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Mantri S, Purks JL, Kinel D, Arbatti L, Hosamath A, Allen A, Amara A, Anderson K, Chahine LM, Eberly S, Mathur S, Standaert D, Oakes D, Weintraub D, Shoulson I, Marras C. In Their Own Words: Fears Expressed by People with Parkinson's Disease in an Online Symptom Database. J Parkinsons Dis 2024:JPD230305. [PMID: 38669556 DOI: 10.3233/jpd-230305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Parkinson's disease (PD) carries substantial psychosocial burden. Using a database of responses by people with PD reporting up to five "most bothersome problems," we identified 225 fear-based verbatims, which were organized using the framework method into 26 categories. Commonly-reported fears included uncertainty of progression (n = 60, 26.7%), fear of future cognitive impairment (n = 24, 10.7%) and fear of becoming a burden on others (n = 23, 10.2%). Fears in PD are wide-ranging and can constitute the most bothersome aspect of the condition. These data can be used to design interventions to lessen the psychosocial burden of PD.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, USA
| | - Jennifer L Purks
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Daniel Kinel
- Department of Neurology, Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lakshmi Arbatti
- Grey Matter Technologies, A Wholly Owned Subsidiary of Modality.ai, San Francisco, CA, USA
| | - Abhishek Hosamath
- Grey Matter Technologies, A Wholly Owned Subsidiary of Modality.ai, San Francisco, CA, USA
| | - Allison Allen
- Department of Neurology, Duke University, Durham, NC, USA
| | - Amy Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen Anderson
- Departments of Psychiatry and Department of Neurology, Georgetown University, Washington, DC, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | | | - David Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ira Shoulson
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Grey Matter Technologies, A Wholly Owned Subsidiary of Modality.ai, San Francisco, CA, USA
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's disease, University Health Network, University of Toronto, Toronto, Canada
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Weintraub D, Marras C, Amara A, Anderson KE, Chahine LM, Eberly S, Hosamath A, Kinel D, Mantri S, Mathur S, Oakes D, Purks JL, Standaert DG, Shoulson I, Arbatti L. Association between Subjective Cognitive Complaints and Incident Functional Impairment in Parkinson's Disease. Mov Disord 2024; 39:706-714. [PMID: 38318953 DOI: 10.1002/mds.29725] [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: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early identification of subjective cognitive complaints (SCC) in Parkinson's disease (PD) may improve patient care if it predicts cognition-related functional impairment (CFI). OBJECTIVES The aim was to determine the cross-sectional and longitudinal association between SCC and CFI in PD. METHODS Data were obtained from Fox Insight, an online longitudinal study that collects PD patient-reported outcomes. Participants completed a PD Patient Report of Problems that asked participants for their five most bothersome disease problems. SCCs were placed into eight categories through human-in-the-loop curation and classification. CFI had a Penn Parkinson's Daily Activities Questionnaire (PDAQ-15) score ≤49. Cox proportional hazards models and Kaplan-Meier survival analyses determined if baseline SCC was associated with incident CFI. RESULTS The PD-PROP cohort (N = 21,160) was 55.8% male, mean age was 65.9 years, and PD duration was 4.8 years. At baseline, 31.9% (N = 6750) of participants reported one or more SCCs among their five most bothersome problems, including memory (13.2%), language/word finding (12.5%), and concentration/attention (9.6%). CFI occurred in 34.7% (N = 7332) of participants. At baseline, SCC was associated with CFI (P-value <0.001). SCC at baseline was associated with incident CFI (hazard ratio [HR] = 1.58 [95% confidence interval: 1.45, 1.72], P-value <0.001), as did cognitive impairment not otherwise specified (HR = 2.31), executive abilities (HR = 1.97), memory (HR = 1.85), and cognitive slowing (HR = 1.77) (P-values <0.001). Kaplan-Meier curves showed that by year 3 an estimated 45% of participants with any SCC at baseline developed new-onset CFI. CONCLUSIONS Self-reported bothersome cognitive complaints are associated with new-onset CFI in PD. Remote electronic assessment can facilitate widespread use of patient self-report at population scale. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Amy Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karen E Anderson
- Departments of Psychiatry and Neurology, Georgetown University, Washington, DC, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Abhishek Hosamath
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
| | - Daniel Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | | | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Jennifer L Purks
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ira Shoulson
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Lakshmi Arbatti
- Grey Matter Technologies, a Wholly Owned Subsidiary of modality.ai, San Francisco, California, USA
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3
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Simuni T, Chahine LM, Poston K, Brumm M, Buracchio T, Campbell M, Chowdhury S, Coffey C, Concha-Marambio L, Dam T, DiBiaso P, Foroud T, Frasier M, Gochanour C, Jennings D, Kieburtz K, Kopil CM, Merchant K, Mollenhauer B, Montine T, Nudelman K, Pagano G, Seibyl J, Sherer T, Singleton A, Stephenson D, Stern M, Soto C, Tanner CM, Tolosa E, Weintraub D, Xiao Y, Siderowf A, Dunn B, Marek K. A biological definition of neuronal α-synuclein disease: towards an integrated staging system for research. Lancet Neurol 2024; 23:178-190. [PMID: 38267190 DOI: 10.1016/s1474-4422(23)00405-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 01/26/2024]
Abstract
Parkinson's disease and dementia with Lewy bodies are currently defined by their clinical features, with α-synuclein pathology as the gold standard to establish the definitive diagnosis. We propose that, given biomarker advances enabling accurate detection of pathological α-synuclein (ie, misfolded and aggregated) in CSF using the seed amplification assay, it is time to redefine Parkinson's disease and dementia with Lewy bodies as neuronal α-synuclein disease rather than as clinical syndromes. This major shift from a clinical to a biological definition of Parkinson's disease and dementia with Lewy bodies takes advantage of the availability of tools to assess the gold standard for diagnosis of neuronal α-synuclein (n-αsyn) in human beings during life. Neuronal α-synuclein disease is defined by the presence of pathological n-αsyn species detected in vivo (S; the first biological anchor) regardless of the presence of any specific clinical syndrome. On the basis of this definition, we propose that individuals with pathological n-αsyn aggregates are at risk for dopaminergic neuronal dysfunction (D; the second biological anchor). Our biological definition establishes a staging system, the neuronal α-synuclein disease integrated staging system (NSD-ISS), rooted in the biological anchors (S and D) and the degree of functional impairment caused by clinical signs or symptoms. Stages 0-1 occur without signs or symptoms and are defined by the presence of pathogenic variants in the SNCA gene (stage 0), S alone (stage 1A), or S and D (stage 1B). The presence of clinical manifestations marks the transition to stage 2 and beyond. Stage 2 is characterised by subtle signs or symptoms but without functional impairment. Stages 2B-6 require both S and D and stage-specific increases in functional impairment. A biological definition of neuronal α-synuclein disease and an NSD-ISS research framework are essential to enable interventional trials at early disease stages. The NSD-ISS will evolve to include the incorporation of data-driven definitions of stage-specific functional anchors and additional biomarkers as they emerge and are validated. Presently, the NSD-ISS is intended for research use only; its application in the clinical setting is premature and inappropriate.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen Poston
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Teresa Buracchio
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michelle Campbell
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Sohini Chowdhury
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | | | - Peter DiBiaso
- Patient Advisory Council, New York, NY, USA; Clinical Solutions and Strategic Partnerships, WCG Clinical, Princeton, NJ, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Mark Frasier
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline Gochanour
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Catherine M Kopil
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Thomas Montine
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kelly Nudelman
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Andrew Singleton
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Diane Stephenson
- Critical Path for Parkinson's, Critical Path Institute, Tucson, AZ, USA
| | - Matthew Stern
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Claudio Soto
- Amprion, San Diego, CA, USA; Mitchell Center for Alzheimer's Disease and Related Brain Disorders, Department of Neurology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, USA; Parkinson's Disease Research Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Weintraub
- University of Pennsylvania and the Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center Philadelphia, PA, USA
| | - Yuge Xiao
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Billy Dunn
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Griffith G, Lamotte G, Mehta N, Fan P, Nikolich J, Springman V, Suttman E, Joslin E, Balfany K, Dunlap M, Kohrt WM, Christiansen CL, Melanson EL, Josbeno D, Chahine LM, Patterson CG, Corcos DM. Chronotropic Incompetence During Exercise Testing as a Marker of Autonomic Dysfunction in Individuals with Early Parkinson's Disease. J Parkinsons Dis 2024; 14:121-133. [PMID: 38189712 PMCID: PMC10836543 DOI: 10.3233/jpd-230006] [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] [Accepted: 11/19/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND An attenuated heart rate response to exercise, termed chronotropic incompetence, has been reported in Parkinson's disease (PD). Chronotropic incompetence may be a marker of autonomic dysfunction and a cause of exercise intolerance in early stages of PD. OBJECTIVE To investigate the relationship between chronotropic incompetence, orthostatic blood pressure change (supine - standing), and exercise performance (maximal oxygen consumption, VO2peak) in individuals with early PD within 5 years of diagnosis not on dopaminergic medications. METHODS We performed secondary analyses of heart rate and blood pressure data from the Study in Parkinson's Disease of Exercise (SPARX). RESULTS 128 individuals were enrolled into SPARX (63.7±9.3 years; 57.0% male, 0.4 years since diagnosis [median]). 103 individuals were not taking chronotropic medications, of which 90 had a normal maximal heart rate response to exercise testing (155.3±14.0 bpm; PDnon-chrono) and 13 showed evidence of chronotropic incompetence (121.3±11.3 bpm; PDchrono, p < 0.05). PDchrono had decreased VO2peak compared to PDnon-chrono (19.7±4.5 mL/kg/min and 24.3±5.8 mL/kg/min, respectively, p = 0.027). There was a positive correlation between peak heart rate during exercise and the change in systolic blood pressure from supine to standing (r = 0.365, p < 0.001). CONCLUSIONS A subgroup of individuals with early PD not on dopaminergic medication had chronotropic incompetence and decreased VO2peak, which may be related to autonomic dysfunction. Evaluation of both heart rate responses to incremental exercise and orthostatic vital signs may serve as biomarkers of early autonomic impairment and guide treatment. Further studies should investigate whether cardiovascular autonomic dysfunction affects the ability to exercise and whether exercise training improves autonomic dysfunction.
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Affiliation(s)
- Garett Griffith
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Niyati Mehta
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Peng Fan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Juliana Nikolich
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Victoria Springman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Erin Suttman
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Joslin
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Katherine Balfany
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Wendy M. Kohrt
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Cory L. Christiansen
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Edward L. Melanson
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Deborah Josbeno
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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5
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Chahine LM, Arbatti L, Hosamath A, Amara A, Anderson KE, Purks J, Eberly S, Kinel D, Mantri S, Mathur S, Oakes D, Standaert DG, Weintraub D, Shoulson I, Marras C. Internal tremor in people with Parkinson's Disease: Demographic characteristics and comorbid symptoms. Clin Park Relat Disord 2023; 9:100229. [PMID: 38045566 PMCID: PMC10689282 DOI: 10.1016/j.prdoa.2023.100229] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/13/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Internal tremor (IT) occurs in > 30 % of people with Parkinson's Disease (PwPD), but remains largely uninvestigated. Our objective was to describe demographic characteristics and associated symptoms in PwPD who reported IT. Methods This was a matched case-control survey study. Data were from PwPD in the Fox Insight study who answered the Patient Report of Problems (PD-PROP) assessment, a series of open-ended questions that asks people to report in their own words their most bothersome PD-related problems. Cases were those who reported IT ≥ 1 times compared with PwPD controls who did not report IT and were matched 1:3 by age and disease duration. Results 243 PwPD reported IT as a bothersome problem. Mean (SD) age of cases was 64.9 (9.4) years and disease duration was 3.8 (4.0) years. The proportion of women was greater among cases compared to controls (74 % vs 47 %, p < 0.0001). External tremor as a PD-PROP symptom was reported by 98 % cases and 48 % controls (p < 0.0001). Several non-motor symptoms were more common among cases than controls, including anxiety (35 % vs 20 %), fatigue (41 % vs 31 %), and pain (57 % vs 37 %). The odds of IT was significantly higher in women when adjusting for anxiety and motor experiences of daily living score (OR 3.07, 95 %CI 2.14-4.41, p < 0.0001). Conclusion PwPD with IT report a range of associated symptoms, including external tremor, anxiety, and pain. Sex differences in the experience of IT may exist. Studies of IT are needed to understand its etiology and inform clinical care.
