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Nigro S, Filardi M, Tafuri B, Nicolardi M, De Blasi R, Giugno A, Gnoni V, Milella G, Urso D, Zoccolella S, Logroscino G. Deep Learning-based Approach for Brainstem and Ventricular MR Planimetry: Application in Patients with Progressive Supranuclear Palsy. Radiol Artif Intell 2024; 6:e230151. [PMID: 38506619 DOI: 10.1148/ryai.230151] [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: 03/21/2024]
Abstract
Purpose To develop a fast and fully automated deep learning (DL)-based method for the MRI planimetric segmentation and measurement of the brainstem and ventricular structures most affected in patients with progressive supranuclear palsy (PSP). Materials and Methods In this retrospective study, T1-weighted MR images in healthy controls (n = 84) were used to train DL models for segmenting the midbrain, pons, middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), third ventricle, and frontal horns (FHs). Internal, external, and clinical test datasets (n = 305) were used to assess segmentation model reliability. DL masks from test datasets were used to automatically extract midbrain and pons areas and the width of MCP, SCP, third ventricle, and FHs. Automated measurements were compared with those manually performed by an expert radiologist. Finally, these measures were combined to calculate the midbrain to pons area ratio, MR parkinsonism index (MRPI), and MRPI 2.0, which were used to differentiate patients with PSP (n = 71) from those with Parkinson disease (PD) (n = 129). Results Dice coefficients above 0.85 were found for all brain regions when comparing manual and DL-based segmentations. A strong correlation was observed between automated and manual measurements (Spearman ρ > 0.80, P < .001). DL-based measurements showed excellent performance in differentiating patients with PSP from those with PD, with an area under the receiver operating characteristic curve above 0.92. Conclusion The automated approach successfully segmented and measured the brainstem and ventricular structures. DL-based models may represent a useful approach to support the diagnosis of PSP and potentially other conditions associated with brainstem and ventricular alterations. Keywords: MR Imaging, Brain/Brain Stem, Segmentation, Quantification, Diagnosis, Convolutional Neural Network Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Mohajer in this issue.
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Affiliation(s)
- Salvatore Nigro
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Marco Filardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Benedetta Tafuri
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Martina Nicolardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Roberto De Blasi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Alessia Giugno
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Valentina Gnoni
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giammarco Milella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Daniele Urso
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Stefano Zoccolella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giancarlo Logroscino
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
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Ferrari AJ, Santomauro DF, Aali A, Abate YH, Abbafati C, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdollahi A, Abdullahi A, Abegaz KH, Abeldaño Zuñiga RA, Aboagye RG, Abolhassani H, Abreu LG, Abualruz H, Abu-Gharbieh E, Abu-Rmeileh NME, Ackerman IN, Addo IY, Addolorato G, Adebiyi AO, Adepoju AV, Adewuyi HO, Afyouni S, Afzal S, Afzal S, Agodi A, Ahmad A, Ahmad D, Ahmad F, Ahmad S, Ahmed A, Ahmed LA, Ahmed MB, Ajami M, Akinosoglou K, Akkaif MA, Al Hasan SM, Alalalmeh SO, Al-Aly Z, Albashtawy M, Aldridge RW, Alemu MD, Alemu YM, Alene KA, Al-Gheethi AAS, Alharrasi M, Alhassan RK, Ali MU, Ali R, Ali SSS, Alif SM, Aljunid SM, Al-Marwani S, Almazan JU, Alomari MA, Al-Omari B, Altaany Z, Alvis-Guzman N, Alvis-Zakzuk NJ, Alwafi H, Al-Wardat MS, Al-Worafi YM, Aly S, Alzoubi KH, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amugsi DA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Ansari H, Antony CM, Anwar S, Anwar SL, Anwer R, Anyanwu PE, Arab JP, Arabloo J, Arafat M, Araki DT, Aravkin AY, Arkew M, Armocida B, Arndt MB, Arooj M, Artamonov AA, Aruleba RT, Arumugam A, Ashbaugh C, Ashemo MY, Ashraf M, Asika MO, Askari E, Astell-Burt T, Athari SS, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awotidebe AW, Awuviry-Newton K, Ayala Quintanilla BP, Ayuso-Mateos JL, Azadnajafabad S, Azevedo RMS, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bah S, Bai R, Baker JL, Bakkannavar SM, Bako AT, Balakrishnan S, Bam K, Banik PC, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Barqawi HJ, Barrow A, Barteit S, Barua L, Bashiri Aliabadi S, Basiru A, Basu S, Basu S, Bathini PP, Batra K, Baune BT, Bayileyegn NS, Behnam B, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Bell ML, Bello OO, Beloukas A, Bensenor IM, Berezvai Z, Bernabe E, Bernstein RS, Bettencourt PJG, Bhagavathula AS, Bhala N, Bhandari D, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bitra VR, Bjørge T, Bodolica V, Bodunrin AO, Bogale EK, Bonakdar Hashemi M, Bonny A, Bora Basara B, Borhany H, Boxe C, Brady OJ, Bragazzi NL, Braithwaite D, Brant LC, Brauer M, Breitner S, Brenner H, Brown J, Brugha T, Bulamu NB, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt ZA, Byun J, Caetano dos Santos FL, Calina D, Cámera LA, Campos-Nonato IR, Cao C, Capodici A, Carr S, Carreras G, Carugno A, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catapano AL, Cattaruzza MS, Caye A, Cegolon L, Cembranel F, Cenderadewi M, Cerin E, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Charalampous P, Chattu VK, Chatzimavridou-Grigoriadou V, Chen AW, Chen AT, Chen CS, Chen H, Chen NM, Cheng ETW, Chimed-Ochir O, Chimoriya R, Ching PR, Cho WCS, Choi S, Chong B, Chong YY, Choudhari SG, Chowdhury R, Christensen SWM, Chu DT, Chukwu IS, Chung E, Chung E, Chutiyami M, Claassens MM, Cogen RM, Columbus A, Conde J, Cortesi PA, Cousin E, Criqui MH, Cruz-Martins N, Dadras O, Dai S, Dai X, Dai Z, Dalaba MA, Damiani G, Das JK, Das S, Dashti M, Dávila-Cervantes CA, Davletov K, De Leo D, Debele AT, Debopadhaya S, DeCleene NK, Deeba F, Degenhardt L, Del Bo' C, Delgado-Enciso I, Demetriades AK, Denova-Gutiérrez E, Dervenis N, Desai HD, Desai R, Deuba K, Dhama K, Dharmaratne SD, Dhingra S, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Dirac MA, Do THP, do Prado CB, Dohare S, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorsey ER, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Dube J, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dzianach PA, Dziedzic AM, Eboreime E, Ebrahimi A, Edinur HA, Edvardsson D, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, El Tantawi M, Elbarazi I, Elemam NM, ElGohary GMT, Elhadi M, Elmeligy OAA, ELNahas G, Elshaer M, Elsohaby I, Engelbert Bain L, Erkhembayar R, Eshrati B, Estep K, Fabin N, Fagbamigbe AF, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faro A, Farrokhi P, Fatehizadeh A, Fauk NK, Feigin VL, Feng X, Fereshtehnejad SM, Feroze AH, Ferreira N, Ferreira PH, Fischer F, Flavel J, Flood D, Flor LS, Foigt NA, Folayan MO, Force LM, Fortuna D, Foschi M, Franklin RC, Freitas A, Fukumoto T, Furtado JM, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Galali Y, Ganbat M, Gandhi AP, Ganesan B, Ganie MA, Ganiyani MA, Gardner WM, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremariam TBB, Gebremeskel TG, Gela YY, Georgescu SR, Getachew Obsa A, Gething PW, Getie M, Ghadiri K, Ghadirian F, Ghailan KY, Ghajar A, Ghasemi M, Ghasempour Dabaghi G, Ghasemzadeh A, Ghazy RM, Gholamrezanezhad A, Ghorbani M, Ghotbi E, Gibson RM, Gill TK, Ginindza TG, Girmay A, Glasbey JC, Göbölös L, Godinho MA, Goharinezhad S, Goldust M, Golechha M, Goleij P, Gona PN, Gorini G, Goulart AC, Grada A, Grivna M, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta B, Gupta I, Gupta M, Gupta R, Gupta VB, Gupta VK, Gupta VK, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadi NR, Haep N, Hafezi-Nejad N, Hafiz A, Hagins H, Halboub ES, Halimi A, Haller S, Halwani R, Hamilton EB, Hankey GJ, Hannan MA, Haque MN, Harapan H, Haro JM, Hartvigsen J, Hasaballah AI, Hasan I, Hasanian M, Hasnain MS, Hassan A, Haubold J, Havmoeller RJ, Hay SI, Hayat K, Hebert JJ, Hegazi OE, Heidari G, Helfer B, Hemmati M, Hendrie D, Henson CA, Hezam K, Hiraike Y, Hoan NQ, Holla R, Hon J, Hossain MM, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hsu JM, Huang J, Hugo FN, Hushmandi K, Hussain J, Hussein NR, Huynh CK, Huynh HH, Hwang BF, Iannucci VC, Ihler AL, Ikiroma AI, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Irham LM, Islam MR, Islam SMS, Islami F, Ismail F, Ismail NE, Isola G, Iwagami M, Iwu CCD, Iyer M, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jaiswal A, Jakovljevic M, Jatau AI, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jee SH, Jeganathan J, Jeyakumar A, Jha AK, Jiang H, Jin Y, Jonas JB, Joo T, Joseph A, Joseph N, Joshua CE, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kalani R, Kalankesh LR, Kaliyadan F, Kalra S, Kamenov K, Kamyari N, Kanagasabai T, Kandel H, Kanmanthareddy AR, Kanmodi KK, Kantar RS, Karaye IM, Karim A, Karimi SE, Karimi Y, Kasraei H, Kassel MB, Kauppila JH, Kawakami N, Kayode GA, Kazemi F, Kazemian S, Keikavoosi-Arani L, Keller C, Kempen JH, Kerr JA, Keshtkar K, Kesse-Guyot E, Keykhaei M, Khajuria H, Khalaji A, Khalid A, Khalid N, Khalilian A, Khamesipour F, Khan A, Khan I, Khan M, Khan MAB, Khanmohammadi S, Khatab K, Khatami F, Khatatbeh MM, Khater AM, Khayat Kashani HR, Khidri FF, Khodadoust E, Khormali M, Khorrami Z, Kifle ZD, Kim MS, Kimokoti RW, Kisa A, Kisa S, Knudsen AKS, Kocarnik JM, Kochhar S, Koh HY, Kolahi AA, Kompani F, Koren G, Korzh O, Kosen S, Koulmane Laxminarayana SL, Krishan K, Krishna V, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kuddus M, Kuitunen I, Kulkarni V, Kumar M, Kumar N, Kumar R, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lafranconi A, Lahariya C, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Le HH, Le LKD, Le NHH, Le TDT, Leasher JL, Ledda C, Lee M, Lee PH, Lee SW, Lee SW, Lee WC, Lee YH, LeGrand KE, Lenzi J, Leong E, Leung J, Li MC, Li W, Li X, Li Y, Li Y, Lim LL, Lim SS, Lindstrom M, Linn S, Liu G, Liu R, Liu S, Liu W, Liu X, Liu X, Llanaj E, Lo CH, López-Bueno R, Loreche AM, Lorenzovici L, Lozano R, Lubinda J, Lucchetti G, Lunevicius R, Lusk JB, lv H, Ma ZF, Machairas N, Madureira-Carvalho ÁM, Magaña Gómez JA, Maghazachi AA, Maharjan P, Mahasha PW, Maheri M, Mahjoub S, Mahmoud MA, Mahmoudi E, Majeed A, Makris KC, Malakan Rad E, Malhotra K, Malik AA, Malik I, Malta DC, Manla Y, Mansour A, Mansouri P, Mansournia MA, Mantilla Herrera AM, Mantovani LG, Manu E, Marateb HR, Mardi P, Martinez G, Martinez-Piedra R, Martini D, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Mathangasinghe Y, Mathieson S, Mathioudakis AG, Mattumpuram J, Maugeri A, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McPhail MA, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Mendoza W, Menezes RG, Mensah GA, Mentis AFA, Meo SA, Meresa HA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Mettananda KCD, Mettananda S, Michalek IM, Miller PA, Miller TR, Mills EJ, Minh LHN, Mirijello A, Mirrakhimov EM, Mirutse MK, Mirza-Aghazadeh-Attari M, Mirzaei M, Mirzaei R, Misganaw A, Mishra AK, Mitchell PB, Mittal C, Moazen B, Moberg ME, Mohamed J, Mohamed MFH, Mohamed NS, Mohammadi E, Mohammadi S, Mohammed H, Mohammed S, Mohammed S, Mohr RM, Mokdad AH, Molinaro S, Momtazmanesh S, Monasta L, Mondello S, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosapour A, Mosser JF, Mossialos E, Motappa R, Mougin V, Mouodi S, Mrejen M, Msherghi A, Mubarik S, Mueller UO, Mulita F, Munjal K, Murillo-Zamora E, Murlimanju BV, Mustafa G, Muthu S, Muzaffar M, Myung W, Nagarajan AJ, Naghavi P, Naik GR, Nainu F, Nair S, Najmuldeen HHR, Nangia V, Naqvi AA, Narayana AI, Nargus S, Nascimento GG, Nashwan AJ, Nasrollahizadeh A, Nasrollahizadeh A, Natto ZS, Nayak BP, Nayak VC, Nduaguba SO, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nesbit OD, Netsere HB, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen HQ, Niazi RK, Nikolouzakis TK, Nikoobar A, Nikoomanesh F, Nikpoor AR, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Norrving B, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nurrika D, Nzoputam CI, Nzoputam OJ, Oancea B, Odetokun IA, O'Donnell MJ, Oguntade AS, Oguta JO, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Olusanya JO, Omar HA, Omer GL, Omonisi AEE, Onie S, Onwujekwe OE, Ordak M, Orish VN, Ortega-Altamirano DV, Ortiz A, Ortiz-Brizuela E, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, P A MP, Padron-Monedero A, Padubidri JR, Palicz T, Palladino C, Pan F, Pandi-Perumal SR, Pangaribuan HU, Panos GD, Panos LD, Pantea Stoian AM, Pardhan S, Parikh RR, Pashaei A, Pasovic M, Passera R, Patel J, Patel SK, Patil S, Patoulias D, Patthipati VS, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Peprah P, Perdigão J, Pereira MO, Perianayagam A, Perico N, Pesudovs K, Petermann-Rocha FE, Petri WA, Pham HT, Philip AK, Phillips MR, Pigeolet M, Pigott DM, Pillay JD, Piracha ZZ, Pirouzpanah S, Plass D, Plotnikov E, Poddighe D, Polinder S, Postma MJ, Pourtaheri N, Prada SI, Pradhan PMS, Prakash V, Prasad M, Prates EJS, Priscilla T, Pritchett N, Puri P, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Rabiee Rad M, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raghav PR, Rahim MJ, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmani S, Rahmanian M, Rahmawaty S, Rajaa S, Ramadan MM, Ramasamy SK, Ramasubramani P, Ramazanu S, Rana K, Ranabhat CL, Rancic N, Rane A, Rao CR, Rao K, Rao M, Rao SJ, Rashidi MM, Rathnaiah Babu G, Rauniyar SK, Rawaf DL, Rawaf S, Razo C, Reddy MMRK, Redwan EMM, Reifels L, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Reyes LF, Rezaei N, Rezaei N, Rezaei N, Rezaei Hachesu P, Rezaeian M, Rickard J, Rodrigues CF, Rodriguez JAB, Roever L, Ronfani L, Roshandel G, Rotimi K, Rout HS, Roy B, Roy N, Roy P, Rubagotti E, S N C, Saad AMA, Saber-Ayad MM, Sabour S, Sacco S, Sachdev PS, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Saeb MR, Saeed U, Safi SZ, Sagar R, Sagoe D, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salami AA, Salaroli LB, Saleh MA, Salem MR, Salem MZY, Sallam M, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santos IS, Santric-Milicevic MM, Sarasmita MA, Sarikhani Y, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathyanarayan A, Satpathy M, Sawhney M, Scarmeas N, Schaarschmidt BM, Schmidt MI, Schneider IJC, Schumacher AE, Schwebel DC, Schwendicke F, Sedighi M, Senapati S, Senthilkumaran S, Sepanlou SG, Sethi Y, Setoguchi S, Seylani A, Shadid J, Shafie M, Shah H, Shah NS, Shah PA, Shahbandi A, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharifan A, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan AM, Shayan M, Shehabeldine AME, Shetty PH, Shibuya K, Shifa JE, Shiferaw D, Shiferaw WS, Shigematsu M, Shiri R, Shitaye NA, Shittu A, Shivakumar KM, Shivarov V, Shokati Eshkiki Z, Shool S, Shrestha S, Shuval K, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva DAS, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh H, Singh JA, Singh M, Singh P, Skou ST, Sleet DA, Slepak ELN, Solanki R, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Stark BA, Starodubova AV, Stein C, Stein DJ, Steiner C, Steiner TJ, Steinmetz JD, Steiropoulos P, Stockfelt L, Stokes MA, Subedi NS, Subramaniyan V, Suemoto CK, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sundström J, Swain CK, Szarpak L, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabche C, Tabish M, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tavakoli Oliaee R, Tavangar SM, Teimoori M, Temsah MH, Teramoto M, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thomas NK, Thum CCC, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran MTN, Tran NM, Tran NH, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tyrovolas S, Udoh A, Umair M, Umakanthan S, Umar TP, Undurraga EA, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Van den Eynde J, Varga O, Varma RP, Vart P, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Veroux M, Verras GI, Vervoort D, Villafañe JH, Violante FS, Vlassov V, Vollset SE, Volovat SR, Vongpradith A, Waheed Y, Wang C, Wang F, Wang N, Wang S, Wang Y, Wang YP, Ward P, Wassie EG, Weaver MR, Weerakoon KG, Weintraub RG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Whisnant JL, Whiteford HA, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wimo A, Woldegebreal DH, Wolf AW, Wong YJ, Woolf AD, Wu C, Wu F, Wu X, Wu Z, Wulf Hanson S, Xia Y, Xiao H, Xu X, Xu YY, Yadav L, Yadollahpour A, Yaghoubi S, Yamagishi K, Yang L, Yano Y, Yao Y, Yaribeygi H, Yazdanpanah MH, Ye P, Yehualashet SS, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yismaw Y, Yon DK, Yonemoto N, Younis MZ, Yu C, Yu Y, Yusuf H, Zahid MH, Zakham F, Zaki L, Zaki N, Zaman BA, Zamora N, Zand R, Zandieh GGZ, Zar HJ, Zarrintan A, Zastrozhin MS, Zhang H, Zhang N, Zhang Y, Zhao H, Zhong C, Zhong P, Zhou J, Zhu Z, Ziafati M, Zielińska M, Zimsen SRM, Zoladl M, Zumla A, Zyoud SH, Vos T, Murray CJL. