration linked to ATP production, were significantly reduced in the FTLD patient–derived fibroblasts from both C9-HRE carriers and non-carriers. Our findings suggest that FTLD patient–derived fibroblasts, regardless of whether they carry the C9-HRE expansion, show unchanged proteasomal and autophagic function, but significantly impaired mitochondrial function and increased accumulation of p62 when compared to control fibroblasts. These findings suggest the possibility of utilizing FTLD patient–derived fibroblasts as a platform for biomarker discovery and testing of drugs targeted to specific cellular functions, such as mitochondrial respiration.
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Affiliation(s)
- Stina Leskelä
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211, Kuopio, Finland
| | - Dorit Hoffmann
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211, Kuopio, Finland
| | - Hannah Rostalski
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211, Kuopio, Finland
| | - Nadine Huber
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211, Kuopio, Finland
| | - Rebekka Wittrahm
- Institute of Biomedicine, University of Eastern Finland, Yliopistonranta 1E, 70211, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, 70029, Kuopio, Finland
| | - Ville Korhonen
- Neuro Center, Neurosurgery, Kuopio University Hospital, 70029, Kuopio, Finland
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
| | - Ville Leinonen
- Neuro Center, Neurosurgery, Kuopio University Hospital, 70029, Kuopio, Finland
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Yliopistonranta 1E, 70211, Kuopio, Finland
| | - Eino Solje
- Neuro Center, Neurology, Kuopio University Hospital, 70029, Kuopio, Finland
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, P.O. Box 8000, 90014, Oulu, Finland
- MRC Oulu, Oulu University Hospital, P.O. Box 8000, 90014, Oulu, Finland
| | - Annakaisa Haapasalo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211, Kuopio, Finland.
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28
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Korpioja A, Krüger J, Koivuluoma S, Pylkäs K, Moilanen V, Helisalmi S, Hiltunen M, Remes AM. Novel Rare SORL1 Variants in Early-Onset Dementia. J Alzheimers Dis 2021; 82:761-770. [PMID: 34092641 DOI: 10.3233/jad-210207] [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 Rare variants of SORL1 have been associated with an increased risk of early-onset or late-onset Alzheimer's disease (AD). However, a lot remains to be clarified about their significance in the pathogenesis of the disease. OBJECTIVE To evaluate the role of SORL1 variants among Finnish patients with early-onset AD (EOAD). METHODS The rare SORL1variants were screened in a cohort of 115 Finnish EOAD patients (mean age at onset 58.3 years, range 46-65 years) by using the whole-exome sequencing. RESULTS We found one novel nonsense variant (p.Gln290*) and eight missense variants in SORL1. This is the first study reporting the SORL1 variants p.Lys80Arg, p.Ala789Val and p.Arg866Gln in EOAD patients. Furthermore, two of these three missense variants were overrepresented in EOAD patients compared to gnomAD non-neuro Finnish samples. CONCLUSION This study strengthens the earlier findings, that the rare variants in SORL1 are associated with EOAD.
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Affiliation(s)
- Anita Korpioja
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Susanna Koivuluoma
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit and Biocenter Oulu, University of Oulu, NordLab Oulu, Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit and Biocenter Oulu, University of Oulu, NordLab Oulu, Oulu, Finland
| | - Virpi Moilanen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
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Rauma I, Mustonen T, Seppä JM, Ukkonen M, Männikkö M, Verkkoniemi-Ahola A, Kartau M, Saarinen JT, Luostarinen L, Simula S, Ryytty M, Ahmasalo R, Sipilä JOT, Pieninkeroinen I, Tapiola T, Remes AM, Kuusisto H. Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients. J Neurol 2021; 269:824-835. [PMID: 34255182 PMCID: PMC8782800 DOI: 10.1007/s00415-021-10664-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 12/05/2022]
Abstract
Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1–3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.
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Affiliation(s)
- Ilkka Rauma
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. .,Department of Neurology, Tampere University Hospital, Tampere, Finland. .,Department of Neurology, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Tiina Mustonen
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Maritta Ukkonen
- Department of Neurology, Tampere University Hospital, Tampere, Finland
| | - Marianne Männikkö
- Department of Neurology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Auli Verkkoniemi-Ahola
- Clinical Neurosciences, Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Marge Kartau
- Clinical Neurosciences, Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Liisa Luostarinen
- Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Mervi Ryytty
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Research Unit of Clinical Neuroscience, University of Oulu, Faculty of Medicine, Oulu, Finland
| | - Riitta Ahmasalo
- Department of Neurology, Lapland Central Hospital, Rovaniemi, Finland
| | - Jussi O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | | | - Tero Tapiola
- Department of Neurology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Anne M Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Research Unit of Clinical Neuroscience, University of Oulu, Faculty of Medicine, Oulu, Finland
| | - Hanna Kuusisto
- Department of Neurology, Tampere University Hospital, Tampere, Finland.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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30
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Luukkainen L, Huttula S, Väyrynen H, Helisalmi S, Kytövuori L, Haapasalo A, Hiltunen M, Remes AM, Krüger J. Mutation Analysis of the Genes Associated with Parkinson's Disease in a Finnish Cohort of Early-Onset Dementia. J Alzheimers Dis 2021; 76:955-965. [PMID: 32568194 DOI: 10.3233/jad-200069] [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 Alzheimer's disease, frontotemporal lobar degeneration, dementia with Lewy bodies, and Parkinson's disease (PD) overlap in clinical characteristics, neuropathology, and genetics. OBJECTIVE The aim of this study was to evaluate the role of pathogenic mutations and rare variants in genes associated with PD among early-onset dementia (EOD) patients. METHODS Rare non-synonymous variants (MAF < 0.01) in ten genes (SNCA, PARK2, PARK7, LRRK2, PINK1, ATP13A2, UCHL1, HTRA2, GBA, and SNCAIP) and low-frequency (MAF < 0.05) GBA variants were screened using a targeted next-generation sequencing panel in a strictly defined cohort of 37 early-onset (age at onset (AAO) <65 years) dementia patients presenting with atypical features (e.g., myoclonia or spasticity), rapidly progressive course of the disease or with a family history of dementia. The identified variations were further screened in a larger cohort of EOD (n = 279, mean AAO 57, range 36-65) patients. RESULTS No pathogenic mutations were found, but we identified seven possible risk variants for neurodegeneration (LRRK2 p.Arg793Met, PARK2 p.Ala82Glu, SNCAIP p.Arg240Gln, SNCAIP p.Phe369Leu, GBA p.Asn409Ser, GBA p.Glu365Lys, GBA p.Thr408Met). DISCUSSION Altogether, the frequency of these variants was two times higher in the first selected cohort compared to the whole cohort. This suggests that specific rare variants in the genes associated with PD might play a role also especially in familial EOD.
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Affiliation(s)
- Laura Luukkainen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Unit of Cancer and Translational Research, Pathology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Samuli Huttula
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Henri Väyrynen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Laura Kytövuori
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
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Solje E, Benussi A, Buratti E, Remes AM, Haapasalo A, Borroni B. State-of-the-Art Methods and Emerging Fluid Biomarkers in the Diagnostics of Dementia-A Short Review and Diagnostic Algorithm. Diagnostics (Basel) 2021; 11:diagnostics11050788. [PMID: 33925655 PMCID: PMC8145467 DOI: 10.3390/diagnostics11050788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
The most common neurodegenerative dementias include Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). The correct etiology-based diagnosis is pivotal for clinical management of these diseases as well as for the suitable timing and choosing the accurate disease-modifying therapies when these become available. Enzyme-linked immunosorbent assay (ELISA)-based methods, detecting altered levels of cerebrospinal fluid (CSF) Tau, phosphorylated Tau, and Aβ-42 in AD, allowed the wide use of this set of biomarkers in clinical practice. These analyses demonstrate a high diagnostic accuracy in AD but suffer from a relatively restricted usefulness due to invasiveness and lack of prognostic value. In recent years, the development of novel advanced techniques has offered new state-of-the-art opportunities in biomarker discovery. These include single molecule array technology (SIMOA), a tool for non-invasive analysis of ultra-low levels of central nervous system-derived molecules from biofluids, such as CSF or blood, and real-time quaking (RT-QuIC), developed to analyze misfolded proteins. In the present review, we describe the history of methods used in the fluid biomarker analyses of dementia, discuss specific emerging biomarkers with translational potential for clinical use, and suggest an algorithm for the use of new non-invasive blood biomarkers in clinical practice.