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Affiliation(s)
- Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, the United States of America
| | - Lakshmi Arbatti
- Grey Matter Technologies, a wholly owned subsidiary of Modality.ai, San Francisco, CA, the United States of America
| | - Abhishek Hosamath
- Grey Matter Technologies, a wholly owned subsidiary of Modality.ai, San Francisco, CA, the United States of America
| | - Amy Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, the United States of America
| | - Karen E. Anderson
- Departments of Psychiatry and Neurology, Georgetown University, Washington, DC, the United States of America
| | - Jennifer Purks
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, the United States of America
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, the United States of America
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, the United States of America
| | - Daniel Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, the United States of America
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, the United States of America
| | | | - David Oakes
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, the United States of America
| | - David G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, the United States of America
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, the United States of America
| | - Ira Shoulson
- Grey Matter Technologies, a wholly owned subsidiary of Modality.ai, San Francisco, CA, the United States of America
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, the United States of America
| | - Connie Marras
- Edmond J Safra Program in Parkinson’s Disease, University Health Network, University of Toronto, Toronto, Canada
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Chahine LM, Darweesh SKL. Physical Activity and the Risk of Parkinson Disease: Moving in the Right Direction. Neurology 2023; 101:151-152. [PMID: 37197992 DOI: 10.1212/wnl.0000000000207527] [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: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Lana M Chahine
- From the Department of Neurology (L.M.C.), University of Pittsburgh, PA; and Department of Neurology (S.K.L.D.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands.
| | - Sirwan K L Darweesh
- From the Department of Neurology (L.M.C.), University of Pittsburgh, PA; and Department of Neurology (S.K.L.D.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
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7
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [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: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Weintraub D, Picillo M, Cho HR, Caspell‐Garcia C, Blauwendraat C, Brown EG, Chahine LM, Coffey CS, Dobkin RD, Foroud T, Galasko D, Kieburtz K, Marek K, Merchant K, Mollenhauer B, Poston KL, Simuni T, Siderowf A, Singleton A, Seibyl J, Tanner CM. Impact of the Dopamine System on Long-Term Cognitive Impairment in Parkinson Disease: An Exploratory Study. Mov Disord Clin Pract 2023; 10:943-955. [PMID: 37332638 PMCID: PMC10272925 DOI: 10.1002/mdc3.13751] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Little is known about the impact of the dopamine system on development of cognitive impairment (CI) in Parkinson disease (PD). Objectives We used data from a multi-site, international, prospective cohort study to explore the impact of dopamine system-related biomarkers on CI in PD. Methods PD participants were assessed annually from disease onset out to 7 years, and CI determined by applying cut-offs to four measures: (1) Montreal Cognitive Assessment; (2) detailed neuropsychological test battery; (3) Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) cognition score; and (4) site investigator diagnosis of CI (mild cognitive impairment or dementia). The dopamine system was assessed by serial Iodine-123 Ioflupane dopamine transporter (DAT) imaging, genotyping, and levodopa equivalent daily dose (LEDD) recorded at each assessment. Multivariate longitudinal analyses, with adjustment for multiple comparisons, determined the association between dopamine system-related biomarkers and CI, including persistent impairment. Results Demographic and clinical variables associated with CI were higher age, male sex, lower education, non-White race, higher depression and anxiety scores and higher MDS-UPDRS motor score. For the dopamine system, lower baseline mean striatum dopamine transporter values (P range 0.003-0.005) and higher LEDD over time (P range <0.001-0.01) were significantly associated with increased risk for CI. Conclusions Our results provide preliminary evidence that alterations in the dopamine system predict development of clinically-relevant, cognitive impairment in Parkinson's disease. If replicated and determined to be causative, they demonstrate that the dopamine system is instrumental to cognitive health status throughout the disease course. TRIAL REGISTRATION Parkinson's Progression Markers Initiative is registered with ClinicalTrials.gov (NCT01141023).
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Affiliation(s)
- Daniel Weintraub
- Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marina Picillo
- Assistant Professor in Neurology at the Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoItaly
| | - Hyunkeun Ryan Cho
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | | | - Cornelis Blauwendraat
- Center for Alzheimer's and Related Dementias, and the Integrative Neurogenomics Unit, Laboratory of NeurogeneticsNational Institute on Aging, National Institutes of HealthBethesdaMarylandUSA
| | - Ethan G. Brown
- Department of NeurologyWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | - Roseanne D. Dobkin
- Department of PsychiatryRutgers University, Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Tatiana Foroud
- Department of Medical and Molecular GeneticsIndiana UniversityIndianapolisIndianaUSA
| | - Doug Galasko
- Department of NeurologyUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Karl Kieburtz
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenConnecticutUSA
| | - Kalpana Merchant
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Brit Mollenhauer
- Department of NeurologyUniversity Medical Center GoettingenGoettingenGermany
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford UniversityStanfordCaliforniaUSA
| | - Tanya Simuni
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Andrew Siderowf
- Department of NeurologyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew Singleton
- Center for Alzheimer's and Related Dementias, and the Molecular Genetics SectionLaboratory of Neurogenetics, National Institute on Aging, National Institutes of HealthBethesdaMarylandUSA
| | - John Seibyl
- Institute for Neurodegenerative DisordersNew HavenConnecticutUSA
| | - Caroline M. Tanner
- Department of NeurologyWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
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9
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Hernandez‐Con P, Lin I, Mamikonyan E, Deeb W, Feldman R, Althouse A, Barmore R, Eisinger RS, Spindler M, Okun MS, Weintraub D, Chahine LM. Course of Impulse Control Disorder Symptoms in Parkinson's Disease: Deep Brain Stimulation Versus Medications. Mov Disord Clin Pract 2023; 10:903-913. [PMID: 37332637 PMCID: PMC10272921 DOI: 10.1002/mdc3.13738] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background The effect of surgery on impulse control disorders (ICDs) remains unclear in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS). Objective To examine changes in ICD symptoms in PD patients undergoing DBS compared to a medication-only control group. Methods The study was a 2-center, 12-month, prospective, observational investigation of PD patients undergoing DBS and a control group matched on age, sex, dopamine agonist use, and baseline presence of ICDs. Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) and total levodopa equivalent daily dose (LEDD) were collected at baseline, 3, 6, and 12 months. Linear mixed-effects models assessed changes in mean QUIP-RS score (sum of buying, eating, gambling, and hypersexuality items). Results The cohort included 54 participants (DBS = 26, controls = 28), mean (SD) age 64.3 (8.1) and PD duration 8.0 (5.2) years. Mean baseline QUIP-RS was higher in the DBS group at baseline (8.6 (10.7) vs. 5.3 (6.9), P = 0.18). However, scores at 12 months follow-up were nearly identical (6.6 (7.3) vs. 6.0 (6.9) P = 0.79). Predictors of change in QUIP-RS score were baseline QUIP-RS score (β = 0.483, P < 0.001) and time-varying LEDD (β = 0.003, P = 0.02). Eight patients (four in each group) developed de novo ICD symptoms during follow-up, although none met diagnostic criteria for an impulse control disorder. Conclusions ICD symptoms (including de novo symptoms) at 12 months follow-up were similar between PD patients undergoing DBS and patients treated with pharmacological therapy only. Monitoring for emergence of ICD symptoms is important in both surgically- and medication-only-treated PD patients.
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Affiliation(s)
- Pilar Hernandez‐Con
- Department of Pharmaceutical Outcomes and PolicyUniversity of FloridaGainesvilleFloridaUSA
| | - Iris Lin
- Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Eugenia Mamikonyan
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Wissam Deeb
- Department of NeurologyUniversity of MassachusettsAmherstMassachusettsUSA
| | - Robert Feldman
- Center for Research on Health Care Data CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Andrew Althouse
- Center for Research on Health Care Data CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ryan Barmore
- Department of NeurologyBanner HealthPhoenixArizonaUSA
| | - Robert S. Eisinger
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Meredith Spindler
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael S. Okun
- Department of NeurologyNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Daniel Weintraub
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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10
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Chahine LM, Beach TG, Adler CH, Hepker M, Kanthasamy A, Appel S, Pritzkow S, Pinho M, Mosovsky S, Serrano GE, Coffey C, Brumm MC, Oliveira LMA, Eberling J, Mollenhauer B. Central and peripheral α-synuclein in Parkinson disease detected by seed amplification assay. Ann Clin Transl Neurol 2023; 10:696-705. [PMID: 36972727 PMCID: PMC10187727 DOI: 10.1002/acn3.51753] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/11/2022] [Revised: 01/29/2023] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES Detection of α-synuclein aggregates by seed amplification is a promising Parkinson disease biomarker assay. Understanding intraindividual relationships of α-synuclein measures could inform optimal biomarker development. The objectives were to test accuracy of α-synuclein seed amplification assay in central (cerebrospinal fluid) and peripheral (submandibular gland) sources, compare to total α-synuclein measures, and investigate within-subject relationships. METHODS The Systemic Synuclein Sampling Study aimed to characterize α-synuclein in multiple tissues and biofluids within Parkinson disease subjects (n = 59) and compared to healthy controls (n = 21). Motor and non-motor measures and dopamine transporter scans were obtained. Four measures of α-synuclein were compared: seed amplification assay in cerebrospinal fluid and formalin-fixed paraffin-embedded submandibular gland, total α-synuclein quantified in biofluids using enzyme-linked immunoassay, and aggregated α-synuclein in submandibular gland detected by immunohistochemistry. Accuracy of seed amplification assay for Parkinson disease diagnosis was examined and within-subject α-synuclein measures were compared. RESULTS Sensitivity and specificity of α-synuclein seed amplification assay for Parkinson disease diagnosis was 92.6% and 90.5% in cerebrospinal fluid, and 73.2% and 78.6% in submandibular gland, respectively. 25/38 (65.8%) Parkinson disease participants were positive for both cerebrospinal fluid and submandibular gland seed amplification assay. Comparing accuracy for Parkinson disease diagnosis of different α-synuclein measures, cerebrospinal fluid seed amplification assay was the highest (Youden Index = 83.1%). 98.3% of all Parkinson disease cases had ≥1 measure of α-synuclein positive. INTERPRETATION α-synuclein seed amplification assay (cerebrospinal fluid>submandibular gland) had higher sensitivity and specificity compared to total α-synuclein measures, and within-subject relationships of central and peripheral α-synuclein measures emerged.
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Affiliation(s)
- Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Charles H. Adler
- Department of NeurologyMayo Clinic College of MedicineScottsdaleArizonaUSA
| | | | - Anumantha Kanthasamy
- Center for Brain Science and Neurodegenerative Diseases, Department of Physiology and PharmacologyUniversity of GeorgiaAthensGeorgiaUSA
| | - Scott Appel
- Biostatistics Analysis CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sandra Pritzkow
- Department of NeurologyUniversity of Texas, McGovern Medical SchoolHoustonTexasUSA
| | - Michelle Pinho
- Department of NeurologyUniversity of Texas, McGovern Medical SchoolHoustonTexasUSA
| | - Sherri Mosovsky
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Christopher Coffey
- Banner Sun Health Research InstituteSun CityArizonaUSA
- Department of BiostatisticsUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Michael C. Brumm
- Department of BiostatisticsUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Luis M. A. Oliveira
- Banner Sun Health Research InstituteSun CityArizonaUSA
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew YorkUSA
| | - Jamie Eberling
- Banner Sun Health Research InstituteSun CityArizonaUSA
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew YorkUSA
| | - Brit Mollenhauer
- Center of Parkinsonism and Movement Disorders, Department of NeurologyParacelsus‐Elena Klinik Kassel and University Medical Center GöttingenGöttingenGermany
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11
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Siderowf A, Concha-Marambio L, Lafontant DE, Farris CM, Ma Y, Urenia PA, Nguyen H, Alcalay RN, Chahine LM, Foroud T, Galasko D, Kieburtz K, Merchant K, Mollenhauer B, Poston KL, Seibyl J, Simuni T, Tanner CM, Weintraub D, Videnovic A, Choi SH, Kurth R, Caspell-Garcia C, Coffey CS, Frasier M, Oliveira LMA, Hutten SJ, Sherer T, Marek K, Soto C. Assessment of heterogeneity among participants in the Parkinson's Progression Markers Initiative cohort using α-synuclein seed amplification: a cross-sectional study. Lancet Neurol 2023; 22:407-417. [PMID: 37059509 PMCID: PMC10627170 DOI: 10.1016/s1474-4422(23)00109-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 132.0] [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: 01/02/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Emerging evidence shows that α-synuclein seed amplification assays (SAAs) have the potential to differentiate people with Parkinson's disease from healthy controls. We used the well characterised, multicentre Parkinson's Progression Markers Initiative (PPMI) cohort to further assess the diagnostic performance of the α-synuclein SAA and to examine whether the assay identifies heterogeneity among patients and enables the early identification of at-risk groups. METHODS This cross-sectional analysis is based on assessments done at enrolment for PPMI participants (including people with sporadic Parkinson's disease from LRRK2 and GBA variants, healthy controls, prodromal individuals with either rapid eye movement sleep behaviour disorder (RBD) or hyposmia, and non-manifesting carriers of LRRK2 and GBA variants) from 33 participating academic neurology outpatient practices worldwide (in Austria, Canada, France, Germany, Greece, Israel, Italy, the Netherlands, Norway, Spain, the UK, and the USA). α-synuclein SAA analysis of CSF was performed using previously described methods. We assessed the sensitivity and specificity of the α-synuclein SAA in participants with Parkinson's disease and healthy controls, including subgroups based on genetic and clinical features. We established the frequency of positive α-synuclein SAA results in prodromal participants (RBD and hyposmia) and non-manifesting carriers of genetic variants associated with Parkinson's disease, and compared α-synuclein SAA to clinical measures and other biomarkers. We used odds ratio estimates with 95% CIs to measure the association between α-synuclein SAA status and categorical measures, and two-sample 95% CIs from the resampling method to assess differences in medians between α-synuclein SAA positive and negative participants for continuous measures. A linear regression model was used to control for potential confounders such as age and sex. FINDINGS This analysis included 1123 participants who were enrolled between July 7, 2010, and July 4, 2019. Of these, 545 had Parkinson's disease, 163 were healthy controls, 54 were participants with scans without evidence of dopaminergic deficit, 51 were prodromal participants, and 310 were non-manifesting carriers. Sensitivity for Parkinson's disease was 87·7% (95% CI 84·9-90·5), and specificity for healthy controls was 96·3% (93·4-99·2). The sensitivity of the α-synuclein SAA in sporadic Parkinson's disease with the typical olfactory deficit was 98·6% (96·4-99·4). The proportion of positive α-synuclein SAA was lower than this figure in subgroups including LRRK2 Parkinson's disease (67·5% [59·2-75·8]) and participants with sporadic Parkinson's disease without olfactory deficit (78·3% [69·8-86·7]). Participants with LRRK2 variant and normal olfaction had an even lower α-synuclein SAA positivity rate (34·7% [21·4-48·0]). Among prodromal and at-risk groups, 44 (86%) of 51 of participants with RBD or hyposmia had positive α-synuclein SAA (16 of 18 with hyposmia, and 28 of 33 with RBD). 25 (8%) of 310 non-manifesting carriers (14 of 159 [9%] LRRK2 and 11 of 151 [7%] GBA) were positive. INTERPRETATION This study represents the largest analysis so far of the α-synuclein SAA for the biochemical diagnosis of Parkinson's disease. Our results show that the assay classifies people with Parkinson's disease with high sensitivity and specificity, provides information about molecular heterogeneity, and detects prodromal individuals before diagnosis. These findings suggest a crucial role for the α-synuclein SAA in therapeutic development, both to identify pathologically defined subgroups of people with Parkinson's disease and to establish biomarker-defined at-risk cohorts. FUNDING PPMI is funded by the Michael J Fox Foundation for Parkinson's Research and funding partners, including: Abbvie, AcureX, Aligning Science Across Parkinson's, Amathus Therapeutics, Avid Radiopharmaceuticals, Bial Biotech, Biohaven, Biogen, BioLegend, Bristol-Myers Squibb, Calico Labs, Celgene, Cerevel, Coave, DaCapo Brainscience, 4D Pharma, Denali, Edmond J Safra Foundation, Eli Lilly, GE Healthcare, Genentech, GlaxoSmithKline, Golub Capital, Insitro, Janssen Neuroscience, Lundbeck, Merck, Meso Scale Discovery, Neurocrine Biosciences, Prevail Therapeutics, Roche, Sanofi Genzyme, Servier, Takeda, Teva, UCB, VanquaBio, Verily, Voyager Therapeutics, and Yumanity.
