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Gill S, Blair M, Kershaw M, Jesso S, MacKinley J, Coleman K, Pantazopoulos K, Pasternak S, Finger E. Financial capacity in frontotemporal dementia and related presentations. J Neurol 2019; 266:1698-1707. [PMID: 31011799 PMCID: PMC6586696 DOI: 10.1007/s00415-019-09317-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
Background Changes in financial judgement and skills can herald a neurodegenerative dementia and are a common reason for referral for cognitive neurologic assessment. However, patients with neurodegenerative diseases affecting the frontal or temporal lobes may perform well on standard cognitive tests, complicating clinical determinations about their diagnosis and financial capacity. Methods Forty-five patients with possible or probable FTD or Alzheimer’s disease and 22 healthy controls completed two financial assessment batteries, the FACT and the FCAI. Patients’ performance was compared to study partner estimates of patients’ financial abilities. Results All three patient groups performed worse than controls on both the FACT and the FCAI. Study partners over-estimated the performance of patients with Alzheimer’s disease. Conclusions These initial findings suggest that accurate clinical assessment of financial skills and judgement in patients with possible neurodegenerative dementias requires performance-based assessment. Electronic supplementary material The online version of this article (10.1007/s00415-019-09317-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sascha Gill
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Mervin Blair
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Mavis Kershaw
- Australian Psychological Society, Melbourne, Australia.,International Association of Applied Psychology, New York, USA.,Australia and New Zealand Association of Psychiatry, Psychology and Law, Melbourne, Australia
| | - Sarah Jesso
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Julia MacKinley
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Kristy Coleman
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Koula Pantazopoulos
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Stephen Pasternak
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Parkwood Institute, Lawson Health Research Institute, University of Western Ontario, 550 Wellington Rd, London, ON, Canada.
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Silveira CRA, MacKinley J, Coleman K, Li Z, Finger E, Bartha R, Morrow SA, Wells J, Borrie M, Tirona RG, Rupar CA, Zou G, Hegele RA, Mahuran D, MacDonald P, Jenkins ME, Jog M, Pasternak SH. Ambroxol as a novel disease-modifying treatment for Parkinson's disease dementia: protocol for a single-centre, randomized, double-blind, placebo-controlled trial. BMC Neurol 2019; 19:20. [PMID: 30738426 PMCID: PMC6368728 DOI: 10.1186/s12883-019-1252-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/01/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Currently there are no disease-modifying treatments for Parkinson's disease dementia (PDD), a condition linked to aggregation of the protein α-synuclein in subcortical and cortical brain areas. One of the leading genetic risk factors for Parkinson's disease is being a carrier in the gene for β-Glucocerebrosidase (GCase; gene name GBA1). Studies in cell culture and animal models have shown that raising the levels of GCase can decrease levels of α-synuclein. Ambroxol is a pharmacological chaperone for GCase and is able to raise the levels of GCase and could therefore be a disease-modifying treatment for PDD. The aims of this trial are to determine if Ambroxol is safe and well-tolerated by individuals with PDD and if Ambroxol affects cognitive, biochemical, and neuroimaging measures. METHODS This is a phase II, single-centre, double-blind, randomized placebo-controlled trial involving 75 individuals with mild to moderate PDD. Participants will be randomized into Ambroxol high-dose (1050 mg/day), low-dose (525 mg/day), or placebo treatment arms. Assessments will be undertaken at baseline, 6-months, and 12-months follow up times. Primary outcome measures will be the Alzheimer's disease Assessment Scale-cognitive subscale (ADAS-Cog) and the ADCS Clinician's Global Impression of Change (CGIC). Secondary measures will include the Parkinson's disease Cognitive Rating Scale, Clinical Dementia Rating, Trail Making Test, Stroop Test, Unified Parkinson's disease Rating Scale, Purdue Pegboard, Timed Up and Go, and gait kinematics. Markers of neurodegeneration will include MRI and CSF measures. Pharmacokinetics and pharmacodynamics of Ambroxol will be examined through plasma levels during dose titration phase and evaluation of GCase activity in lymphocytes. DISCUSSION If found effective and safe, Ambroxol will be one of the first disease-modifying treatments for PDD. TRIAL REGISTRATION ClinicalTrials.gov NCT02914366, 26 Sep 2016/retrospectively registered.