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Affiliation(s)
- Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, 70211 Kuopio, Finland;
- Neuro Center, Neurology, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy;
| | - Emanuele Buratti
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy;
| | - Anne M. Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, 90230 Oulu, Finland;
- Medical Research Center (MRC), Oulu University Hospital, 90220 Oulu, Finland
| | - Annakaisa Haapasalo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70211 Kuopio, Finland;
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy;
- Correspondence:
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Rajna Z, Mattila H, Huotari N, Tuovinen T, Krüger J, Holst SC, Korhonen V, Remes AM, Seppänen T, Hennig J, Nedergaard M, Kiviniemi V. Cardiovascular brain impulses in Alzheimer's disease. Brain 2021; 144:2214-2226. [PMID: 33787890 PMCID: PMC8422353 DOI: 10.1093/brain/awab144] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Accumulation of amyloid-β is a key neuropathological feature in brain of
Alzheimer’s disease patients. Alterations in cerebral haemodynamics,
such as arterial impulse propagation driving the (peri)vascular CSF flux,
predict future Alzheimer’s disease progression. We now present a
non-invasive method to quantify the three-dimensional propagation of
cardiovascular impulses in human brain using ultrafast 10 Hz magnetic
resonance encephalography. This technique revealed spatio-temporal abnormalities
in impulse propagation in Alzheimer’s disease. The arrival latency and
propagation speed both differed in patients with Alzheimer’s disease.
Our mapping of arterial territories revealed Alzheimer’s
disease-specific modifications, including reversed impulse propagation around
the hippocampi and in parietal cortical areas. The findings imply that pervasive
abnormality in (peri)vascular CSF impulse propagation compromises vascular
impulse propagation and subsequently glymphatic brain clearance of
amyloid-β in Alzheimer’s disease.
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Affiliation(s)
- Zalán Rajna
- Center for Machine Vision and Signal Analysis, University of Oulu, 90570 Oulu, Finland
| | - Heli Mattila
- Oulu Functional Neuroimaging Group, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, 90570 Oulu, Finland
| | - Niko Huotari
- Oulu Functional Neuroimaging Group, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, 90570 Oulu, Finland
| | - Timo Tuovinen
- Oulu Functional Neuroimaging Group, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, 90570 Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, 90570 Oulu, Finland
| | - Sebastian C Holst
- Neurobiology Research Unit, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Vesa Korhonen
- Department of Diagnostic Radiology, Medical Research Center, Oulu University Hospital, 90220 Oulu, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, 90570 Oulu, Finland
| | - Tapio Seppänen
- Center for Machine Vision and Signal Analysis, University of Oulu, 90570 Oulu, Finland
| | - Jürgen Hennig
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Vesa Kiviniemi
- Oulu Functional Neuroimaging Group, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, 90570 Oulu, Finland
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Korhonen T, Katisko K, Cajanus A, Hartikainen P, Koivisto AM, Haapasalo A, Remes AM, Solje E. Comparison of Prodromal Symptoms of Patients with Behavioral Variant Frontotemporal Dementia and Alzheimer Disease. Dement Geriatr Cogn Disord 2021; 49:98-106. [PMID: 32485711 DOI: 10.1159/000507544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/11/2020] [Accepted: 03/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Behavioral variant frontotemporal dementia (bvFTD) is the most common clinical subtype of frontotemporal lobar degeneration. bvFTD is often characterized by changes in behavior and personality, frequently leading to psychiatric misdiagnoses. On the other hand, substantial clinical overlap with other neurodegenerative diseases, such as Alzheimer disease (AD), further complicates the diagnostics. OBJECTIVE Our aim was to identify the main differences in early symptoms of bvFTD and AD in the prodromal stages of the diseases. In addition, patients with bvFTD were analyzed separately according to whether they carry the C9orf72repeat expansion or not. METHODS Patient records of bvFTD (n = 75) and AD (n = 83) patients were analyzed retrospectively for memory and neuropsychiatric symptoms, sleeping disorders, and somatic complaints before the setting of the accurate diagnosis. RESULTS A total of 84% of bvFTD patients (n = 63) and 98.8% of AD patients (n = 82) reported subjective memory disturbances in the prodromal phases of the disease. bvFTD patients presented significantly more often with sleeping disorders, headache, inexplicable collapses, transient loss of consciousness, somatization, delusions, and hallucinations, suicidality, changes in oral behaviors, and urinary problems. In addition, poor financial judgement was frequently detected in patients with prodromal bvFTD. Aberrant sensations in the nose and throat without any physical explanation, regarded as somatizations, emerged only in bvFTD patients with the C9orf72 repeat expansion. CONCLUSIONS Subjective reporting of impaired episodic memory is a poor indicator in differentiating bvFTD from AD. Sleeping disturbances, delusions, hallucinations, and unexplained somatic complaints in a patient with cognitive disturbances should prompt the clinicians to consider bvFTD as a possible diagnostic option behind these symptoms. The spectrum of symptoms in the prodromal stages of bvFTD may be more diverse than the latest criteria suggest.
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Affiliation(s)
- Titta Korhonen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Koivisto
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.,Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland, .,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland,
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Ylä-Herttuala S, Hakulinen M, Poutiainen P, Laitinen TM, Koivisto AM, Remes AM, Hallikainen M, Lehtola JM, Saari T, Korhonen V, Könönen M, Vanninen R, Mussalo H, Laitinen T, Mervaala E. Severe Obstructive Sleep Apnea and Increased Cortical Amyloid-β Deposition. J Alzheimers Dis 2021; 79:153-161. [PMID: 33216027 DOI: 10.3233/jad-200736] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The suggested association between severe obstructive sleep apnea (OSA) and risk of Alzheimer's disease (AD) needs further study. Only few recent reports exist on associations between brain amyloid-β (Aβ) burden and severe OSA in middle-aged patients. OBJECTIVE Examine the possible presence of cortical Aβ accumulation in middle-aged patients with severe OSA. METHODS We performed detailed multimodal neuroimaging in 19 cognitive intact patients (mean 44.2 years) with severe OSA (Apnea-Hypopnea Index >30 h-1). Known etiological factors for possible Aβ accumulation were used as exclusion criteria. Aβ uptake was studied with [11C]-PiB-PET, glucose metabolism with [18F]-FDG-PET, and structural imaging with 3.0T MRI. RESULTS When analyzed individually, in [11C]-PiB-PET a substantial number (∼32%) of the patients exhibited statistically significant evidence of increased cortical Aβ uptake based on elevated regional Z-score values, mostly seen bilaterally in the precuneus and posterior cingulum regions. Cortical glucose hypometabolism in [18F]-FDG-PET was seen in two patients. MRI did not show structural changes suggestive of AD-related pathology. CONCLUSION Increased [11C]-PiB uptake was seen in middle-aged cognitively intact patients with severe OSA. These findings are similar to those described in cognitive unimpaired older OSA patients. The changes in cortical Aβ uptake suggest that severe OSA itself may predispose to alterations related to AD already in middle-age. Aβ clearance may be compromised without simultaneous evidence of metabolic or structural alterations. The results emphasize the importance of early diagnostics and proper treatment of severe OSA in cognitively intact middle-aged subjects, possibly diminishing the individual risk for later cognitive dysfunction.
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Affiliation(s)
- Salla Ylä-Herttuala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hakulinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pekka Poutiainen
- Department of Cyclotron and Radiopharmacy, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Neurosciences, University of Helsinki, Helsinki, Finland.,Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Merja Hallikainen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha-Matti Lehtola
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Toni Saari
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Educational Sciences and Psychology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Ville Korhonen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Mussalo
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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35
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Nurmi SM, Halkoaho A, Moilanen J, Remes AM, Solje E. The ethical implications of genetic testing in neurodegenerative diseases: A systematic review. Scand J Caring Sci 2020; 35:1057-1074. [PMID: 33210792 DOI: 10.1111/scs.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Availability of genetic testing in neurodegenerative disorders has developed rapidly. This growing ability is providing specific genetic information to individuals and, in turn, their families, raising ethical concerns. However, family members' perspective is a seldom-studied phenomenon. AIM The aim of this systematic review was to describe the ethical aspect of genetic testing in neurodegenerative diseases from the perspective of at-risk family members. METHOD A systematic review of data was performed in accordance with the PRISMA statement. The data search was conducted using the CINAHL, PubMed and Scopus databases to identify original peer-reviewed studies published between January 2009 and April 2019. A total of 24 articles were selected. The data were analysed using inductive content analysis. FINDINGS On the basis of the analysis, four central ethical implications were identified: (i) decision-making in genetic testing as a dilemma: balance between autonomy and responsibility, (ii) the individual's right to make a voluntary and informed decision for genetic testing, (iii) conflicting emotions after knowing one's genetic status and (iv) privacy and confidentiality of genetic information: the fear of genetic discrimination and stigma. CONCLUSIONS The findings of this review increase understanding about the central ethical implications of genetic testing in neurodegenerative diseases from the perspective of family members, and identify and underline outstanding needs for further research.