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, Ahmed SA, Ajami M, Aji B, Akara EM, Akbarialiabad H, Akinosoglou K, Akinyemiju T, Akkaif MA, Akyirem S, Al Hamad H, Al Hasan SM, Alahdab F, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam M, Alam N, Al-amer RM, Alanezi FM, Alanzi TM, Al-Azzam S, Albakri A, Albashtawy M, AlBataineh MT, Alcalde-Rabanal JE, Aldawsari KA, Aldhaleei WA, Aldridge RW, Alema HB, Alemayohu MA, Alemi S, Alemu YM, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali L, Ali MU, Ali R, Ali S, Ali SSS, Alicandro G, Alif SM, Alikhani R, Alimohamadi Y, Aliyi AA, Aljasir MAM, Aljunid SM, Alla F, Allebeck P, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani L, Almidani O, Alomari MA, Al-Omari B, Alonso J, Alqahtani JS, Alqalyoobi S, Alqutaibi AY, Al-Sabah SK, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alwafi H, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Angus C, Anil A, Anil S, Anoushiravani A, Ansari H, Ansariadi A, Ansari-Moghaddam A, Antony CM, Antriyandarti E, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyasodor AE, Aqeel M, Arab JP, Arabloo J, Arafat M, Aravkin AY, Areda D, Aremu A, Aremu O, Ariffin H, Arkew M, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Asaad M, Asadi-Lari M, Asgedom AA, Asghariahmadabad M, Asghari-Jafarabadi M, Ashraf M, Aslani A, Astell-Burt T, Athar M, Athari SS, Atinafu BTT, Atlaw HW, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awedew AF, Aweke AM, Ayala Quintanilla BP, Ayatollahi H, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azevedo RMS, Azzam AY, B DB, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bahmanziari N, Bai R, Baig AA, Baker JL, Bako AT, Bakshi RK, Balakrishnan S, Balasubramanian M, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik PC, Bansal H, Bansal K, Barbic F, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Barua L, Basharat Z, Bashiri A, Basiru A, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basting AVL, Basu S, Batra K, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Beghi M, Behboudi E, Behera P, Behnoush AH, Behzadifar M, Beiranvand M, Bejarano Ramirez DF, Béjot Y, Belay SA, Belete CM, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bender RG, Bensenor IM, Beran A, Berezvai Z, Berhie AY, Berice BN, Bernstein RS, Bertolacci GJ, Bettencourt PJG, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bisulli F, Biswas A, Biswas B, Bitaraf S, Bitew BD, Bitra VR, Bjørge T, Boachie MK, Boampong MS, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bohlouli S, Bolarinwa OA, Boloor A, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borhany H, Borzutzky A, Bouaoud S, Boustany A, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brant LC, Brauer M, Brazinova A, Brazo-Sayavera J, Breitborde NJK, Breitner S, Brenner H, Briko AN, Briko NI, Britton G, Brown J, Brugha T, Bulamu NB, Bulto LN, Buonsenso D, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalheiro CG, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Cederroth CR, Cegolon L, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chadwick J, Chahine Y, Chakraborty C, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Chang CK, Chang JC, Chanie GS, Charalampous P, Chattu VK, Chaturvedi P, Chatzimavridou-Grigoriadou V, Chaurasia A, Chen AW, Chen AT, Chen CS, Chen H, Chen MX, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Cheru WA, Chien JH, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Choudhari SG, Chowdhury R, Christopher DJ, Chukwu IS, Chung E, Chung E, Chung E, Chung SC, Chutiyami M, Cindi Z, Cioffi I, Claassens MM, Claro RM, Coberly K, Cogen RM, Columbus A, Comfort H, Conde J, Cortese S, Cortesi PA, Costa VM, Costanzo S, Cousin E, Couto RAS, Cowden RG, Cramer KM, Criqui MH, Cruz-Martins N, Cuadra-Hernández SM, Culbreth GT, Cullen P, Cunningham M, Curado MP, Dadana S, Dadras O, Dai S, Dai X, Dai Z, Dalli LL, Damiani G, Darega Gela J, Das JK, Das S, Das S, Dascalu AM, Dash NR, Dashti M, Dastiridou A, Davey G, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, de Luca K, Debele AT, Debopadhaya S, Degenhardt L, Dehghan A, Deitesfeld L, Del Bo' C, Delgado-Enciso I, Demessa BH, Demetriades AK, Deng K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert Bain L, Erkhembayar R, Esezobor CI, Eshrati B, Eskandarieh S, Espinosa-Montero J, Esubalew H, Etaee F, Fabin N, Fadaka AO, Fagbamigbe AF, Fahim A, Fahimi S, Fakhri-Demeshghieh A, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faris PS, Faro A, Fasanmi AO, Fatehizadeh A, Fattahi H, Fauk NK, Fazeli P, Feigin VL, Feizkhah A, Fekadu G, Feng X, Fereshtehnejad SM, Feroze AH, Ferrante D, Ferrari AJ, Ferreira N, Fetensa G, Feyisa BR, Filip I, Fischer F, Flavel J, Flood D, Florin BT, Foigt NA, Folayan MO, Fomenkov AA, Foroutan B, Foroutan M, Forthun I, Fortuna D, Foschi M, Fowobaje KR, Francis KL, Franklin RC, Freitas A, Friedman J, Friedman SD, Fukumoto T, Fuller JE, Fux B, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Gakidou E, Galali Y, Galles NC, Gallus S, Ganbat M, Gandhi AP, Ganesan B, Ganiyani MA, Garcia-Gordillo MA, Gardner WM, Garg J, Garg N, Gautam RK, Gbadamosi SO, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Georgescu SR, Getachew T, Gething PW, Getie M, Ghadiri K, Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, Hankey GJ, Hanna F, Hannan MA, Haque MN, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan I, Hasan MT, Hasani H, Hasanian M, Hashi A, Hasnain MS, Hassan I, Hassanipour S, Hassankhani H, Haubold J, Havmoeller RJ, Hay SI, He J, Hebert JJ, Hegazi OE, Heidari G, Heidari M, Heidari-Foroozan M, Helfer B, Hendrie D, Herrera-Serna BY, Herteliu C, Hesami H, Hezam K, Hill CL, Hiraike Y, Holla R, Horita N, Hossain MM, Hossain S, Hosseini MS, Hosseinzadeh H, Hosseinzadeh M, Hosseinzadeh Adli A, Hostiuc M, Hostiuc S, Hsairi M, Hsieh VCR, Hsu RL, Hu C, Huang J, Hultström M, Humayun A, Hundie TG, Hussain J, Hussain MA, Hussein NR, Hussien FM, Huynh HH, Hwang BF, Ibitoye SE, Ibrahim KS, Iftikhar PM, Ijo D, Ikiroma AI, Ikuta KS, Ikwegbue PC, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Inamdar S, Indriasih E, Iqhrammullah M, Iradukunda A, Iregbu KC, Islam MR, Islam SMS, Islami F, Ismail F, Ismail NE, Iso H, Isola G, Iwagami M, Iwu CCD, Iyamu IO, Iyer M, J LM, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jafarzadeh A, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain N, Jairoun AA, Jaiswal A, Jamshidi E, Janko MM, Jatau AI, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jebai R, Jee SH, Jeganathan J, Jha AK, Jha RP, Jiang H, Jin Y, Johnson O, Jokar M, Jonas JB, Joo T, Joseph A, Joseph N, Joshua CE, Joshy G, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kadir DH, Kalani R, Kalankesh LR, Kalankesh LR, Kaliyadan F, Kalra S, Kamal VK, Kamarajah SK, Kamath R, Kamiab Z, Kamyari N, Kanagasabai T, Kanchan T, Kandel H, Kanmanthareddy AR, Kanmiki EW, Kanmodi KK, Kannan S S, Kansal SK, Kantar RS, Kapoor N, Karajizadeh M, Karanth SD, Karasneh RA, Karaye IM, Karch A, Karim A, Karimi SE, Karimi Behnagh A, Kashoo FZ, Kasnazani QHA, Kasraei H, Kassebaum NJ, Kassel MB, Kauppila JH, Kaur N, Kawakami N, Kayode GA, Kazemi F, Kazemian S, Kazmi TH, Kebebew GM, Kebede AD, Kebede F, Keflie TS, Keiyoro PN, Keller C, Kelly JT, Kempen JH, Kerr JA, Kesse-Guyot E, Khajuria H, Khalaji A, Khalid N, Khalil AA, Khalilian A, Khamesipour F, Khan A, Khan A, Khan G, Khan I, Khan IA, Khan MN, Khan M, Khan MJ, Khan MAB, Khan ZA, Khan suheb MZ, Khanmohammadi S, Khatab K, Khatami F, Khatatbeh H, Khatatbeh MM, Khavandegar A, Khayat Kashani HR, Khidri FF, Khodadoust E, Khorgamphar M, Khormali M, Khorrami Z, Khosravi A, Khosravi MA, Kifle ZD, Kim G, Kim J, Kim K, Kim MS, Kim YJ, Kimokoti RW, Kinzel KE, Kisa A, Kisa S, Klu D, Knudsen AKS, Kocarnik JM, Kochhar S, Kocsis T, Koh DSQ, Kolahi AA, Kolves K, Kompani F, Koren G, Kosen S, Kostev K, Koul PA, Koulmane Laxminarayana SL, Krishan K, Krishna H, Krishna V, Krishnamoorthy V, Krishnamoorthy Y, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kulimbet M, Kulkarni V, Kumar A, Kumar A, Kumar H, Kumar M, Kumar R, Kumari M, Kumie FT, Kundu S, Kurmi OP, Kusnali A, Kusuma D, Kwarteng A, Kyriopoulos I, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lagat AK, Lager ACJ, Lahmar A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini BP, Marateb HR, Maravilla JC, Marconi AM, Mardi P, Marino M, Marjani A, Martinez G, Martinez-Guerra BA, Martinez-Piedra R, Martini D, Martini S, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Masaka A, Masrie A, Mathieson S, Mathioudakis AG, Mathur MR, Mattumpuram J, Matzopoulos R, Maude RJ, Maugeri A, Maulik PK, Mayeli M, Mazaheri M, Mazidi M, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail SM, Mechili EA, Medina JRC, Mediratta RP, Meena JK, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Meles GG, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mengist B, Mentis AFA, Meo SA, Meresa HA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mettananda KCD, Mettananda S, Meylakhs P, Mhlanga A, Mhlanga L, Mi T, Miazgowski T, Micha G, Michalek IM, Miller TR, Mills EJ, Minh LHN, Mini GK, Mir Mohammad Sadeghi P, Mirica A, Mirijello A, Mirrakhimov EM, Mirutse MK, Mirzaei M, Misganaw A, Mishra A, Misra S, Mitchell PB, Mithra P, Mittal C, Mobayen M, Moberg ME, Mohamadkhani A, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammed H, Mohammed H, Mohammed M, Mohammed S, Mohammed S, Mohan V, Mojiri-Forushani H, Mokari A, Mokdad AH, Molinaro S, Molokhia M, Momtazmanesh S, Monasta L, Mondello S, Moni MA, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moradzadeh M, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosser JF, Motappa R, Mougin V, Mouodi S, Mousavi P, Mousavi SE, Mousavi Khaneghah A, Mpolya EA, Mrejen M, Mubarik S, Muccioli L, Mueller UO, Mughal F, Mukherjee S, Mulita F, Munjal K, Murillo-Zamora E, Musaigwa F, Musallam KM, Mustafa A, Mustafa G, Muthupandian S, Muthusamy R, Muzaffar M, Myung W, Nagarajan AJ, Nagel G, Naghavi P, Naheed A, Naik GR, Naik G, Nainu F, Nair S, Najmuldeen HHR, Nakhostin Ansari N, Nangia V, Naqvi AA, Narasimha Swamy S, Narayana AI, Nargus S, Nascimento BR, Nascimento GG, Nasehi S, Nashwan AJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Nazri-Panjaki A, Ndejjo R, Nduaguba SO, Negash H, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nejjari C, Nena E, Nepal S, Ng M, Nggada HA, Nguefack-Tsague G, Ngunjiri JW, Nguyen AH, Nguyen DH, Nguyen HTH, Nguyen PT, Nguyen VT, Niazi RK, Nielsen KR, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikoomanesh F, Nikpoor AR, Ningrum DNA, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Noreen M, Noroozi N, Norrving B, Noubiap JJ, Novotney A, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nuñez-Samudio V, Nurrika D, Nutor JJ, Oancea B, Obamiro KO, Oboh MA, Odetokun IA, Odogwu NM, O'Donnell MJ, Oduro MS, Ofakunrin AOD, Ogunkoya A, Oguntade AS, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olaiya MT, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omar Bali A, Omer GL, Ondayo MA, Ong S, Onwujekwe OE, Onyedibe KI, Ordak M, Orisakwe OE, Orish VN, Ortega-Altamirano DV, Ortiz A, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, Ozten Y, P A MP, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Palladino C, Palladino R, Palma-Alvarez RF, Pan F, Pan HF, Pana A, Panda P, Panda-Jonas S, Pandi-Perumal SR, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Papadopoulou P, Parikh RR, Park S, Parthasarathi A, Pashaei A, Pasovic M, Passera R, Pasupula DK, Patel HM, Patel J, Patel SK, Patil S, Patoulias D, Patthipati VS, Paudel U, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Pensato U, Pepito VCF, Peprah EK, Peprah P, Perdigão J, Pereira M, Peres MFP, Perianayagam A, Perico N, Pestell RG, Pesudovs K, Petermann-Rocha FE, Petri WA, Pham HT, Philip AK, Phillips MR, Pierannunzio D, Pigeolet M, Pigott DM, Pilgrim T, Piracha ZZ, Piradov MA, Pirouzpanah S, Plakkal N, Plotnikov E, Podder V, Poddighe D, Polinder S, Polkinghorne KR, Poluru R, Ponkilainen VT, Porru F, Postma MJ, Poudel GR, Pourshams A, Pourtaheri N, Prada SI, Pradhan PMS, Prakasham TN, Prasad M, Prashant A, Prates EJS, Prieto Alhambra D, PRISCILLA TINA, Pritchett N, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Qiu S, Qureshi MF, Rabiee Rad M, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raghav PR, Raheem N, Rahim F, Rahim MJ, Rahimi-Movaghar V, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajaa S, Rajput P, Rakovac I, Ramasamy SK, Ramazanu S, Rana K, Ranabhat CL, Rancic N, Rane A, Rao CR, Rao IR, Rao M, Rao SJ, Rasali DP, Rasella D, Rashedi S, Rashedi V, Rashidi MM, Rasouli-Saravani A, Rasul A, Rathnaiah Babu G, Rauniyar SK, Ravangard R, Ravikumar N, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Rawlley B, Raza RZ, Razo C, Redwan EMM, Rehman FU, Reifels L, Reiner Jr RC, Remuzzi G, Reyes LF, Rezaei M, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riaz MA, Ribeiro ALP, Rickard J, Riva HR, Robinson-Oden HE, Rodrigues CF, Rodrigues M, Roever L, Rogowski ELB, Rohloff P, Romadlon DS, Romero-Rodríguez E, Romoli M, Ronfani L, Roshandel G, Roth GA, Rout HS, Roy N, Roy P, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Rwegerera GM, Rynkiewicz A, S N C, Saad AMA, Saadatian Z, Saber K, Saber-Ayad MM, SaberiKamarposhti M, Sabour S, Sacco S, Sachdev PS, Sachdeva R, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi E, Sadeghian F, Saeb MR, Saeed U, Safaeinejad F, Safi SZ, Sagar R, Saghazadeh A, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahoo U, Sahu M, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salamati P, Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santomauro DF, Santos IS, Santric-Milicevic MM, Sao Jose BP, Sarasmita MA, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Satpathy M, Sayeed A, Sayeed MA, Saylan M, Sayyah M, Scarmeas N, Schaarschmidt BM, Schlaich MP, Schlee W, Schmidt MI, Schneider IJC, Schuermans A, Schumacher AE, Schutte AE, Schwarzinger M, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Senapati S, Senthilkumaran S, Sepanlou SG, Serban D, Sethi Y, Sha F, Shabany M, Shafaat A, Shafie M, Shah NS, Shah PA, Shah SM, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh A, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shetty A, Shetty BSK, Shetty PH, Shi P, Shibuya K, Shiferaw D, Shigematsu M, Shin MJ, Shin YH, Shiri R, Shirkoohi R, Shitaye NA, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shokraneh F, Shokri A, Shool S, Shorofi SA, Shrestha S, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh G, Singh J, Singh NP, Singh P, Singh S, Sinha DN, Sinto R, Siraj MS, Sirota SB, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Spearman S, Sreeramareddy CT, Srivastava VK, Stanaway JD, Stanikzai MH, Stark BA, Starnes JR, Starodubova AV, Stein C, Stein DJ, Steinbeis F, Steiner C, Steinmetz JD, Steiropoulos P, Stevanović A, Stockfelt L, Stokes MA, Stortecky S, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun HZ, Sun J, Sundström J, Sunkersing D, Sunnerhagen KS, Swain CK, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabish M, TADAKAMADLA JYOTHI, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taiba J, Takahashi K, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tang HK, Tarigan IU, Tariku MK, Tariqujjaman M, Tarkang EE, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tefera YM, Temsah MH, Temsah RMH, Teramoto M, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Tharwat S, Thayakaran R, Thomas N, Thomas NK, Thomson AM, Thrift AG, Thum CCC, Thygesen LC, Tian J, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Titova MV, Tonelli M, Topor-Madry R, Toriola AT, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran NM, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah I, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Valizadeh R, Van de Velde SM, Van den Eynde J, Varga O, Vart P, Varthya SB, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Villanueva GI, Vinayak M, Violante FS, Viskadourou M, Vladimirov SK, Vlassov V, Vo B, Vollset SE, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang N, Wang S, Wang S, Wang Y, Wang YP, Waqas M, Ward P, Wassie EG, Watson S, Watson SLW, Weerakoon KG, Wei MY, Weintraub RG, Weiss DJ, Westerman R, Whisnant JL, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wilson S, Wojewodzic MW, Woldegebreal DH, Wolf AW, Wolfe CDA, Wondimagegene YA, Wong YJ, Wongsin U, Wu AM, Wu C, Wu F, Wu X, Wu Z, Xia J, Xiao H, Xie Y, Xu S, Xu WD, Xu X, Xu YY, Yadollahpour A, Yamagishi K, Yang D, Yang L, Yano Y, Yao Y, Yaribeygi H, Ye P, Yehualashet SS, Yesiltepe M, Yesuf SA, Yezli S, Yi S, Yigezu A, Yiğit A, Yiğit V, Yip P, Yismaw MB, Yismaw Y, Yon DK, Yonemoto N, Yoon SJ, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuh FH, Zadey S, Zadnik V, Zafari N, Zakham F, Zaki N, Zaman SB, Zamora N, Zand R, Zangiabadian M, Zar HJ, Zare I, Zarrintan A, Zeariya MGM, Zeinali Z, Zhang H, Zhang J, Zhang J, Zhang L, Zhang Y, Zhang ZJ, Zhao H, Zhong C, Zhou J, Zhu B, Zhu L, Ziafati M, Zielińska M, Zitoun OA, Zoladl M, Zou Z, Zuhlke LJ, Zumla A, Zweck E, Zyoud SH, Wool EE, Murray CJL. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Barone R, Bramato G, Gnoni V, Giugno A, Urso D, Zecca C, Nigro S, Filardi M, Logroscino G. Sarcopenia in subjects with Alzheimer's disease: prevalence and comparison of agreement between EGWSOP1, EGWSOP2, and FNIH criteria. BMC Geriatr 2024; 24:278. [PMID: 38515016 PMCID: PMC10958903 DOI: 10.1186/s12877-024-04890-w] [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: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Sarcopenia is an age-related clinical syndrome characterized by the progressive loss of muscle mass and muscle strength. It appears to be closely linked to dementia, particularly Alzheimer's disease (AD); however, its prevalence among AD patients remains unclear. In this study, we assessed differences in sarcopenia prevalence between non-demented individuals and AD patients. Moreover, we assessed sex-specific differences in sarcopenia prevalence and explored the diagnostic value of the Muscle Quality Index (MQI) for diagnosing sarcopenia among AD patients. METHOD Cross-sectional study including 145 patients with probable AD and 51 older adults with normal cognition. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP1 and EWGSOP2) and of the Foundation for the National Institutes of Health (FNIH). The MQI was computed as the ratio of handgrip strength to skeletal muscle mass. RESULTS No significant difference in sarcopenia prevalence was observed between AD patients and controls. Prevalence ranged from 3.4 to 23.4% in AD patients and from 2 to 11.8% in controls, depending on diagnostic criteria. Prevalence was higher using EWGSOP1 and decreased using EWGSOP2 and FNIH. Prevalence was higher in males than in females with AD. The MQI was lower in AD patients than in controls (95%CI: - 0.23, - 0.05, p < 0.001), but displayed poor diagnostic accuracy in identifying sarcopenia cases. CONCLUSIONS AD patients and controls show comparable sarcopenia prevalence. Sarcopenia prevalence is higher in males than females among AD patients and higher when using EWGSOP1 compared to FNIH and EWGSOP2 criteria.
