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Tufekcioglu Z, Lange J, Pedersen KF, Tysnes OB, Alves G, Emre M. Cognitive Profile in Parkinson's Disease Dementia Patients with Low versus Normal Cerebrospinal Fluid Amyloid Beta. Dement Geriatr Cogn Dis Extra 2023; 13:39-47. [PMID: 38025590 PMCID: PMC10645440 DOI: 10.1159/000534552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In patients with Parkinson's disease (PD), low cerebrospinal fluid (CSF) amyloid beta 1-42 (Ab42) at baseline is the most consistent CSF biomarker as a risk factor for developing dementia. Low CSF Ab42 is, however, a typical hallmark of Alzheimer's disease (AD). Hence, low CSF Ab42 in patients with PD may indicate presence of comorbid AD pathology and may predict a more AD-like cognitive profile when they develop dementia. Our study aimed to investigate if low CSF Ab42 at baseline is associated with a more AD-like cognitive profile in PD patients with dementia. Methods In a prospectively followed-up, population-based cohort of newly diagnosed PD patients, we compared the cognitive profile of dementia in those with a low CSF Ab42 level at baseline with that of patients who had normal levels at the time when they developed dementia. Four different cognitive domain z-scores (memory, attention, executive, visuospatial) were calculated. Patients were subdivided into three tertiles or categorized dichotomously based on the baseline CSF Ab42 levels as measured by electrochemiluminescence and ELISA. Results During 10-year follow-up, 37 patients met the inclusion criteria. Memory domain composite z-scores, memory subtest z-scores, and the difference between long-delay free recall versus recognition scores were not significantly different between the groups. Composite z-scores of visuospatial functions significantly differed between the tertiles, which was not significant after Bonferroni correction. In the dichotomous group analysis, z-scores of visuospatial functions significantly differed between the two groups. The other cognitive domain z-scores were not significantly different. Conclusions In patients with PD dementia, low CSF Ab42 level at baseline is not associated with a specific cognitive profile.
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Affiliation(s)
- Zeynep Tufekcioglu
- Department of Neurology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Johannes Lange
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Kenn Freddy Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Ole-Bjørn Tysnes
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Murat Emre
- Behavioural Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Cengiz S, Arslan DB, Kicik A, Erdogdu E, Yildirim M, Hatay GH, Tufekcioglu Z, Uluğ AM, Bilgic B, Hanagasi H, Demiralp T, Gurvit H, Ozturk-Isik E. Identification of metabolic correlates of mild cognitive impairment in Parkinson's disease using magnetic resonance spectroscopic imaging and machine learning. MAGMA 2022; 35:997-1008. [PMID: 35867235 DOI: 10.1007/s10334-022-01030-6] [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] [Received: 12/06/2021] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate metabolic changes of mild cognitive impairment in Parkinson's disease (PD-MCI) using proton magnetic resonance spectroscopic imaging (1H-MRSI). METHODS Sixteen healthy controls (HC), 26 cognitively normal Parkinson's disease (PD-CN) patients, and 34 PD-MCI patients were scanned in this prospective study. Neuropsychological tests were performed, and three-dimensional 1H-MRSI was obtained at 3 T. Metabolic parameters and neuropsychological test scores were compared between PD-MCI, PD-CN, and HC. The correlations between neuropsychological test scores and metabolic intensities were also assessed. Supervised machine learning algorithms were applied to classify HC, PD-CN, and PD-MCI groups based on metabolite levels. RESULTS PD-MCI had a lower corrected total N-acetylaspartate over total creatine ratio (tNAA/tCr) in the right precentral gyrus, corresponding to the sensorimotor network (p = 0.01), and a lower tNAA over myoinositol ratio (tNAA/mI) at a part of the default mode network, corresponding to the retrosplenial cortex (p = 0.04) than PD-CN. The HC and PD-MCI patients were classified with an accuracy of 86.4% (sensitivity = 72.7% and specificity = 81.8%) using bagged trees. CONCLUSION 1H-MRSI revealed metabolic changes in the default mode, ventral attention/salience, and sensorimotor networks of PD-MCI patients, which could be summarized mainly as 'posterior cortical metabolic changes' related with cognitive dysfunction.
