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Wang W, Baker K, Umamahesan C, Gilmour S, Charlett A, Taylor D, Young AH, Dobbs RJ, Dobbs SM. Bradyphrenia and Tachyphrenia in Idiopathic Parkinsonism Appear, in Part, Iatrogenic: An Observational Study with Systematic Review Background. J Clin Med 2023; 12:6499. [PMID: 37892637 PMCID: PMC10607457 DOI: 10.3390/jcm12206499] [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: 08/31/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
We question whether bradyphrenia, slowing of cognitive processing not explained by depression or a global cognitive assessment, is a nosological entity in idiopathic parkinsonism (IP). The time taken to break contact of an index finger with a touch-sensitive plate was measured, with and without a warning in the alerting signal as to which side the imperative would indicate, in 77 people diagnosed with IP and in 124 people without an IP diagnosis. The ability to utilise a warning, measured by the difference between loge-transformed reaction times (unwarned minus warned), was termed 'cognitive efficiency'. It was approximately normally distributed. A questionnaire on self- and partner perception of proband's bradyphrenia was applied. A multivariable model showed that those prescribed levodopa were less cognitively efficient (mean -5.2 (CI -9.5, -1.0)% per 300 mg/day, p = 0.02), but those prescribed the anti-muscarinic trihexyphenidyl were more efficient (14.7 (0.2, 31.3)% per 4 mg/day, p < 0.05) and those prescribed monoamine oxidase-B inhibitor (MAOBI) tended to be more efficient (8.3 (0.0, 17.4)%, p = 0.07). The variance in efficiency was greater within IP (F-test, p = 0.01 adjusted for any demographic covariates: coefficient of variation, with and without IP, 0.68 and 0.46, respectively), but not so after adjustment for anti-parkinsonian medication (p = 0.13: coefficient of variation 0.62). The within-participant follow-up time, a median of 4.8 (interquartile range 3.1, 5.5) years (101 participants), did not influence efficiency, irrespective of IP status. Perception of bradyphrenia did not usefully predict efficiency. We conclude that both bradyphrenia and 'tachyphrenia' in IP appear to have iatrogenic components, of clinically important size, related to the dose of antiparkinsonian medication. Levodopa is the most commonly prescribed first-line medication: co-prescribing a MAOBI may circumvent its associated bradyphrenia. The previously reported greater efficiency associated with (low-dose) anti-muscarinic was confirmed.
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Affiliation(s)
- Wenjing Wang
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Kieran Baker
- Department of Mathematics, King’s College London, London WC2R 2LS, UK (S.G.)
| | - Chianna Umamahesan
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
| | - Steven Gilmour
- Department of Mathematics, King’s College London, London WC2R 2LS, UK (S.G.)
| | - André Charlett
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
- Statistics, Modelling and Economics, UK Health Security Agency, London NW9 5EQ, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
| | - Allan H. Young
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - R. John Dobbs
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
| | - Sylvia M. Dobbs
- South London and Maudsley NHS Foundation Trust, London SE5 8AB, UK (C.U.); (D.T.); (A.H.Y.)
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK;
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
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Augustin A, Guennec AL, Umamahesan C, Kendler‐Rhodes A, Tucker RM, Chekmeneva E, Takis P, Lewis M, Balasubramanian K, DeSouza N, Mullish BH, Taylor D, Ryan S, Whelan K, Ma Y, Ibrahim MAA, Bjarnason I, Hayee BH, Charlett A, Dobbs SM, Dobbs RJ, Weller C. Faecal metabolite deficit, gut inflammation and diet in Parkinson's disease: Integrative analysis indicates inflammatory response syndrome. Clin Transl Med 2023; 13:e1152. [PMID: 36588088 PMCID: PMC9806009 DOI: 10.1002/ctm2.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/16/2022] [Accepted: 12/08/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gut-brain axis is widely implicated in the pathophysiology of Parkinson's disease (PD). We take an integrated approach to considering the gut as a target for disease-modifying intervention, using continuous measurements of disease facets irrespective of diagnostic divide. METHODS We characterised 77 participants with diagnosed-PD, 113 without, by dietary/exogenous substance intake, faecal metabolome, intestinal inflammation, serum cytokines/chemokines, clinical phenotype including colonic transit time. Complete-linkage hierarchical cluster analysis of metabolites discriminant for PD-status was performed. RESULTS Longer colonic transit was linked to deficits in faecal short-chain-fatty acids outside PD, to a 'tryptophan-containing metabolite cluster' overall. Phenotypic cluster analysis aggregated colonic transit with brady/hypokinesia, tremor, sleep disorder and dysosmia, each individually associated with tryptophan-cluster deficit. Overall, a faster pulse was associated with deficits in a metabolite cluster including benzoic acid and an imidazole-ring compound (anti-fungals) and vitamin B3 (anti-inflammatory) and with higher serum CCL20 (chemotactic for lymphocytes/dendritic cells towards mucosal epithelium). The faster pulse in PD was irrespective of postural hypotension. The benzoic acid-cluster deficit was linked to (well-recognised) lower caffeine and alcohol intakes, tryptophan-cluster deficit to higher maltose intake. Free-sugar intake was increased in PD, maltose intake being 63% higher (p = .001). Faecal calprotectin was 44% (95% CI 5%, 98%) greater in PD [p = .001, adjusted for proton-pump inhibitors (p = .001)], with 16% of PD-probands exceeding a cut-point for clinically significant inflammation compatible with inflammatory bowel disease. Higher maltose intake was associated with exceeding this calprotectin cut-point. CONCLUSIONS Emerging picture is of (i) clinical phenotype being described by deficits in microbial metabolites essential to gut health; (ii) intestinal inflammation; (iii) a systemic inflammatory response syndrome.