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Affiliation(s)
- Roberta Barone
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Giulia Bramato
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Chiara Zecca
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy.
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy.
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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5
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See QR, Raheel K, Duncan I, Biabani N, Di Giulio I, Romigi A, Kumari V, O’Regan D, Cairney S, Urso D, Chaudhuri KR, Gnoni V, Drakatos P, Rosenzweig I. Dreaming Characteristics in Non-Rapid Eye Movement Parasomnia and Idiopathic Rapid Eye Movement Sleep Behaviour Disorder: Similarities and Differences. Nat Sci Sleep 2024; 16:263-277. [PMID: 38482468 PMCID: PMC10933526 DOI: 10.2147/nss.s435201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
Background Speech graph analysis (SGA) of dreams has recently shown promise as an objective and language-invariant diagnostic tool that can aid neuropsychiatric diagnosis. Whilst the notion that dreaming mentations reflect distinct physiologic processes is not new, such studies in patients with sleep disorders remain exceptionally scarce. Here, using SGA and other dream content analyses, we set to investigate structural and thematic differences in morning dream recalls of patients diagnosed with Non-Rapid Eye Movement Parasomnia (NREMP) and Idiopathic REM Sleep Behavior Disorder (iRBD). Methods A retrospective cross-sectional study of morning dream recalls of iRBD and NREMP patients was undertaken. Traditional dream content analyses, such as Orlinsky and Hall and Van de Castle analyses, were initially conducted. Subsequently, SGA was performed in order to objectively quantify structural speech differences between the dream recalls of the two patient groups. Results Comparable rate of morning recall of dreams in the sleep laboratory was recorded; 25% of iRBD and 18.35% of NREMP patients. Aggression in dreams was recorded by 28.57% iRBD versus 20.00% in NREMP group. iRBD patients were more likely to recall dreams (iRBD vs NREMP; P = 0.007), but they also had more white dreams, ie having a feeling of having dreamt, but with no memory of it. Visual and quantitative graph speech analyses of iRBD dreams suggested stable sequential structure, reflecting the linearity of the chronological narrative. Conversely, NREMP dream reports displayed more recursive, less stable systems, with significantly higher scores of graph connectivity measures. Conclusion The findings of our exploratory study suggest that iRBD and NREMP patients may not only differ on what is recalled in their dreams but also, perhaps more strikingly, on how dreams are recalled. It is hoped that future SGA-led dream investigations of larger groups of patients will help discern distinct mechanistic underpinnings and any associated clinical implications.
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Affiliation(s)
- Qi Rui See
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
| | - Kausar Raheel
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
| | - Iain Duncan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
| | - Nazanin Biabani
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
| | - Irene Di Giulio
- School of Basic and Medical Biosciences, Faculty of Life Science and Medicine, King’s College London, London, U.K
| | - Andrea Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo Pozzilli (IS), Pozzilli, Italy
| | - Veena Kumari
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, U.K
| | - David O’Regan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
- School of Basic and Medical Biosciences, Faculty of Life Science and Medicine, King’s College London, London, U.K
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, U.K
| | - Scott Cairney
- Department of Psychology, University of York and York Biomedical Research Institute, University of York, York, U.K
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
- Movement Disorders Unit, King’s College Hospital and Department of Clinical and Basic Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson Foundation Centre of Excellence, King’s College London, London, U.K
| | - K Ray Chaudhuri
- Movement Disorders Unit, King’s College Hospital and Department of Clinical and Basic Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson Foundation Centre of Excellence, King’s College London, London, U.K
| | - Valentina Gnoni
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
- School of Basic and Medical Biosciences, Faculty of Life Science and Medicine, King’s College London, London, U.K
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, U.K
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, U.K
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, U.K
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Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdoun M, Abdullahi A, Abdurehman AM, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abhilash ES, Abiodun OO, Aboagye RG, Abolhassani H, Abouzid M, Abreu LG, Abrha WA, Abrigo MRM, Abtahi D, Abu Rumeileh S, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Acuna JM, Adair T, Addo IY, Adebayo OM, Adegboye OA, Adekanmbi V, Aden B, Adepoju AV, Adetunji CO, Adeyeoluwa TE, Adeyomoye OI, Adha R, Adibi A, Adikusuma W, Adnani QES, Adra S, Afework A, Afolabi AA, Afraz A, Afyouni S, Afzal S, Agasthi P, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmadzade M, Ahmed A, Ahmed H, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akalu GT, Akara EM, Akinosoglou K, Akkala S, Akyirem S, Al Hamad H, Al Hasan SM, Al Homsi A, Al Qadire M, Ala M, Aladelusi TO, AL-Ahdal TMA, Alalalmeh SO, Al-Aly Z, Alam K, Alam M, Alam Z, Al-amer RM, Alanezi FM, Alanzi TM, Albashtawy M, AlBataineh MT, Aldridge RW, Alemi S, Al-Eyadhy A, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali BA, Ali H, Ali MU, Ali R, Ali SSS, Ali Z, Alian Samakkhah S, Alicandro G, Alif SM, Aligol M, Alimi R, Aliyi AA, Al-Jumaily A, Aljunid SM, Almahmeed W, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani O, Alomari MA, Alonso N, Alqahtani JS, Alqutaibi AY, Al-Sabah SK, Altaf A, Al-Tawfiq JA, Altirkawi KA, Alvi FJ, Alwafi H, Al-Worafi YM, Aly H, Alzoubi KH, Amare AT, Ameyaw EK, Amhare AF, Amin TT, Amindarolzarbi A, Aminian Dehkordi J, Amiri S, Amu H, Amugsi DA, Amzat J, Ancuceanu R, Anderlini D, Andrade PP, Andrei CL, Andrei T, Angappan D, Anil A, Anjum A, Antony CM, Antriyandarti E, Anuoluwa IA, Anwar SL, Anyasodor AE, Appiah SCY, Aqeel M, Arabloo J, Arabzadeh Bahri R, Arab-Zozani M, Arafat M, Araújo AM, Aravkin AY, Aremu A, Ariffin H, Aripov T, Armocida B, Arooj M, Artamonov AA, Artanti KD, Arulappan J, Aruleba IT, Aruleba RT, Arumugam A, Asaad M, Asgary S, Ashemo MY, Ashraf M, Asika MO, Athari SS, Atout MMW, Atreya A, Attia S, Aujayeb A, Avan A, Awotidebe AW, Ayala Quintanilla BP, Ayanore MA, Ayele GM, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azhar GS, Aziz S, Azzam AY, Babashahi M, Babu AS, Badar M, Badawi A, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bai J, Bai R, Baker JL, Bakkannavar SM, Bako AT, Balakrishnan S, Balogun SA, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik B, Banik PC, Bansal H, Barati S, Barchitta M, Bardhan M, Barker-Collo SL, Barone-Adesi F, Barqawi HJ, Barr RD, Barrero LH, Basharat Z, Bashir AIJ, Bashiru HA, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basu S, Batra K, Batra R, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Begum T, Behboudi E, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Belgaumi UI, Bell ML, Bello AK, Bello MB, Bello OO, Belo L, Beloukas A, Bendak S, Bennett DA, Bensenor IM, Benzian H, Berezvai Z, Berman AE, Bermudez ANC, Bettencourt PJG, Beyene HB, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Binmadi N, Bintoro BS, Biondi A, Bisignano C, Bisulli F, Biswas A, Biswas RK, Bitaraf S, Bjørge T, Bleyer A, Boampong MS, Bodolica V, Bodunrin AO, Bolarinwa OA, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borodo SB, Borschmann R, Botero Carvajal A, Bouaoud S, Boudalia S, Boyko EJ, Bragazzi NL, Braithwaite D, Brenner H, Britton G, Browne AJ, Brunoni AR, Bulamu NB, Bulto LN, Buonsenso D, Burkart K, Burns RA, Burugina Nagaraja S, Busse R, Bustanji Y, Butt ZA, Caetano dos Santos FL, Cai T, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cardenas CA, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Caye A, Cederroth CR, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chacón-Uscamaita PRU, Chahine Y, Chakraborty C, Chan JSK, Chang CK, Charalampous P, Charan J, Chattu VK, Chatzimavridou-Grigoriadou V, Chavula MP, Cheema HA, Chen AT, Chen H, Chen L, Chen MX, Chen S, Cherbuin N, Chew DS, Chi G, Chirinos-Caceres JL, Chitheer A, Cho SMJ, Cho WCS, Chong B, Chopra H, Choudhary R, Chowdhury R, Chu DT, Chukwu IS, Chung E, Chung E, Chung SC, Cini KI, Clark CCT, Coberly K, Columbus A, Comfort H, Conde J, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Criqui MH, Cruz-Martins N, Culbreth GT, Cullen P, Cunningham M, da Silva e Silva D, Dadana S, Dadras O, Dai Z, Dalal K, Dalli LL, Damiani G, D'Amico E, Daneshvar S, Darwesh AM, Das JK, Das S, Dash NR, Dashti M, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, Debele AT, Degenhardt L, Dehbandi R, Deitesfeld L, Delgado-Enciso I, Delgado-Ortiz L, Demant D, Demessa BH, Demetriades AK, Deng X, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Desai HD, Desai R, Deuba K, Devanbu VGC, Dey S, Dhali A, Dhama K, Dhimal ML, Dhimal M, Dhingra S, Dias da Silva D, Diaz D, Dima A, Ding DD, Dirac MA, Dixit A, Dixit SG, Do TC, Do THP, do Prado CB, Dodangeh M, Dokova KG, Dolecek C, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Douiri A, Dowou RK, Driscoll TR, Dsouza HL, Dube J, Dumith SC, Dunachie SJ, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dutta S, Dzianach PA, Dziedzic AM, Ebenezer O, Eboreime E, Ebrahimi A, Echieh CP, Ed-Dra A, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Eghdami S, Eikemo TA, Eini E, Ekholuenetale M, Ekpor E, Ekundayo TC, El Arab RA, El Morsi DAW, El Sayed Zaki M, El Tantawi M, Elbarazi I, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, Elmeligy OAA, Elshaer M, Elsohaby I, Emami Zeydi A, Emamverdi M, Emeto TI, Engelbert Bain L, Erkhembayar R, Eshetie TC, Eskandarieh S, Espinosa-Montero J, Estep K, Etaee F, Eze UA, Fabin N, Fadaka AO, Fagbamigbe AF, Fahimi S, Falzone L, Farinha CSES, Faris MEM, Farjoud Kouhanjani M, Faro A, Farrokhpour H, Fatehizadeh A, Fattahi H, Fauk NK, Fazeli P, Feigin VL, Fekadu G, Fereshtehnejad SM, Feroze AH, Ferrante D, Ferrara P, Ferreira N, Fetensa G, Filip I, Fischer F, Flavel J, Flaxman AD, Flor LS, Florin BT, Folayan MO, Foley KM, Fomenkov AA, Force LM, Fornari C, Foroutan B, Foschi M, Francis KL, Franklin RC, Freitas A, Friedman J, Friedman SD, Fukumoto T, Fuller JE, Gaal PA, Gadanya MA, Gaihre S, Gaipov A, Gakidou E, Galali Y, Galehdar N, Gallus S, Gan Q, Gandhi AP, Ganesan B, Garg J, Gau SY, Gautam P, Gautam RK, Gazzelloni F, Gebregergis MW, Gebrehiwot M, Gebremariam TB, Gerema U, Getachew ME, Getachew T, Gething PW, Ghafourifard M, Ghahramani S, Ghailan KY, Ghajar A, Ghanbarnia MJ, Ghasemi M, Ghasemzadeh A, Ghassemi F, Ghazy RM, Ghimire S, Gholamian A, Gholamrezanezhad A, Ghorbani Vajargah P, Ghozali G, Ghozy S, Ghuge AD, Gialluisi A, Gibson RM, Gil AU, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Goel A, Goldust M, Golechha M, Goleij P, Golestanfar A, Golinelli D, Gona PN, Goudarzi H, Goudarzian AH, Goyal A, Greenhalgh S, Grivna M, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta IR, Gupta RD, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Hachinski V, Haddadi M, Haddadi R, Haep N, Hajj Ali A, Halboub ES, Halim SA, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hamagharib Abdullah K, Hamidi S, Hamiduzzaman M, Hammoud A, Hanifi N, Hankey GJ, Hannan MA, Haque MN, Harapan H, Haro JM, Hasaballah AI, Hasan F, Hasan I, Hasan MT, Hasani H, Hasanian M, Hasanpour- Dehkordi A, Hassan AM, Hassan A, Hassanian-Moghaddam H, Hassanipour S, Haubold J, Havmoeller RJ, Hay SI, Hbid Y, Hebert JJ, Hegazi OE, Heidari G, Heidari M, Heidari-Foroozan M, Heidari-Soureshjani R, Helfer B, Herteliu C, Hesami H, Hettiarachchi D, Heyi DZ, Hezam K, Hiraike Y, Hoffman HJ, Holla R, Horita N, Hossain MB, Hossain MM, Hossain S, Hosseini MS, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hsairi M, Hsieh VCR, Hu C, Huang J, Huda MN, Hugo FN, Hultström M, Hussain J, Hussain S, Hussein NR, Huy LD, Huynh HH, Hwang BF, Ibitoye SE, Idowu OO, Ijo D, Ikuta KS, Ilaghi M, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Inbaraj LR, Iradukunda A, Iravanpour F, Iregbu KC, Islam MR, Islam MM, Islam SMS, Islami F, Ismail NE, Isola G, Iwagami M, Iwu CCD, Iwu-Jaja CJ, Iyer M, J LM, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jakovljevic M, Jalilzadeh Yengejeh R, Jamshidi E, Jani CT, Janko MM, Jatau AI, Jayapal SK, Jayaram S, Jeganathan J, Jema AT, Jemere DM, Jeong W, Jha AK, Jha RP, Ji JS, Jiang H, Jin Y, Jin Y, Johnson O, Jomehzadeh N, Jones DP, Joo T, Joseph A, Joseph N, Joshua CE, Jozwiak JJ, Jürisson M, Kaambwa B, Kabir A, Kabir H, Kabir Z, Kadashetti V, Kahe F, Kakodkar PV, Kalani R, Kalankesh LR, Kaliyadan F, Kalra S, Kamath A, Kamireddy A, Kanagasabai T, Kandel H, Kanmiki EW, Kanmodi KK, Kantar RS, Kapoor N, Karajizadeh M, Karami Matin B, Karanth SD, Karaye IM, Karim A, Karimi H, Karimi SE, Karimi Behnagh A, Karkhah S, Karna AK, Kashoo FZ, Kasraei H, Kassaw NA, Kassebaum NJ, Kassel MB, Katamreddy A, Katikireddi SV, Katoto PDMC, Kauppila JH, Kaur N, Kaydi N, Kayibanda JF, Kayode GA, Kazemi F, Kazemian S, Kazeminia S, Keikavoosi-Arani L, Keller C, Kempen JH, Kerr JA, Kesse-Guyot E, Keykhaei M, Khadembashiri MM, Khadembashiri MA, Khafaie MA, Khajuria H, Khalafi M, Khalaji A, Khalid N, Khalil IA, Khamesipour F, Khan A, Khan G, Khan I, Khan IA, Khan M, Khan MAB, Khan T, Khan suheb MZ, Khanmohammadi S, Khatab K, Khatami F, Khavandegar A, Khayat Kashani HR, Kheirallah KA, Khidri FF, Khodadoust E, Khormali M, Khosrowjerdi M, Khubchandani J, Khusun H, Kifle ZD, Kim G, Kim J, Kimokoti RW, Kinzel KE, Kiross GT, Kisa A, Kisa S, Kiss JB, Kivimäki M, Klu D, Knudsen AKS, Kolahi AA, Kompani F, Koren G, Kosen S, Kostev K, Kotnis AL, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Kravchenko MA, Krishan K, Krishna H, Krishnamoorthy V, Krishnamoorthy Y, Krohn KJ, Kuate Defo B, Kubeisy CM, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kujan O, Kulimbet M, Kulkarni V, Kumar A, Kumar H, Kumar N, Kumar R, Kumar S, Kumari M, Kurmanova A, Kurmi OP, Kusnali A, Kusuma D, Kutluk T, Kuttikkattu A, Kyei EF, Kyriopoulos I, La Vecchia C, Ladan MA, Laflamme L, Lahariya C, Lahmar A, Lai DTC, Laksono T, Lal DK, Lalloo R, Lallukka T, Lám J, Lamnisos D, Lan T, Lanfranchi F, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Latief K, Latif M, Latifinaibin K, Lauriola P, Le LKD, Le NHH, Le TTT, Le TDT, Lee M, Lee PH, Lee SW, Lee SW, Lee WC, Lee YH, Legesse SM, Leigh J, Lenzi J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Libra M, Ligade VS, Likaka ATM, Lim LL, Lin RT, Lin S, Lioutas VA, Listl S, Liu J, Liu S, Liu X, Livingstone KM, Llanaj E, Lo CH, Loreche AM, Lorenzovici L, Lotfi M, Lotfizadeh M, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma J, Ma S, Ma ZF, Mabrok M, Machairas N, Machoy M, Madsen C, Magaña Gómez JA, Maghazachi AA, Maharaj SB, Maharjan P, Mahjoub S, Mahmoud MA, Mahmoudi E, Mahmoudi M, Makram OM, Malagón-Rojas JN, Malakan Rad E, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malinga LA, Malta DC, Mamun AA, Manla Y, Mannan F, Mansoori Y, Mansour A, Mansouri V, Mansournia MA, Mantovani LG, Marasini BP, Marateb