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Affiliation(s)
- Sevim Cengiz
- Institute of Biomedical Engineering, Bogazici University, 34684, Istanbul, Turkey
| | - Dilek Betul Arslan
- Institute of Biomedical Engineering, Bogazici University, 34684, Istanbul, Turkey
| | - Ani Kicik
- Neuroimaging Unit, Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey
- Department of Physiology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Emel Erdogdu
- Neuroimaging Unit, Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey
- Department of Psychology, Faculty of Economics and Administrative Sciences, Isik University, Istanbul, Turkey
| | - Muhammed Yildirim
- Institute of Biomedical Engineering, Bogazici University, 34684, Istanbul, Turkey
| | - Gokce Hale Hatay
- Institute of Biomedical Engineering, Bogazici University, 34684, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Neurology, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Aziz Müfit Uluğ
- Institute of Biomedical Engineering, Bogazici University, 34684, Istanbul, Turkey
- CorTechs Labs, San Diego, CA, USA
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasmet Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tamer Demiralp
- Neuroimaging Unit, Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esin Ozturk-Isik
- Institute of Biomedical Engineering, Bogazici University, 34684, Istanbul, Turkey.
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Gultekin M, Tufekcioglu Z. COVID-19 infection presented as severe dyskinesia in a patient with Parkinson’s disease: a case with daily video recording. Neurol Sci 2022; 43:2961-2963. [PMID: 35137350 PMCID: PMC9023739 DOI: 10.1007/s10072-022-05912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022]
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Sumbul-Sekerci B, Hanagasi HA, Bilgic B, Tufekcioglu Z, Gurvit H, Emre M. Medication management and treatment adherence in Parkinson's disease patients with mild cognitive impairment. Acta Neurol Belg 2022:10.1007/s13760-022-01916-1. [PMID: 35325434 DOI: 10.1007/s13760-022-01916-1] [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: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The key feature that distinguishes mild cognitive impairment (MCI) from dementia is the absence of significant functional decline because of cognitive impairment. In Parkinson's disease patients (PD) with MCI (PD-MCI), the effect of cognitive impairment on complex instrumental daily activities, such as medication management, is not well established. METHOD 26 patients with PD-MCI (diagnosed to Level 2 Movement Disorders Society diagnostic criteria) and 32 idiopathic PD patients without cognitive impairment participated in the study. A detailed neuropsychological testing battery (including tests for attention and working memory, executive functions, language, visuospatial functions, episodic memory) and various prospective memory tasks were applied to the patients. Medication taking behaviors were evaluated using two different methods based on the performance (medication management ability assessment) and self-reporting (adherence scale). RESULTS The PD-MCI group obtained significantly lower scores in medication management assessment and made more mistakes on following prescription instructions (e.g., they took more or less tablets and did not use medications as instructed with regard to meal times). Cognitive areas predicting success in medication management performance were language, event-based prospective memory and visuospatial functions. There was no significant difference between the two groups' self-reporting of adherence. CONCLUSION Mild cognitive impairment in patients with PD adversely affects medication management. Diagnosing MCI in PD is important to ensure that the appropriate measures can be taken to provide support and improve the medication management process. Adherence assessments based on self-reporting may not provide reliable and sensitive information in patients with PD-MCI.
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Affiliation(s)
- Betul Sumbul-Sekerci
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hasmet A Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Gultekin M, Tufekcioglu Z, Baydemir R. Novel frameshift CTSF mutation causing kufs disease type B mimicking frontotemporal dementia-parkinsonism. Neurocase 2022; 28:107-109. [PMID: 35139754 DOI: 10.1080/13554794.2022.2038635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adult-onset neuronal ceroid lipofuscinoses (ANCLs, Kufs disease-KD) are rare, inherited, progressive, neurodegenerative, lysosomal storage diseases. Mutations in cathepsin F (CTSF) were linked to KD type B. Conversely, Frontotemporal dementia (FTD) is the second most common type of presenile dementia and Parkinsonism is a mostly common accompanying feature. Due to pronounced behavioral, cognitive, and motor features in the patients with KD type B, mutations in CTSF may resemble FTD-parkinsonism. Here, we present a case of KD type B with a novel homozygous frameshift pathogenic variant (p.Gly439Alafs*36) in the Cathepsin F (CTSF) gene presenting behavioral changes, cognitive disturbances and parkinsonism with a family history mimicking FTD-parkinsonism.