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Affiliation(s)
- Andrew Siderowf
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | | | - David-Erick Lafontant
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Carly M Farris
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Yihua Ma
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Paula A Urenia
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Hieu Nguyen
- Research and Development Unit, Amprion, San Diego, CA, USA
| | - Roy N Alcalay
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Paracelsus-Elena Klinik, Kassel, and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; Parkinson's Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Aleksandar Videnovic
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seung Ho Choi
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Ryan Kurth
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Mark Frasier
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Luis M A Oliveira
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Samantha J Hutten
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Claudio Soto
- Research and Development Unit, Amprion, San Diego, CA, USA; Department of Neurology, University of Texas McGovern Medical School at Houston, TX, USA
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12
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Chahine LM, Merchant K, Siderowf A, Sherer T, Tanner C, Marek K, Simuni T. Proposal for a Biologic Staging System of Parkinson's Disease. J Parkinsons Dis 2023; 13:297-309. [PMID: 37066922 DOI: 10.3233/jpd-225111] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
The Parkinson's disease (PD) research field has seen the advent of several promising biomarkers and a deeper understanding of the clinical features of the disease from the earliest stages of pathology to manifest disease. Despite progress, a biologically based PD staging system does not exist. Such staging would be a useful framework within which to model the disease, develop and validate biomarkers, guide therapeutic development, and inform clinical trials design. We propose that the presence of aggregated neuronal α-synuclein, dopaminergic neuron dysfunction/degeneration, and clinical signs and symptoms identifies a group of individuals that have Lewy body pathology, which in early stages manifests with what is now referred to as prodromal non-motor features and later stages with the manifestations of PD and related Lewy body diseases as defined by clinical diagnostic criteria. Based on the state of the field, we herein propose a definition and staging of PD based on biology. We present the biologic basis for such a staging system and review key assumptions and evidence that support the proposed approach. We identify gaps in knowledge and delineate crucial research priorities that will inform the ultimate integrated biologic staging system for PD.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kalpana Merchant
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of San Francisco, San Francisco, CA, USA
| | | | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Chahine LM, Simuni T. Role of novel endpoints and evaluations of response in Parkinson disease. Handb Clin Neurol 2023; 193:325-345. [PMID: 36803820 DOI: 10.1016/b978-0-323-85555-6.00010-2] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
With progress in our understanding of Parkinson disease (PD) and other neurodegenerative disorders, from clinical features to imaging, genetic, and molecular characterization comes the opportunity to refine and revise how we measure these diseases and what outcome measures are used as endpoints in clinical trials. While several rater-, patient-, and milestone-based outcomes for PD exist that may serve as clinical trial endpoints, there remains an unmet need for endpoints that are clinically meaningful, patient centric while also being more objective and quantitative, less susceptible to effects of symptomatic therapy (for disease-modification trials), and that can be measured over a short period and yet accurately represent longer-term outcomes. Several novel outcomes that may be used as endpoints in PD clinical trials are in development, including digital measures of signs and symptoms, as well a growing array of imaging and biospecimen biomarkers. This chapter provides an overview of the state of PD outcome measures as of 2022, including considerations for selection of clinical trial endpoints in PD, advantages and limitations of existing measures, and emerging potential novel endpoints.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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Marras C, Arbatti L, Hosamath A, Amara A, Anderson KE, Chahine LM, Eberly S, Kinel D, Mantri S, Mathur S, Oakes D, Purks JL, Standaert DG, Tanner CM, Weintraub D, Shoulson I. What Patients Say: Large-Scale Analyses of Replies to the Parkinson's Disease Patient Report of Problems (PD-PROP). J Parkinsons Dis 2023; 13:757-767. [PMID: 37334615 PMCID: PMC10473108 DOI: 10.3233/jpd-225083] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Free-text, verbatim replies in the words of people with Parkinson's disease (PD) have the potential to provide unvarnished information about their feelings and experiences. Challenges of processing such data on a large scale are a barrier to analyzing verbatim data collection in large cohorts. OBJECTIVE To develop a method for curating responses from the Parkinson's Disease Patient Report of Problems (PD-PROP), open-ended questions that asks people with PD to report their most bothersome problems and associated functional consequences. METHODS Human curation, natural language processing, and machine learning were used to develop an algorithm to convert verbatim responses to classified symptoms. Nine curators including clinicians, people with PD, and a non-clinician PD expert classified a sample of responses as reporting each symptom or not. Responses to the PD-PROP were collected within the Fox Insight cohort study. RESULTS Approximately 3,500 PD-PROP responses were curated by a human team. Subsequently, approximately 1,500 responses were used in the validation phase; median age of respondents was 67 years, 55% were men and median years since PD diagnosis was 3 years. 168,260 verbatim responses were classified by machine. Accuracy of machine classification was 95% on a held-out test set. 65 symptoms were grouped into 14 domains. The most frequently reported symptoms at first report were tremor (by 46% of respondents), gait and balance problems (>39%), and pain/discomfort (33%). CONCLUSION A human-in-the-loop method of curation provides both accuracy and efficiency, permitting a clinically useful analysis of large datasets of verbatim reports about the problems that bother PD patients.
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Affiliation(s)
- Connie Marras
- Edmond J Safra Program in Parkinson’s Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Lakshmi Arbatti
- Grey Matter Technologies, a Wholly Owned Subsidiary of Modality.ai, San Francisco, CA, USA
| | - Abhishek Hosamath
- Grey Matter Technologies, a Wholly Owned Subsidiary of Modality.ai, San Francisco, CA, USA
| | - Amy Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen E. Anderson
- Departments of Psychiatry and Neurology, Georgetown University, Washington DC, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shirley Eberly
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Dan Kinel
- Department of Neurology, University of Rochester, Rochester NY, USA
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, USA
| | | | - David Oakes
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | | | | | - Caroline M. Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California – San Francisco, San Francisco, CA, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ira Shoulson
- Grey Matter Technologies, a Wholly Owned Subsidiary of Modality.ai, San Francisco, CA, USA
- Department of Neurology, University of Rochester, Rochester NY, USA
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15
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Brumm MC, Siderowf A, Simuni T, Burghardt E, Choi SH, Caspell-Garcia C, Chahine LM, Mollenhauer B, Foroud T, Galasko D, Merchant K, Arnedo V, Hutten SJ, O’Grady AN, Poston KL, Tanner CM, Weintraub D, Kieburtz K, Marek K, Coffey CS. Parkinson's Progression Markers Initiative: A Milestone-Based Strategy to Monitor Parkinson's Disease Progression. J Parkinsons Dis 2023; 13:899-916. [PMID: 37458046 PMCID: PMC10578214 DOI: 10.3233/jpd-223433] [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] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Identifying a meaningful progression metric for Parkinson's disease (PD) that reflects heterogeneity remains a challenge. OBJECTIVE To assess the frequency and baseline predictors of progression to clinically relevant motor and non-motor PD milestones. METHODS Using data from the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort, we monitored 25 milestones across six domains ("walking and balance"; "motor complications"; "cognition"; "autonomic dysfunction"; "functional dependence"; "activities of daily living"). Milestones were intended to be severe enough to reflect meaningful disability. We assessed the proportion of participants reaching any milestone; evaluated which occurred most frequently; and conducted a time-to-first-event analysis exploring whether baseline characteristics were associated with progression. RESULTS Half of participants reached at least one milestone within five years. Milestones within the cognitive, functional dependence, and autonomic dysfunction domains were reached most often. Among participants who reached a milestone at an annual follow-up visit and remained active in the study, 82% continued to meet criteria for any milestone at one or more subsequent annual visits and 55% did so at the next annual visit. In multivariable analysis, baseline features predicting faster time to reaching a milestone included age (p < 0.0001), greater MDS-UPDRS total scores (p < 0.0001), higher GDS-15 depression scores (p = 0.0341), lower dopamine transporter binding (p = 0.0043), and lower CSF total α-synuclein levels (p = 0.0030). Symptomatic treatment was not significantly associated with reaching a milestone (p = 0.1639). CONCLUSION Clinically relevant milestones occur frequently, even in early PD. Milestones were significantly associated with baseline clinical and biological markers, but not with symptomatic treatment. Further studies are necessary to validate these results, further assess the stability of milestones, and explore translating them into an outcome measure suitable for observational and therapeutic studies.
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Affiliation(s)
- Michael C. Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elliot Burghardt
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Seung Ho Choi
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Samantha J. Hutten
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Alyssa N. O’Grady
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Kathleen L. Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, SanFrancisco, CA, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Departmentof Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - on behalf of the Parkinson’s Progression Markers Initiative
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, University of California, San Diego, CA, USA
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, SanFrancisco, CA, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Departmentof Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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16
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Miller-Patterson C, Hsu JY, Chahine LM, Morley JF, Willis AW. Selected autonomic signs and symptoms as risk markers for phenoconversion and functional dependence in prodromal Parkinson's disease. Clin Auton Res 2022; 32:463-476. [PMID: 36057046 PMCID: PMC10979289 DOI: 10.1007/s10286-022-00889-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine whether dysautonomia can stratify individuals with other prodromal markers of Parkinson's disease (PD) for risk of phenoconversion and functional decline, which may help identify subpopulations appropriate for experimental studies. METHODS Data were obtained from Parkinson's Progression Markers Initiative. Cohorts without PD but with at-risk features were included (hyposmia and/or rapid-eye-movement-sleep behavior disorder, LRRK2 gene mutation, GBA gene mutation). Dysautonomia measures included Scales-for-Outcomes-in-Parkinson's-Disease Autonomic (SCOPA-AUT), seven SCOPA-AUT subscales, and cardiovascular dysfunction (supine hypertension, low pulse pressure, neurogenic orthostatic hypotension). Outcome measures were phenoconversion and Schwab-and-England Activities-of-Daily-Living (SE-ADL) ≤ 70, which indicates functional dependence. Cox proportional-hazards regression was used to evaluate survival to phenoconversion/SE-ADL ≤ 70 for each dysautonomia measure. If a significant association was identified, a likelihood-ratio test was employed to evaluate whether a significant interaction existed between the measure and cohort. If so, regression analysis was repeated stratified by cohort. RESULTS Median follow-up was 30 months. On multivariable analysis, gastrointestinal and female sexual dysfunction subscales were associated with increased risk of phenoconversion, while the cardiovascular subscale and neurogenic orthostatic hypotension were associated with increased risk of SE-ADL ≤ 70; respective hazard ratios (95% confidence intervals) were 1.13 (1.01-1.27), 3.26 (1.39-7.61), 1.87 (1.16-2.99), 5.45 (1.40-21.25). Only the association between the cardiovascular subscale and SE-ADL ≤ 70 was modified by cohort. CONCLUSIONS Symptoms of gastrointestinal and female sexual dysfunction predict phenoconversion in individuals with other risk markers for PD, while signs and symptoms of cardiovascular dysfunction may be associated with functional decline.
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Affiliation(s)
- Cameron Miller-Patterson
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 3900 Woodland Ave., Philadelphia, PA, 19104, USA.
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James F Morley
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Epidemiology and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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17
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Chahine LM. Prodromal α-Synucleinopathies. Continuum (Minneap Minn) 2022; 28:1268-1280. [DOI: 10.1212/con.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Miller-Patterson C, Hsu JY, Chahine LM. Early Autonomic Symptoms Predict Functional Decline in Parkinson's Disease Independent of Dopaminergic Therapy. NEURODEGENER DIS 2022; 22:15-23. [PMID: 35785765 DOI: 10.1159/000525664] [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: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) has variable progression; identifying determinants of functional decline in PD is needed for accurate prognostication. Autonomic symptoms can result from dopaminergic therapy, but may also independently predict functional decline. METHODS The sample included individuals with newly-diagnosed PD in Parkinson's Progression Markers Initiative. Autonomic symptoms were measured with the Scales-for-Outcomes-in-Parkinson's-Disease-Autonomic (SCOPA-AUT). Presence/absence of autonomic symptoms for SCOPA-AUT total scale and seven subscales was defined and baseline demographic/clinical data were compared between groups with and without autonomic symptoms. Time-to-functional-dependence, or Schwab-and-England Activities-of-Daily-Living (SE-ADL) ≤70, was compared between groups using hazard models, adjusting for covariates including time-varying levodopa-equivalent daily dosage (LEDD). If a subscale was associated with a significant subhazard ratio (SHR), hazard models for items in that subscale were generated and gender was evaluated as an effect modifier. RESULTS 399 participants were included. Over a median of 72 months (range 6-84), 91 (22.81%) reached SE-ADL≤70. SCOPA-AUT total/gastrointestinal/urinary/pupillomotor scales were associated with SE-ADL≤70; respective multivariable SHRs (95% CI, p-value) were 1.98 (1.06-3.70, .03), 1.71 (1.04-2.81, .03), 1.94 (1.25-3.01, <.01), 2.56 (1.24-5.31, .01). Individual items in the gastrointestinal and urinary scales drove associations. Urinary scale associations were seen in males only. CONCLUSIONS Symptoms of gastrointestinal, urinary, pupillomotor dysfunction are associated with functional decline risk in PD, independent of dopaminergic therapy. Detailed assessments of autonomic symptomatology should be utilized in studies attempting to refine predictive models of PD progression.