HR, Maravilla JC, Marconi AM, Mardi P, Marino M, Marjani A, Marrugo Arnedo CA, Martinez-Guerra BA, Martinez-Piedra R, Martins CA, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Mate KKV, Matei CN, Mathioudakis AG, Maude RJ, Maugeri A, May EA, Mayeli M, Mazaheri M, Mazidi M, Mazzotti A, McAlinden C, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail MA, McPhail SM, Mechili EA, Mediratta RP, Meena JK, Mehari M, Mehlman ML, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mehrotra R, Mekonnen MM, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Mensah LG, Mentis AFA, Meo SA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mhlanga A, Mhlanga L, Mi T, Micha G, Michalek IM, Miller TR, Mindlin SN, Minelli G, Minh LHN, Mini GK, Minja NW, Mirdamadi N, Mirghafourvand M, Mirica A, Mirinezhad SK, Mirmosayyeb O, Mirutse MK, Mirza-Aghazadeh-Attari M, Mirzaei M, Misgana T, Misra S, Mitchell PB, Mithra P, Mittal C, Mittal M, Moazen B, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammad-pour S, Mohammadshahi M, Mohammed M, Mohammed S, Mohammed S, Mojiri-forushani H, Mokdad AH, Mokhtarzadehazar P, Momenzadeh K, Momtazmanesh S, Monasta L, Moni MA, Montazeri F, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moradinazar M, Moradpour F, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosaddeghi Heris R, Mosser JF, Mossialos E, Mostafavi H, Mostofinejad A, Mougin V, Mouodi S, Mousavi P, Mousavi SE, Mousavi Khaneghah A, Mpundu-Kaambwa C, Mrejen M, Mubarik S, Muccioli L, Mueller UO, Mughal F, Mukherjee S, Mukoro GD, Mulita A, Mulita F, Muniyandi M, Munjal K, Musaigwa F, Musallam KM, Mustafa G, Muthu S, Muthupandian S, Myung W, Nabhan AF, Nafukho FM, Nagarajan AJ, Naghavi M, Naghavi P, Naik GR, Naik G, Naimzada MD, Nair S, Nair TS, Najmuldeen HHR, Naldi L, Nangia V, Nargus S, Nascimento BR, Nascimento GG, Naser AY, Nasiri MJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Nayyar AK, Nazri-Panjaki A, Negash H, Negero AK, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nejjari C, Nematollahi MH, Nena E, Nepal S, Nesbit OD, Newton CRJ, Ngunjiri JW, Nguyen DH, Nguyen PT, Nguyen PT, Nguyen TT, Nguyen VT, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikpoor AR, Nizam MA, Nomura S, Noreen M, Noroozi N, Norouzian Baghani A, Norrving B, Noubiap JJ, Novotney A, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nuñez-Samudio V, Nurrika D, Oancea B, Obamiro KO, Odetokun IA, Ofakunrin AOD, Ogunsakin RE, Oguta JO, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okidi L, Okonji OC, Okwute PG, Olagunju AT, Olaiya MT, Olanipekun TO, Olatubi MI, Olivas-Martinez A, Oliveira GMM, Oliver S, Olorukooba AA, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Oluwatunase GO, Omar HA, Omer GL, Ong S, Onwujekwe OE, Onyedibe KI, Opio JN, Ordak M, Orellana ER, Orisakwe OE, Orish VN, Orru H, Ortega-Altamirano DV, Ortiz A, Ortiz-Brizuela E, Ortiz-Prado E, Osuagwu UL, Otoiu A, Otstavnov N, Ouyahia A, Ouyang G, Owolabi MO, Oyeyemi IT, Oyeyemi OT, Ozten Y, P A MP, Padubidri JR, Pahlavikhah Varnosfaderani M, Pal PK, Palicz T, Palladino C, Palladino R, Palma-Alvarez RF, Pana A, Panahi P, Pandey A, Pandi-Perumal SR, Pando-Robles V, Pangaribuan HU, Panos GD, Pantazopoulos I, Papadopoulou P, Pardhan S, Parikh RR, Park S, Parthasarathi A, Pashaei A, Pasupula DK, Patel JR, Patel SK, Pathan AR, Patil A, Patil S, Patoulias D, Patthipati VS, Paudel U, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Pereira G, Pereira J, Pereira M, Peres MFP, Perianayagam A, Perico N, Petcu IR, Petermann-Rocha FE, Pezzani R, Pham HT, Phillips MR, Pierannunzio D, Pigeolet M, Pigott DM, Pilgrim T, Pinheiro M, Piradov MA, Plakkal N, Plotnikov E, Poddighe D, Pollner P, Poluru R, Pond CD, Postma MJ, Poudel GR, Poudel L, Pourali G, Pourtaheri N, Prada SI, Pradhan PMS, Prajapati VK, Prakash V, Prasad CP, Prasad M, Prashant A, Prates EJS, Purnobasuki H, Purohit BM, Puvvula J, Qaisar R, Qasim NH, Qattea I, Qian G, Quan NK, Radfar A, Radhakrishnan V, Raee P, Raeisi Shahraki H, Rafiei Alavi SN, Rafique I, Raggi A, Rahim F, Rahman MM, Rahman M, Rahman MA, Rahman T, Rahmani AM, Rahmani S, Rahnavard N, Rai P, Rajaa S, Rajabpour-Sanati A, Rajput P, Ram P, Ramadan H, Ramasamy SK, Ramazanu S, Rana J, Rana K, Ranabhat CL, Rancic N, Rani S, Ranjan S, Rao CR, Rao IR, Rao M, Rao SJ, Rasali DP, Rasella D, Rashedi S, Rashedi V, Rashid AM, Rasouli-Saravani A, Rastogi P, Rasul A, Ravangard R, Ravikumar N, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghian-Jahromi I, Reddy MMRK, Redwan EMM, Rehman FU, Reiner Jr RC, Remuzzi G, Reshmi B, Resnikoff S, Reyes LF, Rezaee M, Rezaei N, Rezaei N, Rezaeian M, Riaz MA, Ribeiro AI, Ribeiro DC, Rickard J, Rios-Blancas MJ, Robinson-Oden HE, Rodrigues M, Rodriguez JAB, Roever L, Rohilla R, Rohloff P, Romadlon DS, Ronfani L, Roshandel G, Roshanzamir S, Rostamian M, Roy B, Roy P, Rubagotti E, Rumisha SF, Rwegerera GM, Rynkiewicz A, S M, S N C, S Sunnerhagen K, Saad AMA, Sabbatucci M, Saber K, Saber-Ayad MM, Sacco S, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Sadeghian S, Saeed U, Saeedi M, Safi S, Sagar R, Saghazadeh A, Saheb Sharif-Askari N, Sahoo SS, Sahraian MA, Sajedi SA, Sajid MR, Sakshaug JW, Salahi S, Salahi S, Salamati P, Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samara KA, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanganyado E, Sanjeev RK, Sanmarchi F, Sanna F, Santri IN, Santric-Milicevic MM, Sarasmita MA, Saravanan A, Saravi B, Sarikhani Y, Sarkar C, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sattin D, Saulam J, Sawyer SM, Saxena S, Saya GK, Sayadi Y, Sayeed A, Sayeed MA, Saylan M, Scarmeas N, Schaarschmidt BM, Schlee W, Schmidt MI, Schuermans A, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Sertsu A, Sethi Y, SeyedAlinaghi S, Seyedi SA, Shafaat A, Shafaat O, Shafie M, Shafiee A, Shah NS, Shah PA, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shakil H, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Shariff M, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shenoy MM, Shetty BSK, Shetty RS, Shey RA, Shiani A, Shibuya K, Shiferaw D, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shrestha S, Shuja KH, Shuval K, Si Y, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Silva S, Simões JP, Simpson CR, Singal A, Singh A, Singh A, Singh A, Singh BB, Singh B, Singh M, Singh M, Singh NP, Singh P, Singh S, Siraj MS, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Slepak ELN, Sohrabi H, Soleimani H, Soliman SSM, Solmi M, Solomon Y, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Starnes JR, Starodubov VI, Starodubova AV, Stefan SC, Stein DJ, Steinbeis F, Steiropoulos P, Stockfelt L, Stokes MA, Stortecky S, Stranges S, Stroumpoulis K, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Susanty S, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taborda-Barata LM, Tabuchi T, Tadesse BT, Taheri A, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tamuzi JL, Tan KK, Tang H, Tang HK, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tebeje TM, Tefera YM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Tesfaye SH, Thangaraju P, Thankappan KR, Thapa R, Thapar R, Thomas N, Thrift AG, Thum CCC, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tohidast SA, Tonelli M, Touvier M, Tovani-Palone MR, Tram KH, Tran NM, Trico D, Trihandini I, Tromans SJ, Truong VT, Truyen TTTT, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Ubah CS, Udoakang AJ, Udoh A, Ulhaq I, Ullah S, Ullah S, Umair M, Umar TP, Umeokonkwo CD, Umesh A, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Vacante M, Vahdani AM, Vaithinathan AG, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Varma SA, Vart P, Varthya SB, Vasankari TJ, Veerman LJ, Venketasubramanian N, Venugopal D, Verghese NA, Verma M, Verma P, Veroux M, Verras GI, Vervoort D, Vieira RJ, Villafañe JH, Villani L, Villanueva GI, Villeneuve PJ, Violante FS, Visontay R, Vlassov V, Vo B, Vollset SE, Volovat SR, Volovici V, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wado YD, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang D, Wang F, Wang S, Wang S, Wang Y, Wang YP, Ward P, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Werdecker A, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Wijeratne T, Wilson S, Wojewodzic MW, Wool EE, Woolf AD, Wu D, Wulandari RD, Xiao H, Xu B, Xu X, Yadav L, Yaghoubi S, Yang L, Yano Y, Yao Y, Ye P, Yesera GE, Yesodharan R, Yesuf SA, Yiğit A, Yiğit V, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Zadey S, Zadnik V, Zafari N, Zahedi M, Zahid MN, Zahir M, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Filardi M, Gnoni V, Tamburrino L, Nigro S, Urso D, Vilella D, Tafuri B, Giugno A, De Blasi R, Zoccolella S, Logroscino G. Sleep and circadian rhythm disruptions in behavioral variant frontotemporal dementia. Alzheimers Dement 2024; 20:1966-1977. [PMID: 38183333 PMCID: PMC10984421 DOI: 10.1002/alz.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Sleep and rest-activity rhythm alterations are common in neurodegenerative diseases. However, their characterization in patients with behavioral variant frontotemporal dementia (bvFTD) has proven elusive. We investigated rest-activity rhythm alterations, sleep disturbances, and their neural correlates in bvFTD. METHODS Twenty-seven bvFTD patients and 25 healthy controls completed sleep questionnaires and underwent 7 days of actigraphy while concurrently maintaining a sleep diary. Cortical complexity and thickness were calculated from T1-weighted magnetic resonance (MR) images. RESULTS Compared to controls, bvFTD patients showed longer time in bed (95% confidence interval [CI]: 79.31, 321.83) and total sleep time (95% CI: 24.38, 321.88), lower sleep efficiency (95% CI: -12.58, -95.54), and rest-activity rhythm alterations in the morning and early afternoon. Increased sleep duration was associated with reduced cortical thickness in frontal regions. DISCUSSION Patients with bvFTD showed longer sleep duration, lower sleep quality, and rest-activity rhythm alterations. Actigraphy could serve as a cost-effective and accessible tool for ecologically monitoring changes in sleep duration in bvFTD patients. HIGHLIGHTS We assessed sleep and circadian rhythms in behavioral variant frontotemporal dementia (bvFTD) using actigraphy. Patients with bvFTD show increased sleep duration and reduced sleep quality. Patients with bvFTD show rest-activity alterations in the morning and early afternoon. Sleep duration is associated with reduced cortical thickness in frontal regions. These alterations may represent an early sign of neurodegeneration.
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Affiliation(s)
- Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Ludovica Tamburrino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Benedetta Tafuri
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Department of Diagnostic ImagingPia Fondazione “Card. G. Panico”TricaseItaly
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Neurology Unit, San Paolo HospitalAzienda Sanitaria Locale (ASL) BariBariItaly
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
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Urso D, Nigro S, Tafuri B, De Blasi R, Pereira JB, Logroscino G. Nucleus Basalis of Meynert Degeneration Predicts Cognitive Decline in Corticobasal Syndrome. Biol Psychiatry 2024:S0006-3223(24)00061-1. [PMID: 38309321 DOI: 10.1016/j.biopsych.2024.01.018] [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: 07/16/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Cognitive changes are common in corticobasal syndrome (CBS) and significantly impact quality of life and caregiver burden. However, relatively few studies have investigated the neural substrates of cognitive changes in CBS, and reliable predictors of cognitive impairment are currently lacking. The nucleus basalis of Meynert (NbM), which serves as the primary source of cortical cholinergic innervation, has been functionally associated with cognition. This study aimed to explore whether patients with CBS exhibit reduced NbM volumes compared with healthy control participants and whether NbM degeneration can serve as a predictor of cognitive impairment in patients with CBS. METHODS In this study, we investigated in vivo volumetric changes of the NbM in 38 patients with CBS and 84 healthy control participants. Next, we assessed whether gray matter degeneration of the NbM evaluated at baseline could predict cognitive impairment during a 12-month follow-up period in patients with CBS. All volumetric analyses were performed using 3T T1-weighted images obtained from the 4-Repeat Tauopathy Neuroimaging Initiative. RESULTS Patients with CBS displayed significantly lower NbM volumes than control participants (p < .001). Structural damage of the NbM also predicted the development of cognitive impairment in patients with CBS as assessed by longitudinal measurements of the Clinical Dementia Rating Sum of Boxes (p < .001) and Mini-Mental State Examination (p = .035). CONCLUSIONS Our findings suggest that NbM atrophy may represent a promising noninvasive in vivo marker of cognitive decline in CBS and provide new insights into the neural mechanisms that underlie cognitive impairment in CBS.
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Affiliation(s)
- Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Italy; Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Italy; Institute of Nanotechnology, National Research Council, Lecce, Italy
| | - Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Italy; Department of Translational Biomedicine and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Roberto De Blasi
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione Card. G. Panico, Tricase, Italy
| | - Joana B Pereira
- Department of Clinical Neurosciences, Neuro Division, Karolinska Institute, Solna, Sweden
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Italy; Department of Translational Biomedicine and Neurosciences, University of Bari Aldo Moro, Bari, Italy.
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Michelutti M, Urso D, Gnoni V, Giugno A, Zecca C, Vilella D, Accadia M, Barone R, Dell'Abate MT, De Blasi R, Manganotti P, Logroscino G. Narcissistic Personality Disorder as Prodromal Feature of Early-Onset, GRN-Positive bvFTD: A Case Report. J Alzheimers Dis 2024; 98:425-432. [PMID: 38393901 DOI: 10.3233/jad-230779] [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: 02/25/2024]
Abstract
Background Behavioral variant frontotemporal dementia (bvFTD) typically involves subtle changes in personality that can delay a timely diagnosis. Objective Here, we report the case of a patient diagnosed of GRN-positive bvFTD at the age of 52 presenting with a 7-year history of narcissistic personality disorder, accordingly to DSM-5 criteria. Methods The patient was referred to neurological and neuropsychological examination. She underwent 3 Tesla magnetic resonance imaging (MRI) and genetic studies. Results The neuropsychological examination revealed profound deficits in all cognitive domains and 3T brain MRI showed marked fronto-temporal atrophy. A mutation in the GRN gene further confirmed the diagnosis. Conclusions The present case documents an unusual onset of bvFTD and highlights the problematic nature of the differential diagnosis between prodromal psychiatric features of the disease and primary psychiatric disorders. Early recognition and diagnosis of bvFTD can lead to appropriate management and support for patients and their families. This case highlights the importance of considering neurodegenerative diseases, such as bvFTD, in the differential diagnosis of psychiatric disorders, especially when exacerbations of behavioral traits manifest in adults.