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Affiliation(s)
- Murat Gultekin
- Department of Neurology, M.D. Erciyes University, Kayseri, Turkey
| | | | - Recep Baydemir
- Department of Neurology, Erciyes University, Kayseri, Turkey
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Azamat S, Betul Arslan D, Erdogdu E, Kicik A, Cengiz S, Eryürek K, Tufekcioglu Z, Bilgic B, Hanagasi H, Demiralp T, Gurvit H, Ozturk-Isik E. Detection of visual and frontoparietal network perfusion deficits in Parkinson's disease dementia. Eur J Radiol 2021; 144:109985. [PMID: 34619619 DOI: 10.1016/j.ejrad.2021.109985] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/02/2021] [Accepted: 09/26/2021] [Indexed: 11/15/2022]
Abstract
Mild cognitive impairment of Parkinson's disease (PD) may be an early manifestation that may progressively worsen to dementia. Cognitive decline has been associated with changes in the brain perfusion pattern. This study aimed to evaluate cerebral blood flow (CBF) deficits specific to different stages of cognitive decline. Seventeen patients with cognitively normal PD (PD-CN), 18 patients with PD with mild cognitive impairment (PD-MCI), and 16 patients with PD with dementia (PDD) were included in this study. The participants were scanned using a 3 T Philips MRI scanner. Arterial spin labelling magnetic resonance (ASL-MR) images were acquired, followed by calculation of the CBF maps, and registration onto the MNI152 brain atlas. A whole-brain voxel-based CBF comparison was performed among the patient groups using age as a covariate. The mean age of patients with PDD was significantly higher than that of patients with PD-MCI (P = 0.015) and PD-CN (P = 0.001). The CBF values of the three groups were significantly different in the left cuneus of the visual network (VN), left inferior frontal gyrus of the frontoparietal network (FPN), and left dorsomedial nucleus of the thalamus. PDD had lower perfusion values than PD-MCI group in the same regions detected in the main group analysis. Additionally, comparison of PDD with PD-CN and non-demented groups revealed that the perfusion reduction extended into the bilateral cuneus of the VN, bilateral thalami, and left inferior frontal gyrus of the FPN. PDD could be separated from PD-MCI and PD-CN stages with CBF deficits in non-dopaminergically mediated posterior and dopaminergically mediated frontal networks.
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Affiliation(s)
- Sena Azamat
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey; Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Dilek Betul Arslan
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Emel Erdogdu
- Neuroimaging Unit Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey; Department of Psychology, Faculty of Arts and Sciences, Isik University, Istanbul, Turkey
| | - Ani Kicik
- Neuroimaging Unit Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey; Department of Physiology, Faculty of Medicine, Demircioglu Bilim University, Istanbul, Turkey
| | - Sevim Cengiz
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Kardelen Eryürek
- Neuroimaging Unit Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey; Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasmet Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tamer Demiralp
- Neuroimaging Unit Hulusi Behcet Life Sciences Research Center, Istanbul University, Istanbul, Turkey; Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Esin Ozturk-Isik
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
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Tufekcioglu Z, Bilgic B, Zeylan AE, Salah AA, Dibeklioglu H, Emre M. Do Alzheimer's Disease Patients Appear Younger than Their Real Age? Dement Geriatr Cogn Disord 2021; 49:483-488. [PMID: 33080614 DOI: 10.1159/000510359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The most prominent risk factor of Alzheimer's disease (AD) is aging. Aging also influences the physical appearance. Our clinical experience suggests that patients with AD may appear younger than their actual age. Based on this empirical observation, we set forth to test the hypothesis with human and computer-based estimation systems. METHOD We compared 50 early-stage AD patients with 50 age and sex-matched controls. Facial images of all subjects were recorded using a video camera with high resolution, frontal view, and clear lighting. Subjects were recorded during natural conversations while performing Mini-Mental State Examination, including spontaneous smiles in addition to static images. The images were used for age estimation by 2 methods: (1) computer-based age estimation; (2) human-based age estimation. Computer-based system used a state-of-the-art deep convolutional neural network classifier to process the facial images contained in a single-video session and performed frame-based age estimation. Individuals who estimated the age by visual inspection of video sequences were chosen following a pilot selection phase. The mean error (ME) of estimations was the main end point of this study. RESULTS There was no statistically significant difference between the ME scores for AD patients and healthy controls (p = 0.33); however, the difference was in favor of younger estimation of the AD group. The average ME score for AD patients was lower than that for healthy controls in computer-based estimation system, indicating that AD patients were on average estimated to be younger than their actual age as compared to controls. This difference was statistically significant (p = 0.007). CONCLUSION There was a tendency for humans to estimate AD patients younger, and computer-based estimations showed that AD patients were estimated to be younger than their real age as compared to controls. The underlying mechanisms for this observation are unclear.