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Affiliation(s)
- Cameron Miller-Patterson
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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19
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Signaevsky M, Marami B, Prastawa M, Tabish N, Iida MA, Zhang XF, Sawyer M, Duran I, Koenigsberg DG, Bryce CH, Chahine LM, Mollenhauer B, Mosovsky S, Riley L, Dave KD, Eberling J, Coffey CS, Adler CH, Serrano GE, White CL, Koll J, Fernandez G, Zeineh J, Cordon-Cardo C, Beach TG, Crary JF. Antemortem detection of Parkinson's disease pathology in peripheral biopsies using artificial intelligence. Acta Neuropathol Commun 2022; 10:21. [PMID: 35164870 PMCID: PMC8842941 DOI: 10.1186/s40478-022-01318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
The diagnosis of Parkinson's disease (PD) is challenging at all stages due to variable symptomatology, comorbidities, and mimicking conditions. Postmortem assessment remains the gold standard for a definitive diagnosis. While it is well recognized that PD manifests pathologically in the central nervous system with aggregation of α-synuclein as Lewy bodies and neurites, similar Lewy-type synucleinopathy (LTS) is additionally found in the peripheral nervous system that may be useful as an antemortem biomarker. We have previously found that detection of LTS in submandibular gland (SMG) biopsies is sensitive and specific for advanced PD; however, the sensitivity is suboptimal especially for early-stage disease. Further, visual microscopic assessment of biopsies by a neuropathologist to identify LTS is impractical for large-scale adoption. Here, we trained and validated a convolutional neural network (CNN) for detection of LTS on 283 digital whole slide images (WSI) from 95 unique SMG biopsies. A total of 8,450 LTS and 35,066 background objects were annotated following an inter-rater reliability study with Fleiss Kappa = 0.72. We used transfer learning to train a CNN model to classify image patches (151 × 151 pixels at 20× magnification) with and without the presence of LTS objects. The trained CNN model showed the following performance on image patches: sensitivity: 0.99, specificity: 0.99, precision: 0.81, accuracy: 0.99, and F-1 score: 0.89. We further tested the trained network on 1230 naïve WSI from the same cohort of research subjects comprising 42 PD patients and 14 controls. Logistic regression models trained on features engineered from the CNN predictions on the WSI resulted in sensitivity: 0.71, specificity: 0.65, precision: 0.86, accuracy: 0.69, and F-1 score: 0.76 in predicting clinical PD status, and 0.64 accuracy in predicting PD stage, outperforming expert neuropathologist LTS density scoring in terms of sensitivity but not specificity. These findings demonstrate the practical utility of a CNN detector in screening for LTS, which can translate into a computational tool to facilitate the antemortem tissue-based diagnosis of PD in clinical settings.
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20
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Mantri S, Chahine LM, Nabieva K, Feldman R, Althouse A, Torsney B, Albert SM, Kopil C, Marras C. Demographic Influences on the Relationship Between Fatigue and Quality of Life in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:76-81. [PMID: 35005068 DOI: 10.1002/mdc3.13360] [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: 06/16/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background Fatigue has a major impact on health-related quality of life (HR-QOL) in Parkinson's disease (PD). Objectives To determine whether demographic characteristics modify the relationship between fatigue and HR-QOL. Methods Patients with PD in the Fox Insight study completed the Parkinson Fatigue Scale (PFS-16) and Geriatric Depression Scale (GDS-15). Linear regression examined the relationship between the PFS-16 and Parkinson Disease Quality of Life, as modified by age, sex, and GDS-15. Results A total of 1029 participants (44% female, mean age 67.4 years, and mean disease duration 4.6 years) were included in this analysis. Multivariable regression modeling demonstrated a negative effect modification for age (β = -0.07, P < 0.001) and a positive effect modification for the GDS-15 (β = 0.057, P = 0.002), but not for sex (β = -0.021, P = 0.231). Conclusion The association between fatigue and worse HR-QOL is greater at younger ages and in individuals with more depressive symptoms. Targeted therapeutics for these individuals may provide the greatest impact on fatigue in PD.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology Duke University School of Medicine Durham North Carolina USA
| | - Lana M Chahine
- Department of Neurology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Karina Nabieva
- The Edmond J Safra Program in Parkinson's disease Toronto Western Hospital, University of Toronto Toronto Ontario Canada
| | - Robert Feldman
- Center for Clinical Trials and Data Coordination, Division of General Internal Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Andrew Althouse
- Center for Clinical Trials and Data Coordination, Division of General Internal Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Benjamin Torsney
- Temple University College of Education and Human Development Philadelphia Pennsylvania USA
| | - Steven M Albert
- Behavioral and Community Health Sciences, Graduate School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | | | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease Toronto Western Hospital, University of Toronto Toronto Ontario Canada
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21
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Felix C, Chahine LM, Hengenius J, Chen H, Rosso AL, Zhu X, Cao Z, Rosano C. Diffusion Tensor Imaging of the Olfactory System in Older Adults With and Without Hyposmia. Front Aging Neurosci 2021; 13:648598. [PMID: 34744681 PMCID: PMC8569942 DOI: 10.3389/fnagi.2021.648598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/21/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To compare gray matter microstructural characteristics of higher-order olfactory regions among older adults with and without hyposmia. Methods: Data from the Brief Smell Identification Test (BSIT) were obtained in 1998–99 for 265 dementia-free adults from the Health, Aging, and Body Composition study (age at BSIT: 74.9 ± 2.7; 62% White; 43% male) who received 3T diffusion tensor imaging in 2006–08 [Interval of time: mean (SD): 8.01 years (0.50)], Apolipoprotein (ApoEε4) genotypes, and repeated 3MS assessments until 2011–12. Cognitive status (mild cognitive impairment, dementia, normal cognition) was adjudicated in 2011–12. Hyposmia was defined as BSIT ≤ 8. Microstructural integrity was quantified by mean diffusivity (MD) in regions of the primary olfactory cortex amygdala, orbitofrontal cortex (including olfactory cortex, gyrus rectus, the orbital parts of the superior, middle, and inferior frontal gyri, medial orbital part of the superior frontal gyrus), and hippocampus. Multivariable regression models were adjusted for total brain atrophy, demographics, cognitive status, and ApoEε4 genotype. Results: Hyposmia in 1998–99 (n = 57, 21.59%) was significantly associated with greater MD in 2006–08, specifically in the orbital part of the middle frontal gyrus, and amygdala, on the right [adjusted beta (p value): 0.414 (0.01); 0.527 (0.01); respectively]. Conclusion: Older adults with higher mean diffusivity in regions important for olfaction are more likely to have hyposmia up to ten years prior. Future studies should address whether hyposmia can serve as an early biomarker of brain microstructural abnormalities for older adults with a range of cognitive functions, including those with normal cognition.
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Affiliation(s)
- Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - James Hengenius
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zichun Cao
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
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22
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Chahine LM, Edison B, Daeschler M, Siddiqi B, Kopil C, Marras C, Mantri S. Use of Figurative Language by People With Parkinson Disease to Describe "Off" Periods: Clear as Mud. Neurol Clin Pract 2021; 11:e462-e471. [PMID: 34476127 PMCID: PMC8382437 DOI: 10.1212/cpj.0000000000001059] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Abstract
Objective “Off” periods are characterized by the reemergence of motor and nonmotor symptoms in individuals with Parkinson disease (PD) and often negatively affect daily functioning. Individuals' experiences are diverse and may be difficult to articulate; figurative language is often used by patients to describe such experiences. Our objective was to understand how individuals with PD use figurative language to explain off periods and how experts interpret such expressions. Methods Individuals with self-reported PD participating in the online Fox Insight study were invited to participate in a survey about off periods. Those endorsing off periods were asked to describe their experiences with open-ended free-text responses. Instances where any type of figurative language was used were identified and classified into themes. Three movement disorder neurologists reviewed each phrase and specified what symptoms they felt were likely represented. Results A total of 109 instances of figurative language phrases were identified across descriptions from 86 patients. Allusions to viscous materials (e.g., mud and cement) and effects of chemicals (e.g., drunkenness) were common (18.35% and 17.43% of phrases, respectively). Most phrases were interpreted by the neurologists as representing motor symptoms, but neurologists agreed on what specific symptom was being referred to for only 42 (38.5%) phrases. Conclusions To describe off periods, individuals with PD use various forms of figurative language, but this language is not uniformly interpreted and understood by specialists. Given the subjective interpretation of figurative language, exploring what patients are trying to convey when they use such language is important and could improve patient-physician communication.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Briana Edison
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Margaret Daeschler
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Bernadette Siddiqi
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Catherine Kopil
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Connie Marras
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
| | - Sneha Mantri
- Department of Neurology (LMC, BE), University of Pittsburgh, PA; Georgetown University (MD), Washington, DC; The Michael J. Fox Foundation for Parkinson's Research (BS, CK), New York; The Edmond J Safra Program in Parkinson's Disease (CM), Toronto Western Hospital, University of Toronto, Ontario, Canada; and Department of Neurology (SM), Duke University, Durham, NC
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23
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Kremer T, Taylor KI, Siebourg‐Polster J, Gerken T, Staempfli A, Czech C, Dukart J, Galasko D, Foroud T, Chahine LM, Coffey CS, Simuni T, Weintraub D, Seibyl J, Poston KL, Toga AW, Tanner CM, Marek K, Hutten SJ, Dziadek S, Trenkwalder C, Pagano G, Mollenhauer B. Longitudinal Analysis of Multiple Neurotransmitter Metabolites in Cerebrospinal Fluid in Early Parkinson's Disease. Mov Disord 2021; 36:1972-1978. [PMID: 33942926 PMCID: PMC8453505 DOI: 10.1002/mds.28608] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) levels of monoamine metabolites may represent biomarkers of Parkinson's disease (PD). OBJECTIVE The aim of this study was quantification of multiple metabolites in CSF from PD versus healthy control subjects (HCs), including longitudinal analysis. METHODS Absolute levels of multiple monoamine metabolites in CSF were quantified by liquid chromatography coupled with tandem mass spectrometry from 161 individuals with early PD and 115 HCs from the Parkinson's Progression Marker Initiative and de novo PD (DeNoPA) studies. RESULTS Baseline levels of homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid (DOPAC) were lower in individuals with PD compared with HCs. HVA levels correlated with Movement Disorder Society Unified Parkinson's Disease Rating Scale total scores (P < 0.01). Both HVA/dopamine and DOPAC/dopamine levels correlated with caudate nucleus and raw DOPAC with putamen dopamine transporter single-photon emission computed tomography uptake ratios (P < 0.01). No metabolite changed over 2 years in drug-naive individuals, but some changed on starting levodopa treatment. CONCLUSIONS HVA and DOPAC CSF levels mirrored nigrostriatal pathway damage, confirming the central role of dopaminergic degeneration in early PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Kremer
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Diseases, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
| | - Kirsten I. Taylor
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Diseases, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
- Faculty of PsychologyUniversity of BaselBaselSwitzerland
| | - Juliane Siebourg‐Polster
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
| | | | - Andreas Staempfli
- Roche Pharmaceutical Research and Early Development, Therapeutic Modalities, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
| | - Christian Czech
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Diseases, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
- Present address:
Current address for Dr. Czech: Pfizer Rare Disease UnitBerlinGermany
| | - Juergen Dukart
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Diseases, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM‐7)Research Centre JülichJulichGermany
- Institute of Systems Neuroscience, Medical FacultyHeinrich Heine University DüsseldorfDüsseldorfGermany
| | - Douglas Galasko
- Department of NeurosciencesUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Tatiana Foroud
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | - Tanya Simuni
- Parkinson's Disease and Movement Disorders CenterNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Daniel Weintraub
- Department of Neurology Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John Seibyl
- Institute for Neurodegenerative DisordersNew HavenConnecticutUSA
| | - Kathleen L. Poston
- Department of Neurology & Neurological SciencesSchool of Medicine, Stanford UniversityStanfordCaliforniaUSA
| | - Arthur W. Toga
- Laboratory of Neuro ImagingUniversity of Southern California (USC) Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Caroline M. Tanner
- Department of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Parkinson's Disease Research Education and Clinical Center, San Francisco Veterans Affairs Health Care SystemSan DiegoCaliforniaUSA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenConnecticutUSA
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew YorkUSA
| | - Samantha J. Hutten
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew YorkUSA
| | - Sebastian Dziadek
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Diseases, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
| | - Claudia Trenkwalder
- Department of NeurosurgeryUniversity Medical Center GöttingenGöttingenGermany
- Paracelsus‐Elena‐KlinikKasselGermany
| | - Gennaro Pagano
- Roche Pharmaceutical Research and Early Development, NRD Neuroscience and Rare Diseases, Roche Innovation Center BaselF. Hoffmann–La Roche Ltd.BaselSwitzerland
| | - Brit Mollenhauer
- Paracelsus‐Elena‐KlinikKasselGermany
- Department of NeurologyUniversity Medical Center GöttingenGöttingenGermany
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24
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Severson KA, Chahine LM, Smolensky LA, Dhuliawala M, Frasier M, Ng K, Ghosh S, Hu J. Discovery of Parkinson's disease states and disease progression modelling: a longitudinal data study using machine learning. Lancet Digit Health 2021; 3:e555-e564. [PMID: 34334334 DOI: 10.1016/s2589-7500(21)00101-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/26/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Parkinson's disease is heterogeneous in symptom presentation and progression. Increased understanding of both aspects can enable better patient management and improve clinical trial design. Previous approaches to modelling Parkinson's disease progression assumed static progression trajectories within subgroups and have not adequately accounted for complex medication effects. Our objective was to develop a statistical progression model of Parkinson's disease that accounts for intra-individual and inter-individual variability and medication effects. METHODS In this longitudinal data study, data were collected for up to 7-years on 423 patients with early Parkinson's disease and 196 healthy controls from the Parkinson's Progression Markers Initiative (PPMI) longitudinal observational study. A contrastive latent variable model was applied followed by a novel personalised input-output hidden Markov model to define disease states. Clinical significance of the states was assessed using statistical tests on seven key motor or cognitive outcomes (mild cognitive impairment, dementia, dyskinesia, presence of motor fluctuations, functional impairment from motor fluctuations, Hoehn and Yahr score, and death) not used in the learning phase. The results were validated in an independent sample of 610 patients with Parkinson's disease from the National Institute of Neurological Disorders and Stroke Parkinson's Disease Biomarker Program (PDBP). FINDINGS PPMI data were download July 25, 2018, medication information was downloaded on Sept 24, 2018, and PDBP data were downloaded between June 15 and June 24, 2020. The model discovered eight disease states, which are primarily differentiated by functional impairment, tremor, bradykinesia, and neuropsychiatric measures. State 8, the terminal state, had the highest prevalence of key clinical outcomes including 18 (95%) of 19 recorded instances of dementia. At study outset 4 (1%) of 333 patients were in state 8 and 138 (41%) of 333 patients reached stage 8 by year 5. However, the ranking of the starting state did not match the ranking of reaching state 8 within 5 years. Overall, patients starting in state 5 had the shortest time to terminal state (median 2·75 [95% CI 1·75-4·25] years). INTERPRETATION We developed a statistical progression model of early Parkinson's disease that accounts for intra-individual and inter-individual variability and medication effects. Our predictive model discovered non-sequential, overlapping disease progression trajectories, supporting the use of non-deterministic disease progression models, and suggesting static subtype assignment might be ineffective at capturing the full spectrum of Parkinson's disease progression. FUNDING Michael J Fox Foundation.