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Affiliation(s)
- Marco Michelutti
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, University Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Gnoni
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alessia Giugno
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Chiara Zecca
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Davide Vilella
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Maria Accadia
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Roberta Barone
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Maria Teresa Dell'Abate
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Roberto De Blasi
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione "Card. G.Panico", Tricase, Italy
| | - Paolo Manganotti
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, University Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
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Milella G, Zoccolella S, Giugno A, Filardi M, Urso D, Nigro S, Tafuri B, Tamburrino L, Gnoni V, Logroscino G. The impact of upper and lower motor neuron burden on diagnostic certainty, and clinical course of spinal-onset amyotrophic lateral sclerosis: a cluster-based approach. J Neurol 2023; 270:4868-4875. [PMID: 37338613 DOI: 10.1007/s00415-023-11827-7] [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: 04/13/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Upper motor neuron (UMN) and lower motor neuron (LMN) involvement represent the core clinical features of amyotrophic lateral sclerosis (ALS). Several studies divided patients into prevalent UMN and LMN impairment phenotypes to investigate the association between motor systems impairments and ALS clinical course. However, this distinction was somehow heterogeneous and significantly affected the comparability across studies. AIMS This study aimed to investigate whether patients spontaneously segregate based on the extent of UMN and LMN involvement without a-priori categorization and to identify potential clinical and prognostic features of different clusters. METHODS Eighty-eight consecutive spinal-onset ALS patients were referred to an ALS tertiary center between 2015 and 2022. UMN and LMN burden was assessed with the Penn Upper Motor Neuron scale (PUMNS) and the Devine score, respectively. PUMNS and LMN scores were normalized into 0-1 and analyzed using a two-step cluster analysis and the Euclidean distance measure. The Bayesian Information Criterion was used to determine the cluster number. Demographic and clinical variables were tested for differences among the clusters. RESULTS Three distinct clusters emerged at cluster analysis. Patients in "cluster-1" showed moderate UMN and severe LMN involvement, corresponding to the typical ALS phenotype. Patients in "cluster-2" showed mild LMN and severe UMN damage, corresponding to a predominant UMN phenotype, while "cluster-3" patients showed mild UMN and moderate LMN damage, corresponding to a predominant LMN phenotype. Patients in "cluster-1" and "cluster-2" showed a higher prevalence of definite ALS than those in "cluster-3" (61% and 46 vs 9%, p < 0.001). "Cluster-1" patients had a lower median ALSFRS-r score compared to both "cluster-2" and 3 patients (27 vs 40 and 35, < 0.001). "Cluster-1" (HR: 8.5; 95% CI 2.1-35.1 and p = 0.003) and 3 (HR: 3.2; 95% CI 1.1-9.1; p = 0.03) were associated with shorter survival than those in "cluster-2". CONCLUSIONS Spinal-onset ALS can be categorized into three groups according to LMN and UMN burden. The UMN burden is related to higher diagnostic certainty and broader disease spread, while LMN involvement is associated with higher disease severity and shorter survival.
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Affiliation(s)
- Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Stefano Zoccolella
- Neurology Unit, ASL Bari, San Paolo Hospital, Bari, Italy.
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy.
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Benedetta Tafuri
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Ludovica Tamburrino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
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Ghirelli A, Tafuri B, Urso D, Milella G, De Blasi R, Nigro S, Logroscino G. Cortical signature of depressive symptoms in frontotemporal dementia: A surface-based analysis. Ann Clin Transl Neurol 2023; 10:1704-1713. [PMID: 37522381 PMCID: PMC10578898 DOI: 10.1002/acn3.51860] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Depressive symptoms are frequently reported in patients affected by frontotemporal dementia (FTD). At structural MRI, cortical features of depressed FTD patients have been poorly described. Our objective was to investigate correlations between cortical measures and depression severity in FTD patients. METHODS Data were obtained from the Frontotemporal Lobar Degeneration Neuroimaging Initiative (FTLDNI) database. We included 98 controls and 92 FTD patients, n = 38 behavioral variant FTD (bvFTD), n = 26 non-fluent variant Primary Progressive Aphasia (nfvPPA), and n = 28 semantic variant Primary Progressive Aphasia (svPPA). Patients underwent clinical and cognitive evaluations, as well as a 3D T1-weighted MRI on a 3 Tesla scanner (Siemens, Trio Tim system). Depression was evaluated by means of Geriatric Depression Scale (GDS). Surface-based analysis was performed on T1-weighted images to evaluate cortical thickness, a measure of gray matter integrity, and local gyrification index (lGI), a quantitative metric of cortical folding. RESULTS Patients affected by svPPA were more depressed than controls at NPI and depression severity at GDS was higher in svPPA and bvFTD. Severity of depression correlated with a decrease in lGI in left precentral and superior frontal gyrus, supramarginal and postcentral gyrus and right precentral, supramarginal, superior parietal and superior frontal gyri. Furthermore, depression severity correlated positively with cortical thickness in the left medial orbitofrontal cortex. DISCUSSION We found that lGI was associated with depressive symptoms over brain regions involved in the pathophysiology of major depressive disorder. This finding provides novel insights into the mechanisms underlying psychiatric symptoms in FTD.
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Affiliation(s)
- Alma Ghirelli
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Translational Biomedicine and Neuroscience (DiBraiN)University of Bari ‘Aldo Moro’BariItaly
| | - Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Translational Biomedicine and Neuroscience (DiBraiN)University of Bari ‘Aldo Moro’BariItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Neurosciences, King's College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Giammarco Milella
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Translational Biomedicine and Neuroscience (DiBraiN)University of Bari ‘Aldo Moro’BariItaly
| | - Roberto De Blasi
- Department of Diagnostic ImagingPia Fondazione di Culto e Religione “Card. G. Panico”LecceItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Institute of Nanotechnology (NANOTEC), National Research CouncilLecceItaly
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in NeurologyUniversity of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”LecceItaly
- Department of Diagnostic ImagingPia Fondazione di Culto e Religione “Card. G. Panico”LecceItaly
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Tafuri B, Urso D, Nigro S, Macchitella L, De Blasi R, Ray Chaudhuri K, Logroscino G. Grey-matter correlates of empathy in 4-Repeat Tauopathies. NPJ Parkinsons Dis 2023; 9:138. [PMID: 37758794 PMCID: PMC10533505 DOI: 10.1038/s41531-023-00576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Loss of empathy is an early and central symptom of frontotemporal lobar degeneration spectrum diseases. We aimed to investigate the topographical distribution of morphometric brain changes associated with empathy in Progressive Supranuclear Palsy (PSP) and Corticobasal Syndrome (CBS) patients. Twenty-seven participants with CBS and 31 with PSP were evaluated using Interpersonal Reactivity Index scales in correlation with gray matter atrophy using a voxel-based morphometry approach. Lower levels of empathy were associated with an increased atrophy in fronto-temporal cortical structures. At subcortical level, empathy scores were positively correlated with gray matter volume in the amygdala, hippocampus and the cerebellum. These findings allow to extend the traditional cortico-centric view of cognitive empathy to the cerebellar regions in patients with neurodegenerative disorders and suggest that the cerebellum may play a more prominent role in social cognition than previously appreciated.
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Affiliation(s)
- Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Luigi Macchitella
- IRCCS "E. Medea"- Unit for Severe disabilities in developmental age and young adults (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - K Ray Chaudhuri
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy.
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Urso D, Batzu L, Logroscino G, Ray Chaudhuri K, Pereira JB. Neurofilament light predicts worse nonmotor symptoms and depression in Parkinson's disease. Neurobiol Dis 2023; 185:106237. [PMID: 37499883 DOI: 10.1016/j.nbd.2023.106237] [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: 03/15/2023] [Revised: 06/18/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The identification of biomarkers that reflect worse progression of nonmotor symptoms (NMS) in Parkinson's disease (PD) is currently an unmet need. The main aim of this study was to investigate whether cerebrospinal fluid (CSF) and serum neurofilament light (NfL), measured at baseline or longitudinally, can be used to predict the progression of NMS in patients with PD. METHODS Baseline and longitudinal NfL levels were measured in the CSF and serum in 392 PD patients and 184 healthy controls from the Parkinson's Progression Marker Initiative. NMS were assessed using several scales, including, but not restricted to, the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part I, the Geriatric Depression Scale (GDS) and the State-Trait Anxiety Inventory (STAI). The relationship between baseline and longitudinal NfL levels with changes in NMS was assessed using linear mixed effects models (LME) in PD patients. In addition, we compared CSF and serum NfL levels between groups and assessed the relationship between NfL biomarkers with baseline NMS. Finally, to assess the specificity of our findings we ran the previous LME models using other biomarkers such as CSF amyloid-β1-42, total tau, phosphorylated tau181 and total α-synuclein and we also ran the models in healthy controls. RESULTS Baseline levels and longitudinal changes in serum and CSF NfL predicted worse longitudinal MDS-UPDRS-I and depression scores over time in PD (p < 0.01). This relationship remained significant only for CSF NfL when controlling for motor and cognitive status. Furthermore, longitudinal changes in serum and CSF NfL were associated with worse anxiety over time in PD patients (p < 0.05). In contrast to CSF NfL, serum NfL levels were slightly higher at baseline (p = 0.043) and showed significant longitudinal increases (p < 0.001) in PD patients compared to controls. There were no significant correlations between NfL levels (CSF or serum) with other NMS scales, baseline NMS variables, other biomarkers or in healthy controls. CONCLUSIONS Our findings indicate that both serum and CSF NfL are associated with worse longitudinal NMS burden, particularly in relation to the progression of depression and anxiety. Serum NfL showed stronger associations with NMS suggesting it could potentially be used as a non-invasive marker of NMS progression for PD.
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Affiliation(s)
- Daniele Urso
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom; Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - K Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Joana B Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden..
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14
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Zoccolella S, Giugno A, Milella G, Filardi M, Introna A, Fraddosio A, D'Errico E, Gnoni V, Tamburrino L, Urso D, Caputo F, Misceo S, Logroscino G. A Clinical Scale for Rating the Severity of Bulbar Lower Motor Neuron Dysfunction in Amyotrophic Lateral Sclerosis. Biomedicines 2023; 11:2039. [PMID: 37509677 PMCID: PMC10376980 DOI: 10.3390/biomedicines11072039] [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: 06/26/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is characterized by the progressive loss of upper (UMN) and lower motor neurons (LMN) in four different body regions (bulbar, cervical, thoracic, and lumbosacral). Over the past decades, several clinical scoring systems have been developed to assess the UMN and LMN burden in ALS. However, concerning the bulbar LMN burden, the available scoring systems solely assess the presence/absence of bulbar LMN signs without providing a degree of impairment. Therefore, in this study, we proposed a novel scale to stratify subjects with ALS according to the bulbar LMN involvement and assessed its prognostic value. METHODS We developed a four-item scale based on the LMN signs according to the El Escorial criteria. Ten raters, specializing in ALS or neurocognitive disorders, retrospectively applied the scale to the first evaluation of 195 patients with ALS. Cohen's kappa (Cohen's k) and an intra-class correlation coefficient (ICC) were used to assess the inter-rater reliability. The Kaplan-Mayer estimator was used to estimate survival distribution according to the bulbar scale scores. RESULTS The raters showed a substantial to excellent agreement with Cohen's k, ranging from 0.834 to 0.975, with an overall ICC of 0.922 (95% CI = 0.906-0.936). The survival distribution was statistically different across the three bulbar scale scores (χ2(2) = 9.50, p < 0.01). CONCLUSIONS Our bulbar LMN scale represents a reliable measure of the bulbar LMN signs in ALS. This easy-to-administer clinical scale could provide unique information in phenotyping and predicting survival in ALS.
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Affiliation(s)
- Stefano Zoccolella
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, 70132 Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Alessandro Introna
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Angela Fraddosio
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Eustachio D'Errico
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Francesca Caputo
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Salvatore Misceo
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, 70132 Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
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15
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Gnoni V, Zoccolella S, Giugno A, Urso D, Tamburrino L, Filardi M, Logroscino G. Hypothalamus and amyotrophic lateral sclerosis: potential implications in sleep disorders. Front Aging Neurosci 2023; 15:1193483. [PMID: 37465321 PMCID: PMC10350538 DOI: 10.3389/fnagi.2023.1193483] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that affects both motor and non-motor functions, including sleep regulation. Emerging evidence suggests that the hypothalamus, a brain region that plays a critical role in sleep-wake regulation, may be involved in the pathogenesis of ALS-related sleep disturbances. In this review, we have summarized results of studies on sleep disorders in ALS published between 2000 and 2023. Thereafter, we examined possible mechanisms by which hypothalamic dysfunctions may contribute to ALS-related sleep disturbances. Achieving a deeper understanding of the relationship between hypothalamic dysfunction and sleep disturbances in ALS can help improve the overall management of ALS and reduce the burden on patients and their families.
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Affiliation(s)
- Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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16
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Batzu L, Urso D, Grothe MJ, Veréb D, Chaudhuri KR, Pereira JB. Increased basal forebrain volumes could prevent cognitive decline in LRRK2 Parkinson's disease. Neurobiol Dis 2023:106182. [PMID: 37286171 DOI: 10.1016/j.nbd.2023.106182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It has been recently suggested that LRRK2 mutations are associated with a more benign clinical phenotype and a potentially more preserved cholinergic function in Parkinson's disease (PD). However, to our knowledge, no studies have tested whether the better clinical progression observed in LRRK2-PD patients is associated with more preserved volumes of a cholinergic brain area, the basal forebrain (BF). To address this hypothesis, here we compared BF volumes in LRRK2 carriers with and without PD with respect to idiopathic PD (iPD) patients and controls, and assessed whether they are associated with better clinical progression observed in LRRK2-PD compared to iPD. METHODS Thirty-one symptomatic LRRK2-PD patients and 13 asymptomatic LRRK2 individuals were included from the Parkinson's Progression Markers Initiative. In addition, 31 patients with iPD and 13 healthy controls matched to the previous groups were also included. BF volumes were automatically extracted from baseline T1-weighted MRI scans using a stereotactic atlas of cholinergic nuclei. These volumes were then compared between groups and their relationship with longitudinal cognitive changes was evaluated using linear mixed effects models. Mediation analyses assessed whether BF volumes mediated differences in cognitive trajectories between groups. RESULTS LRRK2-PD patients showed significantly higher BF volumes compared to iPD (P = 0.019) as did asymptomatic LRRK2 subjects compared to controls (P = 0.008). There were no other significant differences in cortical regions or subcortical volumes between these groups. BF volumes predicted longitudinal decline in several cognitive functions in iPD patients but not in LRRK2-PD, who did not show cognitive changes over a 4-year follow-up period. BF volumes were a significant mediator of the different cognitive trajectories between iPD and LRRK2-PD patients (95% CI 0.056-2.955). DISCUSSION Our findings suggest that mutations in LRRK2 are associated with increased BF volumes, potentially reflecting a compensatory hypercholinergic state that could prevent cognitive decline in LRRK2-PD patients.
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Affiliation(s)
- Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom; Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Dániel Veréb
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Joana B Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Milella G, Zoccolella S, Urso D, Nigro S, Tamburrino L, Gnoni V, Filardi M, Logroscino G. Different patterns of spreading direction and motor neurons involvement in a cohort of limb-onset amyotrophic lateral sclerosis patients from Southern Italy: Potential implication on disease course or progression? Brain Behav 2023; 13:e2899. [PMID: 37208847 PMCID: PMC10275554 DOI: 10.1002/brb3.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Currently, there is a lack of knowledge concerning where the pathological process starts and how the neurodegeneration spreads during the course of amyotrophic lateral sclerosis (ALS). AIMS This study aims to evaluate the spreading direction of the disease and the corresponding clinical characteristics in a cohort of patients with limb-onset ALS. PATIENTS AND METHODS Consecutive incident ALS patients referring to an ALS tertiary center from Southern Italy, between 2015 and 2021, were recruited in the study. According to the initial directions of spread, patients were dichotomized into horizontal spreading pattern (HSP) or vertical spreading pattern (VSP) groups. RESULTS Among 137 newly diagnosed ALS, 87 presented a spinal onset. Ten patients with pure LMN were not included in the study. All cases reported a clear spread direction. The frequency of HSP and VSP spreading was similar overall (47 vs. 30). The prevalence of HSP was higher (74% vs. 50%) in patients with upper limb-onset (UL-ALS), compared to patients with lower limb-onset (LL-ALS; p < .05). Conversely, the occurrence of VSP spread was threefold higher in patients with LL-ALS, compared to UL-ALS (p < .05). Patients with VSP showed a wider upper motor neuron impairment, whereas the involvement of LMN resulted greater in patients with HSP. Patients with HSP exhibited a greater drop of ALSFRS-r sub-score in the region of onset, while VSP showed a slighter but more diffuse reduction of ASLFRS-r subscore in more body districts beyond the site of onset. Patients with VSP were also characterized by a higher median progression rate and an earlier median bulbar involvement, compared to HSP. CONCLUSIONS Our findings suggested investigating the spreading direction of ALS among patients with spinal onset, to better delineate the clinical profiles of patients with ALS, and predict an earlier impairment of bulbar muscle and a more rapid progression of the disease.
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Affiliation(s)
- Giammarco Milella
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Stefano Zoccolella
- ASL BariSan Paolo Hospital, Neurology UnitMilanItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
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18
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Iacolucci CM, Urso D, Zoccolella S, Vitulli A, Barone R, Logroscino G. Clinical Conundrum: Dysphagia Associated with Sleep Disorders. Dysphagia 2023; 38:726-728. [PMID: 35751739 DOI: 10.1007/s00455-022-10474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Carlo Maria Iacolucci
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy.
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
| | - Alessandra Vitulli
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
| | - Roberta Barone
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy.
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
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Tafuri B, Filardi M, Urso D, Gnoni V, De Blasi R, Nigro S, Logroscino G. Asymmetry of radiomics features in the white matter of patients with primary progressive aphasia. Front Aging Neurosci 2023; 15:1120935. [PMID: 37213534 PMCID: PMC10196268 DOI: 10.3389/fnagi.2023.1120935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Primary Progressive Aphasia (PPA) is a neurological disease characterized by linguistic deficits. Semantic (svPPA) and non-fluent/agrammatic (nfvPPA) variants are the two main clinical subtypes. We applied a novel analytical framework, based on radiomic analysis, to investigate White Matter (WM) asymmetry and to examine whether asymmetry is associated with verbal fluency performance. Methods Analyses were performed on T1-weighted images including 56 patients with PPA (31 svPPA and 25 nfvPPA) and 53 age- and sex-matched controls. Asymmetry Index (AI) was computed for 86 radiomics features in 34 white matter regions. The relationships between AI, verbal fluency performance (semantic and phonemic) and Boston Naming Test score (BNT) were explored through Spearman correlation analysis. Results Relative to controls, WM asymmetry in svPPA patients involved regions adjacent to middle temporal cortex as part of the inferior longitudinal (ILF), fronto-occipital (IFOF) and superior longitudinal fasciculi. Conversely, nfvPPA patients showed an asymmetry of WM in lateral occipital regions (ILF/IFOF). A higher lateralization involving IFOF, cingulum and forceps minor was found in nfvPPA compared to svPPA patients. In nfvPPA patients, semantic fluency was positively correlated to asymmetry in ILF/IFOF tracts. Performances at BNT were associated with AI values of the middle temporal (ILF/SLF) and parahippocampal (ILF/IFOF) gyri in svPPA patients. Discussion Radiomics features depicted distinct pathways of asymmetry in svPPA and nfvPPA involving damage of principal fiber tracts associated with speech and language. Assessing asymmetry of radiomics in PPA allows achieving a deeper insight into the neuroanatomical damage and may represent a candidate severity marker for language impairments in PPA patients.