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Affiliation(s)
- Zeynep Tufekcioglu
- Department of Neurology, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey,
| | - Başar Bilgic
- Department of Neurology, Movement Disorders and Behavioural Neurology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah Emir Zeylan
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Albert Ali Salah
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hamdi Dibeklioglu
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
| | - Murat Emre
- Department of Neurology, Movement Disorders and Behavioural Neurology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Samanci B, Sahin E, Bilgic B, Tufekcioglu Z, Gurvit H, Emre M, Demir K, Hanagasi HA. Neurological features and outcomes of Wilson's disease: a single-center experience. Neurol Sci 2021; 42:3829-3834. [PMID: 33474589 DOI: 10.1007/s10072-020-05013-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/11/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022]
Abstract
Wilson's disease (WD) is an autosomal recessive genetic disorder of copper metabolism, and WD patients can present with neurologic symptoms. We aimed to report the general characteristics and prognosis of a Turkish series of WD patients with neurological manifestations. A total of 12,352 patients were screened from the patient database, and 53 WD patients were included. Patients were classified based on the predominant neurological syndrome type including tremor, dystonia, parkinsonism, or discrete neurological signs and were classified as having "good outcome," "stable," and "poor outcome" according to their treatment response. There were 32 male and 21 female patients, aged 20-66 years. The mean follow-up was 11.3 ± 4.56 years. Sixty-two percent of patients presented predominantly with neurological symptoms. Neurological WD diagnosis was established after a mean time delay of 2.3 years from the WD diagnosis. The most common neurological manifestation was dystonia, followed by tremor and parkinsonism. Fifteen patients had a family history of WD. Consanguinity was present in 20 patients. Patients were treated with D-penicillamine, trientine, zinc salts, or their combinations. Besides the main treatments, 41 patients were on symptomatic treatment for neurologic symptoms. Thirty-six patients had a "good outcome," five patients were stable, and six patients had "poor outcome." Post-chelation neurological worsening was observed in 11 patients. WD should be considered in differential diagnosis in any patient with unexplained neurologic symptoms. Early diagnosis is important, and appropriate treatment should be promptly initiated to prevent progressive and irreversible damage, with good prognosis and stable disease in the majority of the patients with treatment compliance.
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Affiliation(s)
- Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey.
| | - Erdi Sahin
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
| | - Kadir Demir
- Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
| | - Hasmet A Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey
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Yunisova G, Tufekcioglu Z, Dogu O, Bilgic B, Kaleagasi H, Akca Kalem S, Lohmann E, Gurvit H, Emre M, Hanagasi H. Patients with Lately Diagnosed Cerebrotendinous Xanthomatosis. NEURODEGENER DIS 2020; 19:218-224. [DOI: 10.1159/000506770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/24/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive inborn lipid storage disorder due to various pathogenic mutations in the CYP27A1 gene. Although the symptoms begin commonly in infancy, CTX diagnosis is often delayed. In this study, we report 7 Turkish CTX patients who had a delayed diagnosis despite early clinical signs and belonged to 6 unrelated families. Methods: We have retrospectively evaluated clinical, laboratory, imaging, and genetic findings of CTX patients, which were collected from 2 centers specialized in movement disorders: the Department of Neurology, Faculty of Medicine, Istanbul University, and the Department of Neurology, Faculty of Medicine, Mersin University. Results: All patients were diagnosed with CTX after neurological symptom development, and their mean age at diagnosis was 38.7 ± 9.6 years, despite a mean onset age of 12.4 ± 10.6 years. The mean follow-up period was 28 months (range: 3–60 months). The most common initial clinical abnormalities in our cohort were unexplained chronic diarrhea (42%), febrile convulsion (42%), juvenile cataract (85%), childhood depression and autism (14%), parkinsonism (14%), and intellectual disability (100%). The most prominent neurological findings were the pyramidal-cerebellar syndrome (85%) and extrapyramidal signs (42%). All patients were genetically confirmed. Serum cholestanol levels were elevated in all patients and decreased after chenodeoxycholic acid (CDCA) treatment in 6 patients. Conclusion: This cohort is the largest CTX case series in Turkey. All cases showed improvement in gastrointestinal symptoms as a response to CDCA treatment and stabilization on neurological symptoms, i.e., no further progression of neurological abnormalities were noted during this treatment. Therefore, early diagnosis and treatment is crucial in preventing clinical deterioration.