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Affiliation(s)
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Soumya Ghosh
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Jianying Hu
- Center for Computational Health, IBM Research, Yorktown Heights, NY, USA
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25
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Dobkin RD, Amondikar N, Kopil C, Caspell-Garcia C, Brown E, Chahine LM, Marras C, Dahodwala N, Mantri S, Standaert DG, Dean M, Shoulson I, Marek K, Katz A, Korell M, Riley L, Tanner CM. Innovative Recruitment Strategies to Increase Diversity of Participation in Parkinson's Disease Research: The Fox Insight Cohort Experience. J Parkinsons Dis 2021; 10:665-675. [PMID: 32250321 PMCID: PMC7242847 DOI: 10.3233/jpd-191901] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Clinical research in Parkinson’s disease (PD) faces practical and ethical challenges due to two interrelated problems: participant under-recruitment and lack of diversity. Fox Insight (FI) is a web-based longitudinal study collecting patient-reported outcomes and genetic data worldwide to inform therapeutic studies. FI’s online platform provides an opportunity to evaluate online strategies for recruiting large, diverse research cohorts. Objective: This project aimed to determine 1) whether FI’s digital marketing was associated with increased enrollment overall and from under-represented patient groups, compared to traditional recruitment methods; 2) the clinical and demographic characteristics of samples recruited online, and 3) the cost of this online recruitment. Method: FI recruitment during a 6-week baseline period without digital promotion was compared to recruitment during several periods of digital outreach. Separate online recruiting intervals included general online study promotion and unique Facebook and Google ad campaigns targeting under-represented subgroups: early PD, late/advanced PD, and residents of underrepresented/rural geographic areas. Results: Early PD, late PD, and geotargeting campaigns enrolled more individuals in their respective cohorts compared to baseline. All online campaigns also yielded greater total FI enrollment, attracting more participants who were non-White, Hispanic, older, female, and had lower educational attainment and income, and more medical comorbidities. Cost per new participant ranged from $21 (Facebook) to $108 (Google). Conclusion: Digital marketing may allow researchers to increase, accelerate, and diversify recruitment for PD clinical studies, by tailoring digital ads to target PD cohort characteristics.
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Affiliation(s)
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | | | - Ethan Brown
- University of California, & San Francisco Veterans Affairs Medical Care Plan, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Marissa Dean
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Andrea Katz
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Monica Korell
- University of California, & San Francisco Veterans Affairs Medical Care Plan, San Francisco, San Francisco, CA, USA
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline M Tanner
- University of California, & San Francisco Veterans Affairs Medical Care Plan, San Francisco, San Francisco, CA, USA
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26
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Chahine LM, Chin I, Caspell-Garcia C, Standaert DG, Brown E, Smolensky L, Arnedo V, Daeschler D, Riley L, Korell M, Dobkin R, Amondikar N, Gradinscak S, Shoulson I, Dean M, Kwok K, Cannon P, Marek K, Kopil C, Tanner CM, Marrason C. Comparison of an Online-Only Parkinson's Disease Research Cohort to Cohorts Assessed In Person. J Parkinsons Dis 2021; 10:677-691. [PMID: 31958097 PMCID: PMC7242834 DOI: 10.3233/jpd-191808] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Online tools for data collection could be of value in patient-oriented research. The Fox Insight (FI) study collects data online from individuals with self-reported Parkinson's disease (PD). Comparing the FI cohort to other cohorts assessed through more traditional (in-person) observational research studies would inform the representativeness and utility of FI data. OBJECTIVE To compare self-reported demographic characteristics, symptoms, medical history, and PD medication use of the FI PD cohort to other recent observational research study cohorts assessed with in-person visits. METHODS The FI PD cohort (n = 12,654) was compared to 3 other cohorts, selected based on data accessibility and breadth of assessments: Parkinson's Progression Markers Initiative (PPMI; PD n = 422), Parkinson's Disease Biomarker Program (PDBP; n = 700), and PD participants in the LRRK2 consortium without LRRK2 mutations (n = 508). Demographics, motor and non-motor assessments, and medications were compared across cohorts. Where available, identical items on surveys and assessments were compared; otherwise, expert opinion was used to determine comparable definitions for a given variable. RESULTS The proportion of females was significantly higher in FI (45.56%) compared to PPMI (34.36%) and PDBP (35.71%). The FI cohort had greater educational attainment as compared to all other cohorts. Overall, prevalence of difficulties with motor experiences of daily living and non-motor symptoms in the FI cohort was similar to other cohorts, with only a few significant differences that were generally small in magnitude. Missing data were rare for the FI cohort, except on a few variables. DISCUSSION Patterns of responses to patient-reported assessments obtained online on the PD cohort of the FI study were similar to PD cohorts assessed in-person.
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Affiliation(s)
| | | | | | | | - Ethan Brown
- University of California, and San Francisco Veterans Affairs Medical Care Plan, San Francisco, CA, USA
| | - Luba Smolensky
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Daisy Daeschler
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Monica Korell
- University of California, and San Francisco Veterans Affairs Medical Care Plan, San Francisco, CA, USA
| | - Roseanne Dobkin
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Stephen Gradinscak
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | | | - Marissa Dean
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Kwok
- Theravance Biopharma, San Francisco, CA, USA
| | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline M Tanner
- University of California, and San Francisco Veterans Affairs Medical Care Plan, San Francisco, CA, USA
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27
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Mantri S, Lepore M, Edison B, Daeschler M, Kopil CM, Marras C, Chahine LM. The Experience of OFF Periods in Parkinson's Disease: Descriptions, Triggers, and Alleviating Factors. J Patient Cent Res Rev 2021; 8:232-238. [PMID: 34322575 DOI: 10.17294/2330-0698.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Wearing off of Parkinson's disease medication is common, but triggers and coping strategies for this transient phenomenon are poorly understood. We aimed to assess the lived experience of OFF periods for people with Parkinson's disease. Methods Participants in the longitudinal Fox Insight study who endorsed OFF periods were invited to complete a survey consisting of both multiple-choice and free-text responses. Descriptive statistics were used to summarize multiple-choice responses, and free-text responses were classified into themes through iterative discussion by 3 movement disorders specialists. Results A total of 2110 participants (52.4% male) completed the survey. Tremor was the most common description of OFF periods (n=1038, 49.2%), followed by gait changes (n=535, 25.4%) and rigidity (n=430, 20.4%). Of 1498 specific triggers for OFF symptoms, the most common was stress (n=920, 61.4%), followed by anxiety/depression (n=476, 31.8%) and tiredness/fatigue (n=351, 23.4%). Common coping strategies (n=1416 responses) included exercise (n=678, 47.9%), taking a break (n=504, 35.6%), and meditation (n=276, 19.5%). Conclusions Although OFF periods are common, the individual experiences of OFF vary. This knowledge could be used to develop new counseling strategies for OFF periods in people with Parkinson's disease.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology, Duke University, Durham, NC
| | - Madeline Lepore
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
| | | | - Catherine M Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA
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28
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Tian Q, Ehrenkranz R, Rosso AL, Glynn NW, Chahine LM, Hengenius J, Zhu X, Rosano C. Mild parkinsonian signs, energy decline, and striatal volume in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2021; 77:800-806. [PMID: 34049395 DOI: 10.1093/gerona/glab150] [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: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mild Parkinsonian Signs (MPS), highly prevalent in older adults, predict disability. It is unknown whether energy decline, a predictor of mobility disability, is also associated with MPS. We hypothesized that those with MPS had greater decline in self-reported energy levels (SEL) than those without MPS, and that SEL decline and MPS share neural substrates. METHODS Using data from the Health, Aging and Body Composition Study, we analyzed 293 Parkinson's Disease-free participants (83±3 years old, 39% Black, 58% women) with neuroimaging data, MPS evaluation by Unified Parkinson Disease Rating Scale in 2006-2008, and ≥ 3 measures of SEL since 1999-2000. Individual SEL slopes were computed via linear mixed models. Associations of SEL slopes with MPS were tested using logistic regression models. Association of SEL slope with volume of striatum, sensorimotor, and cognitive regions were examined using linear regression models adjusted for normalized total gray matter volume. Models were adjusted for baseline SEL, mobility, demographics, and comorbidities. RESULTS Compared to those without MPS (n=165), those with MPS (n=128) had 37% greater SEL decline in the prior eight years (p=0.001). Greater SEL decline was associated with smaller right striatal volume (adjusted standardized β=0.126, p=0.029). SEL decline was not associated with volumes in other regions. The association of SEL decline with MPS remained similar after adjustment for right striatal volume (adjusted OR=2.03, 95% CI: 1.16 - 3.54). CONCLUSION SEL decline may be faster in those with MPS. Striatal atrophy may be important for declining energy but does not explain the association with MPS.
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Affiliation(s)
- Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland
| | - Rebecca Ehrenkranz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lana M Chahine
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James Hengenius
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xiaonan Zhu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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29
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Beach T, Chahine LM, Adler CH, Mollenhauer B. Author Response: In Vivo Distribution of α-Synuclein in Multiple Tissues and Biofluids in Parkinson Disease. Neurology 2021; 96:965-967. [PMID: 34001544 DOI: 10.1212/wnl.0000000000011938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Chahine LM, Zhu X, Ehrenkranz R, Chen H, Glynn NW, Rosano C. Changes in Self-Reported Energy Levels in Prodromal Parkinson's Disease. Mov Disord 2021; 36:1276-1277. [PMID: 33634907 DOI: 10.1002/mds.28535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiaonan Zhu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Ehrenkranz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, Lansing, Michigan, USA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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31
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Lin I, Edison B, Mantri S, Albert S, Daeschler M, Kopil C, Marras C, Chahine LM. Triggers and alleviating factors for fatigue in Parkinson's disease. PLoS One 2021; 16:e0245285. [PMID: 33540422 PMCID: PMC7861907 DOI: 10.1371/journal.pone.0245285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fatigue is common in Parkinson's Disease, but few effective treatments are available for it. Exploring triggers and alleviating factors, including effects of exercise, could inform development of management strategies for Parkinson's Disease fatigue. OBJECTIVES To examine triggers and alleviating factors for fatigue reported by individuals with Parkinson's Disease, including perceived effect of exercise. METHODS A sample of individuals with self-reported Parkinson's Disease participating in the study Fox Insight were administered an online survey. The survey included the Parkinson's Fatigue Scale, the Physical Activity Scale for the Elderly, and multiple-choice questions about triggers and alleviating factors for fatigue. RESULTS Among the sample of 1,029 individuals with Parkinson's disease, mean (standard deviation (SD)) age was 67.4 (9.3) years, 44.0% were female. Parkinson's Fatigue Scale score ranged from 16-80, mean (SD) 48.8 (16.2). Poor sleep (62.1%) and physical exertion (45.1%) were frequently reported triggers for fatigue. Coping strategies including sitting quietly (58.1%), laying down with or without napping, and exercise (20%). Physical Activity Scale for the Elderly scores were higher in those who reported that exercise alleviated their fatigue (49.7%) compared to those who reported it worsened their fatigue (18.9%) (mean (SD) score 158.5 (88.8) vs 119.8 (66.6) respectively; p<0.001). CONCLUSIONS Several behavioral and environmental triggers and alleviating strategies for fatigue are reported by individuals with Parkinson's disease. Many feel that exercise alleviates fatigue, though the relationship between exercise and fatigue in Parkinson's Disease appears complex. This exploratory study may inform future development of treatments or coping strategies for Parkinson's disease fatigue.