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Affiliation(s)
- Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- *Correspondence: Benedetta Tafuri,
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King’s College London, London, United Kingdom
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Borroni B, Urso D, Zecca C, Binetti G, Fostinelli S, Benussi L, Ghidoni R, Tarantino B, Rivolta J, Dell'Abate MT, Alberici A, Logroscino G. Survival in Incident Cases with Frontotemporal Lobar Degeneration: A Registry-Based Study. J Alzheimers Dis 2023; 96:1019-1024. [PMID: 37927261 DOI: 10.3233/jad-230676] [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: 11/07/2023]
Abstract
Population-based registries represent a unique sample to estimate survival. The aim of the present study was to assess survival rates and predictors of outcome in incidental frontotemporal lobar degeneration (FTLD). Incident cases with FTLD, included between January 1, 2017 to December 31, 2017, have been followed for five years. Median survival was 8.16 years from disease onset and 5.38 years from diagnosis. Survival rates did not differ between phenotypes. Shorter disease duration from onset to diagnosis was associated with poorer outcome (p = 0.01). FTLD is a relatively homogeneous disease in terms of survival. Future multinational population-based studies are needed to confirm these findings.
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Affiliation(s)
- Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
- Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia, Brescia, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Chiara Zecca
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Giuliano Binetti
- MAC-Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Fostinelli
- MAC-Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Barbara Tarantino
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy
| | - Jasmine Rivolta
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Maria Teresa Dell'Abate
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Antonella Alberici
- Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia, Brescia, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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21
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Alaoui AA, Alaoui S, Hajjar R, Urso D, Gnoni V. Head and neck cancer radiotherapy and obstructive sleep apnea. Ann Palliat Med 2022; 11:3592-3595. [PMID: 36510460 DOI: 10.21037/apm-22-972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Affiliation(s)
| | - Souad Alaoui
- Faculty of Dental Medicine, University of Montreal, Quebec, Canada
| | - Roy Hajjar
- Faculty of Medicine, University of Montreal, Quebec, Canada
| | - Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Valentina Gnoni
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
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Rota S, Urso D, van Wamelen DJ, Leta V, Boura I, Odin P, Espay AJ, Jenner P, Chaudhuri KR. Why do 'OFF' periods still occur during continuous drug delivery in Parkinson's disease? Transl Neurodegener 2022; 11:43. [PMID: 36229860 PMCID: PMC9558383 DOI: 10.1186/s40035-022-00317-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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Continuous drug delivery (CDD) is used in moderately advanced and late-stage Parkinson’s disease (PD) to control motor and non-motor fluctuations (‘OFF’ periods). Transdermal rotigotine is indicated for early fluctuations, while subcutaneous apomorphine infusion and levodopa-carbidopa intestinal gel are utilised in advanced PD. All three strategies are considered examples of continuous dopaminergic stimulation achieved through CDD. A central premise of the CDD is to achieve stable control of the parkinsonian motor and non-motor states and avoid emergence of ‘OFF’ periods. However, data suggest that despite their efficacy in reducing the number and duration of ‘OFF’ periods, these strategies still do not prevent ‘OFF’ periods in the middle to late stages of PD, thus contradicting the widely held concepts of continuous drug delivery and continuous dopaminergic stimulation. Why these emergent ‘OFF’ periods still occur is unknown. In this review, we analyse the potential reasons for their persistence. The contribution of drug- and device-related involvement, and the problems related to site-specific drug delivery are analysed. We propose that changes in dopaminergic and non-dopaminergic mechanisms in the basal ganglia might render these persistent ‘OFF’ periods unresponsive to dopaminergic therapy delivered via CDD.
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Affiliation(s)
- Silvia Rota
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK. .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro, "Pia Fondazione Cardinale G. Panico", 73039, Tricase, Italy
| | - Daniel J van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Iro Boura
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Medicine, University of Crete, Crete, Greece.,Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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Urso D, Zoccolella S, Gnoni V, Logroscino G. Amyotrophic Lateral Sclerosis-The Complex Phenotype-From an Epidemiological Perspective: A Focus on Extrapyramidal and Non-Motor Features. Biomedicines 2022; 10:biomedicines10102537. [PMID: 36289799 PMCID: PMC9599737 DOI: 10.3390/biomedicines10102537] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease (MND) and has emerged, among the disorders, with the largest increase in incidence in Western countries. Although the typical clinical phenotype of ALS involves simultaneous upper and lower motor neurons, there is growing evidence that the neurodegeneration during the course of the disease can also involve other motor and non-motor regions. In this review, we analyzed and discussed available data from epidemiological population-based studies on extrapyramidal and non-motor features during the course of ALS.
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Affiliation(s)
- Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Correspondence: (D.U.); (G.L.)
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro’, 70121 Bari, Italy
- Correspondence: (D.U.); (G.L.)
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24
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Urso D, Gnoni V, De Blasi R, Anastasia A, Aarsland D, Chaudhuri Ray K, Logroscino G. Neuroimaging Biomarkers in a Patient With Probable Psychiatric-Onset Prodromal Dementia With Lewy Bodies. Neurology 2022; 99:654-657. [PMID: 35953291 DOI: 10.1212/wnl.0000000000201166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Psychiatric-onset prodromal dementia with Lewy bodies (DLBs) is a recently proposed clinical entity characterized by psychiatric presentation that may predate clinical dementia by many years. It is not yet clear how to identify patients with prominent late-onset psychiatric symptoms who may have underlying Lewy body disease. In this article, we describe how neuroimaging can assist in the identification of this condition. METHODS A 77-year-old man presented with late-onset psychosis. He underwent an extensive clinical and neuropsychological evaluation. These included brain MRI with arterial spin labeling (ASL) which quantifies perfusion. [123I] FP-CIT SPECT and I-metaiodobenzylguanidine scintigraphy assessed striatal dopaminergic and cardiac adrenergic integrity, respectively. RESULTS Clinical evaluation revealed a history of REM sleep behavior disorder and parkinsonism induced by antipsychotics. The patient's cognitive function was normal. Conventional MRI showed parieto-occipital atrophy, and posterior hypoperfusion was revealed by ASL-MRI. Of note, the "cingulate island sign" was present. [123I]FP-CIT SPECT and I-metaiodobenzylguanidine endorsed the suspicion of α-synucleinopathy. The patient fulfils the recently proposed key features of psychiatric-onset prodromal DLB. DISCUSSION Prodromal DLB is an emerging concept. Biomarkers have not been yet established. We propose that nuclear imaging and advanced MRI technics showing posterior hypoperfusion and the presence of the "cingulate island sign" could be promising biomarker candidates.
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Affiliation(s)
- Daniele Urso
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Valentina Gnoni
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Roberto De Blasi
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Anastasia
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Dag Aarsland
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Kallo Chaudhuri Ray
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giancarlo Logroscino
- From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.
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Tafuri B, Lombardi A, Nigro S, Urso D, Monaco A, Pantaleo E, Diacono D, De Blasi R, Bellotti R, Tangaro S, Logroscino G. The impact of harmonization on radiomic features in Parkinson’s disease and healthy controls: A multicenter study. Front Neurosci 2022; 16:1012287. [PMID: 36300169 PMCID: PMC9589497 DOI: 10.3389/fnins.2022.1012287] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Radiomics is a challenging development area in imaging field that is greatly capturing interest of radiologists and neuroscientists. However, radiomics features show a strong non-biological variability determined by different facilities and imaging protocols, limiting the reproducibility and generalizability of analysis frameworks. Our study aimed to investigate the usefulness of harmonization to reduce site-effects on radiomics features over specific brain regions. We selected T1-weighted magnetic resonance imaging (MRI) by using the MRI dataset Parkinson’s Progression Markers Initiative (PPMI) from different sites with healthy controls (HC) and Parkinson’s disease (PD) patients. First, the investigation of radiomics measure discrepancies were assessed on healthy brain regions-of-interest (ROIs) via a classification pipeline based on LASSO feature selection and support vector machine (SVM) model. Then, a ComBat-based harmonization approach was applied to correct site-effects. Finally, a validation step on PD subjects evaluated diagnostic accuracy before and after harmonization of radiomics data. Results on healthy subjects demonstrated a dependence from site-effects that could be corrected with ComBat harmonization. LASSO regressor after harmonization was unable to select any feature to distinguish controls by site. Moreover, harmonized radiomics features achieved an area under the receiving operating characteristic curve (AUC) of 0.77 (compared to AUC of 0.71 for raw radiomics measures) in distinguish Parkinson’s patients from HC. We found a not-negligible site-effect studying radiomics of HC pre- and post-harmonization of features. Our validation study on PD patients demonstrated a significant influence of non-biological noise source in diagnostic performances. Finally, harmonization of multicenter radiomic data represent a necessary step to make analysis pipelines reliable and replicable for multisite neuroimaging studies.
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Affiliation(s)
- Benedetta Tafuri
- Dipartimento di Ricerca Clinica in Neurologia, Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Pia Fondazione Cardinale G. Panico, Università degli Studi di Bari Aldo Moro, Lecce, Italy
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari Aldo Moro, Bari, Italy
- *Correspondence: Benedetta Tafuri,
| | - Angela Lombardi
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
- Dipartimento Interateneo di Fisica M. Merlin, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Salvatore Nigro
- Dipartimento di Ricerca Clinica in Neurologia, Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Pia Fondazione Cardinale G. Panico, Università degli Studi di Bari Aldo Moro, Lecce, Italy
- Istituto di Nanotecnologia, Consiglio Nazionale delle Ricerche (CNR-NANOTEC), Lecce, Italy
| | - Daniele Urso
- Dipartimento di Ricerca Clinica in Neurologia, Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Pia Fondazione Cardinale G. Panico, Università degli Studi di Bari Aldo Moro, Lecce, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Alfonso Monaco
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
| | - Ester Pantaleo
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
- Dipartimento Interateneo di Fisica M. Merlin, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Domenico Diacono
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
| | - Roberto De Blasi
- Dipartimento di Ricerca Clinica in Neurologia, Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Pia Fondazione Cardinale G. Panico, Università degli Studi di Bari Aldo Moro, Lecce, Italy
- Dipartimento di Radiologia, Pia Fondazione Cardinale G. Panico, Lecce, Italy
| | - Roberto Bellotti
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
- Dipartimento Interateneo di Fisica M. Merlin, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Sabina Tangaro
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
- Dipartimento di Scienze del Suolo, Della Pianta e degli Alimenti, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Dipartimento di Ricerca Clinica in Neurologia, Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Pia Fondazione Cardinale G. Panico, Università degli Studi di Bari Aldo Moro, Lecce, Italy
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari Aldo Moro, Bari, Italy
- Giancarlo Logroscino,
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Logroscino G, Urso D, Tortelli R. The challenge of amyotrophic lateral sclerosis descriptive epidemiology: to estimate low incidence rates across complex phenotypes in different geographic areas. Curr Opin Neurol 2022; 35:678-685. [PMID: 35946801 PMCID: PMC9593328 DOI: 10.1097/wco.0000000000001097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Amyotrophic lateral sclerosis (ALS) is a rare progressive neurodegenerative disease of motor neurons with a fatal outcome. The rareness of the disease and the rapidly fatal course are the main challenges for the ALS epidemiological research. The understanding of ALS has clearly advanced in the recent years both in the genetics and in the leading pathways of disease determinants. Epidemiological research has played a primary role in these discoveries. RECENT FINDINGS Epidemiological studies have shown a variation of incidence, mortality and prevalence of ALS between geographical areas and different populations, supporting the notion that genetic factors, linked to populations' ancestries, along with environmental and lifestyle factors, play a significant role in the occurrence of the disease. The burden of motor neuron diseases is increasing and currently more relevant in high-income countries but increasing at the highest rate in low and middle-income countries. The ALS phenotype is not restricted to motor functions. C9orf72 repeat expansion seems to present a recognizable phenotype characterized by earlier disease onset, the presence of cognitive and behavioural impairment. SUMMARY Population-based disease registries have played a major role in developing new knowledge on ALS, in characterizing genotype-phenotype correlations, in discovering new genetic modifiers and finally in planning research and health services, considering the high cost of motor neuron disease care. Epidemiological research based on multicentre international collaboration is essential to provide new data on ALS, especially in some regions of the world with poor data.
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Affiliation(s)
- Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ’Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari ’Aldo Moro’, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ’Aldo Moro’, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Rosanna Tortelli
- Neuroscience and Rare Diseases Discovery and Translational Area, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Leta V, Urso D, Batzu L, Lau YH, Mathew D, Boura I, Raeder V, Falup-Pecurariu C, van Wamelen D, Ray Chaudhuri K. Viruses, parkinsonism and Parkinson's disease: the past, present and future. J Neural Transm (Vienna) 2022; 129:1119-1132. [PMID: 36036863 PMCID: PMC9422946 DOI: 10.1007/s00702-022-02536-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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] [Received: 04/22/2022] [Accepted: 08/01/2022] [Indexed: 01/01/2023]
Abstract
Parkinsonism secondary to viral infections is not an uncommon occurrence and has been brought under the spotlight with the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A variety of viruses have been described with a potential of inducing or contributing to the occurrence of parkinsonism and Parkinson's disease (PD), although the relationship between the two remains a matter of debate originating with the description of encephalitis lethargica in the aftermath of the Spanish flu in 1918. While some viral infections have been linked to an increased risk for the development of PD, others seem to have a causal link with the occurrence of parkinsonism. Here, we review the currently available evidence on viral-induced parkinsonism with a focus on potential pathophysiological mechanisms and clinical features. We also review the evidence on viral infections as a risk factor for developing PD and the link between SARS-CoV-2 and parkinsonism, which might have important implications for future research and treatments.
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Affiliation(s)
- Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK
| | - Yue Hui Lau
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK
| | - Donna Mathew
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK
| | - Iro Boura
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Neurology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Vanessa Raeder
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | | | - Daniel van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RT, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, SE5 9RS, UK.
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Logroscino G, Urso D, Savica R. Descriptive epidemiology of neurodegenerative diseases: What are the critical questions? Neuroepidemiology 2022; 56:309-318. [PMID: 35728570 DOI: 10.1159/000525639] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
The field of neurodegenerative diseases is a major challenge faced by Public Health and is still in need of robust preventive measures and disease-modifying treatments. Population-based studies can offer the framework in the context primary and secondary prevention of neurodegenerative diseases. The epidemiology of neurodegenerative disorders in the last decades has focused on descriptive studies mainly based on the use of clinical criteria. However, clinical definition is basically insufficient both to well characterize different phenotypes and to make an early diagnosis. Descriptive epidemiology needs a new framework to update the area of neurodegenerative research, based on advancement of both clinical and biological diagnostic criteria and the urgency for an early diagnosis of the disease. In here, we address the present and future of population-based studies in neurodegenerative disorders and discuss the shift of paradigms in the diagnosis of disease and disease definition. We further debate the changes in biomarker implementation models and type of biomarkers used in population-based studies. Descriptive epidemiology of neurogenerative disorders is rapidly evolving. These implementations will improve the future design and outcome of population-based studies and policy-making in Public Health intervention.
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Affiliation(s)
- Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card G. Panico" Hospital Tricase (Le), Tricase, Italy
- Department of Basic Medicine Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card G. Panico" Hospital Tricase (Le), Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Tafuri B, Filardi M, Urso D, De Blasi R, Rizzo G, Nigro S, Logroscino G. Radiomics Model for Frontotemporal Dementia Diagnosis Using T1-Weighted MRI. Front Neurosci 2022; 16:828029. [PMID: 35794955 PMCID: PMC9251132 DOI: 10.3389/fnins.2022.828029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Abstract
Radiomics has been proposed as a useful approach to extrapolate novel morphological and textural information from brain Magnetic resonance images (MRI). Radiomics analysis has shown unique potential in the diagnostic work-up and in the follow-up of patients suffering from neurodegenerative diseases. However, the potentiality of this technique in distinguishing frontotemporal dementia (FTD) subtypes has so far not been investigated. In this study, we explored the usefulness of radiomic features in differentiating FTD subtypes, namely, the behavioral variant of FTD (bvFTD), the non-fluent and/or agrammatic (PNFA) and semantic (svPPA) variants of a primary progressive aphasia (PPA). Classification analyses were performed on 3 Tesla T1-weighted images obtained from the Frontotemporal Lobar Degeneration Neuroimaging Initiative. We included 49 patients with bvFTD, 25 patients with PNFA, 34 patients with svPPA, and 60 healthy controls. Texture analyses were conducted to define the first-order statistic and textural features in cortical and subcortical brain regions. Recursive feature elimination was used to select the radiomics signature for each pairwise comparison followed by a classification framework based on a support vector machine. Finally, 10-fold cross-validation was used to assess classification performances. The radiomics-based approach successfully identified the brain regions typically involved in each FTD subtype, achieving a mean accuracy of more than 80% in distinguishing between patient groups. Note mentioning is that radiomics features extracted in the left temporal regions allowed achieving an accuracy of 91 and 94% in distinguishing patients with svPPA from those with PNFA and bvFTD, respectively. Radiomics features show excellent classification performances in distinguishing FTD subtypes, supporting the clinical usefulness of this approach in the diagnostic work-up of FTD.
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Affiliation(s)
- Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Radiology, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Institute of Nanotechnology (NANOTEC), Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Giancarlo Logroscino,
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Pantaleo E, Monaco A, Amoroso N, Lombardi A, Bellantuono L, Urso D, Lo Giudice C, Picardi E, Tafuri B, Nigro S, Pesole G, Tangaro S, Logroscino G, Bellotti R. A Machine Learning Approach to Parkinson’s Disease Blood Transcriptomics. Genes (Basel) 2022; 13:genes13050727. [PMID: 35627112 PMCID: PMC9141063 DOI: 10.3390/genes13050727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 12/23/2022] Open
Abstract
The increased incidence and the significant health burden associated with Parkinson’s disease (PD) have stimulated substantial research efforts towards the identification of effective treatments and diagnostic procedures. Despite technological advancements, a cure is still not available and PD is often diagnosed a long time after onset when irreversible damage has already occurred. Blood transcriptomics represents a potentially disruptive technology for the early diagnosis of PD. We used transcriptome data from the PPMI study, a large cohort study with early PD subjects and age matched controls (HC), to perform the classification of PD vs. HC in around 550 samples. Using a nested feature selection procedure based on Random Forests and XGBoost we reached an AUC of 72% and found 493 candidate genes. We further discussed the importance of the selected genes through a functional analysis based on GOs and KEGG pathways.
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Affiliation(s)
- Ester Pantaleo
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy;
- Dipartimento Interateneo di Fisica M. Merlin, Università degli Studi di Bari Aldo Moro, Via G. Amendola 173, 70125 Bari, Italy
| | - Alfonso Monaco
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
| | - Nicola Amoroso
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, Via A. Orabona 4, 70125 Bari, Italy
| | - Angela Lombardi
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
- Dipartimento Interateneo di Fisica M. Merlin, Università degli Studi di Bari Aldo Moro, Via G. Amendola 173, 70125 Bari, Italy
- Correspondence:
| | - Loredana Bellantuono
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Daniele Urso
- Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Dipartimento di Ricerca Clinica in Neurologia, Università degli Studi di Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy; (D.U.); (B.T.); (S.N.)