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Affiliation(s)
| | - Arja Halkoaho
- Tampere University of Applied Sciences, Tampere, Finland
| | - Jukka Moilanen
- Department of Clinical Genetics, Oulu University Hospital, Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu and Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
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36
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Luikku AJ, Hall A, Nerg O, Koivisto AM, Hiltunen M, Helisalmi S, Herukka SK, Junkkari A, Sutela A, Kojoukhova M, Korhonen V, Mattila J, Lötjönen J, Rummukainen J, Alafuzoff I, Jääskeläinen JE, Remes AM, Solomon A, Kivipelto M, Soininen H, Rauramaa T, Leinonen V. Predicting Development of Alzheimer's Disease in Patients with Shunted Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis 2020; 71:1233-1243. [PMID: 31498122 DOI: 10.3233/jad-190334] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/24/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) patients often develop Alzheimer's disease (AD) related brain pathology. Disease State Index (DSI) is a method to combine data from various sources for differential diagnosis and progression of neurodegenerative disorders. OBJECTIVE To apply DSI to predict clinical AD in shunted iNPH-patients in a defined population. METHODS 335 shunted iNPH-patients (median 74 years) were followed until death (n = 185) or 6/2015 (n = 150). DSI model (including symptom profile, onset age of NPH symptoms, atrophy of medial temporal lobe in CT/MRI, cortical brain biopsy finding, and APOE genotype) was applied. Performance of DSI model was evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS A total of 70 (21%) patients developed clinical AD during median follow-up of 5.3 years. DSI-model predicted clinical AD with moderate effectiveness (AUC = 0.75). Significant factors were cortical biopsy (0.69), clinical symptoms (0.66), and medial temporal lobe atrophy (0.66). CONCLUSION We found increased occurrence of clinical AD in previously shunted iNPH patients as compared with general population. DSI supported the prediction of AD. Cortical biopsy during shunt insertion seems indicated for earlier diagnosis of comorbid AD.
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Affiliation(s)
- Antti J Luikku
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ossi Nerg
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Antti Junkkari
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Maria Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Ville Korhonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Jaana Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Department of Pathology, University of Eastern Finland, Kuopio, Finland
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University and Departmentof Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden
| | - Juha E Jääskeläinen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Alina Solomon
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Department of Pathology, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Research Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
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37
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Jääskeläinen O, Solje E, Hall A, Katisko K, Korhonen V, Tiainen M, Kangas AJ, Helisalmi S, Pikkarainen M, Koivisto A, Hartikainen P, Hiltunen M, Ala-Korpela M, Soininen H, Soininen P, Haapasalo A, Remes AM, Herukka SK. Low Serum High-Density Lipoprotein Cholesterol Levels Associate with the C9orf72 Repeat Expansion in Frontotemporal Lobar Degeneration Patients. J Alzheimers Dis 2020; 72:127-137. [PMID: 31561355 PMCID: PMC6839456 DOI: 10.3233/jad-190132] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Decreased levels of serum high-density lipoprotein (HDL) cholesterol have previously been linked to systemic inflammation and neurodegenerative diseases, such as Alzheimer’s disease. Here, we aimed to analyze the lipoprotein profile and inflammatory indicators, the high-sensitivity C-reactive peptide (hs-CRP) and glycoprotein acetyls (GlycA), in sporadic and C9orf72 repeat expansion-associated frontotemporal lobar degeneration (FTLD) patients. The C9orf72 hexanucleotide repeat expansion is the most frequent genetic etiology underlying FTLD. The concentrations of different lipid measures in the sera of 67 FTLD patients (15 C9orf72 repeat expansion carriers), including GlycA, were analyzed by nuclear magnetic resonance spectroscopy. To verify the state of systemic inflammation, hs-CRP was also quantified from patient sera. We found that the total serum HDL concentration was decreased in C9orf72 repeat expansion carriers when compared to non-carriers. Moreover, decreased concentrations of HDL particles of different sizes and subclass were consistently observed. No differences were detected in the very low- and low-density lipoprotein subclasses between the C9orf72 repeat expansion carriers and non-carriers. Furthermore, hs-CRP and GlycA levels did not differ between the C9orf72 repeat expansion carriers and non-carriers. In conclusion, the HDL-related changes were linked with C9orf72 repeat expansion associated FTLD but were not seen to associate with systemic inflammation. The underlying reason for the HDL changes remains unclear.
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Affiliation(s)
- Olli Jääskeläinen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ville Korhonen
- Neuro Center, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Mika Tiainen
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti J Kangas
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Maria Pikkarainen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne Koivisto
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Mika Ala-Korpela
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland.,Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.,Systems Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Hilkka Soininen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Pasi Soininen
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Kuopio University Hospital, Kuopio, Finland
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38
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Haapanen M, Katisko K, Hänninen T, Krüger J, Hartikainen P, Haapasalo A, Remes AM, Solje E. C9orf72 Repeat Expansion Does Not Affect the Phenotype in Primary Progressive Aphasia. J Alzheimers Dis 2020; 78:919-925. [PMID: 33074234 DOI: 10.3233/jad-200795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary progressive aphasia (PPA) forms the spectrum of language variants of frontotemporal lobar degeneration (FTLD), including three subtypes each consisting of distinctive speech and language features. Repeat expansion in C9orf72 gene is the most common genetic cause of FTLD. However, thus far only little is known about the effects of the C9orf72 repeat expansion on the phenotype of PPA. This retrospective study aimed at determining the differences between the PPA phenotypes of the C9orf72 expansion carriers and non-carriers. Our results demonstrated no significant differences between these groups, indicating that the C9orf72 repeat expansion does not substantially affect the phenotype of PPA.
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Affiliation(s)
- Marjut Haapanen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.,Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
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39
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Rostalski H, Hietanen T, Leskelä S, Behánová A, Abdollahzadeh A, Wittrahm R, Mäkinen P, Huber N, Hoffmann D, Solje E, Remes AM, Natunen T, Takalo M, Tohka J, Hiltunen M, Haapasalo A. BV-2 Microglial Cells Overexpressing C9orf72 Hexanucleotide Repeat Expansion Produce DPR Proteins and Show Normal Functionality but No RNA Foci. Front Neurol 2020; 11:550140. [PMID: 33123074 PMCID: PMC7573144 DOI: 10.3389/fneur.2020.550140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
Hexanucleotide repeat expansion (HRE) in the chromosome 9 open-reading frame 72 (C9orf72) gene is the most common genetic cause underpinning frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). It leads to the accumulation of toxic RNA foci and various dipeptide repeat (DPR) proteins into cells. These C9orf72 HRE-specific hallmarks are abundant in neurons. So far, the role of microglia, the immune cells of the brain, in C9orf72 HRE-associated FTLD/ALS is unclear. In this study, we overexpressed C9orf72 HRE of a pathological length in the BV-2 microglial cell line and used biochemical methods and fluorescence imaging to investigate its effects on their phenotype, viability, and functionality. We found that BV-2 cells expressing the C9orf72 HRE presented strong expression of specific DPR proteins but no sense RNA foci. Transiently increased levels of cytoplasmic TAR DNA-binding protein 43 (TDP-43), slightly altered levels of p62 and lysosome-associated membrane protein (LAMP) 2A, and reduced levels of polyubiquitinylated proteins, but no signs of cell death were detected in HRE overexpressing cells. Overexpression of the C9orf72 HRE did not affect BV-2 cell phagocytic activity or response to an inflammatory stimulus, nor did it shift their RNA profile toward disease-associated microglia. These findings suggest that DPR proteins do not affect microglial cell viability or functionality in BV-2 cells. However, additional studies in other models are required to further elucidate the role of C9orf72 HRE in microglia.
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Affiliation(s)
- Hannah Rostalski
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tomi Hietanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Stina Leskelä
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Andrea Behánová
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ali Abdollahzadeh
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Rebekka Wittrahm
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Petra Mäkinen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Dorit Hoffmann
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center (MRC) Oulu, Oulu University Hospital, Oulu, Finland
| | - Teemu Natunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Mari Takalo
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Tohka
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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40
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Luukkainen L, Helisalmi S, Kytövuori L, Ahmasalo R, Solje E, Haapasalo A, Hiltunen M, Remes AM, Krüger J. Mutation Analysis of the Genes Linked to Early Onset Alzheimer's Disease and Frontotemporal Lobar Degeneration. J Alzheimers Dis 2020; 69:775-782. [PMID: 31127772 DOI: 10.3233/jad-181256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/12/2022]
Abstract
A lot of effort has been done to unravel the genetics underlying early-onset Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). However, many familial early-onset dementia (EOD) cases still show an unclear genetic background. The aim of this study was to evaluate the role of the known causative mutations and possible pathogenic variants associated with AD and FTLD in a Finnish EOD cohort. The cohort consisted of 39 patients (mean age at onset 54.8 years, range 39-65) with a positive family history of dementia or an atypical or rapidly progressive course of the disease. None of the patients carried the C9orf72 hexanucleotide repeat expansion. Mutations and variants in APP, PSEN1, PSEN2, MAPT, GRN, VCP, CHMP2B, FUS, TARDBP, TREM2, TMEM106B, UBQLN2, SOD1, PRNP, UBQLN1, and BIN1 were screened by using a targeted next generation sequencing panel. Two previously reported pathogenic mutations (PSEN1 p.His163Arg and MAPT p.Arg406Trp) were identified in the cohort. Both patients had familial dementia with an atypical early onset phenotype. In addition, a heterozygous p.Arg71Trp mutation in PSEN2 with an uncertain pathogenic nature was identified in a patient with neuropathologically confirmed AD. In conclusion, targeted investigation of the known dementia-linked genes is worthwhile in patients with onset age under 55 and a positive family history, as well as in patients with atypical features.