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Guven G, Bilgic B, Tufekcioglu Z, Erginel Unaltuna N, Hanagasi H, Gurvit H, Singleton A, Hardy J, Emre M, Gulec C, Bras J, Guerreiro R, Lohmann E. Peripheral GRN mRNA and Serum Progranulin Levels as a Potential Indicator for Both the Presence of Splice Site Mutations and Individuals at Risk for Frontotemporal Dementia. J Alzheimers Dis 2020; 67:159-167. [PMID: 30475763 DOI: 10.3233/jad-180599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Progranulin (GRN) gene mutations are a major cause of frontotemporal dementia (FTD). Most mutations identified to date are null mutations, which are predicted to cause the pathology via haploinsufficiency. Decreased peripheral progranulin protein (PGRN) levels are associated with the presence of GRN null mutations and are accepted as reliable biomarkers. In this study, our aim was to test whether the presence of specific GRN splice site mutations (c.- 8+2T>G and c.708+6_9del), could be predicted by peripheral mRNA or protein GRN levels, by studying affected and asymptomatic individuals from FTD families. We also tested four missense GRN variants to assess if altered GRN levels depended on the type of mutation.Our results confirmed a reduction in both mRNA and protein PGRN levels in the splice site mutation carriers, which is consistent with previous reports for null mutations. Our results also suggested that both decreased peripheral GRN mRNA and serum PGRN levels indicate the presence of pathogenic mutations in affected individuals, and identify the asymptomatic individuals at risk, without previous knowledge of genetic status. Both inferences suggest a potential use of peripheral GRN mRNA or serum PGRN levels as biomarkers for families with FTD.
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Affiliation(s)
- Gamze Guven
- Department of Genetics, Aziz Sancar Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Başar Bilgic
- Department of Neurology, Behavioural Neurology and Movement Disorders Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Department of Neurology, Behavioural Neurology and Movement Disorders Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nihan Erginel Unaltuna
- Department of Genetics, Aziz Sancar Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hasmet Hanagasi
- Department of Neurology, Behavioural Neurology and Movement Disorders Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Department of Neurology, Behavioural Neurology and Movement Disorders Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - John Hardy
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Murat Emre
- Department of Neurology, Behavioural Neurology and Movement Disorders Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cagri Gulec
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jose Bras
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK.,Department of Medical Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal.,UK Dementia Research Institute at UCL (UK DRI), London, UK
| | - Rita Guerreiro
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK.,Department of Medical Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal.,UK Dementia Research Institute at UCL (UK DRI), London, UK
| | - Ebba Lohmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
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Ersoz Huseyinsinoglu B, Tufekcioglu Z, Birinci T, Demirdag F. The Reliability and Validity of the Turkish Version of the Survey of Activities and Fear of Falling in the Elderly. J Geriatr Phys Ther 2020; 44:E132-E137. [PMID: 32049753 DOI: 10.1519/jpt.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The Survey of Activities and Fear of Falling in the Elderly (SAFE) was originally developed in English to determine the level of fear of falling and its interactions with activities of daily living. The purpose of this study was to translate and cross-culturally adapt the SAFE instrument into Turkish and investigate its psychometric properties. PARTICIPANTS One hundred eleven older adults (72 females) with a mean age of 69 years (SD = 7.22; range, 60-87) were included. METHODS For cross-cultural adaptation, 2 bilingual translators used the back-translation procedure. Within a 5- to 7-day period after the first assessment, the participants completed the Turkish version of the SAFE (SAFE-T) to evaluate test-retest reliability. Cronbach's α was used to assess internal consistency. The correlation with the Turkish version of the Falls Efficacy Scale-International (FES-T) was determined to check the validity. RESULTS The SAFE-T had excellent internal consistency (α = 0.96) and test-retest reliability (intraclass correlation coefficient [ICC2,1] = 0.96 for activity level, ICC2,1 = 0.95 for fear of falling, and ICC2,1 = 0.86 for activity restriction subscales). The SAFE-T activity level and SAFE-T activity restriction subscales were moderately correlated with the FES-I (ρ = -0.51, P < .001; ρ = 0.55, P < .001, respectively). A strong positive correlation was found between the SAFE-T fear of falling subscale and the FES-I (ρ = 0.75, P < .001), indicating good concurrent validity. CONCLUSIONS The results show that the SAFE-T is semantically and linguistically adequate to assess the fear of falling in adults older than 60 years. Excellent internal validity and test-retest reliability of the SAFE-T were defined to evaluate the fear of falling among Turkish speaking older adults.