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Affiliation(s)
- Iris Lin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, United States of America
| | - Steven Albert
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Margaret Daeschler
- Columbia University School of Social Work, New York, NY, United States of America
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, United States of America
| | - Connie Marras
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
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32
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Mantri S, Edison B, Alzyoud L, Albert SM, Daeschler M, Kopil C, Marras C, Chahine LM. Knowledge, Responsibilities, and Peer Advice From Care Partners of Patients With Parkinson Disease Psychosis. Front Neurol 2021; 12:633645. [PMID: 33597918 PMCID: PMC7882678 DOI: 10.3389/fneur.2021.633645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction: Care partners (CPs) of individuals with Parkinson disease psychosis (PDP) experience increased strain and rely on informal support networks. The objective of this study was to characterize CP responsibilities, sources of support, and peer advice. Methods: This was a mixed-methods cross-sectional study. The sample was recruited from the online Fox Insight study cohort. CPs who indicated their care recipient suffered hallucinations and/or delusions were administered a questionnaire regarding their caregiving experience to person with PDP. A free-text question asked CPs to give advice to a hypothetical peer CP. Responses to multiple-choice questions were tabulated; responses to the free-text question were grouped into advice categories. Results: 145 CP of individuals with PDP were included in this analysis, mean age (standard deviation, SD) 66.4 (9.4) years; 110 (75.9%) were women. Most (115, 79.3%) provided caregiving on a daily basis, with a range of responsibilities. Only 16 (11%) learned about PDP from a physician; communication challenges included perceived embarrassment or having to prioritize other issues in a limited appointment time. The most common peer advice was to alert the care recipient's neurologist (n = 38, 30.4%); only 8 (6.4%) suggested medication changes. Conclusion: CPs face challenges with clinician communication and learn about psychosis from a variety of informal sources. Few CPs advocate for medications to control PDP, instead preferring non-pharmacological management strategies. Peer advice favored alerting the care recipient's physician, suggesting that CPs do desire more information from the medical team.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, United States
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lamees Alzyoud
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven M Albert
- Department of Behavioral and Community Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Margaret Daeschler
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Catherine Kopil
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
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Chahine LM, Brumm MC, Caspell-Garcia C, Oertel W, Mollenhauer B, Amara A, Fernandez-Arcos A, Tolosa E, Simonet C, Hogl B, Videnovic A, Hutten SJ, Tanner C, Weintraub D, Burghardt E, Coffey C, Cho HR, Kieburtz K, Poston KL, Merchant K, Galasko D, Foroud T, Siderowf A, Marek K, Simuni T, Iranzo A. Dopamine transporter imaging predicts clinically-defined α-synucleinopathy in REM sleep behavior disorder. Ann Clin Transl Neurol 2020; 8:201-212. [PMID: 33321002 PMCID: PMC7818144 DOI: 10.1002/acn3.51269] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Individuals with idiopathic rapid eye movement sleep behavior disorder (iRBD) are at high risk for a clinical diagnosis of an α-synucleinopathy (aSN). They could serve as a key population for disease-modifying trials. Abnormal dopamine transporter (DAT) imaging is a strong candidate biomarker for risk of aSN diagnosis in iRBD. Our primary objective was to identify a quantitative measure of DAT imaging that predicts diagnosis of clinically-defined aSN in iRBD. METHODS The sample included individuals with iRBD, early Parkinson's Disease (PD), and healthy controls (HC) enrolled in the Parkinson Progression Marker Initiative, a longitudinal, observational, international, multicenter study. The iRBD cohort was enriched with individuals with abnormal DAT binding at baseline. Motor and nonmotor measures were compared across groups. DAT specific binding ratios (SBR) were used to calculate the percent of expected DAT binding for age and sex using normative data from HCs. Receiver operative characteristic analyses identified a baseline DAT binding cutoff that distinguishes iRBD participants diagnosed with an aSN in follow-up versus those not diagnosed. RESULTS The sample included 38 with iRBD, 205 with PD, and 92 HC who underwent DAT-SPECT at baseline. Over 4.7 years of mean follow-up, 14 (36.84%) with iRBD were clinically diagnosed with aSN. Risk of aSN diagnosis was significantly elevated among those with baseline putamen SBR ≤ 48% of that expected for age and sex, relative to those above this cutoff (hazard ratio = 17.8 [95%CI: 3.79-83.3], P = 0.0003). CONCLUSION We demonstrate the utility of DAT SBR to identify individuals with iRBD with increased short-term risk of an aSN diagnosis.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael C Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.,Paracelsus-Elena-Klinik, Kassel, Germany
| | - Amy Amara
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Eduardo Tolosa
- Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Simonet
- Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Birgit Hogl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Caroline Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Daniel Weintraub
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elliot Burghardt
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Hyunkeun R Cho
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Karl Kieburtz
- University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
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Chahine LM, Edison B, Mantri S, Kopil C, Marras C. Reply to Comment on: The Most Bothersome Aspects of off Periods Reported by Individuals with Parkinson's Disease. Mov Disord Clin Pract 2020; 7:879-880. [PMID: 33043094 DOI: 10.1002/mdc3.13021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lana M Chahine
- Department of Neurology University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Briana Edison
- Department of Neurology University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Sneha Mantri
- Department of Neurology Duke University Durham North Carolina USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research New York New York USA
| | - Connie Marras
- Department of Neurology University of Toronto Toronto Ontario Canada
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35
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Affiliation(s)
- Kristine A Wilckens
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Lana M Chahine
- University of Pittsburgh, School of Medicine, Department of Neurology, Pittsburgh, PA, USA.
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36
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Alcalay RN, Wolf P, Chiang MSR, Helesicova K, Zhang XK, Merchant K, Hutten SJ, Scherzer C, Caspell-Garcia C, Blauwendraat C, Foroud T, Nudelman K, Gan-Or Z, Simuni T, Chahine LM, Levy O, Zheng D, Li G, Sardi SP. Longitudinal Measurements of Glucocerebrosidase activity in Parkinson's patients. Ann Clin Transl Neurol 2020; 7:1816-1830. [PMID: 32888397 PMCID: PMC7545591 DOI: 10.1002/acn3.51164] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Reduction in glucocerebrosidase (GCase; encoded by GBA) enzymatic activity has been linked to Parkinson’s disease (PD). Here, we correlated GCase activity and PD phenotype in the Parkinson’s Progression Markers Initiative (PPMI) cohort. Methods We measured GCase activity in dried blood spots from 1559 samples of participants in the inception PPMI cohort, collected in four annual visits (from baseline visit to Year‐3). Participants (PD, n = 392; controls, n = 175) were fully sequenced for GBA variants by means of genome‐wide genotyping arrays, whole‐exome sequencing, whole‐genome sequencing, Sanger sequencing, and RNA‐sequencing. Results Fifty‐two PD participants (13.4%) and 13 (7.4%) controls carried a GBA variant. GBA status was strongly associated with GCase activity. Among noncarriers, GCase activity was similar between PD and controls. Among GBA p.E326K carriers (PD, n = 20; controls, n = 5), activity was significantly lower in PD carriers than control carriers (9.53 µmol/L/h vs. 11.68 µmol/L/h, P = 0.035). Glucocerebrosidase activity was moderately (r = 0.45) associated with white blood cell (WBC) count. Next, we divided the noncarriers with PD to tertiles based on WBC count‐corrected enzymatic activity. Members of the lower tertile had higher MDS‐Unified Parkinson’s Disease Rating Scale motor score in the “off” medication examination at year‐III exam. Longitudinal analyses demonstrated slight reduction of activity in samples collected earlier on in the study, likely because of longer storage time. Interpretation GCase activity is associated with GBA genotype, WBC count, and among p.E326K variant carriers, with PD status. Reduced activity may also be associated with worse phenotype but longer follow up is required to confirm this observation.
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Affiliation(s)
- Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center New York, New York, USA
| | - Pavlina Wolf
- Translational Sciences, Sanofi, Framingham, Massachusetts, USA
| | - Ming Sum Ruby Chiang
- Rare and Neurological Diseases Therapeutic Area, Sanofi, Framingham, Massachusetts, USA
| | | | | | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Clemens Scherzer
- Advanced Center for Parkinson's Disease Research of Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Precision Neurology Program, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Tatiana Foroud
- Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kelly Nudelman
- Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ziv Gan-Or
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Oren Levy
- Department of Neurology, Columbia University Irving Medical Center New York, New York, USA
| | - Dandi Zheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center New York, New York, USA
| | - Gen Li
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center New York, New York, USA
| | - Sergio Pablo Sardi
- Rare and Neurological Diseases Therapeutic Area, Sanofi, Framingham, Massachusetts, USA
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Mollenhauer B, Dakna M, Kruse N, Galasko D, Foroud T, Zetterberg H, Schade S, Gera RG, Wang W, Gao F, Frasier M, Chahine LM, Coffey CS, Singleton AB, Simuni T, Weintraub D, Seibyl J, Toga AW, Tanner CM, Kieburtz K, Marek K, Siderowf A, Cedarbaum JM, Hutten SJ, Trenkwalder C, Graham D. Validation of Serum Neurofilament Light Chain as a Biomarker of Parkinson's Disease Progression. Mov Disord 2020; 35:1999-2008. [PMID: 32798333 PMCID: PMC8017468 DOI: 10.1002/mds.28206] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/19/2020] [Indexed: 01/15/2023] Open
Abstract
Background: The objective of this study was to assess neurofilament light chain as a Parkinson’s disease biomarker. Methods: We quantified neurofilament light chain in 2 independent cohorts: (1) longitudinal cerebrospinal fluid samples from the longitudinal de novo Parkinson’s disease cohort and (2) a large longitudinal cohort with serum samples from Parkinson’s disease, other cognate/neurodegenerative disorders, healthy controls, prodromal conditions, and mutation carriers. Results: In the Parkinson’s Progression Marker Initiative cohort, mean baseline serum neurofilament light chain was higher in Parkinson’s disease patients (13 ± 7.2 pg/mL) than in controls (12 ± 6.7 pg/mL), P = 0.0336. Serum neurofilament light chain increased longitudinally in Parkinson’s disease patients versus controls (P < 0.01). Motor scores were positively associated with neurofilament light chain, whereas some cognitive scores showed a negative association. Conclusions: Neurofilament light chain in serum samples is increased in Parkinson’s disease patients versus healthy controls, increases over time and with age, and correlates with clinical measures of Parkinson’s disease severity. Although the specificity of neurofilament light chain for Parkinson’s disease is low, it is the first blood-based biomarker candidate that could support disease stratification of Parkinson’s disease versus other cognate/neurodegenerative disorders, track clinical progression, and possibly assess responsiveness to neuroprotective treatments. However, use of neurofilament light chain as a biomarker of response to neuroprotective interventions remains to be assessed.
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Affiliation(s)
- Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany.,Paracelsus-Elena Klinik, Kassel, Germany
| | - Mohammed Dakna
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Niels Kruse
- Department of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,UK Dementia Research Institute at UCL, London, United Kingdom
| | - Sebastian Schade
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Roland G Gera
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Wenting Wang
- Biostatistics, Biogen, Cambridge, Massachusetts, USA
| | - Feng Gao
- Biostatistics, Biogen, Cambridge, Massachusetts, USA
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Andrew B Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Tanya Simuni
- Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, University of Southern California, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA, and Parkinson's Disease Research Education and Clinical Center, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Karl Kieburtz
- Clinical Trials Coordination Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth Marek
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA.,Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Danielle Graham
- Discovery and Early Development Biomarkers, Biogen, Cambridge, Massachusetts, USA
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38
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Chahine LM, Beach TG, Brumm MC, Adler CH, Coffey CS, Mosovsky S, Caspell-Garcia C, Serrano GE, Munoz DG, White CL, Crary JF, Jennings D, Taylor P, Foroud T, Arnedo V, Kopil CM, Riley L, Dave KD, Mollenhauer B. In vivo distribution of α-synuclein in multiple tissues and biofluids in Parkinson disease. Neurology 2020; 95:e1267-e1284. [PMID: 32747521 PMCID: PMC7538226 DOI: 10.1212/wnl.0000000000010404] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective The Systemic Synuclein Sampling Study (S4) measured α-synuclein in multiple tissues and biofluids within the same patients with Parkinson disease (PD) vs healthy controls (HCs). Methods S4 was a 6-site cross-sectional observational study of participants with early, moderate, or advanced PD and HCs. Motor and nonmotor measures and dopamine transporter SPECT were obtained. Biopsies of skin, colon, submandibular gland (SMG), CSF, saliva, and blood were collected. Tissue biopsy sections were stained with 5C12 monoclonal antibody against pathologic α-synuclein; digital images were interpreted by neuropathologists blinded to diagnosis. Biofluid total α-synuclein was quantified using ELISA. Results The final cohort included 59 patients with PD and 21 HCs. CSF α-synuclein was lower in patients with PD vs HCs; sensitivity/specificity of CSF α-synuclein for PD diagnosis was 87.0%/63.2%, respectively. Sensitivity of α-synuclein immunoreactivity for PD diagnosis was 56.1% for SMG and 24.1% for skin; specificity was 92.9% and 100%, respectively. There were no significant relationships between different measures of α-synuclein within participants. Conclusions S4 confirms lower total α-synuclein levels in CSF in patients with PD compared to HCs, but specificity is low. In contrast, α-synuclein immunoreactivity in skin and SMG is specific for PD but sensitivity is low. Relationships within participants across different tissues and biofluids could not be demonstrated. Measures of pathologic forms of α-synuclein with higher accuracy are critically needed. Classification of evidence This study provides Class III evidence that total CSF α-synuclein does not accurately distinguish patients with PD from HCs, and that monoclonal antibody staining for SMG and skin total α-synuclein is specific but not sensitive for PD diagnosis.
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Affiliation(s)
- Lana M Chahine
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany.