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Affiliation(s)
- C R A Silveira
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - J MacKinley
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - K Coleman
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Z Li
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - E Finger
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Deparment of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - R Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - S A Morrow
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Deparment of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - J Wells
- Lawson Health Research Institute, London, Ontario, Canada.,Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - M Borrie
- Lawson Health Research Institute, London, Ontario, Canada.,Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - R G Tirona
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - C A Rupar
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - G Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - R A Hegele
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - D Mahuran
- Laboratory of Medicine and Pathobiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - P MacDonald
- Deparment of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - M E Jenkins
- Lawson Health Research Institute, London, Ontario, Canada.,Deparment of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - M Jog
- Lawson Health Research Institute, London, Ontario, Canada.,Deparment of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S H Pasternak
- Cognitive Neurology and Alzheimer's Disease Research Centre, Parkwood Institute - Main Building, Room A230, 550, Wellington Road, London, Ontario, N6G 0A7, Canada. .,Lawson Health Research Institute, London, Ontario, Canada. .,Deparment of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. .,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. .,Robarts Research Institute, Western University, London, Ontario, Canada.
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Finger EC, MacKinley J, Blair M, Oliver LD, Jesso S, Tartaglia MC, Borrie M, Wells J, Dziobek I, Pasternak S, Mitchell DGV, Rankin K, Kertesz A, Boxer A. Oxytocin for frontotemporal dementia: a randomized dose-finding study of safety and tolerability. Neurology 2014; 84:174-81. [PMID: 25503617 DOI: 10.1212/wnl.0000000000001133] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the safety and tolerability of 3 doses of intranasal oxytocin (Syntocinon; Novartis, Bern, Switzerland) administered to patients with frontotemporal dementia (FTD). METHODS We conducted a randomized, parallel-group, double-blind, placebo-controlled study using a dose-escalation design to test 3 clinically feasible doses of intranasal oxytocin (24, 48, or 72 IU) administered twice daily for 1 week to 23 patients with behavioral variant FTD or semantic dementia (clinicaltrials.gov registration number NCT01386333). Primary outcome measures were safety and tolerability at each dose. Secondary measures explored efficacy across the combined oxytocin vs placebo groups and examined potential dose-related effects. RESULTS All 3 doses of intranasal oxytocin were safe and well tolerated. CONCLUSIONS A multicenter trial is warranted to determine the therapeutic efficacy of long-term intranasal oxytocin for behavioral symptoms in FTD. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with FTD, intranasal oxytocin is not significantly associated with adverse events or significant changes in the overall neuropsychiatric inventory.
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Affiliation(s)
- Elizabeth C Finger
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine.
| | - Julia MacKinley
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Mervin Blair
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Lindsay D Oliver
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Sarah Jesso
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Maria C Tartaglia
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Michael Borrie
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Jennie Wells
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Isabel Dziobek
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Stephen Pasternak
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Derek G V Mitchell
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Katherine Rankin
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Andrew Kertesz
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
| | - Adam Boxer
- From the Departments of Clinical Neurological Sciences (E.C.F., J.M., M.B., S.J., S.P., A.K.), Medicine (M.B., J.W.), Psychiatry (D.G.V.M.), and Anatomy and Cell Biology (D.G.V.M.), and Graduate Program in Neuroscience (L.D.O.), Schulich School of Medicine and Dentistry, Western University, London, Ontario; Tanz Centre for Research in Neurodegenerative Disease (M.C.T.), University of Toronto, Canada; Freie Universität Berlin (I.D.), Cluster of Excellence Languages of Emotion, Berlin, Germany; and Department of Neurology (K.R., A.B.), University of California San Francisco School of Medicine
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