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Affiliation(s)
- Burcu Ersoz Huseyinsinoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Turkey
| | - Zeynep Tufekcioglu
- Department of Neurology, Faculty of Medicine, Istanbul Aydın University, Turkey
| | - Tansu Birinci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Turkey
| | - Filiz Demirdag
- Department of Geriatric Medicine, Istanbul Medeniyet University Göztepe Training and Research Hospital, Turkey
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Tufekcioglu Z, Ersöz Hüseyinsinoğlu B, ZİREK E, Bilgic B, Gürvit H, Hanagasi H. Factors Predicting Falls in Parkinson’s Disease: Investigation of Motor, Non-motor Findings and Different Dual Task Activities. tnd 2020. [DOI: 10.4274/tnd.galenos.2019.71235] [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: 12/01/2022] Open
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Kuipers DJ, Tufekcioglu Z, Bilgiç B, Olgiati S, Dremmen MH, van IJcken WF, Breedveld GJ, Mancini GM, Hanagasi HA, Emre M, Bonifati V. Late-onset phenotype associated with a homozygous GJC2 missense mutation in a Turkish family. Parkinsonism Relat Disord 2019; 66:228-231. [DOI: 10.1016/j.parkreldis.2019.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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Gurvit HI, Yildirim Z, Bilgiç B, Tufekcioglu Z, Tatlidede AD, Ak DG, Dursun E, Hanagasi HA, Emre M. P1-228: THE APPLICATION OF THE NIA-AA ATN SYSTEM TO THE ISTANBUL COHORT. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.783] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Hakan I. Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine; Istanbul University; Istanbul Turkey
| | - Zerrin Yildirim
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine; Istanbul University; Istanbul Turkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - Asli Demirtas Tatlidede
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - Duygu Gezen Ak
- Department of Medical Biology, Faculty of Medicine; Istanbul University-Cerrahpasa; Istanbul Turkey
| | - Erdinc Dursun
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of Medicine; Istanbul University-Cerrahpasa; Istanbul Turkey
| | - Hasmet A. Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
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15
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Zirek E, Ersoz Huseyinsinoglu B, Tufekcioglu Z, Bilgic B, Hanagasi H. Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson’s disease: a controlled study. Neurol Sci 2018; 39:2151-2157. [DOI: 10.1007/s10072-018-3564-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/07/2018] [Indexed: 12/23/2022]
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Bilgiç B, Samancı B, Tufekcioglu Z, Tatlidede AD, Dursun E, Gezen-Ak D, Hanagasi HA, Gurvit HI, Emre M. P2‐302: CLINICAL FEATURES AND DIAGNOSIS OF EARLY ONSET DEGENERATIVE DEMENTIAS IN TURKEY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.992] [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] [Indexed: 10/28/2022]
Affiliation(s)
- Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Bedia Samancı
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Asli Demirtas Tatlidede
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Erdinc Dursun
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Duygu Gezen-Ak
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Hasmet A. Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Hakan I. Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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Dursun E, Alaylıoğlu M, Atasoy IL, Sengul B, Buyukiscan ES, Yildirim E, Sezgin M, Samanci B, Tufekcioglu Z, Tatlidede AD, Bilgiç B, Hanagasi HA, Emre M, Gurvit HI, Gezen-Ak D. P2‐244: THE CORRELATION BETWEEN CSF AMYLOID BETA 1‐42 LEVELS AND CSF VITAMIN D (25OHD) LEVELS IN PATIENTS WITH SPORADIC ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Erdinc Dursun
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Merve Alaylıoğlu
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Irem L. Atasoy
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Busra Sengul
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ezgi Soncu Buyukiscan
- Department of Neuroscience, Aziz Sancar Institute of Experimental MedicineIstanbul UniversityIstanbulTurkey