| | - Thomas G Beach
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Michael C Brumm
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Charles H Adler
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Christopher S Coffey
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Sherri Mosovsky
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Chelsea Caspell-Garcia
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Geidy E Serrano
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - David G Munoz
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Charles L White
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - John F Crary
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Danna Jennings
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Peggy Taylor
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Tatiana Foroud
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Vanessa Arnedo
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Catherine M Kopil
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Lindsey Riley
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Kuldip D Dave
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
| | - Brit Mollenhauer
- From the Department of Neurology (L.M.C., S.M.), University of Pittsburgh, PA; Banner Sun Health Research Institute (T.G.B., G.E.S.), Sun City, AZ; University of Iowa (M.C.B., C.S.C., C.C.-G.), Iowa City; Department of Neurology (C.H.A.), Mayo Clinic College of Medicine, Scottsdale, AZ; St. Michael's Hospital (D.G.M.), Toronto, Canada; University of Texas Southwestern Medical School (C.L.W.), Dallas; Icahn School of Medicine at Mount Sinai (J.F.C.), New York, NY; Institute for Neurodegenerative Disorders (D.J.), New Haven, CT; BioLegend Inc. (P.T.), Dedham, MA; Indiana University (T.F.), Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (V.A., C.M.K., L.R., K.D.D.), New York, NY; and Department of Neurology (B.M.), Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Göttingen, Germany
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Chahine LM, Siderowf A, Barnes J, Seedorff N, Caspell-Garcia C, Simuni T, Coffey CS, Galasko D, Mollenhauer B, Arnedo V, Daegele N, Frasier M, Tanner C, Kieburtz K, Marek K. Predicting Progression in Parkinson's Disease Using Baseline and 1-Year Change Measures. J Parkinsons Dis 2020; 9:665-679. [PMID: 31450510 PMCID: PMC6839498 DOI: 10.3233/jpd-181518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improved prediction of Parkinson's disease (PD) progression is needed to support clinical decision-making and to accelerate research trials. OBJECTIVES To examine whether baseline measures and their 1-year change predict longer-term progression in early PD. METHODS Parkinson's Progression Markers Initiative study data were used. Participants had disease duration ≤2 years, abnormal dopamine transporter (DAT) imaging, and were untreated with PD medications. Baseline and 1-year change in clinical, cerebrospinal fluid (CSF), and imaging measures were evaluated as candidate predictors of longer-term (up to 5 years) change in Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score and DAT specific binding ratios (SBR) using linear mixed-effects models. RESULTS Among 413 PD participants, median follow-up was 5 years. Change in MDS-UPDRS from year-2 to last follow-up was associated with disease duration (β= 0.351; 95% CI = 0.146, 0.555), male gender (β= 3.090; 95% CI = 0.310, 5.869), and baseline (β= -0.199; 95% CI = -0.315, -0.082) and 1-year change (β= 0.540; 95% CI = 0.423, 0.658) in MDS-UPDRS; predictors in the model accounted for 17.6% of the variance in outcome. Predictors of percent change in mean SBR from year-2 to last follow-up included baseline rapid eye movement sleep behavior disorder score (β= -0.6229; 95% CI = -1.2910, 0.0452), baseline (β= 7.232; 95% CI = 2.268, 12.195) and 1-year change (β= 45.918; 95% CI = 35.994,55.843) in mean striatum SBR, and 1-year change in autonomic symptom score (β= -0.325;95% CI = -0.695, 0.045); predictors in the model accounted for 44.1% of the variance. CONCLUSIONS Baseline clinical, CSF, and imaging measures in early PD predicted change in MDS-UPDRS and dopamine-transporter binding, but the predictive value of the models was low. Adding the short-term change of possible predictors improved the predictive value, especially for modeling change in dopamine-transporter binding.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janel Barnes
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Nicholas Seedorff
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Douglas Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany and Paracelsus-Elena-Klinik, Kassel, Germany
| | | | - Nichole Daegele
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Mark Frasier
- The Michael J. Fox Foundation, New York, NY, USA
| | - Caroline Tanner
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Irwin DJ, Fedler J, Coffey CS, Caspell-Garcia C, Kang JH, Simuni T, Foroud T, Toga AW, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten S, Weintraub D, Mollenhauer B, Galasko DR, Siderowf A, Marek K, Trojanowski JQ, Shaw LM. Evolution of Alzheimer's Disease Cerebrospinal Fluid Biomarkers in Early Parkinson's Disease. Ann Neurol 2020; 88:574-587. [PMID: 32542885 PMCID: PMC7497251 DOI: 10.1002/ana.25811] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We analyzed the longitudinal profile of Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers in early Parkinson's disease (PD) compared with healthy controls (HCs) and tested baseline CSF biomarkers for prediction of clinical decline in PD. METHODS Amyloid-β 1 to 42 (Aβ42 ), total tau (t-tau) and phosphorylated tau (p-tau) at the threonine 181 position were measured using the high-precision Roche Elecsys electrochemiluminescence immunoassay in all available CSF samples from longitudinally studied patients with PD (n = 416) and HCs (n = 192) followed for up to 3 years in the Parkinson's Progression Markers Initiative (PPMI). Longitudinal CSF and clinical data were analyzed with linear-mixed effects models. RESULTS We found patients with PD had lower CSF t-tau (median = 157.7 pg/mL; range = 80.9-467.0); p-tau (median = 13.4 pg/mL; range = 8.0-40.1), and Aβ42 (median = 846.2 pg/mL; range = 238.8-3,707.0) than HCs at baseline (CSF t-tau median = 173.5 pg/mL; range = 82.0-580.8; p-tau median = 15.4 pg/mL; range = 8.1-73.6; and Aβ42 median = 926.5 pg/mL; range = 239.1-3,297.0; p < 0.05-0.001) and a moderate-to-strong correlation among these biomarkers in both patients with PD and HCs (Rho = 0.50-0.97; p < 0.001). Of the patients with PD, 31.5% had pathologically low levels of CSF Aβ42 at baseline and these patients with PD had lower p-tau levels (median = 10.8 pg/mL; range = 8.0-32.8) compared with 27.7% of HCs with pathologically low CSF Aβ42 (CSF p-tau median = 12.8 pg/mL; range 8.2-73.6; p < 0.03). In longitudinal CSF analysis, we found patients with PD had greater decline in CSF Aβ42 (mean difference = -41.83 pg/mL; p = 0.03) and CSF p-tau (mean difference = -0.38 pg/mL; p = 0.03) at year 3 compared with HCs. Baseline CSF Aβ42 values predicted small but measurable decline on cognitive, autonomic, and motor function in early PD. INTERPRETATION Our data suggest baseline CSF AD biomarkers may have prognostic value in early PD and that the dynamic change of these markers, although modest over a 3-year period, suggest biomarker profiles in PD may deviate from healthy aging. ANN NEUROL 2020;88:574-587.
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Affiliation(s)
- David J Irwin
- Department of Neurology, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Janel Fedler
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Ju Hee Kang
- Department of Pharmacology & Clinical Pharmacology, Inha University, Incheon, South Korea
| | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, University of Southern California, Los Angeles, CA, USA
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Daniel Weintraub
- Department of Neurology, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry Perelman, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Michael J. Crescenz VA Medical Center, Parkinson's Disease Research, Education, and Clinical Center, Philadelphia, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center, Göttingen Paracelsus-Elena-Klinik, Kassel, Germany
| | - Douglas R Galasko
- Department of Neurology, University of San Diego, San Diego, CA, USA
| | - Andrew Siderowf
- Department of Neurology, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Neurodegenerative Disease Research, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Miller-Patterson C, Edwards KA, Chahine LM. Sex Disparities in Autonomic Symptom Treatment in Parkinson's Disease. Mov Disord Clin Pract 2020; 7:718-719. [PMID: 32775527 DOI: 10.1002/mdc3.12997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/04/2020] [Accepted: 05/22/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Kyle A Edwards
- Department of Neurology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Lana M Chahine
- Department of Neurology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
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Mantri S, Klawson E, Albert S, Nabieva K, Lepore M, Kahl S, Daeschler M, Mamikonyan E, Kopil C, Marras C, Chahine LM. Understanding the Lexicon of Fatigue in Parkinson's Disease. J Parkinsons Dis 2020; 10:1185-1193. [PMID: 32568110 PMCID: PMC7458521 DOI: 10.3233/jpd-202029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Fatigue in Parkinson’s disease (PD) is multifaceted and associated with reduced quality of life. In turn, the language used by people with PD to describe fatigue is variable and poorly understood. We sought to elucidate the lexicon of fatigue using a qualitative grounded theory approach. Objective: The objective of this study was to understand how patients with PD describe fatigue. Methods: A pre-study phase of online journaling (Phase 1) provided information regarding topics of importance to patients. Following this, two independent samples of fatigued subjects were studied. Individuals with PD participated in a telephone interview (Phase 2); interview transcripts were analyzed to develop a detailed codebook. To ensure trustworthiness of the findings, an online survey (Phase 3) was administered to individuals with self-reported PD participating in the online study Fox Insight. The survey included the following question: “How do you define fatigue? Please provide your definition in the space below.” The codebook developed from Phase 2 was applied to the Phase 3 responses. Results: Fifteen individuals participated in Phase 2 and 413 individuals completed Phase 3. Fatigue was subdivided into three domains: cognitive, emotional, and physical. Nearly all individuals experienced more than one domain of fatigue. The most common themes included tiredness, lack of energy, and negative motivation. Conclusion: Fatigue in PD is multidimensional. Questionnaires that only assess the physical impact of fatigue may not be adequate to capture the broad range of experiences of fatigue among people with PD.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, USA
| | - Emily Klawson
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karina Nabieva
- The Edmond J Safra Program in Parkinson's disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, USA
| | - Madeline Lepore
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Kahl
- Tuck School of Business, Dartmouth College, Hanover, NH, USA
| | | | - Eugenia Mamikonyan
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Purri R, Brennan L, Rick J, Xie SX, Deck BL, Chahine LM, Dahodwala N, Chen-Plotkin A, Duda JE, Morley JF, Akhtar RS, Trojanowski JQ, Siderowf A, Weintraub D. Subjective Cognitive Complaint in Parkinson's Disease Patients With Normal Cognition: Canary in the Coal Mine? Mov Disord 2020; 35:1618-1625. [PMID: 32520435 DOI: 10.1002/mds.28115] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 01/24/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the frequency and impact of subjective cognitive complaint (SCC) in Parkinson's disease (PD) patients with normal cognition. METHODS Patients with PD with expert consensus-determined normal cognition at baseline were asked a single question regarding the presence of SCC. Baseline (N = 153) and longitudinal (up to 4 follow-up visits during a 5-year period; N = 121) between-group differences in patients with PD with (+SCC) and without (-SCC) cognitive complaint were examined, including cognitive test performance and self-rated and informant-rated functional abilities. RESULTS A total of 81 (53%) participants reported a cognitive complaint. There were no between-group differences in global cognition at baseline. Longitudinally, the +SCC group declined more than the -SCC group on global cognition (Mattis Dementia Rating Scale-2 total score, F1,431 = 5.71, P = 0.02), processing speed (Symbol Digit Modalities Test, F1,425 = 7.52, P = 0.006), and executive function (Trail Making Test Part B, F1,419 = 4.48, P = 0.04), although the results were not significant after correction for multiple testing. In addition, the +SCC group was more likely to progress to a diagnosis of cognitive impairment over time (hazard ratio = 2.61, P = 0.02). The +SCC group also demonstrated significantly lower self-reported and knowledgeable informant-reported cognition-related functional abilities at baseline, and declined more on an assessment of global functional abilities longitudinally. CONCLUSIONS Patients with PD with normal cognition, but with SCC, report poorer cognition-specific functional abilities, and are more likely to be diagnosed with cognitive impairment and experience global functional ability decline long term. These findings suggest that SCC and worse cognition-related functional abilities may be sensitive indicators of initial cognitive decline in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rachael Purri
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura Brennan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jacqueline Rick
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin L Deck
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alice Chen-Plotkin
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - John E Duda
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - James F Morley
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Rizwan S Akhtar
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
BACKGROUND In patients with early parkinsonism, misdiagnosis may occur in >30% of cases. This can have detrimental consequences clinically and in clinical trials. Dopamine transporter (DAT) SPECT imaging can help improve diagnostic accuracy. OBJECTIVE To describe characteristics of individuals initially diagnosed with idiopathic Parkinson's disease (iPD) and with abnormal DAT SPECT imaging who had a change in diagnosis on follow-up. METHODS Data were obtained from the biomarker study Parkinson's Progression Markers Initiative (PPMI). PPMI is a multicenter, observational study that enrolled 423 individuals with a diagnosis of iPD of ≤2 years duration and with abnormal DAT SPECT imaging. Participants were assessed at least annually, and diagnosis was documented by the site neurologist. Characteristics of those that had a change in diagnosis were compared to those with stable diagnosis. RESULTS 390 subjects were included. Eight (2%) had a change in diagnosis. The diagnosis was changed to multiple system atrophy in 5 cases, dementia with Lewy bodies in 2, and corticobasal degeneration in 1. Revision of diagnosis occurred 2-5.2 years from enrollment. Mean motor score was higher (26.9 vs 20.6; p = 0.01), DAT binding lower (1.056 vs 1.406; p = 0.01), genetic risk score lower (-0.016 vs -0.022; p = 0.0470), and olfaction score higher (28.75 vs 22.05; p = 0.03) in those whose diagnosis changed compared to those who did not. CONCLUSION Diagnosis remained stable in most individuals with early parkinsonism diagnosed with iPD and with abnormal DAT imaging. A small number had a revision in diagnosis. Clinical and biomarker abnormalities were greater at baseline in those whose diagnosis changed.
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Affiliation(s)
- Jason Massa
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Weintraub D, Caspell‐Garcia C, Simuni T, Cho HR, Coffey CS, Aarsland D, Alcalay RN, Barrett MJ, Chahine LM, Eberling J, Espay AJ, Hamilton J, Hawkins KA, Leverenz J, Litvan I, Richard I, Rosenthal LS, Siderowf A, York M. Neuropsychiatric symptoms and cognitive abilities over the initial quinquennium of Parkinson disease. Ann Clin Transl Neurol 2020; 7:449-461. [PMID: 32285645 PMCID: PMC7187707 DOI: 10.1002/acn3.51022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine the evolution of numerous neuropsychiatric symptoms and cognitive abilities in Parkinson disease from disease onset. METHODS Prospectively collected, longitudinal (untreated, disease onset to year 5), observational data from Parkinson's Progression Markers Initiative annual visits was used to evaluate prevalence, correlates, and treatment of 10 neuropsychiatric symptoms and cognitive impairment in Parkinson disease participants and matched healthy controls. RESULTS Of 423 Parkinson disease participants evaluated at baseline, 315 (74.5%) were assessed at year 5. Eight neuropsychiatric symptoms studied increased in absolute prevalence by 6.2-20.9% at year 5 relative to baseline, and cognitive impairment increased by 2.7-6.2%. In comparison, the frequency of neuropsychiatric symptoms in healthy controls remained stable or declined over time. Antidepressant and anxiolytic/hypnotic use in Parkinson disease were common at baseline and increased over time (18% to 27% for the former; 13% to 24% for the latter); antipsychotic and cognitive-enhancing medication use was uncommon throughout (2% and 5% of patients at year 5); and potentially harmful anticholinergic medication use was common and increased over time. At year 5 the cross-sectional prevalence for having three or more neuropsychiatric disorders/cognitive impairment was 56% for Parkinson disease participants versus 13% for healthy controls, and by then seven of the examined disorders had either occurred or been treated at some time point in the majority of Parkinson disease patients. Principal component analysis suggested an affective disorder subtype only. INTERPRETATION Neuropsychiatric features in Parkinson disease are common from the onset, increase over time, are frequently comorbid, and fluctuate in severity.