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Claudio Lo Giudice
- Dipartimento di Bioscienze, Biotecnologie e Biofarmaceutica, Università degli Studi di Bari Aldo Moro, Via A. Orabona 4, 70125 Bari, Italy; (C.L.G.); (E.P.); (G.P.)
| | - Ernesto Picardi
- Dipartimento di Bioscienze, Biotecnologie e Biofarmaceutica, Università degli Studi di Bari Aldo Moro, Via A. Orabona 4, 70125 Bari, Italy; (C.L.G.); (E.P.); (G.P.)
- Istituto di Biomembrane, Bioenergetica e Biotecnologie Molecolari, Consiglio Nazionale delle Ricerche, Via G. Amendola 122/O, 70126 Bari, Italy
| | - Benedetta Tafuri
- Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Dipartimento di Ricerca Clinica in Neurologia, Università degli Studi di Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy; (D.U.); (B.T.); (S.N.)
| | - Salvatore Nigro
- Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Dipartimento di Ricerca Clinica in Neurologia, Università degli Studi di Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy; (D.U.); (B.T.); (S.N.)
- Istituto di Nanotecnologia (NANOTEC), Consiglio Nazionale delle Ricerche, Via Monteroni, 73100 Lecce, Italy
| | - Graziano Pesole
- Dipartimento di Bioscienze, Biotecnologie e Biofarmaceutica, Università degli Studi di Bari Aldo Moro, Via A. Orabona 4, 70125 Bari, Italy; (C.L.G.); (E.P.); (G.P.)
- Istituto di Biomembrane, Bioenergetica e Biotecnologie Molecolari, Consiglio Nazionale delle Ricerche, Via G. Amendola 122/O, 70126 Bari, Italy
| | - Sabina Tangaro
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari Aldo Moro, Via A. Orabona 4, 70125 Bari, Italy
| | - Giancarlo Logroscino
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy;
- Centro per le Malattie Neurodegenerative e l’Invecchiamento Cerebrale, Dipartimento di Ricerca Clinica in Neurologia, Università degli Studi di Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy; (D.U.); (B.T.); (S.N.)
| | - Roberto Bellotti
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Via A. Orabona 4, 70125 Bari, Italy; (E.P.); (A.M.); (N.A.); (L.B.); (S.T.); (R.B.)
- Dipartimento Interateneo di Fisica M. Merlin, Università degli Studi di Bari Aldo Moro, Via G. Amendola 173, 70125 Bari, Italy
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Urso D, Leta V, Rukavina K. Management strategies of sexual dysfunctions in Parkinson's disease. Int Rev Neurobiol 2022; 162:97-116. [PMID: 35397790 DOI: 10.1016/bs.irn.2021.12.004] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual dysfunctions (SD) are frequent and highly disabling nonmotor manifestations of Parkinson's disease (PD) but are also potentially treatable. Neurologists should actively discuss, recognize and treat sexual health issues as an integral part of the management of the disease. In this chapter, we provide recommendations for managing and treating both primary and secondary SD in PD. Many sexual problems can be, at least partially, improved by adjusting the treatment of motor, nonmotor symptoms and comorbidities. Although some treatments of primary SD are evidence-based, many therapeutic options have not been yet systematically studied in patients with PD. The development of new treatments and repurposing of existing remedies in patients with PD remain an unmet need.
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Affiliation(s)
- Daniele Urso
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom; Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| | - Valentina Leta
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Katarina Rukavina
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
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Urso D, Tafuri B, De Blasi R, Nigro S, Logroscino G. Imaging correlates of depression in progressive supranuclear palsy. J Neurol 2022; 269:3522-3528. [PMID: 34997852 DOI: 10.1007/s00415-021-10939-2] [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: 11/08/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Depression is highly common in Progressive Supranuclear Palsy (PSP) and is a meaningful determinant of quality of life. However, neurobiological and neuroimaging correlates of this neuropsychiatric disturbance in PSP patients are still unknown. In this study, we aimed to investigate the topographical distribution of morphometric changes associated with depression in PSP patients using cortical thickness. Forty patients with PSP were evaluated at baseline with clinical rating scales and MRI scans. Based on the response to the 15-item Geriatric Depression Scale we identified 21 PSP patients with depression (GDS-15 score ≥ 5) and 19 PSP patients without depression (GDS-15 score < 5). In vertex-wise analysis, comparison of cortical thickness between PSP patients with and without depression was performed using a general linear model. PSP patients with depressions showed reduced cortical thickness in temporo-parieto-occipital areas, more pronounced in the right hemisphere. These findings propose neurobiological conceptualizations of depression in PSP as being associated with a multiregional pattern of morphometric grey matter reduction.
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Affiliation(s)
- Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Benedetta Tafuri
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Roberto De Blasi
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy
| | - Salvatore Nigro
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy. .,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
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Nigro S, Tafuri B, Urso D, De Blasi R, Cedola A, Gigli G, Logroscino G. Altered structural brain networks in linguistic variants of frontotemporal dementia. Brain Imaging Behav 2021; 16:1113-1122. [PMID: 34755293 PMCID: PMC9107413 DOI: 10.1007/s11682-021-00560-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/31/2022]
Abstract
Semantic (svPPA) and nonfluent (nfvPPA) variants of primary progressive aphasia (PPA) have recently been associated with distinct patterns of white matter and functional network alterations in left frontoinsular and anterior temporal regions, respectively. Little information exists, however, about the topological characteristics of gray matter covariance networks in these two PPA variants. In the present study, we used a graph theory approach to describe the structural covariance network organization in 34 patients with svPPA, 34 patients with nfvPPA and 110 healthy controls. All participants underwent a 3 T structural MRI. Next, we used cortical thickness values and subcortical volumes to define subject-specific connectivity networks. Patients with svPPA and nfvPPA were characterized by higher values of normalized characteristic path length compared with controls. Moreover, svPPA patients had lower values of normalized clustering coefficient relative to healthy controls. At a regional level, patients with svPPA showed a reduced connectivity and impaired information processing in temporal and limbic brain areas relative to controls and nfvPPA patients. By contrast, local network changes in patients with nfvPPA were focused on frontal brain regions such as the pars opercularis and the middle frontal cortex. Of note, a predominance of local metric changes was observed in the left hemisphere in both nfvPPA and svPPA brain networks. Taken together, these findings provide new evidences of a suboptimal topological organization of the structural covariance networks in svPPA and nfvPPA patients. Moreover, we further confirm that distinct patterns of structural network alterations are related to neurodegenerative mechanisms underlying each PPA variant.
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Affiliation(s)
- Salvatore Nigro
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
| | - Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy.,Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
| | - Alessia Cedola
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Giuseppe Gigli
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy.,Department of Mathematics and Physics Ennio De Giorgi, University of Salento, Campus Ecotekne, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy. .,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
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Vela-Desojo L, Urso D, Kurtis-Urra M, García-Ruiz PJ, Pérez-Fernández E, Lopez-Valdes E, Posada-Rodriguez I, Ybot-Gorrin I, Lopez-Manzanares L, Mata M, Borrue C, Ruiz-Huete C, Del Valle M, Martinez-Castrillo JC. Sexual Dysfunction in Early-Onset Parkinson's Disease: A Cross-Sectional, Multicenter Study. J Parkinsons Dis 2021; 10:1621-1629. [PMID: 32925093 DOI: 10.3233/jpd-202066] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is one of the least studied non-motor symptoms in Parkinson's disease (PD). OBJECTIVES To assess sexual function in a cohort of patients with early-onset PD (EOPD) and compare it to a group of healthy controls. METHODS In this cross-sectional multicenter study, SD was assessed with gender-specific multi-dimensional self-reported questionnaires: The Brief Male Sexual Function Inventory (BSFI-M) and the Female Sexual Function Index (FSFI). Scores between patients and controls were compared and associations between SD and demographical and clinical variables were studied. RESULTS One hundred and five patients (mean age 47.35±7.8, disease duration 6 (3-11) years, UPDRS part III 17 (10-23) and 90 controls were recruited. The BSFI-M total score was lower in EOPD men than in controls, and specific items were also significantly lower, such as drive, erections, ejaculation, and satisfaction. EOPD women had lower scores than controls in totalFSFI, and certain domains such as lubrication and pain. SD was present in 70.2% of patients and 52.5% of controls. Sexual satisfaction in 35.2% of patients and 81.2% of controls. By gender, male and female patients had more SD than controls but only male patients had more dissatisfaction than controls. Gender, higher depression scores and urinary dysfunction were associated with SD in multivariate analysis; and gender, UPDRS and urinary dysfunction with sexual satisfactionConclusion:In this Spanish cohort, SD and sexual dissatisfaction was more prevalent in EOPD patients than in the general population. Gender and urinary disfunction were associated with SD and sexual dissatisfaction.
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Affiliation(s)
| | - Daniele Urso
- Centro Integral de Neurociencias, HM Puerta del Sur, Móstoles, Madrid, Spain
| | | | | | | | | | | | - Isabel Ybot-Gorrin
- Hospital Universitario La Paz, Madrid, Spain.,Hospital Vithas-Nuestra Señora de América, Madrid, Spain
| | | | - Marina Mata
- Hospital Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain.,Hospital Ruber Juan Bravo, Madrid, Spain
| | - Carmen Borrue
- Hospital Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
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Leta V, Urso D, Batzu L, Weintraub D, Titova N, Aarsland D, Martinez-Martin P, Borghammer P, van Wamelen DJ, Yousaf T, Rizos A, Rodriguez-Blazquez C, Chung-Faye G, Chaudhuri KR. Constipation is Associated with Development of Cognitive Impairment in de novo Parkinson's Disease: A Longitudinal Analysis of Two International Cohorts. J Parkinsons Dis 2021; 11:1209-1219. [PMID: 33843697 DOI: 10.3233/jpd-212570] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Constipation is regarded as one of the prodromal features of Parkinson's disease (PD) and there is emerging evidence linking gastrointestinal dysfunction and cognitive impairment (CI) in PD. OBJECTIVE We explored whether constipation is associated with development of CI in two independent cohorts of de novo PD patients (n = 196 from the Non-motor International Longitudinal Study [NILS] and n = 423 from the Parkinson's Progression Markers Initiative [PPMI] study). METHODS Constipation was clinically defined using the Non-Motor Symptoms Scale (NMSS) item-21 [NILS] and Scales for Outcomes in PD-Autonomic (SCOPA-AUT) item-5 [PPMI]. We assessed baseline group differences (PD with or without constipation) in CI, global non-motor symptoms burden, motor dysfunction, and striatal dopaminergic denervation. Kaplan-Meier method estimated group differences in cumulative proportion of patients with incident CI over three years. In PPMI, we subsequently performed univariate and multivariate Cox survival analyses to evaluate whether constipation predicts incident mild cognitive impairment or dementia over a 6-year period, including constipation and other known predictors of CI as covariates. RESULTS Patients with constipation had greater motor and global non-motor burden in both cohorts at baseline (p < 0.05). Kaplan-Meier plots showed faster conversion to CI in patients with constipation in both cohorts (p < 0.05). In PPMI, 37 subjects developed dementia during a mean follow-up of 4.9 years, and constipation was an independent predictor of dementia onset (hazard ratio = 2.311; p = 0.02). CONCLUSION Constipation in de novo PD patients is associated with development of cognitive decline and may serve as a clinical biomarker for identification of patients at risk for cognitive impairment.
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Affiliation(s)
- Valentina Leta
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Daniele Urso
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom.,Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', Tricase, Lecce, Italy
| | - Lucia Batzu
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | | | - Nataliya Titova
- Federal State Autonomous Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Department of Neurology, Neurosurgery and Medical Genetics, Moscow, Russia.,Federal State Budgetary Institution "Federal Center of Brain and Neurotechnologies" of the Ministry of Health of the Russian Federation, Department of Neurodegenerative Diseases, Moscow, Russia
| | - Dag Aarsland
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Pablo Martinez-Martin
- Centre for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Per Borghammer
- Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark.,Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel J van Wamelen
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tayyabah Yousaf
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom
| | - Alexandra Rizos
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | | | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital Foundation NHS Trust, London, United Kingdom
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Department of Neurosciences, King's College London, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
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Urso D, Leta V, Batzu L, Yousaf T, Farrell C, van Wamelen DJ, Ray Chaudhuri K. Disentangling the PIGD classification for the prediction of cognitive impairment in de novo Parkinson's disease. J Neurol 2021; 269:1566-1573. [PMID: 34338858 PMCID: PMC8857169 DOI: 10.1007/s00415-021-10730-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Background Postural Instability and Gait difficulties (PIGD) subtype has been associated with worse cognitive performance in Parkinson’s disease (PD). Objective To investigate whether PIGD subtype classification or PIGD-related clinical features predict the development of cognitive decline in de novo PD patients. Methods Data from 422 PD patients with de novo PD were obtained from the PPMI database. At follow-up (up to 6 years), patients were categorized as having cognitive impairment or not. Multivariate Cox survival analysis was carried out including motor subtype and individual MDS-UPDRS items defining PIGD phenotype as predictors. Previously validated clinical predictors of cognitive impairment were included in the model as covariates. Occurrence of cognitive impairment at follow-up was used as the time-to-event and Kaplan–Meier curve was generated. Results At baseline, 76 patients were classified as PIGD, 299 tremor-dominant and 47 as indeterminate. Development of cognitive impairment was not associated with PIGD subtype (p = 0.252). When individual MDS-UPDRS items were interrogated in the model, postural instability proved to be an independent predictor of cognitive impairment (HR = 2.045; 95%CI: 1.068–3.918; p = 0.031), while gait difficulties were not associated with cognitive decline (p = 0.870). Conclusions Our findings suggest that postural instability, as assessed by MDS-UPDRS III, may serve as a possible indicator of the risk of developing cognitive impairment in de novo PD patients rather than the PIGD phenotype.
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Affiliation(s)
- Daniele Urso
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK. .,Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| | - Valentina Leta
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Tayyabah Yousaf
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chloe Farrell
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel J van Wamelen
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
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López-Aguirre M, Caballero-Insaurriaga J, Urso D, Rodríguez-Rojas R, Máñez-Miró JU, Del-Alamo M, Rachmilevitch I, Martínez-Fernández R, Pineda-Pardo JA. Lesion 3D modeling in transcranial MR-guided focused ultrasound thalamotomy. Magn Reson Imaging 2021; 80:71-80. [PMID: 33905832 DOI: 10.1016/j.mri.2021.04.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 01/21/2023]
Abstract
Transcranial magnetic resonance-guided focused ultrasound (tMRgFUS) allows to perform incisionless thermoablation of deep brain structures. This feature makes it a very useful tool for the treatment of multiple neurological and psychiatric disorders. Currently, feedback of the thermoablation process is based on peak temperature readings assessed on real-time two-dimensional MRI thermometry. However, an accurate methodology relating thermal dosimetry with three-dimensional topography and temporal evolution of the lesion is still to be defined, thus hurdling the establishment of well-defined, evidence-based criteria to perform safe and effective treatments. In here we propose threshold-based thermoablation models to predict the volumetric topography of the lesion (whole lesion and necrotic core) in the short-to-mid-term based on thermal dosimetry estimated from intra-treatment MRI thermometry. To define and validate our models we retrospectively analyzed the data of sixty-three tMRgFUS thalamotomies for treating tremor. We used intra-treatment MRI thermometry to estimate whole-treatment three-dimensional thermal dose maps, defined either as peak temperature reached (Tmax) or thermal isoeffective dose (TID). Those maps were thresholded to find the dosimetric level that maximize the agreement (Sorensen-Dice coefficient - SDc) with the boundaries of the whole lesion and its core, assessed on T2w images 1-day (post-24h) and 3-months (post-3M) after treatment. Best predictions were achieved for the whole lesion at post-24h (SDc = 0.71), with Tmax /TID over 50.0 °C/90.5 CEM43. The core at post-24h and whole lesion at post-3M lesions reported a similar behavior in terms of shape accuracy (SDc ~0.35), and thermal dose thresholds ~55 °C/4100.0 CEM43. Finally, the optimal levels for post-3M core lesions were 55.5 °C/5800.0 CEM43 (SDc = 0.21). These thermoablation models could contribute to the real-time decision-making process and improve the outcome of tMRgFUS interventions both in terms of safety and efficacy.
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Affiliation(s)
- Miguel López-Aguirre
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Jaime Caballero-Insaurriaga
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad Politécnica de Madrid, Madrid, Spain
| | - Daniele Urso
- King's College (KCL), Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Rafael Rodríguez-Rojas
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas Instituto Carlos III, Madrid, Spain
| | - Jorge U Máñez-Miró
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Marta Del-Alamo
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | | | - Raúl Martínez-Fernández
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas Instituto Carlos III, Madrid, Spain
| | - José A Pineda-Pardo
- HM CINAC, Centro Integral de Neurociencias AC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Universidad San Pablo CEU, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas Instituto Carlos III, Madrid, Spain.
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Abstract
Background: Several small-scale studies have shown that motor performance in Parkinson’s disease (PD) fluctuates throughout the day. Studies specifically focusing on de novo patients are, however, lacking. Objective: To evaluate the effect of clock time on motor performance in de novo drug-naïve patients with PD. Methods: We retrieved MDS-UPDRS III scores for 421 de novo PD patients from the PPMI cohort and stratified them into three groups based on time of assessment: group 1) 7:00–10:00; group 2) 10:00–13:00, and group 3) 13:00–18:00. Groups were compared using Kruskal-Wallis test and results corrected for multiple testing. In addition, we obtained 27 wearable sensor reports, objectively capturing bradykinesia scores in a home setting over a 6-day continuous period, in 12 drug-naïve patients from the Parkinson’s Kinetigraph Registry held at King’s College Hospital London. Time spent in severe bradykinesia scores were broken down into five daytime (06:00–21:00) three-hourly epochs and scores compared using the Friedman test. Results: There were no group differences in demographic or other clinical variables for the cross-sectional analysis. MDS-UPDRS III total scores worsened significantly during the course of the day (median 18 (group 1); 20 (group 2); and 23 (group 3); p = 0.001). In the longitudinal wearable sensor cohort, diurnal variations were present in percentage of time spent in severe bradykinesia (p < 0.001) with the lowest percentage during the 09:00–12:00 epoch (69.56±16.68%), when most patients are awake and start daily activity, and the highest percentage during the 18:00–21:00 epoch (73.58±16.35%). Conclusion: This exploratory study shows the existence of a diurnal pattern of motor function in patients with de novo PD. The results obtained were corroborated by objective measurements in a small longitudinal cohort confirming a similar diurnal motor score variation.