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Affiliation(s)
- Laura Luukkainen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Laura Kytövuori
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Riitta Ahmasalo
- Department of Neurology, Lapland Central Hospital, Rovaniemi, Finland
| | - Eino Solje
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital, Oulu, Finland
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41
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Räsänen J, Huovinen J, Korhonen VE, Junkkari A, Kastinen S, Komulainen S, Oinas M, Avellan C, Frantzen J, Rinne J, Ronkainen A, Kauppinen M, Lönnrot K, Perola M, Koivisto AM, Remes AM, Soininen H, Hiltunen M, Helisalmi S, Kurki MI, Jääskeläinen JE, Leinonen V. Diabetes is associated with familial idiopathic normal pressure hydrocephalus: a case-control comparison with family members. Fluids Barriers CNS 2020; 17:57. [PMID: 32933532 PMCID: PMC7493374 DOI: 10.1186/s12987-020-00217-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pathophysiological basis of idiopathic normal pressure hydrocephalus (iNPH) is still unclear. Previous studies have shown a familial aggregation and a potential heritability when it comes to iNPH. Our aim was to conduct a novel case-controlled comparison between familial iNPH (fNPH) patients and their elderly relatives, involving multiple different families. METHODS Questionnaires and phone interviews were used for collecting the data and categorising the iNPH patients into the familial (fNPH) and the sporadic groups. Identical questionnaires were sent to the relatives of the potential fNPH patients. Venous blood samples were collected for genetic studies. The disease histories of the probable fNPH patients (n = 60) were compared with their ≥ 60-year-old relatives with no iNPH (n = 49). A modified Charlson Comorbidity Index (CCI) was used to measure the overall disease burden. Fisher's exact test (two-tailed), the Mann-Whitney U test (two-tailed) and a multivariate binary logistic regression analysis were used to perform the statistical analyses. RESULTS Diabetes (32% vs. 14%, p = 0.043), arterial hypertension (65.0% vs. 43%, p = 0.033), cardiac insufficiency (16% vs. 2%, p = 0.020) and depressive symptoms (32% vs. 8%, p = 0.004) were overrepresented among the probable fNPH patients compared to their non-iNPH relatives. In the age-adjusted multivariate logistic regression analysis, diabetes remained independently associated with fNPH (OR = 3.8, 95% CI 1.1-12.9, p = 0.030). CONCLUSIONS Diabetes is associated with fNPH and a possible risk factor for fNPH. Diabetes could contribute to the pathogenesis of iNPH/fNPH, which motivates to further prospective and gene-environmental studies to decipher the disease modelling of iNPH/fNPH.
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Affiliation(s)
- Joel Räsänen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland. .,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland.
| | - Joel Huovinen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Ville E Korhonen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Antti Junkkari
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Sami Kastinen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Simo Komulainen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Minna Oinas
- Department of Neurosurgery, University of Helsinki, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Cecilia Avellan
- Clinical Neurosciences, Department of Neurosurgery, University of Turku, Turku, Finland.,Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Janek Frantzen
- Department of Neurosurgery, University of Helsinki, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, Department of Neurosurgery, University of Turku, Turku, Finland.,Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Mikko Kauppinen
- Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Kimmo Lönnrot
- Department of Neurosurgery, University of Helsinki, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Mitja I Kurki
- Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, USA.,Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Cambridge, USA
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland.,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, P.O.Box 100, 70029, Kuopio, KYS, Finland. .,Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland. .,Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland.
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Hoffmann D, Huber N, Leskelä S, Rostalski H, Solje E, Remes AM, Haapasalo A. Frontotemporal dementia: a conference report from the 2nd FinFTD Symposium. Neurodegener Dis Manag 2020; 10:119-123. [PMID: 32552461 DOI: 10.2217/nmt-2019-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The 2nd FinFTD Symposium was held on 13 September 2019, in Kuopio, Finland, and attracted 80 attendees from six different countries. The program, spanning from molecular mechanisms to biomarkers, prevention, diagnosis and treatment of frontotemporal lobar degeneration and related diseases, provided a great opportunity for researchers, clinicians, healthcare professionals and other participants to discuss about the current status and future directions of frontotemporal lobar degeneration research.
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Affiliation(s)
- Dorit Hoffmann
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Nadine Huber
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Stina Leskelä
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hannah Rostalski
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Annakaisa Haapasalo
- Molecular Neurodegeneration group, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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Cajanus A, Katisko K, Kontkanen A, Jääskeläinen O, Hartikainen P, Haapasalo A, Herukka SK, Vanninen R, Solje E, Hall A, Remes AM. Serum neurofilament light chain in FTLD: association with C9orf72, clinical phenotype, and prognosis. Ann Clin Transl Neurol 2020; 7:903-910. [PMID: 32441885 PMCID: PMC7318100 DOI: 10.1002/acn3.51041] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of the present study was to compare the levels of serum neurofilament light chain (sNfL) in frontotemporal lobar degeneration (FTLD) patients of different clinical subtypes (bvFTD, PPA, and FTLD‐MND) and with or without the C9orf72 repeat expansion, and to correlate sNfL levels to disease progression, assessed by the brain atrophy rate and survival time. Methods The sNfL levels were determined from 78 FTLD patients (C9orf72 repeat expansion carriers [n = 26] and non‐carriers [n = 52]) with Single Molecule Array (SIMOA). The progression of brain atrophy was evaluated using repeated T1‐weighted MRI scans and the survival time from medical records. Results In the total FTLD cohort, sNfL levels were significantly higher in C9orf72 repeat expansion carriers compared to non‐carriers. Considering clinical phenotypes, sNfL levels were higher in the C9orf72 repeat expansion carriers than in the non‐carriers in bvFTD and PPA groups. Furthermore, sNfL levels were the highest in the FTLD‐MND group (median 105 pg/mL) and the lowest in the bvFTD group (median 27 pg/mL). Higher sNfL levels significantly correlated with frontal cortical atrophy rate and subcortical grey matter atrophy rate. The higher sNfL levels also associated with shorter survival time. Interpretation Our results indicate that the C9orf72 repeat expansion carriers show elevated sNFL levels compared to non‐carriers and that the levels differ among different clinical phenotypes of FTLD. Higher sNfL levels correlated with a shorter survival time and cortical and subcortical atrophy rates. Thus, sNfL could prove as a potential prognostic biomarker in FTLD.
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Affiliation(s)
- Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Aleksi Kontkanen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Olli Jääskeläinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
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Bruun M, Frederiksen KS, Rhodius-Meester HFM, Baroni M, Gjerum L, Koikkalainen J, Urhemaa T, Tolonen A, van Gils M, Tong T, Guerrero R, Rueckert D, Dyremose N, Andersen BB, Simonsen AH, Lemstra A, Hallikainen M, Kurl S, Herukka SK, Remes AM, Waldemar G, Soininen H, Mecocci P, van der Flier WM, Lötjönen J, Hasselbalch SG. Impact of a Clinical Decision Support Tool on Dementia Diagnostics in Memory Clinics: The PredictND Validation Study. Curr Alzheimer Res 2020; 16:91-101. [PMID: 30605060 DOI: 10.2174/1567205016666190103152425] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/04/2018] [Accepted: 12/13/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Determining the underlying etiology of dementia can be challenging. Computer- based Clinical Decision Support Systems (CDSS) have the potential to provide an objective comparison of data and assist clinicians. OBJECTIVES To assess the diagnostic impact of a CDSS, the PredictND tool, for differential diagnosis of dementia in memory clinics. METHODS In this prospective multicenter study, we recruited 779 patients with either subjective cognitive decline (n=252), mild cognitive impairment (n=219) or any type of dementia (n=274) and followed them for minimum 12 months. Based on all available patient baseline data (demographics, neuropsychological tests, cerebrospinal fluid biomarkers, and MRI visual and computed ratings), the PredictND tool provides a comprehensive overview and analysis of the data with a likelihood index for five diagnostic groups; Alzheimer´s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia and subjective cognitive decline. At baseline, a clinician defined an etiological diagnosis and confidence in the diagnosis, first without and subsequently with the PredictND tool. The follow-up diagnosis was used as the reference diagnosis. RESULTS In total, 747 patients completed the follow-up visits (53% female, 69±10 years). The etiological diagnosis changed in 13% of all cases when using the PredictND tool, but the diagnostic accuracy did not change significantly. Confidence in the diagnosis, measured by a visual analogue scale (VAS, 0-100%) increased (ΔVAS=3.0%, p<0.0001), especially in correctly changed diagnoses (ΔVAS=7.2%, p=0.0011). CONCLUSION Adding the PredictND tool to the diagnostic evaluation affected the diagnosis and increased clinicians' confidence in the diagnosis indicating that CDSSs could aid clinicians in the differential diagnosis of dementia.