| | - Elif Yildirim
- Department of Neuroscience, Aziz Sancar Institute of Experimental MedicineIstanbul UniversityIstanbulTurkey
| | - Mine Sezgin
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Asli Demirtas Tatlidede
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Hasmet A. Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Hakan I. Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Duygu Gezen-Ak
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
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Gurvit HI, Buyukiscan ES, Yildirim E, Samancı B, Tatlidede AD, Tufekcioglu Z, Hanagasi HA, Alaylıoğlu M, Ak DG, Dursun E, Bilgiç B. P2‐229: THE EFFECT OF CSF AMYLOID BETA CONCENTRATIONS ON MEMORY PERFORMANCE OF THE INDIVIDUALS WITH SUBJECTIVE COGNITIVE IMPAIRMENT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.916] [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] [Indexed: 10/28/2022]
Affiliation(s)
- Hakan I. Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
- Neuroimaging Unit, Hulusi Behcet Life Sciences LabIstanbul UniversityIstanbulTurkey
| | - Ezgi Soncu Buyukiscan
- Department of Neuroscience, Aziz Sancar Institute of Experimental MedicineIstanbul UniversityIstanbulTurkey
| | - Elif Yildirim
- Department of Neuroscience, Aziz Sancar Institute of Experimental MedicineIstanbul UniversityIstanbulTurkey
| | - Bedia Samancı
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Asli Demirtas Tatlidede
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Hasmet A. Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Merve Alaylıoğlu
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Duygu Gezen Ak
- Istanbul UniversityCerrahpasa Faculty of MedicineIstanbulTurkey
| | - Erdinc Dursun
- Brain and Neurodegenerative Disorders Research Unit, Department of Medical Biology, Cerrahpasa Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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Olgiati S, Doğu O, Tufekcioglu Z, Diler Y, Saka E, Gultekin M, Kaleagasi H, Kuipers D, Graafland J, Breedveld GJ, Quadri M, Sürmeli R, Sünter G, Doğan T, Yalçın AD, Bilgiç B, Elibol B, Emre M, Hanagasi HA, Bonifati V. The p.Thr11Met mutation in c19orf12 is frequent among adult Turkish patients with MPAN. Parkinsonism Relat Disord 2017; 39:64-70. [PMID: 28347615 DOI: 10.1016/j.parkreldis.2017.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/13/2017] [Accepted: 03/17/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mutations in the C19orf12 gene cause mitochondrial membrane protein associated neurodegeneration (MPAN), an autosomal recessive form of neurodegeneration with brain iron accumulation (NBIA). A limited number of patients with C19orf12 mutations, particularly those with adult onset of symptoms, have been reported. METHODS We sequenced the entire coding region of C19orf12 in 15 Turkish adult probands with idiopathic NBIA. We also performed haplotype analysis in families with a recurrent C19orf12 mutation. Clinical features were collected using a standardized form. RESULTS Nine of our 15 probands (60%) carried the homozygous c.32C > T mutation in C19orf12 (predicted protein effect: p.Thr11Met). This homozygous mutation co-segregated with the disease in all affected relatives available for testing (16 homozygous subjects). Haplotypes across the C19orf12 locus were identical for a very small region, closest to the mutation, suggesting an old founder, or, two independent founders. The clinical phenotype was characterized by adult onset in most cases (mean 24.5 years, range 10-36), and broad spectrum, including prominent parkinsonism, pyramidal signs, psychiatric disturbances, cognitive decline, and motor axonal neuropathy, in various combinations. On T2- or susceptibility weighted-MRI images, all patients displayed bilateral hypointensities in globus pallidus and substantia nigra, without an eye-of-the-tiger sign; however, hyperintense streaking of the medial medullary lamina between the external and internal parts of globus pallidus was observed frequently. CONCLUSION The C19orf12 p.Thr11Met mutation is frequent among adult Turkish patients with MPAN. These findings contribute to the characterization of this important NBIA form, and have direct implications for genetic testing of patients of Turkish origin.