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Affiliation(s)
- Daniel Weintraub
- Department of PsychiatryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Parkinson’s Disease Research, Education and Clinical CenterPhiladelphia Veterans Affairs Medical CenterPhiladelphiaPennsylvania
| | | | - Tanya Simuni
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Hyunkeun R. Cho
- Department of BiostatisticsCollege of Public HealthUniversity of IowaIowa CityIowa
| | | | - Dag Aarsland
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonEngland
| | - Roy N. Alcalay
- Department of NeurologyColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew York
| | | | - Lana M. Chahine
- Department of NeurologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Jamie Eberling
- Michael J. Fox Foundation for Parkinson’s ResearchNew YorkNew York
| | - Alberto J. Espay
- Department of NeurologyUniversity of Cincinnati Academic Health CenterCincinnatiOhio
| | - Jamie Hamilton
- Michael J. Fox Foundation for Parkinson’s ResearchNew YorkNew York
| | - Keith A. Hawkins
- Department of PsychiatryYale School of MedicineNew HavenConnecticut
| | - James Leverenz
- Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOhio
| | - Irene Litvan
- UCSD Movement Disorder CenterDepartment of NeurosciencesUniversity of California San DiegoSan DiegoCalifornia
| | - Irene Richard
- Departments of Neurology and PsychiatrySchool of Medicine and DentistryUniversity of RochesterRochesterNew York
| | - Liana S. Rosenthal
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Andrew Siderowf
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Michele York
- Departments of Neurology and Psychiatry & Behavioral SciencesBaylor College of MedicineHoustonTexas
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Chahine LM, Edison B, Daeschler M, Mantri S, Kahl S, Rapoport R, Goyle A, Precht C, Kopil C, Marras C. The Most Bothersome Aspects of Off Periods Reported by Individuals with Parkinson's Disease. Mov Disord Clin Pract 2020; 7:284-292. [PMID: 32258226 DOI: 10.1002/mdc3.12915] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction The off periods in Parkinson's disease have a significantly negative impact on quality of life. What the most bothersome aspects of off periods are from the patient's perspective are not well studied, nor is the degree to which screening tools for wearing off such as the Wearing Off Questionnaires (WOQs) capture what bothers patients most. Methods A questionnaire was deployed to eligible participants of Fox Insight, an online study of individuals with self-reported Parkinson's disease. Inclusion criteria were the use of ≥1 dopaminergic medications and an affirmative response to a question on experiencing off periods. Participants provided free-text responses regarding the top 3 most bothersome symptoms they experience when off. A determination was made regarding whether each response would have been captured by the 32-item, 19-item, and 9-item WOQs. Results The final sample had 2106 participants, a mean age of 66.6 years, 52.3% were men, and had a disease duration of 4.9 years. The WOQ-32 items covered all of the most bothersome symptoms for 53.2% of respondents. Among bothersome aspects of off not captured by the WOQs, 597 (66.2%) were specific symptoms, with freezing of gait, apathy, and memory problems being the most common. The functional consequences of off periods were most bothersome to 232 (25.7%), with walking problems being the most common. The emotional response to off periods was the most bothersome aspect to 169 respondents (18.7%). Discussion This study emphasizes the value of narrative data in understanding patient experiences, and what bothers patients most about off periods. The WOQs, although of established utility in the screening for wearing off, may not capture those symptoms most bothersome to patients.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Briana Edison
- Graduate School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | | | - Sneha Mantri
- Department of Neurology Duke University Durham North Carolina USA
| | - Steven Kahl
- Tuck School of Business Dartmouth College Dartmouth New Hampshire USA
| | | | | | | | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research New York New York USA
| | - Connie Marras
- Department of Neurology University of Toronto Ontario Canada
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47
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Simuni T, Brumm MC, Uribe L, Caspell-Garcia C, Coffey CS, Siderowf A, Alcalay RN, Trojanowski JQ, Shaw LM, Seibyl J, Singleton A, Toga AW, Galasko D, Foroud T, Nudelman K, Tosun-Turgut D, Poston K, Weintraub D, Mollenhauer B, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten S, Bressman S, Marek K. Clinical and Dopamine Transporter Imaging Characteristics of Leucine Rich Repeat Kinase 2 (LRRK2) and Glucosylceramidase Beta (GBA) Parkinson's Disease Participants in the Parkinson's Progression Markers Initiative: A Cross-Sectional Study. Mov Disord 2020; 35:833-844. [PMID: 32073681 DOI: 10.1002/mds.27989] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are limited data on the phenotypic and dopamine transporter (DAT) imaging characterization of the Parkinson's disease (PD) patients with leucine rich kinase 2 (LRRK2) and glucosylceramidase beta (GBA) mutations. OBJECTIVE The objective of this study was to examine baseline clinical and DAT imaging characteristics in GBA and LRRK2 mutation carriers with early PD compared with sporadic PD. METHODS The Parkinson's Progression Markers Initiative is an ongoing observational longitudinal study that enrolled participants with sporadic PD, LRRK2 and GBA PD carriers from 33 sites worldwide. All participants are assessed annually with a battery of motor and nonmotor scales, 123-I Ioflupane DAT imaging, and biologic variables. RESULTS We assessed 158 LRRK2 (89% G2019S), 80 GBA (89 %N370S), and 361 sporadic PD participants with the mean (standard deviation) disease duration of 2.9 (1.9), 3.1 (2.0), and 2.6 (0.6) years, respectively. When compared with sporadic PD, the GBA PD patients had no difference in any motor, cognitive, or autonomic features. The LRRK2 PD patients had less motor disability and lower rapid eye movement behavior disorder questionnaire scores, but no meaningful difference in cognitive or autonomic features. Both genetic cohorts had a higher score on the impulse control disorders scale when compared with sporadic PD, but no difference in other psychiatric features. Both genetic PD cohorts had less loss of dopamine transporter on DAT imaging when compared with sporadic PD. CONCLUSIONS We confirm previous reports of milder phenotype associated with LRRK2-PD. A previously reported more aggressive phenotype in GBA-PD is not evident early in the disease in N370s carriers. This observation identifies a window for potential disease-modifying interventions. Longitudinal data will be essential to define the slope of progression for both genetic cohorts. TRIAL REGISTRATION ClinicalTrials.gov (NCT01141023). © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael C Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Andrew Siderowf
- Departments of Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy N Alcalay
- Department of Neurology, The Taub Institite for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - John Q Trojanowski
- Departments of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie M Shaw
- Departments of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda, Maryland, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, California, USA
| | - Doug Galasko
- Department of Neurology, University of California, San Diego, California, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Kelly Nudelman
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana, USA
| | - Duygu Tosun-Turgut
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Caroline M Tanner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alyssa Reimer
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Samantha Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | - Susan Bressman
- Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
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Khalil H, Chahine LM, Siddiqui J, Salari M, El-Jaafary S, Aldaajani Z, Abu Al-Melh M, Mohammad TM, Abu Snineh M, Syed NA, Bhatt M, Habib MA, Habahbeh M, Tabbal SD, Jeon B, Bajwa JA. Parkinson's Disease in the Middle East, North Africa, and South Asia: Consensus from the International Parkinson and Movement Disorder Society Task Force for the Middle East. J Parkinsons Dis 2020; 10:729-741. [PMID: 32176653 PMCID: PMC8203232 DOI: 10.3233/jpd-191751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding the regional needs and available healthcare resources to treat Parkinson's disease (PD) is essential to plan appropriate future priorities. The International Parkinson and Movement Disorder Society (MDS) Task Force for the Middle East was established to raise awareness and promote education across the region on PD and other movement disorders. Broadly, the task force encompasses the countries of the Middle East but has included North Africa and South Asia as well (MENASA). OBJECTIVE To create a list of needs and priorities in the advancement of PD in MENASA countries based on consensuses generated by the MDS task force for the Middle East. METHODS A Strengths Weaknesses-Opportunities-Threats (SWOT) analysis was conducted by the task force members to generate consensus about PD care this region. RESULTS Eight overarching principles emerged for the consensus statement on current needs: more movement disorders specialists, multidisciplinary care, accurate epidemiologic data, educational programs, availability of drugs, and availability of more advanced therapy, enhanced health care resources and infrastructure, and greater levels of awareness within the general population and among health care professionals. CONCLUSION This pilot study sheds light on unmet needs for providing care to people with PD in the MENASA region. These data offer directions on priorities to increase awareness of PD, to develop better infrastructure for research and management of PD, to foster healthcare policy discussions for PD and to provide educational opportunities within these countries.
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Affiliation(s)
- Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Junaid Siddiqui
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zakiyah Aldaajani
- Neurology Unit, King Fahad Medical Military Complex, Dahran, Saudi Arabia
| | | | | | | | | | - Mohit Bhatt
- Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, India
| | - Mohammad Ahsan Habib
- Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Majed Habahbeh
- Department of Medicine, Neurology Section, King Hussein Medical Centre, Amman, Jordan
| | - Samer D. Tabbal
- Department of Neurology, Parkinson & Movement Disorders Program, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Beomseok Jeon
- Department of Neurology, Movement Disorders Center, Seoul National University, Seoul, South Korea
| | - Jawad A. Bajwa
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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49
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Brown EG, Chahine LM, Goldman SM, Korell M, Mann E, Kinel DR, Arnedo V, Marek KL, Tanner CM. The Effect of the COVID-19 Pandemic on People with Parkinson's Disease. J Parkinsons Dis 2020; 10:1365-1377. [PMID: 32925107 PMCID: PMC7683050 DOI: 10.3233/jpd-202249] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effect of the COVID-19 pandemic on people with Parkinson's disease (PD) is poorly understood. OBJECTIVE To rapidly identify areas of need and improve care in people with PD during the COVID-19 pandemic, we deployed a survey to assess COVID-19 symptoms and the pandemic's effect among those with and without COVID-19. METHODS People with and without PD participating in the online study Fox Insight (FI) were invited to complete a survey between April 23 and May 23, 2020. Among people reporting COVID-19 diagnoses, we compared symptoms and outcomes in people with and without PD. Among people not reporting COVID-19, we assessed access to healthcare and services and PD symptoms. RESULTS 7,209/9,762 active FI users responded (approximately 74% response rate), 5,429 people with PD and 1,452 without PD. COVID-19 diagnoses were reported by 51 people with and 26 without PD. Complications were more frequent in people with longer PD duration. People with PD and COVID-19 experienced new or worsening motor (63%) and nonmotor (75%) symptoms. People with PD not diagnosed with COVID-19 reported disrupted medical care (64%), exercise (21%), and social activities (57%), and worsened motor (43%) and non-motor (52%) symptoms. Disruptions were more common for those living alone, with lower income and non-White race. CONCLUSIONS The COVID-19 pandemic is associated with wide-ranging effects on people with PD, and certain groups may be at particular risk. FI provides a rapid, patient-centered means to assess these effects and identify needs that can be used to improve the health of people with PD.
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Affiliation(s)
- Ethan G. Brown
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samuel M. Goldman
- Department of Occupational and Environmental Medicine, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | - Monica Korell
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | - Emerald Mann
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | | | | | - Kenneth L. Marek
- The Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
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50
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Simuni T, Uribe L, Cho HR, Caspell-Garcia C, Coffey CS, Siderowf A, Trojanowski JQ, Shaw LM, Seibyl J, Singleton A, Toga AW, Galasko D, Foroud T, Tosun D, Poston K, Weintraub D, Mollenhauer B, Tanner CM, Kieburtz K, Chahine LM, Reimer A, Hutten SJ, Bressman S, Marek K. Clinical and dopamine transporter imaging characteristics of non-manifest LRRK2 and GBA mutation carriers in the Parkinson's Progression Markers Initiative (PPMI): a cross-sectional study. Lancet Neurol 2019; 19:71-80. [PMID: 31678032 DOI: 10.1016/s1474-4422(19)30319-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Parkinson's Progression Markers Initiative (PPMI) is an ongoing observational, longitudinal cohort study of participants with Parkinson's disease, healthy controls, and carriers of the most common Parkinson's disease-related genetic mutations, which aims to define biomarkers of Parkinson's disease diagnosis and progression. All participants are assessed annually with a battery of motor and non-motor scales, 123-I Ioflupane dopamine transporter (DAT) imaging, and biological variables. We aimed to examine whether non-manifesting carriers of LRRK2 and GBA mutations have prodromal features of Parkinson's disease that correlate with reduced DAT binding. METHODS This cross-sectional analysis is based on assessments done at enrolment in the subset of non-manifesting carriers of LRRK2 and GBA mutations enrolled into the PPMI study from 33 participating sites worldwide. The primary objective was to examine baseline clinical and DAT imaging characteristics in non-manifesting carriers with GBA and LRRK2 mutations compared with healthy controls. DAT deficit was defined as less than 65% of putamen striatal binding ratio expected for the individual's age. We used t tests, χ2 tests, and Fisher's exact tests to compare baseline demographics across groups. An inverse probability weighting method was applied to control for potential confounders such as age and sex. To account for multiple comparisons, we applied a family-wise error rate to each set of analyses. This study is registered with ClinicalTrials.gov, number NCT01141023. FINDINGS Between Jan 1, 2014, and Jan 1, 2019, the study enrolled 208 LRRK2 (93% G2019S) and 184 GBA (96% N370S) non-manifesting carriers. Both groups were similar with respect to mean age, and about 60% were female. Of the 286 (73%) non-manifesting carriers that had DAT imaging results, 18 (11%) LRRK2 and four (3%) GBA non-manifesting carriers had a DAT deficit. Compared with healthy controls, both LRRK2 and GBA non-manifesting carriers had significantly increased mean scores on the Movement Disorders Society Unified Parkinson's Disease Rating Scale (total score 4·6 [SD 4·4] healthy controls vs 8·4 [7·3] LRRK2 vs 9·5 [9·2] GBA, p<0·0001 for both comparisons) and the Scale for Outcomes for PD - autonomic function (5·8 [3·7] vs 8·1 [5·9] and 8·4 [6·0], p<0·0001 for both comparisons). There was no difference in daytime sleepiness, anxiety, depression, impulsive-compulsive disorders, blood pressure, urate, and rapid eye movement (REM) behaviour disorder scores. Hyposmia was significantly more common only in LRRK2 non-manifesting carriers (69 [36%] of 194 healthy controls vs 114 [55%] of 208 LRRK2 non-manifesting carriers; p=0·0003). Finally, GBA but not LRRK2 non-manifesting carriers showed increased DAT striatal binding ratios compared with healthy controls in the caudate (healthy controls 2·98 [SD 0·63] vs GBA 3·26 [0·63]; p<0·0001), putamen (2·15 [0·56] vs 2·48 [0·52]; p<0·0001), and striatum (2·56 [0·57] vs 2·87 [0·55]; p<0·0001). INTERPRETATION Our data show evidence of subtle motor and non-motor signs of Parkinson's disease in non-manifesting carriers compared with healthy controls that can precede DAT deficit. Longitudinal data will be essential to confirm these findings and define the trajectory and predictors for development of Parkinson's disease. FUNDING Michael J Fox Foundation for Parkinson's Research.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hyunkeun Ryan Cho
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Andrew Siderowf
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Departments of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, NIH, Bethesda, MD, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, CA, USA
| | - Doug Galasko
- Department of Neurology, University of California, San Diego, CA, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - Duygu Tosun
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Daniel Weintraub
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Departments of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany; Paracelsus-Elena-Klinik, Kassel, Germany
| | - Caroline M Tanner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Karl Kieburtz
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alyssa Reimer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Samantha J Hutten
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Susan Bressman
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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