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Affiliation(s)
- Marie Bruun
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | - Kristian S Frederiksen
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | | | - Marta Baroni
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Le Gjerum
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | | | - Timo Urhemaa
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Antti Tolonen
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Tong Tong
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Ricardo Guerrero
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Daniel Rueckert
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Nadia Dyremose
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | - Birgitte Bo Andersen
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | - Anja H Simonsen
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | - Afina Lemstra
- Alzheimer Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Merja Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sudhir Kurl
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland and Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Wiesje M van der Flier
- Alzheimer Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Steen G Hasselbalch
- Department of Neurology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Denmark
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Vanhala V, Junkkari A, Korhonen VE, Kurki MI, Hiltunen M, Rauramaa T, Nerg O, Koivisto AM, Remes AM, Perälä J, Suvisaari J, Lehto SM, Viinamäki H, Soininen H, Jääskeläinen JE, Leinonen V. Prevalence of Schizophrenia in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery 2020; 84:883-889. [PMID: 29741669 PMCID: PMC6417909 DOI: 10.1093/neuros/nyy147] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/03/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and potentially treatable neurodegenerative disease affecting elderly people, characterized by gait impairment and ventricular enlargement in brain imaging. Similar findings are seen in some patients with schizophrenia (SCZ). OBJECTIVE To determine the prevalence of SCZ among patients suffering from probable or possible iNPH and the specific effects of comorbid SCZ on the outcome of the cerebrospinal fluid (CSF) shunting. METHODS All medical records of the 521 iNPH patients in the NPH registry were retrospectively analyzed from 1991 until 2017. The prevalence of comorbidity of SCZ was determined and compared to that of general aged (≥65 yr) population in Finland. RESULTS We identified a total of 16 (3.1%) iNPH patients suffering from comorbid SCZ. The prevalence of SCZ among the iNPH patients was significantly higher compared to the general population (3.1% vs 0.9%, P < .001). All iNPH patients with comorbid SCZ were CSF shunted and 12 (75%) had a clinically verified shunt response 3 to 12 mo after the procedure. The CSF shunt response rate did not differ between patients with and without comorbid SCZ. CONCLUSION SCZ seems to occur 3 times more frequently among iNPH patients compared to the general aged population in Finland. The outcome of the treatment was not affected by comorbid SCZ and therefore iNPH patients suffering from comorbid SCZ should not be left untreated. These results merit validation in other populations. In addition, further research towards the potential connection between these chronic conditions is warranted.
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Affiliation(s)
- Vasco Vanhala
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Antti Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Ville E Korhonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland.,Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, and Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Boston, Massachusetts
| | | | | | - Ossi Nerg
- Neurology of NeuroCenter, KUH and UEF, Kuopio, Finland
| | | | - Anne M Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Jonna Perälä
- Department Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Turku University Hospital and University of Turku, Turku, Finland
| | - Jaana Suvisaari
- Department Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Social Psychiatry, School of Public Health, University of Tampere, Tampere, Finland
| | - Soili M Lehto
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Psychiatry and Clinical Research Centre, UEF, Kuopio Finland
| | | | | | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
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Rhodius-Meester HFM, van Maurik IS, Koikkalainen J, Tolonen A, Frederiksen KS, Hasselbalch SG, Soininen H, Herukka SK, Remes AM, Teunissen CE, Barkhof F, Pijnenburg YAL, Scheltens P, Lötjönen J, van der Flier WM. Selection of memory clinic patients for CSF biomarker assessment can be restricted to a quarter of cases by using computerized decision support, without compromising diagnostic accuracy. PLoS One 2020; 15:e0226784. [PMID: 31940390 PMCID: PMC6961870 DOI: 10.1371/journal.pone.0226784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION An accurate and timely diagnosis for Alzheimer's disease (AD) is important, both for care and research. The current diagnostic criteria allow the use of CSF biomarkers to provide pathophysiological support for the diagnosis of AD. How these criteria should be operationalized by clinicians is unclear. Tools that guide in selecting patients in which CSF biomarkers have clinical utility are needed. We evaluated computerized decision support to select patients for CSF biomarker determination. METHODS We included 535 subjects (139 controls, 286 Alzheimer's disease dementia, 82 frontotemporal dementia and 28 vascular dementia) from three clinical cohorts. Positive (AD like) and negative (normal) CSF biomarker profiles were simulated to estimate whether knowledge of CSF biomarkers would impact (confidence in) diagnosis. We applied these simulated CSF values and combined them with demographic, neuropsychology and MRI data to initiate CSF testing (computerized decision support approach). We compared proportion of CSF measurements and patients diagnosed with sufficient confidence (probability of correct class ≥0.80) based on an algorithm with scenarios without CSF (only neuropsychology, MRI and APOE), CSF according to the appropriate use criteria (AUC) and CSF for all patients. RESULTS The computerized decision support approach recommended CSF testing in 140 (26%) patients, which yielded a diagnosis with sufficient confidence in 379 (71%) of all patients. This approach was more efficient than CSF in none (0% CSF, 308 (58%) diagnosed), CSF selected based on AUC (295 (55%) CSF, 350 (65%) diagnosed) or CSF in all (100% CSF, 348 (65%) diagnosed). CONCLUSIONS We used a computerized decision support with simulated CSF results in controls and patients with different types of dementia. This approach can support clinicians in making a balanced decision in ordering additional biomarker testing. Computer-supported prediction restricts CSF testing to only 26% of cases, without compromising diagnostic accuracy.
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Affiliation(s)
- Hanneke F M Rhodius-Meester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Internal Medicine, Geriatric Medicine section, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ingrid S van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Antti Tolonen
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Kristian S Frederiksen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steen G Hasselbalch
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Research Neurology, Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- MRC Oulu, Oulu University Hospital, Oulu, Finland
| | - Charlotte E Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
- Institutes of Neurology and Healthcare Engineering, UCL, London, England, United Kingdom
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Kaipainen A, Jääskeläinen O, Liu Y, Haapalinna F, Nykänen N, Vanninen R, Koivisto AM, Julkunen V, Remes AM, Herukka SK. Cerebrospinal Fluid and MRI Biomarkers in Neurodegenerative Diseases: A Retrospective Memory Clinic-Based Study. J Alzheimers Dis 2020; 75:751-765. [PMID: 32310181 PMCID: PMC7369056 DOI: 10.3233/jad-200175] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) biomarkers of neurodegenerative diseases are relatively sensitive and specific in highly curated research cohorts, but proper validation for clinical use is mostly missing. OBJECTIVE We studied these biomarkers in a novel memory clinic cohort with a variety of different neurodegenerative diseases. METHODS This study consisted of 191 patients with subjective or objective cognitive impairment who underwent neurological, CSF biomarker (Aβ42, p-tau, and tau) and T1-weighted MRI examinations at Kuopio University Hospital. We assessed CSF and imaging biomarkers, including structural MRI focused on volumetric and cortical thickness analyses, across groups stratified based on different clinical diagnoses, including Alzheimer's disease (AD), frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease, vascular dementia, and mild cognitive impairment (MCI), and subjects with no evidence of neurodegenerative disease underlying the cognitive symptoms. Imaging biomarkers were also studied by profiling subjects according to the novel amyloid, tau, and, neurodegeneration (AT(N)) classification. RESULTS Numerous imaging variables differed by clinical diagnosis, including hippocampal, amygdalar and inferior lateral ventricular volumes and entorhinal, lingual, inferior parietal and isthmus cingulate cortical thicknesses, at a false discovery rate (FDR)-corrected threshold for significance (analysis of covariance; p < 0.005). In volumetric comparisons by AT(N) profile, hippocampal volume significantly differed (p < 0.001) between patients with normal AD biomarkers and patients with amyloid pathology. CONCLUSION Our analysis suggests that CSF and MRI biomarkers function well also in clinical practice across multiple clinical diagnostic groups in addition to AD, MCI, and cognitively normal groups.