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Affiliation(s)
- Simone Olgiati
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Okan Doğu
- Department of Neurology, Medical Faculty, Mersin University, Mersin, Turkey
| | - Zeynep Tufekcioglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yunus Diler
- Neurology Clinic, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Esen Saka
- Department of Neurology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Murat Gultekin
- Department of Neurology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Kaleagasi
- Department of Neurology, Medical Faculty, Mersin University, Mersin, Turkey
| | - Demy Kuipers
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Josja Graafland
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Guido J Breedveld
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Marialuisa Quadri
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Reyhan Sürmeli
- Neurology Clinic, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Gülin Sünter
- Neurology Clinic, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Tuğrul Doğan
- Neurology Clinic, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | | | - Başar Bilgiç
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Elibol
- Department of Neurology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Murat Emre
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasmet A Hanagasi
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vincenzo Bonifati
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands.
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Gurvit HI, Bilgiç B, Nur Ozdag AN, Tepgec F, Sahin E, Tufekcioglu Z, Demirtas Tatlidede AD, Hanağası H, Karadeniz D. P1‐233: Sporadic Fatal Insomnia In A Young Man. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.982] [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] [Indexed: 11/30/2022]
Affiliation(s)
- Hakan I. Gurvit
- Istanbul UniversityIstanbul Faculty of MedicineIstanbulTurkey
| | - Başar Bilgiç
- Istanbul UniversityIstanbul Faculty of MedicineIstanbulTurkey
| | | | - Fatih Tepgec
- Istanbul University, Institute of Experimental Medical ResearchIstanbulTurkey
| | - Erdi Sahin
- Istanbul UniversityIstanbul Faculty of MedicineIstanbulTurkey
| | | | | | - Haşmet Hanağası
- Istanbul UniversityIstanbul Faculty of MedicineIstanbulTurkey
| | - Derya Karadeniz
- Istanbul University Cerrahpasa Faculty of Medicine IstanbulTurkey
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Abstract
Phenylketonuria (PKU) is an autosomal recessive metabolic disorder due to mutations in the phenylalanine hydroxylase (PAH) gene, which converts phenylalanine (PHE) to tyrosine. Although it is principally a childhood disorder, in rare cases, the first signs of PKU may develop in late adulthood resembling common neurological diseases. Here we report a 59-year-old, previously normal functioning man who was admitted with blurred vision, cognitive problems, and gait difficulty that began 8 months before. He had brisk reflexes and left side dominant parkinsonism. His Mini-Mental State Examination (MMSE) score was 25/30, and neuropsychological evaluation revealed a dysexecutive syndrome with simultanagnosia and constructional apraxia. His Clinical Dementia Rating score (CDR) was 1. Cranial MRI revealed bilateral diffuse hyperintense lesions in parietal and occipital white matter in T2, fluid-attenuated inversion recovery, and diffusion weighted images. Diagnostic workup for rapidly progressive dementias was all normal except PHE level which was found to be highly elevated (1075 μmol/L, normal 39-240 μmol/L) with normal tyrosine level (61.20 μmol/L, normal 35-100 μmol/L). Three months after PHE-restricted diet, his cognitive impairment and signs of parkinsonism significantly improved, with MRI scan unchanged. This case demonstrates that late-onset PKU is a rare, treatable cause of rapidly progressive dementia and parkinsonism with certain constellations such as consanguinity and white matter abnormalities (WMAs) in imaging.
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Affiliation(s)
- Zeynep Tufekcioglu
- a Department of Neurology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Arman Cakar
- a Department of Neurology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Basar Bilgic
- a Department of Neurology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Hasmet Hanagasi
- a Department of Neurology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Hakan Gurvit
- a Department of Neurology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Murat Emre
- a Department of Neurology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
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