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Affiliation(s)
- Aisha Augustin
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- The Maudsley HospitalLondonUK
| | | | - Chianna Umamahesan
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- The Maudsley HospitalLondonUK
| | | | - Rosalind M. Tucker
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- The Maudsley HospitalLondonUK
| | - Elena Chekmeneva
- National Phenome CentreImperial College LondonLondonUK
- Section of Bioanalytical ChemistryImperial College LondonLondonUK
| | - Panteleimon Takis
- National Phenome CentreImperial College LondonLondonUK
- Section of Bioanalytical ChemistryImperial College LondonLondonUK
| | - Matthew Lewis
- National Phenome CentreImperial College LondonLondonUK
- Section of Bioanalytical ChemistryImperial College LondonLondonUK
| | | | | | - Benjamin H Mullish
- Department of MetabolismDigestion and ReproductionImperial College, LondonUK
| | - David Taylor
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- The Maudsley HospitalLondonUK
| | | | - Kevin Whelan
- Nutritional SciencesKing's College LondonLondonUK
| | - Yun Ma
- Institute of Liver StudiesKing's College HospitalLondonUK
| | | | | | | | - André Charlett
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- Statistics, Modelling and EconomicsUK Health Security AgencyLondonUK
| | - Sylvia M. Dobbs
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- GastroenterologyKing's College HospitalLondonUK
| | - R. John Dobbs
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
- GastroenterologyKing's College HospitalLondonUK
| | - Clive Weller
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
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Peña OA, Lubin A, Rowell J, Hoade Y, Khokhar N, Lemmik H, Mahony C, Dace P, Umamahesan C, Payne EM. Differential Requirement of Gata2a and Gata2b for Primitive and Definitive Myeloid Development in Zebrafish. Front Cell Dev Biol 2021; 9:708113. [PMID: 34589480 PMCID: PMC8475954 DOI: 10.3389/fcell.2021.708113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
Germline loss or mutation of one copy of the transcription factor GATA2 in humans leads to a range of clinical phenotypes affecting hematopoietic, lymphatic and vascular systems. GATA2 heterozygous mice show only a limited repertoire of the features observed in humans. Zebrafish have two copies of the Gata2 gene as a result of an additional round of ancestral whole genome duplication. These genes, Gata2a and Gata2b, show distinct but overlapping expression patterns, and between them, highlight a significantly broader range of the phenotypes observed in GATA2 deficient syndromes, than each one alone. In this manuscript, we use mutants for Gata2a and Gata2b to interrogate the effects on hematopoiesis of these two ohnologs, alone and in combination, during development in order to further define the role of GATA2 in developmental hematopoiesis. We define unique roles for each ohnolog at different stages of developmental myelopoiesis and for the emergence of hematopoietic stem and progenitor cells. These effects are not additive in the haploinsufficient state suggesting a redundancy between these two genes in hematopoietic stem and progenitor cells. Rescue studies additionally support that Gata2b can compensate for the effects of Gata2a loss. Finally we show that adults with loss of combined heterozygosity show defects in the myeloid compartment consistent with GATA2 loss in humans. These results build on existing knowledge from other models of GATA2 deficiency and refine our understanding of the early developmental effects of GATA2. In addition, these studies shed light on the complexity and potential structure-function relationships as well as sub-functionalization of Gata2 genes in the zebrafish model.
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Affiliation(s)
- Oscar A. Peña
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Alexandra Lubin
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Jasmine Rowell
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Yvette Hoade
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Noreen Khokhar
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Hanna Lemmik
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Christopher Mahony
- Department of Pathology and Immunology, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Phoebe Dace
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Chianna Umamahesan
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
| | - Elspeth M. Payne
- Research Department of Haematology, Cancer Institute, University College London, London, United Kingdom
- National Institute for Health Research (NIHR)/UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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