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Affiliation(s)
- Aku Kaipainen
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Olli Jääskeläinen
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Yawu Liu
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Fanni Haapalinna
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Niko Nykänen
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Koivisto
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Valtteri Julkunen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Sanna-Kaisa Herukka
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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48
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Bis JC, Jian X, Kunkle BW, Chen Y, Hamilton-Nelson KL, Bush WS, Salerno WJ, Lancour D, Ma Y, Renton AE, Marcora E, Farrell JJ, Zhao Y, Qu L, Ahmad S, Amin N, Amouyel P, Beecham GW, Below JE, Campion D, Cantwell L, Charbonnier C, Chung J, Crane PK, Cruchaga C, Cupples LA, Dartigues JF, Debette S, Deleuze JF, Fulton L, Gabriel SB, Genin E, Gibbs RA, Goate A, Grenier-Boley B, Gupta N, Haines JL, Havulinna AS, Helisalmi S, Hiltunen M, Howrigan DP, Ikram MA, Kaprio J, Konrad J, Kuzma A, Lander ES, Lathrop M, Lehtimäki T, Lin H, Mattila K, Mayeux R, Muzny DM, Nasser W, Neale B, Nho K, Nicolas G, Patel D, Pericak-Vance MA, Perola M, Psaty BM, Quenez O, Rajabli F, Redon R, Reitz C, Remes AM, Salomaa V, Sarnowski C, Schmidt H, Schmidt M, Schmidt R, Soininen H, Thornton TA, Tosto G, Tzourio C, van der Lee SJ, van Duijn CM, Valladares O, Vardarajan B, Wang LS, Wang W, Wijsman E, Wilson RK, Witten D, Worley KC, Zhang X, Bellenguez C, Lambert JC, Kurki MI, Palotie A, Daly M, Boerwinkle E, Lunetta KL, Destefano AL, Dupuis J, Martin ER, Schellenberg GD, Seshadri S, Naj AC, Fornage M, Farrer LA. Correction: Whole exome sequencing study identifies novel rare and common Alzheimer's-Associated variants involved in immune response and transcriptional regulation. Mol Psychiatry 2020; 25:1901-1903. [PMID: 31636380 PMCID: PMC7387240 DOI: 10.1038/s41380-019-0529-7] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A correction to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Joshua C. Bis
- 0000000122986657grid.34477.33Department of Medicine (General Internal Medicine), University of Washington, Seattle, WA USA
| | - Xueqiu Jian
- 0000 0000 9206 2401grid.267308.8Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Brian W. Kunkle
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Yuning Chen
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Kara L. Hamilton-Nelson
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - William S. Bush
- 0000 0001 2164 3847grid.67105.35Case Western Reserve University, Cleveland Heights, OH USA
| | - William J. Salerno
- 0000 0001 2160 926Xgrid.39382.33Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Daniel Lancour
- 0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Yiyi Ma
- 0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Alan E. Renton
- 0000 0001 0670 2351grid.59734.3cDepartment of Neuroscience and Ronald M Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Edoardo Marcora
- 0000 0001 0670 2351grid.59734.3cDepartment of Neuroscience and Ronald M Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY USA ,0000 0001 0670 2351grid.59734.3cDepartment of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - John J. Farrell
- 0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Yi Zhao
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Liming Qu
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Shahzad Ahmad
- 000000040459992Xgrid.5645.2Erasmus University Medical Center, Rotterdam, Netherlands
| | - Najaf Amin
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Philippe Amouyel
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France ,0000 0001 2159 9858grid.8970.6Institut Pasteur de Lille, Lille, France ,0000 0001 2242 6780grid.503422.2University Lille, U1167-Excellence Laboratory LabEx DISTALZ, Lille, France
| | - Gary W. Beecham
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Jennifer E. Below
- 0000 0004 1936 9916grid.412807.8Department of Medical Genetics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Dominique Campion
- 0000 0004 1785 9671grid.460771.3Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France ,0000 0004 1765 2814grid.477068.aDepartment of Research, Centre Hospitalier du Rouvray, Sotteville-lès-, Rouen, France
| | - Laura Cantwell
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Camille Charbonnier
- 0000 0004 1785 9671grid.460771.3Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Jaeyoon Chung
- 0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Paul K. Crane
- 0000000122986657grid.34477.33Department of Medicine (General Internal Medicine), University of Washington, Seattle, WA USA
| | - Carlos Cruchaga
- 0000 0001 2355 7002grid.4367.6Department of Psychiatry, Washington University, St. Louis, MO USA
| | - L. Adrienne Cupples
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,0000 0001 2293 4638grid.279885.9National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA USA
| | - Jean-François Dartigues
- 0000 0001 2106 639Xgrid.412041.2University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France
| | - Stéphanie Debette
- 0000 0001 2106 639Xgrid.412041.2University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France ,0000 0004 0593 7118grid.42399.35Department of Neurology and Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Memory Clinic, F-33000 Bordeaux, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine, Institut François Jacob, Direction de le Recherche Fondamentale, CEA, Evry, France
| | - Lucinda Fulton
- 0000 0001 2355 7002grid.4367.6McDonnell Genome Institute, Washington University, St. Louis, MO USA
| | | | | | - Richard A. Gibbs
- 0000 0001 2160 926Xgrid.39382.33Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Alison Goate
- 0000 0001 0670 2351grid.59734.3cDepartment of Neuroscience and Ronald M Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY USA ,0000 0001 0670 2351grid.59734.3cDepartment of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Benjamin Grenier-Boley
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Namrata Gupta
- grid.66859.34Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Jonathan L. Haines
- 0000 0001 2164 3847grid.67105.35Case Western Reserve University, Cleveland Heights, OH USA
| | - Aki S. Havulinna
- 0000 0004 0410 2071grid.7737.4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,0000 0001 1013 0499grid.14758.3fNational Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Helisalmi
- 0000 0001 0726 2490grid.9668.1Institute of Clinical Medicine - Neurology and Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- 0000 0001 0726 2490grid.9668.1Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Daniel P. Howrigan
- grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,0000 0004 0386 9924grid.32224.35Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - M. Arfan Ikram
- 000000040459992Xgrid.5645.2Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jaakko Kaprio
- 0000 0004 0410 2071grid.7737.4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Jan Konrad
- 0000 0001 2355 7002grid.4367.6Department of Psychiatry, Washington University, St. Louis, MO USA
| | - Amanda Kuzma
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Eric S. Lander
- grid.66859.34Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Mark Lathrop
- grid.411640.6McGill University and Génome Québec Innovation Centre, Montréal, Canada
| | - Terho Lehtimäki
- 0000 0001 2314 6254grid.502801.eDepartment of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Honghuang Lin
- 0000 0004 0367 5222grid.475010.7Department of Medicine (Computational Biomedicine), Boston University School of Medicine, Boston, MA USA
| | - Kari Mattila
- 0000 0001 2314 6254grid.502801.eDepartment of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Richard Mayeux
- 0000000419368729grid.21729.3fColumbia University, New York, NY USA
| | - Donna M. Muzny
- 0000 0001 2160 926Xgrid.39382.33Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Waleed Nasser
- 0000 0001 2160 926Xgrid.39382.33Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Benjamin Neale
- grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,0000 0004 0386 9924grid.32224.35Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Kwangsik Nho
- 0000 0001 2287 3919grid.257413.6Indiana University School of Medicine, Indianapolis, IN USA
| | - Gaël Nicolas
- 0000 0004 1785 9671grid.460771.3Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Devanshi Patel
- 0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Margaret A. Pericak-Vance
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Markus Perola
- 0000 0004 0410 2071grid.7737.4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,0000 0001 1013 0499grid.14758.3fNational Institute for Health and Welfare, Helsinki, Finland ,0000 0001 0943 7661grid.10939.32University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Bruce M. Psaty
