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Fanciulli A, Stankovic I, Avraham O, Jecmenica Lukic M, Ezra A, Leys F, Goebel G, Krismer F, Petrovic I, Svetel M, Seppi K, Kostic V, Giladi N, Poewe W, Wenning GK, Gurevich T. Early Screening for the Parkinson Variant of Multiple System Atrophy: A 6-Item Score. Mov Disord Clin Pract 2024. [PMID: 38659282 DOI: 10.1002/mdc3.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND A 4-item score based on ≥2 features out of orthostatic hypotension, overactive bladder, urinary retention and postural instability was previously shown to early distinguish the Parkinson-variant of multiple system atrophy (MSA-P) from Parkinson's disease (PD) with 78% sensitivity and 86% specificity. OBJECTIVES To replicate and improve the 4-item MSA-P score. METHODS We retrospectively studied 161 patients with early parkinsonism [ie, ≤2 years disease duration or no postural instability, aged 64 (57; 68) years, 44% females] and a diagnosis of clinically established MSA-P (n = 38) or PD (n = 123) after ≥24 months follow-up. RESULTS The 4-item MSA-P score had a 92% sensitivity and 78% specificity for a final MSA-P diagnosis. By including dopaminergic responsiveness and postural deformities into a 6-item score (range: 0-6), reaching ≥3 points at early disease identified MSA-P patients with 89% sensitivity and 98% specificity. CONCLUSIONS The 6-item MSA-P score is a cost-effective tool to pinpoint individuals with early-stage MSA-P.
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Affiliation(s)
| | - Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Omer Avraham
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Milica Jecmenica Lukic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Adi Ezra
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Igor Petrovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Svetel
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Provincial Hospital of Kufstein, Kufstein, Austria
| | - Vladimir Kostic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Jecmenica Lukic M, Respondek G, Kurz C, Compta Y, Gelpi E, Ferguson LW, Rajput A, Troakes C, van Swieten JC, Giese A, Roeber S, Herms J, Arzberger T, Höglinger G. Long-duration progressive supranuclear palsy: clinical course and pathological underpinnings. Ann Neurol 2022; 92:637-649. [PMID: 35872640 DOI: 10.1002/ana.26455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/21/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To identify the clinical characteristics of the subgroup of benign progressive supranuclear palsy with particularly long disease duration; to define neuropathological determinants underlying variability in disease duration in progressive supranuclear palsy. METHODS Clinical and pathological features were compared among 186 autopsy-confirmed cases with progressive supranuclear palsy with ≥10 years and shorter survival times. RESULTS 45 cases (24.2%) had a disease duration of ≥10 years. The absence of ocular motor abnormalities within the first 3 years from disease onset was the only significant independent clinical predictor of longer survival. Histopathologically, the neurodegeneration parameters in each survival group were paralleled anatomically by the distribution of neuronal cytoplasmic inclusions, whereas the tufted astrocytes displayed anatomically an opposite severity pattern. Most interestingly, we found significantly less coiled bodies in those who survive longer, in contrast to patients with less favorable course. INTERPRETATIONS A considerable proportion of patients had a more 'benign' disease course with ≥10 years survival. They had a distinct pattern and evolution of core symptoms compared to patients with short survival. The inverted anatomical patterns of astrocytic tau distribution suggest distinct implications of these cell types in trans-cellular propagation. The tempo of disease progression appeared to be determined mostly by oligodendroglial tau, where high degree of oligodendroglial tau pathology might affect neuronal integrity and function on top of neuronal tau pathology. The relative contribution of glial tau should be further explored in cellular and animal models. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Milica Jecmenica Lukic
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Clinic of Neurology, The University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Gesine Respondek
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Carolin Kurz
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich, Germany
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Hospital Clínic de Barcelona / IDIBAPS / CIBERNED / (CB06/05/0018-ISCIII) / European Reference Network for Rare Neurological Diseases (ERN-RND) / Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Ellen Gelpi
- Neurological Tissue Bank and Neurology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Centres de Recerca de Catalunya (CERCA), Barcelona, Catalonia, Spain.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Leslie W Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Canada
| | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Canada
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, London, United Kingdom
| | | | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Armin Giese
- Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany
| | - Jochen Herms
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany
| | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU, Munich, Germany.,Center for Neuropathology and Prion Research, Munich, LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany
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Jecmenica Lukic M, Kurz C, Respondek G, Grau-Rivera O, Compta Y, Gelpi E, Troakes C, van Swieten JC, Giese A, Roeber S, Arzberger T, Höglinger G. Copathology in Progressive Supranuclear Palsy: Does It Matter? Mov Disord 2020; 35:984-993. [PMID: 32125724 DOI: 10.1002/mds.28011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The influence of concomitant brain pathologies on the progression rate in PSP is unclear. OBJECTIVES To analyze the frequency and severity of copathologies and their impact on the progression in PSP. METHODS We analyzed clinic-pathological features of 101 PSP patients. Diagnoses and stages of copathologies were established according to standardized criteria, including Alzheimer's disease-related pathology, argyrophilic grains, Lewy-related pathology, transactive response DNA-binding protein 43 pathology, fused in sarcoma pathology, cerebral amyloid angiopathy, and small vessel disease. Demographic data and major clinical milestones (frequency and latency to onset) were extracted from patients' files. RESULTS Only 8% of 101 patients presented with pure PSP pathology without any copathology. Alzheimer's disease-related pathology was the most frequent (84%), followed by argyrophilic grains (58%), both occurring as single copathology or in combination with other proteinopathies or cerebrovascular disease. Lewy-related and transactive response DNA-binding protein 43 copathology occurred rarely (8% and 6%, respectively). Fused in sarcoma-positive cases were not found. While being common, copathology was mostly mild in severity, with the exception of frequently widespread argyrophilic grains. Small vessel disease was also frequent (65%). Cerebral amyloid angiopathy occurred only in the presence of Alzheimer's disease-related changes (25%). The copathologies did not have major impact on prevalence and time frame of major disease milestones. CONCLUSIONS In PSP, concomitant neurodegenerative proteinopathies or cerebrovascular diseases are frequent, but generally mild in severity. Our data confirmed that four repeat tau is still the most relevant target for PSP, whereas the impact of copathologies on progression rate appears to be of less importance. This is relevant information for the development of disease-modifying therapies. © 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)
- Milica Jecmenica Lukic
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Clinic of Neurology, CCS, University of Belgrade, Belgrade, Republic of Serbia
| | - Carolin Kurz
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Gesine Respondek
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oriol Grau-Rivera
- Neurological Tissue Bank of the Biobanc-Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Yaroslau Compta
- Parkinson's Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic de Barcelona/IDIBAPS, Institut de Neurociències-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobanc-Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, London, United Kingdom
| | | | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Armin Giese
- Center for Neuropathology and Prion Research, Munich, LMU Munich, Munich, Germany
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Munich, LMU Munich, Munich, Germany
| | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Munich, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Neurology, Hannover Medical School, Hannover, Germany
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