The value of cerebrospinal fluid α-synuclein and the tau/α-synuclein ratio for diagnosis of neurodegenerative disorders with Lewy pathology.

BACKGROUND AND PURPOSE: Parkinson's disease (PD), dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are three of the most common neurodegenerative disorders. Up to 20% of these patients have the wrong diagnosis, due to overlapping symptoms and shared pathologies. A cerebrospinal fluid (CSF) biomarker panel for AD is making its way into the clinic, but an equivalent panel for PD and DLB and for improved differential diagnoses is still lacking. Using well-defined, community-based cohorts and validated analytical methods, the diagnostic value of CSF total-α-synuclein (t-α-syn) alone and in combination with total tau (t-tau) in newly diagnosed patients with PD, DLB and AD was determined. METHODS: Cerebrospinal fluid concentrations of t-α-syn were assessed using our validated in-house enzyme-linked immunosorbent assay in 78 PD patients, 20 AD patients, 19 DLB patients and 32 controls. t-tau was measured using a commercial assay. Diagnostic performance was assessed by receiver operating characteristic curve analysis. RESULTS: Compared to controls (mean 517 pg/ml), significantly lower levels of CSF t-α-syn in patients with PD (434 pg/ml, 16% reduction, P = 0.036), DLB (398 pg/ml, 23% reduction, P = 0.009) and AD (383 pg/ml, 26% reduction, P = 0.014) were found. t-α-syn levels did not differ significantly between PD, DLB and AD. The t-tau/t-α-syn ratio showed an improved performance compared to the single markers. CONCLUSION: This is the first study to compare patients with PD, DLB and AD at the time of diagnosis. It was found that t-α-syn can contribute as a teammate with tau in a CSF biomarker panel for PD and DLB, and strengthen the existing biomarker panel for AD.

An assessment of cost, quality and outcomes for five HIV prevention youth peer education programs in Zambia.

Youth peer education (YPE) programs are a popular strategy for HIV prevention in sub-Saharan Africa. However, research on the effectiveness of YPE programs is scarce and the wide variation in programs makes it difficult to generalize research findings. Measuring quality and comparing program effectiveness require the use of standardized instruments. In this study, we used standardized evidenced-based instruments to compare program inputs, quality, outputs and outcomes for five YPE programs in Zambia. Clinic surveys were used to measure the following program outcomes: young people's exposure to the YPE programs and referrals of young people to clinics for HIV/sexually transmitted infection (STI) testing and other reproductive health services. The study revealed wide variation in the cost, quality and outcomes of YPE programs. Higher quality programs were associated with greater exposure and more referrals of youth to the clinics. However, one of the two highest quality programs achieved twice as many exposure and referral outcomes at about half the cost per peer educator of the more expensive program. Results indicate that the standardized instruments used in this study are useful for assessing and comparing program attributes among diverse YPE programs.

Occurrence and risk factors for apathy in Parkinson disease: a 4-year prospective longitudinal study.

BACKGROUND: Apathy is a common but under-recognised behavioural disorder associated with depression and cognitive impairment in patients with Parkinson disease (PD). However, the longitudinal course of apathy in PD has not been studied. OBJECTIVE: To examine the occurrence of and risk factors for apathy over time in a representative sample of patients with PD. METHODS: A sample of 139 patients was drawn from a population-based prevalence study of PD in Rogaland County, Western Norway. Apathy was measured with the Neuropsychiatric Inventory, using a composite score >or=4 to indicate clinically significant apathy. Additional measurements included standardised rating scales for parkinsonism, depression and cognitive impairment. A follow-up evaluation was carried out in 79 patients (78.2% of the survivors) 4 years later. RESULTS: Of the 79 patients included in this study, 29 patients (36.7%) had never had apathy, 11 (13.9%) had persistent apathy, and a further 39 (49.4%) developed apathy during follow-up. At follow-up, patients with apathy were more frequently depressed and demented than never-apathetic patients. Dementia at baseline and a more rapid decline in speech and axial impairment during follow-up were independent risk factors for incident apathy. CONCLUSIONS: Apathy is a persistent behavioural feature in PD with a high incidence and prevalence over time. Progression of motor signs predominantly mediated by non-dopaminergic systems may be a useful preclinical marker for incident apathy in PD.

The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson's disease.