- 0000000122986657grid.34477.33Department of Medicine (General Internal Medicine), University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Epidemiology, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Health Services, University of Washington, Seattle, WA USA ,0000 0004 0615 7519grid.488833.cKaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Olivier Quenez
- 0000 0004 1785 9671grid.460771.3Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Farid Rajabli
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Richard Redon
- 0000 0004 0472 0371grid.277151.7Inserm, CNRS, Univ. Nantes, CHU Nantes, l’institut du thorax, Nantes, France
| | - Christiane Reitz
- 0000000419368729grid.21729.3fColumbia University, New York, NY USA
| | - Anne M. Remes
- 0000 0001 0726 2490grid.9668.1Institute of Clinical Medicine - Neurology and Department of Neurology, University of Eastern Finland, Kuopio, Finland ,0000 0004 4685 4917grid.412326.0Unit of Clinical Neuroscience, Neurology, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Veikko Salomaa
- 0000 0001 1013 0499grid.14758.3fNational Institute for Health and Welfare, Helsinki, Finland
| | - Chloe Sarnowski
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Helena Schmidt
- 0000 0000 8988 2476grid.11598.34Department of Neurology, Clinical Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Michael Schmidt
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Reinhold Schmidt
- 0000 0000 8988 2476grid.11598.34Department of Neurology, Clinical Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Hilkka Soininen
- 0000 0001 0726 2490grid.9668.1Institute of Clinical Medicine - Neurology and Department of Neurology, University of Eastern Finland, Kuopio, Finland ,0000 0004 0628 207Xgrid.410705.7Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Timothy A. Thornton
- 0000000122986657grid.34477.33Department of Statistics, University of Washington, Seattle, WA USA
| | - Giuseppe Tosto
- 0000000419368729grid.21729.3fColumbia University, New York, NY USA
| | - Christophe Tzourio
- 0000 0001 2106 639Xgrid.412041.2University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France
| | - Sven J. van der Lee
- 000000040459992Xgrid.5645.2Erasmus University Medical Center, Rotterdam, Netherlands
| | - Cornelia M. van Duijn
- 000000040459992Xgrid.5645.2Erasmus University Medical Center, Rotterdam, Netherlands
| | - Otto Valladares
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Badri Vardarajan
- 0000000419368729grid.21729.3fColumbia University, New York, NY USA
| | - Li-San Wang
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Weixin Wang
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Ellen Wijsman
- 0000000122986657grid.34477.33Department of Medicine (Medical Genetics), University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Richard K. Wilson
- 0000 0001 2355 7002grid.4367.6McDonnell Genome Institute, Washington University, St. Louis, MO USA
| | - Daniela Witten
- 0000000122986657grid.34477.33Department of Statistics, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Kim C. Worley
- 0000 0001 2160 926Xgrid.39382.33Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Xiaoling Zhang
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | | | - Celine Bellenguez
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Jean-Charles Lambert
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Mitja I. Kurki
- 0000 0004 0410 2071grid.7737.4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,0000 0004 0386 9924grid.32224.35Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Aarno Palotie
- 0000 0004 0410 2071grid.7737.4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,0000 0004 0386 9924grid.32224.35Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Mark Daly
- grid.66859.34Broad Institute of MIT and Harvard, Cambridge, MA USA ,0000 0004 0410 2071grid.7737.4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,0000 0004 0386 9924grid.32224.35Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Eric Boerwinkle
- 0000 0001 2160 926Xgrid.39382.33Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA ,0000 0000 9206 2401grid.267308.8School of Public Health, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Kathryn L. Lunetta
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Anita L. Destefano
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Departments of Neurology, Boston University School of Medicine, Boston, MA USA
| | - Josée Dupuis
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Eden R. Martin
- 0000 0004 1936 8606grid.26790.3aJohn P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Gerard D. Schellenberg
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Sudha Seshadri
- 0000 0001 2293 4638grid.279885.9National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA USA ,0000 0004 0367 5222grid.475010.7Departments of Neurology, Boston University School of Medicine, Boston, MA USA ,0000 0001 0629 5880grid.267309.9Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX USA
| | - Adam C. Naj
- 0000 0004 1936 8972grid.25879.31University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Myriam Fornage
- 0000 0000 9206 2401grid.267308.8Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX USA ,0000 0000 9206 2401grid.267308.8School of Public Health, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Lindsay A. Farrer
- 0000 0004 1936 7558grid.189504.1Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Departments of Neurology, Boston University School of Medicine, Boston, MA USA ,0000 0004 1936 7558grid.189504.1Department of Epidemiology, Boston University School of Public Health, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Ophthalmology, Boston University School of Medicine, Boston, MA USA
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49
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Bis JC, Jian X, Kunkle BW, Chen Y, Hamilton-Nelson KL, Bush WS, Salerno WJ, Lancour D, Ma Y, Renton AE, Marcora E, Farrell JJ, Zhao Y, Qu L, Ahmad S, Amin N, Amouyel P, Beecham GW, Below JE, Campion D, Cantwell L, Charbonnier C, Chung J, Crane PK, Cruchaga C, Cupples LA, Dartigues JF, Debette S, Deleuze JF, Fulton L, Gabriel SB, Genin E, Gibbs RA, Goate A, Grenier-Boley B, Gupta N, Haines JL, Havulinna AS, Helisalmi S, Hiltunen M, Howrigan DP, Ikram MA, Kaprio J, Konrad J, Kuzma A, Lander ES, Lathrop M, Lehtimäki T, Lin H, Mattila K, Mayeux R, Muzny DM, Nasser W, Neale B, Nho K, Nicolas G, Patel D, Pericak-Vance MA, Perola M, Psaty BM, Quenez O, Rajabli F, Redon R, Reitz C, Remes AM, Salomaa V, Sarnowski C, Schmidt H, Schmidt M, Schmidt R, Soininen H, Thornton TA, Tosto G, Tzourio C, van der Lee SJ, van Duijn CM, Valladares O, Vardarajan B, Wang LS, Wang W, Wijsman E, Wilson RK, Witten D, Worley KC, Zhang X, Bellenguez C, Lambert JC, Kurki MI, Palotie A, Daly M, Boerwinkle E, Lunetta KL, Destefano AL, Dupuis J, Martin ER, Schellenberg GD, Seshadri S, Naj AC, Fornage M, Farrer LA. Whole exome sequencing study identifies novel rare and common Alzheimer's-Associated variants involved in immune response and transcriptional regulation. Mol Psychiatry 2020; 25:1859-1875. [PMID: 30108311 PMCID: PMC6375806 DOI: 10.1038/s41380-018-0112-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
Abstract
The Alzheimer's Disease Sequencing Project (ADSP) undertook whole exome sequencing in 5,740 late-onset Alzheimer disease (AD) cases and 5,096 cognitively normal controls primarily of European ancestry (EA), among whom 218 cases and 177 controls were Caribbean Hispanic (CH). An age-, sex- and APOE based risk score and family history were used to select cases most likely to harbor novel AD risk variants and controls least likely to develop AD by age 85 years. We tested ~1.5 million single nucleotide variants (SNVs) and 50,000 insertion-deletion polymorphisms (indels) for association to AD, using multiple models considering individual variants as well as gene-based tests aggregating rare, predicted functional, and loss of function variants. Sixteen single variants and 19 genes that met criteria for significant or suggestive associations after multiple-testing correction were evaluated for replication in four independent samples; three with whole exome sequencing (2,778 cases, 7,262 controls) and one with genome-wide genotyping imputed to the Haplotype Reference Consortium panel (9,343 cases, 11,527 controls). The top findings in the discovery sample were also followed-up in the ADSP whole-genome sequenced family-based dataset (197 members of 42 EA families and 501 members of 157 CH families). We identified novel and predicted functional genetic variants in genes previously associated with AD. We also detected associations in three novel genes: IGHG3 (p = 9.8 × 10-7), an immunoglobulin gene whose antibodies interact with β-amyloid, a long non-coding RNA AC099552.4 (p = 1.2 × 10-7), and a zinc-finger protein ZNF655 (gene-based p = 5.0 × 10-6). The latter two suggest an important role for transcriptional regulation in AD pathogenesis.