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Affiliation(s)
- Daniel J. van Wamelen
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; department of neurology; Nijmegen, the Netherlands
| | - Daniele Urso
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - K. Ray Chaudhuri
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
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Nigro S, Tafuri B, Urso D, De Blasi R, Frisullo ME, Barulli MR, Capozzo R, Cedola A, Gigli G, Logroscino G. Brain Structural Covariance Networks in Behavioral Variant of Frontotemporal Dementia. Brain Sci 2021; 11:brainsci11020192. [PMID: 33557411 PMCID: PMC7915789 DOI: 10.3390/brainsci11020192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Recent research on behavioral variant frontotemporal dementia (bvFTD) has shown that personality changes and executive dysfunctions are accompanied by a disease-specific anatomical pattern of cortical and subcortical atrophy. We investigated the structural topological network changes in patients with bvFTD in comparison to healthy controls. In particular, 25 bvFTD patients and 20 healthy controls underwent structural 3T MRI. Next, bilaterally averaged values of 34 cortical surface areas, 34 cortical thickness values, and six subcortical volumes were used to capture single-subject anatomical connectivity and investigate network organization using a graph theory approach. Relative to controls, bvFTD patients showed altered small-world properties and decreased global efficiency, suggesting a reduced ability to combine specialized information from distributed brain regions. At a local level, patients with bvFTD displayed lower values of local efficiency in the cortical thickness of the caudal and rostral middle frontal gyrus, rostral anterior cingulate, and precuneus, cuneus, and transverse temporal gyrus. A significant correlation was also found between the efficiency of caudal anterior cingulate thickness and Mini-Mental State Examination (MMSE) scores in bvFTD patients. Taken together, these findings confirm the selective disruption in structural brain networks of bvFTD patients, providing new insights on the association between cognitive decline and graph properties.
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Affiliation(s)
- Salvatore Nigro
- Institute of Nanotechnology (NANOTEC), National Research Council, 73100 Lecce, Italy; (S.N.); (A.C.); (G.G.)
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
| | - Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
- Department of Radiology, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy
| | - Maria Elisa Frisullo
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
| | - Maria Rosaria Barulli
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
| | - Rosa Capozzo
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
| | - Alessia Cedola
- Institute of Nanotechnology (NANOTEC), National Research Council, 73100 Lecce, Italy; (S.N.); (A.C.); (G.G.)
| | - Giuseppe Gigli
- Institute of Nanotechnology (NANOTEC), National Research Council, 73100 Lecce, Italy; (S.N.); (A.C.); (G.G.)
- Department of Mathematics and Physics “Ennio De Giorgi”, University of Salento, Campus Ecotekne, 73100 Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari ‘Aldo Moro, “Pia Fondazione Cardinale G. Panico”, 73039 Tricase, Italy; (B.T.); (D.U.); (R.D.B.); (M.E.F.); (M.R.B.); (R.C.)
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy
- Correspondence: or giancarlo.; Tel.: +39-0833/773904
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40
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Urso D, Gnoni V, Filardi M, Logroscino G. Delusion and Delirium in Neurodegenerative Disorders: An Overlooked Relationship? Front Psychiatry 2021; 12:808724. [PMID: 35115974 PMCID: PMC8804700 DOI: 10.3389/fpsyt.2021.808724] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/24/2021] [Indexed: 12/04/2022] Open
Abstract
Delusions are part of the neuropsychiatric symptoms that patients suffering from neurodegenerative conditions frequently develop at some point of the disease course and are associated with an increased risk of cognitive and functional decline. Delirium is a syndrome characterized by acute onset of deficits in attention, awareness, and cognition that fluctuate in severity over a short time period. Delusions and delirium are frequently observed in the context of neurodegeneration, and their presence can easily mislead clinicians toward a misdiagnosis of psychiatric disorder further delaying the proper treatment. Risk factors for developing delusion and delirium in neurodegenerative conditions have been investigated separately while the possible interplay between these two conditions has not been explored so far. With this study, we aim to achieve a more comprehensive picture of the relationship between delusions and delirium in neurodegeneration by analyzing prevalence and subtypes of delusions in different neurodegenerative disorders; providing an overview of clinical tools to assess delusions in neurodegenerative patients and how delusions are covered by delirium assessment tools and discussing the possible common pathophysiology mechanisms between delusion and delirium in neurodegenerative patients. A more extensive characterization of the relationship between delusions and delirium may help to understand whether delusions may constitute a risk factor for delirium and may ameliorate the management of both conditions in patients with neurodegenerative disorders.
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Affiliation(s)
- Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Valentina Gnoni
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Filardi
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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41
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Urso D, Chaudhuri KR, Qamar MA, Jenner P. Improving the Delivery of Levodopa in Parkinson's Disease: A Review of Approved and Emerging Therapies. CNS Drugs 2020; 34:1149-1163. [PMID: 33146817 DOI: 10.1007/s40263-020-00769-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 01/28/2023]
Abstract
Levodopa is the most effective drug for the treatment of Parkinson's disease, but its use as an oral medication is complicated by its erratic absorption, extensive metabolism and short plasma half-life. On long-term use and with disease progression, there is a high incidence of motor and non-motor complications, which remain a major clinical and research challenge. It is widely accepted that levodopa needs to be administered using formulations that result in good and consistent bioavailability and the physiologically relevant and continuous formation of dopamine in the brain to maximise its efficacy while avoiding and reversing 'wearing off' and dyskinesia. However, the physicochemical properties of levodopa along with its pharmacokinetic and pharmacodynamic profile make it difficult to deliver the drug in a manner that fulfils these criteria. In this review, we examine the problems associated with the administration of levodopa in Parkinson's disease and how the use of novel technologies and delivery devices is leading to a more consistent and sustained levodopa delivery with the aim of controlling motor function as well as non-motor symptoms.
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Affiliation(s)
- Daniele Urso
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK.
| | - K Ray Chaudhuri
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Mubasher A Qamar
- Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College, London, UK
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Urso D, Leta V, Chaudhuri KR. Non-Motor Symptoms in Cervical Dystonia: A Concept in Evolution. Ann Indian Acad Neurol 2020; 23:428. [PMID: 33223656 PMCID: PMC7657303 DOI: 10.4103/aian.aian_287_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Daniele Urso
- King's College London, Department of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Valentina Leta
- King's College London, Department of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
| | - K. Ray Chaudhuri
- King's College London, Department of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
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Sportelli C, Urso D, Jenner P, Chaudhuri KR. Metformin as a Potential Neuroprotective Agent in Prodromal Parkinson's Disease-Viewpoint. Front Neurol 2020; 11:556. [PMID: 32595595 PMCID: PMC7304367 DOI: 10.3389/fneur.2020.00556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
To date, there are no clinically effective neuroprotective or disease-modifying treatments that can halt Parkinson's disease (PD) progression. The current clinical approach focuses on symptomatic management. This failure may relate to the complex neurobiology underpinning the development of PD and the absence of true translational animal models. In addition, clinical diagnosis of PD relies on presentation of motor symptoms which occur when the neuropathology is already established. These multiple factors could contribute to the unsuccessful development of neuroprotective treatments for PD. Prodromal symptoms develop years prior to formal diagnosis and may provide an excellent tool for early diagnosis and better trial design. Patients with idiopathic rapid eye movement behavior disorder (iRBD) have the highest risk of developing PD and could represent an excellent group to include in neuroprotective trials for PD. In addition, repurposing drugs with excellent safety profiles is an appealing strategy to accelerate drug discovery. The anti-diabetic drug metformin has been shown to target diverse cellular pathways implicated in PD progression. Multiple studies have, additionally, observed the benefits of metformin to counteract other age-related diseases. The purpose of this viewpoint is to discuss metformin's neuroprotective potential by outlining relevant mechanisms of action and the selection of iRBD patients for future clinical trials in PD.
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Affiliation(s)
- Carolina Sportelli
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Daniele Urso
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College, London, United Kingdom
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
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44
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Pineda-Pardo JA, Urso D, Martínez-Fernández R, Rodríguez-Rojas R, del-Alamo M, Millar Vernetti P, Máñez-Miró JU, Hernández-Fernández F, de Luis-Pastor E, Vela-Desojo L, Obeso JA. Transcranial Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Essential Tremor: A Comprehensive Lesion Characterization. Neurosurgery 2019; 87:256-265. [DOI: 10.1093/neuros/nyz395] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/21/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) thalamotomy is a novel and effective treatment for controlling tremor in essential tremor patients.
OBJECTIVE
To provide a comprehensive characterization of the radiological, topographical, and volumetric aspects of the tcMRgFUS thalamic lesion, and to quantify how they relate to the clinical outcomes.
METHODS
In this study, clinical and radiological data from forty patients with medically-refractory essential tremor treated with unilateral tcMRgFUS thalamotomy were retrospectively analyzed. Treatment efficacy was assessed with Clinical Rating Scale for Tremor (CRST). Lesions were manually segmented on T1, T2, and susceptibility-weighted images, and 3-dimensional topographical analysis was then carried out. Statistical comparisons were performed using nonparametric statistics.
RESULTS
The greatest clinical improvement was correlated with a more inferior and posterior lesion, a bigger lesion volume, and percentage of the ventral intermediate nucleus covered by the lesion; whereas, the largest lesions accounted for the occurrence of gait imbalance. Furthermore, the volume of the lesion was significantly predicted by the number of sonications surpassing 52°C.
CONCLUSION
Here we provide a comprehensive characterization of the thalamic tcMRgFUS lesion including radiological and topographical analysis. Our results indicate that the location and volume of the lesion were significantly associated with the clinical outcome and that mid-temperatures may be responsible for the lesion size. This could serve ultimately to improve targeting and judgment and to optimize clinical outcome of tcMRgFUS thalamotomy.
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Affiliation(s)
- José Angel Pineda-Pardo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Daniele Urso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Raul Martínez-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Rafael Rodríguez-Rojas
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Marta del-Alamo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | | | - Jorge U Máñez-Miró
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Frida Hernández-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Nursing
| | | | - Lydia Vela-Desojo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - José A Obeso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
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Urso D, Monje MHG, Piredda R, Ortu R, Pineda-Pardo JA, Martínez-Fernández R, Sechi G. Clinical Reasoning: A 58-year-old man with hand tremor and episodes of neck pain. Neurology 2019; 93:557-561. [PMID: 31527099 DOI: 10.1212/wnl.0000000000008130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Daniele Urso
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Mariana H G Monje
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rosanna Piredda
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Renato Ortu
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - José A Pineda-Pardo
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Raul Martínez-Fernández
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - GianPietro Sechi
- From the Department of Neurology, (D.U., R.P., R.O., G.P.S.), University of Sassari, Italy; University Hospital HM (M.H.G.M., J.A.P.P, R.M.F), CINAC, Madrid, Spain; and Neurodegeneration Imaging Group (D.U.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Arru G, Mameli G, Deiana GA, Rassu AL, Piredda R, Sechi E, Caggiu E, Bo M, Nako E, Urso D, Mariotto S, Ferrari S, Zanusso G, Monaco S, Sechi G, Sechi LA. Humoral immunity response to human endogenous retroviruses K/W differentiates between amyotrophic lateral sclerosis and other neurological diseases. Eur J Neurol 2018; 25:1076-e84. [PMID: 29603839 DOI: 10.1111/ene.13648] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 10/24/2017] [Accepted: 03/26/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Human endogenous retroviruses (HERV) K/W seem to play a role in fostering and exacerbation of some neurological diseases, including amyotrophic lateral sclerosis (ALS). Given these findings, the immunity response against HERV-K and HERV-W envelope surface (env-su) glycoprotein antigens in serum and cerebrospinal fluid (CSF) was investigated for ALS, multiple sclerosis (MS) and Alzheimer's disease patients and in healthy controls. METHODS Four antigenic peptides derived respectively from HERV-K and HERV-W env-su proteins were studied in 21 definite or probable ALS patients, 26 possible or definite relapsing-remitting MS patients, 18 patients with Alzheimer's disease and 39 healthy controls. An indirect enzyme-linked immunosorbent assay was set up to detect specific antibodies (Abs) against env-su peptides. RESULTS Amongst the measured levels of Abs against the four different HERV-K peptide fragments, only HERV-K env-su19-37 was significantly elevated in ALS compared to other groups, both in serum and CSF. Instead, amongst the Abs levels directed against the four different HERV-W peptide fragments, only HERV-W env-su93-108 and HERV-W env-su248-262 were significantly elevated, in the serum and CSF of the MS group compared to other groups. In ALS patients, the HERV-K env-su19-37 Abs levels were significantly correlated with clinical measures of disease severity, both in serum and CSF. CONCLUSIONS Increased circulating levels of Abs directed against the HERV-W env-su93-108 and HERV-W env-su248-262 peptide fragments could serve as possible biomarkers in patients with MS. Similarly, increased circulating levels of Abs directed against the HERV-K env-su19-37 peptide fragment could serve as a possible early novel biomarker in patients with ALS.
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Affiliation(s)
- G Arru
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - G Mameli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - G A Deiana
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - A L Rassu
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - R Piredda
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - E Sechi
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - E Caggiu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - M Bo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - E Nako
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - D Urso
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - S Mariotto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Ferrari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - G Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - G Sechi
- Department of Clinical, Surgery and Experimental Medicine, University of Sassari, Sassari, Italy
| | - L A Sechi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Mariotto S, Ferrari S, Monaco S, Benedetti MD, Schanda K, Alberti D, Farinazzo A, Capra R, Mancinelli C, De Rossi N, Bombardi R, Zuliani L, Zoccarato M, Tanel R, Bonora A, Turatti M, Calabrese M, Polo A, Pavone A, Grazian L, Sechi G, Sechi E, Urso D, Delogu R, Janes F, Deotto L, Cadaldini M, Bianchi MR, Cantalupo G, Reindl M, Gajofatto A. Clinical spectrum and IgG subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes: a multicenter study. J Neurol 2017; 264:2420-2430. [PMID: 29063242 PMCID: PMC5688213 DOI: 10.1007/s00415-017-8635-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [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: 08/28/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 12/24/2022]
Abstract
Anti-myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) recently emerged as a potential biomarker in patients with inflammatory demyelinating diseases of the central nervous system. We here compare the clinical and laboratory findings observed in a cohort of MOG-Ab seropositive and seronegative cases and describe IgG subclass analysis results. Consecutive serum samples referred to Verona University Neuropathology Laboratory for aquaporin-4 (AQP4)-Ab and/or MOG-Ab testing were analysed between March 2014 and May 2017. The presence of AQP4-Ab was determined using a cell-based assay. A live cell immunofluorescence assay was used for the detection of MOG-IgG and IgG subclass analysis. Among 454 analysed samples, 29 were excluded due to AQP4-Ab positivity or to the final demonstration of a disorder not compatible with MOG-Ab. We obtained clinical data in 154 out of 425 cases. Of these, 22 subjects resulted MOG-Ab positive. MOG-Ab positive patients were mainly characterised by the involvement of the optic nerve and/or spinal cord. Half of the cases presented relapses and the recovery was usually partial. Brain MRI was heterogeneous while short lesions were the prevalent observation on spinal cord MRI. MOG-Ab titre usually decreased in non-relapsing cases. In all MOG-IgG positive cases, we observed IgG1 antibodies, which were predominant in most subjects. IgG2 (5/22), IgG3 (9/22) and IgG4 (3/22) antibodies were also detectable. We confirm that MOG-Ab-related syndromes have distinct features in the spectrum of demyelinating conditions, and we describe the possible role of the different IgG subclasses in this condition.
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Affiliation(s)
- Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy.
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Alberti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Alessia Farinazzo
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Chiara Mancinelli
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Roberto Bombardi
- Neurology Unit, St Bassano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Luigi Zuliani
- Neurology Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | | | | | | | - Marco Turatti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Alberto Polo
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | | | - Luisa Grazian
- Pediatric Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - GianPietro Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Elia Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Daniele Urso
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Rachele Delogu
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Francesco Janes
- Neurology Unit, Department of Neuroscience, ASUIUD, Udine, Italy
| | | | | | | | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
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Mangel AW, Bornstein JD, Hamm LR, Buda J, Wang J, Irish W, Urso D. Clinical trial: asimadoline in the treatment of patients with irritable bowel syndrome. Aliment Pharmacol Ther 2008; 28:239-49. [PMID: 18466359 DOI: 10.1111/j.1365-2036.2008.03730.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND In models of irritable bowel syndrome (IBS), asimadoline, a kappa-opioid agonist, improves pain and abnormal bowel function. AIM To evaluate the effects of three doses of asimadoline and placebo in subjects with IBS through a double-blind, randomized, placebo-controlled trial. METHODS Patients were randomly assigned to receive asimadoline 0.15, 0.5, 1.0 mg or placebo BID for 12 weeks. The primary efficacy measure was number of months of adequate relief of IBS pain or discomfort, with a prospective plan to evaluate adequate relief data by entry baseline pain and subtype. Several other endpoints were also evaluated. RESULTS Five hundred and ninety-six patients were randomized. In the ITT population, statistically significant improvement on the primary endpoint was not seen. However, in diarrhoea-predominant IBS patients with at least baseline moderate pain, asimadoline (0.5 mg) produced significant improvement on total number of months with adequate relief of IBS pain or discomfort (46.7% vs. 20.0%), adequate relief of IBS symptoms (46.7% vs. 23.0%), pain scores (week 12: -1.6 vs. -0.7), pain free days (42.9% vs. 18.0%), urgency and stool frequency (-2.3 vs. -0.3). In patients with alternating IBS, significant improvement was seen on adequate relief endpoints. Asimadoline was well tolerated. CONCLUSION Asimadoline warrants further evaluation as a treatment for IBS.
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Affiliation(s)
- A W Mangel
- RTI-Health Solutions, Research Triangle Park, NC, USA.
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Panico A, Santagati A, Cardile V, Urso D, Gentile B, Ronsisvalle G. Calorimetric study on the interaction of thienopyrimidine derivatives with phosphatidylcholine membranes. Colloids Surf B Biointerfaces 2003. [DOI: 10.1016/s0927-7765(02)00118-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Urso D. NIH loses in its attempt to patent genetic materials. J Law Med Ethics 1994; 22:179-182. [PMID: 7921085 DOI: 10.1111/j.1748-720x.1994.tb01293.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
On June 20,1991, Dr. Craig Venter, then a molecular biologist at the National Institute of Neurological Disorders and Stroke, a member agency of the National Institutes of Health (NIH), revealed that the NIH was filing an application with the Patent and Trademark Office (PTO) to patent 351 genetic fragments sequenced from brain tissues. The first of many applications filed by the NIH during the next two years, the agency also applied to patent the complete set of genes encompassing each fragment. These applications were filed despite the fact that the full gene sequences, their protein products, and their functions were still unknown (several genetic fragments make up a gene, and these fragments code for protein those products that have physiological functions; an example of such a product is insulin).
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