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Affiliation(s)
- Joshua C. Bis
- grid.34477.330000000122986657Department of Medicine (General Internal Medicine), University of Washington, Seattle, WA USA
| | - Xueqiu Jian
- grid.267308.80000 0000 9206 2401Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Brian W. Kunkle
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Yuning Chen
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Kara L. Hamilton-Nelson
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - William S. Bush
- grid.67105.350000 0001 2164 3847Case Western Reserve University, Cleveland Heights, OH USA
| | - William J. Salerno
- grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Daniel Lancour
- grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Yiyi Ma
- grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Alan E. Renton
- grid.59734.3c0000 0001 0670 2351Department of Neuroscience and Ronald M Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Edoardo Marcora
- grid.59734.3c0000 0001 0670 2351Department of Neuroscience and Ronald M Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - John J. Farrell
- grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Yi Zhao
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Liming Qu
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Shahzad Ahmad
- grid.5645.2000000040459992XErasmus University Medical Center, Rotterdam, Netherlands
| | - Najaf Amin
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Philippe Amouyel
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France ,grid.8970.60000 0001 2159 9858Institut Pasteur de Lille, Lille, France ,grid.503422.20000 0001 2242 6780University Lille, U1167-Excellence Laboratory LabEx DISTALZ, Lille, France
| | - Gary W. Beecham
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Jennifer E. Below
- grid.412807.80000 0004 1936 9916Department of Medical Genetics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Dominique Campion
- grid.460771.30000 0004 1785 9671Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France ,grid.477068.a0000 0004 1765 2814Department of Research, Centre Hospitalier du Rouvray, Sotteville-lès-, Rouen, France
| | - Laura Cantwell
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Camille Charbonnier
- grid.460771.30000 0004 1785 9671Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Jaeyoon Chung
- grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Paul K. Crane
- grid.34477.330000000122986657Department of Medicine (General Internal Medicine), University of Washington, Seattle, WA USA
| | - Carlos Cruchaga
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University, St. Louis, MO USA
| | - L. Adrienne Cupples
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,grid.510954.c0000 0004 0444 3861National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA USA
| | - Jean-François Dartigues
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France
| | - Stéphanie Debette
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Neurology and Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Memory Clinic, F-33000 Bordeaux, France
| | - Jean-François Deleuze
- grid.418135.a0000 0004 0641 3404Centre National de Recherche en Génomique Humaine, Institut François Jacob, Direction de le Recherche Fondamentale, CEA, Evry, France
| | - Lucinda Fulton
- grid.4367.60000 0001 2355 7002McDonnell Genome Institute, Washington University, St. Louis, MO USA
| | | | | | - Richard A. Gibbs
- grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Alison Goate
- grid.59734.3c0000 0001 0670 2351Department of Neuroscience and Ronald M Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Benjamin Grenier-Boley
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Namrata Gupta
- grid.66859.34Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Jonathan L. Haines
- grid.67105.350000 0001 2164 3847Case Western Reserve University, Cleveland Heights, OH USA
| | - Aki S. Havulinna
- grid.452494.a0000 0004 0409 5350Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499National Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Helisalmi
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine - Neurology and Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- grid.9668.10000 0001 0726 2490Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Daniel P. Howrigan
- grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - M. Arfan Ikram
- grid.5645.2000000040459992XErasmus University Medical Center, Rotterdam, Netherlands
| | - Jaakko Kaprio
- grid.452494.a0000 0004 0409 5350Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Jan Konrad
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University, St. Louis, MO USA
| | - Amanda Kuzma
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Eric S. Lander
- grid.66859.34Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Mark Lathrop
- grid.411640.6McGill University and Génome Québec Innovation Centre, Montréal, Canada
| | - Terho Lehtimäki
- grid.502801.e0000 0001 2314 6254Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Honghuang Lin
- grid.189504.10000 0004 1936 7558Department of Medicine (Computational Biomedicine), Boston University School of Medicine, Boston, MA USA
| | - Kari Mattila
- grid.502801.e0000 0001 2314 6254Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Richard Mayeux
- grid.21729.3f0000000419368729Columbia University, New York, NY USA
| | - Donna M. Muzny
- grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Waleed Nasser
- grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Benjamin Neale
- grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Kwangsik Nho
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, IN USA
| | - Gaël Nicolas
- grid.460771.30000 0004 1785 9671Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Devanshi Patel
- grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | - Margaret A. Pericak-Vance
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Markus Perola
- grid.452494.a0000 0004 0409 5350Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499National Institute for Health and Welfare, Helsinki, Finland ,grid.10939.320000 0001 0943 7661University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Bruce M. Psaty
- grid.34477.330000000122986657Department of Medicine (General Internal Medicine), University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Health Services, University of Washington, Seattle, WA USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Olivier Quenez
- grid.460771.30000 0004 1785 9671Department of Genetics and CNR-MAJ, Normandie Université, UNIROUEN, Inserm U1245 and Rouen University Hospital, F 76000, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Farid Rajabli
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Richard Redon
- grid.277151.70000 0004 0472 0371Inserm, CNRS, Univ. Nantes, CHU Nantes, l’institut du thorax, Nantes, France
| | - Christiane Reitz
- grid.21729.3f0000000419368729Columbia University, New York, NY USA
| | - Anne M. Remes
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine - Neurology and Department of Neurology, University of Eastern Finland, Kuopio, Finland ,grid.412326.00000 0004 4685 4917Unit of Clinical Neuroscience, Neurology, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Veikko Salomaa
- grid.14758.3f0000 0001 1013 0499National Institute for Health and Welfare, Helsinki, Finland
| | - Chloe Sarnowski
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Helena Schmidt
- grid.11598.340000 0000 8988 2476Department of Neurology, Clinical Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Michael Schmidt
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Reinhold Schmidt
- grid.11598.340000 0000 8988 2476Department of Neurology, Clinical Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Hilkka Soininen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine - Neurology and Department of Neurology, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Timothy A. Thornton
- grid.34477.330000000122986657Department of Statistics, University of Washington, Seattle, WA USA
| | - Giuseppe Tosto
- grid.21729.3f0000000419368729Columbia University, New York, NY USA
| | - Christophe Tzourio
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France
| | - Sven J. van der Lee
- grid.5645.2000000040459992XErasmus University Medical Center, Rotterdam, Netherlands
| | - Cornelia M. van Duijn
- grid.5645.2000000040459992XErasmus University Medical Center, Rotterdam, Netherlands
| | - Otto Valladares
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Badri Vardarajan
- grid.21729.3f0000000419368729Columbia University, New York, NY USA
| | - Li-San Wang
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Weixin Wang
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Ellen Wijsman
- grid.34477.330000000122986657Department of Medicine (Medical Genetics), University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Richard K. Wilson
- grid.4367.60000 0001 2355 7002McDonnell Genome Institute, Washington University, St. Louis, MO USA
| | - Daniela Witten
- grid.34477.330000000122986657Department of Statistics, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Kim C. Worley
- grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA
| | - Xiaoling Zhang
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA
| | | | - Celine Bellenguez
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Jean-Charles Lambert
- grid.457380.dInserm, U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Mitja I. Kurki
- grid.452494.a0000 0004 0409 5350Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Aarno Palotie
- grid.452494.a0000 0004 0409 5350Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.66859.34Program in Medical and Population Genetics and Genetic Analysis Platform, Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Mark Daly
- grid.66859.34Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.452494.a0000 0004 0409 5350Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland ,grid.32224.350000 0004 0386 9924Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA USA
| | - Eric Boerwinkle
- grid.39382.330000 0001 2160 926XHuman Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX USA ,grid.267308.80000 0000 9206 2401School of Public Health, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Kathryn L. Lunetta
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Anita L. Destefano
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Departments of Neurology, Boston University School of Medicine, Boston, MA USA
| | - Josée Dupuis
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Eden R. Martin
- grid.26790.3a0000 0004 1936 8606John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Gerard D. Schellenberg
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Sudha Seshadri
- grid.510954.c0000 0004 0444 3861National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA USA ,grid.189504.10000 0004 1936 7558Departments of Neurology, Boston University School of Medicine, Boston, MA USA ,grid.267309.90000 0001 0629 5880Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX USA
| | - Adam C. Naj
- grid.25879.310000 0004 1936 8972University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Myriam Fornage
- grid.267308.80000 0000 9206 2401Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX USA ,grid.267308.80000 0000 9206 2401School of Public Health, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Lindsay A. Farrer
- grid.189504.10000 0004 1936 7558Departments of Biostatistics, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA USA ,grid.189504.10000 0004 1936 7558Departments of Neurology, Boston University School of Medicine, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Epidemiology, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Ophthalmology, Boston University School of Medicine, Boston, MA USA
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Korhonen VE, Remes AM, Helisalmi S, Rauramaa T, Sutela A, Vanninen R, Suhonen NM, Haapasalo A, Hiltunen M, Jääskeläinen JE, Soininen H, Koivisto AM, Leinonen V. Prevalence of C9ORF72 Expansion in a Large Series of Patients with Idiopathic Normal-Pressure Hydrocephalus. Dement Geriatr Cogn Disord 2019; 47:91-103. [PMID: 30861516 DOI: 10.1159/000497306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The C9ORF72 expansion is known to cause frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). We aim to identify the prevalence of the C9ORF72 expansion in idiopathic normal pressure hydrocephalus (iNPH). METHODS We analysed the C9ORF72 expansion in a large cohort of patients with possible iNPH (n = 487) and cognitively intact elderly controls (n = 432; age > 65 years). RESULTS While the C9ORF72 expansion was detected in 1.6% (n = 8/487) of cases with possible iNPH, no control subject was found to carry the mutation. The mean age at onset of symptoms of C9ORF72 expansion carriers was 59 years (range: 52-67 years), 11 years less than non-carriers (p = 0.0002). The most frequent initial/main symptom pertained to gait difficulties. Despite identified mutation, only 3 of the patients fulfilled the criteria for the FTLD-ALS spectrum. Clinically significant shunt response was detected in 6 out of 7 shunted C9ORF72 expansion carriers. CONCLUSION This is the first study cohort identifying the underlying C9ORF72 expansion in patients with iNPH providing evidence for the potential comorbidity between iNPH and the FTLD-ALS spectrum. Analysis of the C9ORF72 expansion should be considered for patients with probable iNPH presenting with frontal atrophy and personality changes or other severe psychiatric symptoms.
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Affiliation(s)
- Ville E Korhonen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland,
| | - Anne M Remes
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Institute of Clinical Medicine - Pathology, School of Medicine, University of Eastern Finland and Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Noora-Maria Suhonen
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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