BACKGROUND: Neuropsychiatric symptoms are common in Parkinson's disease (PD) and have important clinical consequences for patients, caregivers and society. Few studies of neuropsychiatric symptoms in early untreated PD exist. OBJECTIVE: To explore the range, clustering and correlates of neuropsychiatric symptoms in an incidence cohort of untreated subjects with PD. METHODS: All cases with incident PD identified during a 22 month period in four counties of Western and Southern Norway were included. Standardised criteria were used to diagnose PD. The Neuropsychiatric Inventory (NPI) was administered to 175 PD and 166 healthy control subjects with similar age and sex distributions. Cluster analysis was used to investigate the interrelationship of NPI items. RESULTS: The proportion with any NPI symptoms was higher in PD (56%) than in controls (22%) (p<0.001). Depression (37%), apathy (27%), sleep disturbance (18%) and anxiety (17%) were the most common symptoms. Clinically significant symptoms occurred in 27% of the PD group compared with only 3% in the control group (p<.001). Subjects with clinically significant neuropsychiatric symptoms had more severe parkinsonism than those without. Two neuropsychiatric clusters were identified, one characterised by mood symptoms and one by apathy. CONCLUSIONS: Although the majority of patients with early untreated PD do not have clinical significant neuropsychiatric symptoms, these symptoms are more common in patients than in people without PD. Both psychological stress and brain changes associated with PD are likely to contribute to the higher frequencies.

Aberrant T cells in beige mutant mice.

Cytotoxic T lymphocyte (CTL) morphology and function was examined in beige (bg/bg) mutant mice during infection with lymphocytic choriomeningitis virus (LCMV). Virus-specific, class I-restricted CTL activity mediated by total spleen leukocytes isolated from bg/+ or +/+ mice on days 7 or 9 postinfection with LCMV was moderately higher than that mediated by spleen cells isolated from bg/bg mice. The CTL generated in bg/bg mice had aberrant morphology. Lyt-2+ cells isolated from bg/+ or +/+ mice had typical large granular lymphocyte (LGL) morphology and contained numerous small azurophilic granules, whereas Lyt-2+ cells isolated from bg/bg mice contained only one or two large atypical granules in their cytoplasm. Aberrant LGL morphology correlated with reduced lytic capacity. The bg/bg CTL were inefficient killer cells mediating, on a per cell basis, only one fourth of the lysis mediated by bg/+ CTL. The bg/bg mice appeared to mount a compensatory response to regulate virus replication, because frequencies of Lyt-2+ cells and cells that specifically bound to virus-infected target cells were elevated as compared with their frequencies in bg/+ mice. The higher proportion of the CTL phenotype cells appeared to be a consequence of expanded proliferation of Lyt-2+ cells. These results demonstrate that, in comparison with bg/+ and +/+ mice, bg/bg mice have CTL with reduced lytic capacities, but may compensate during virus infection by expanding the number of these cells. Furthermore, these data suggest that the depressed lytic activity may be a consequence of aberrant granule formation.

Purification and target cell range of in vivo elicited blast natural killer cells.

Blast natural killer (NK) cells were elicited in the spleens of mice by treatments with the interferon inducers lymphocytic choriomeningitis virus (LCMV) or polyinosinic-polycytidylic acid (poly I:C). The blast-NK cells, separated on the basis of size by centrifugal elutriation, were compared with blast cytotoxic T lymphocytes (CTL) generated during infection with LCMV. In vivo treatments with antibody to asialo GM1 (AGM1) blocked the appearance of blast-NK cells but not blast-CTL. Antibody and complement depletion experiments indicated that the blast-NK cells were AGM1+, NK 1.2+/-, Lyt-5+/-, Thy+/-, Qa-5/NK 1.1+, Lyt-2-, B23.1-, and J11d-. Blast-NK cells could be unequivocally distinguished from blast-CTL, because the blast-CTL were completely sensitive to treatments with anti-Lyt-2 and complement, whereas the blast-NK cells were completely resistant. The blast-NK cells were purified from populations of large-size cells by antibody and complement treatments that depleted the co-eluting monocyte/macrophages and polymorphonuclear leukocytes. The population resulting after separation from dead cells over Percoll gradients represented approximately 1% of the total spleen cells, contained greater than 60% large granular lymphocytes and mediated greater than 15% killing of YAC-1 target cells in a 4-hr 51Cr release assay at an effector to target cell ratio of 1:1. The purified blast-NK cells lysed a broad range of target cells at relatively low effector to target cell ratios. The order of sensitivity of the target cells was YAC-1 much greater than K562 approximately equal to L-929 much greater than P815, consistent with that reported for NK cell-mediated lysis. The ability of the blast-NK cells to mediate lysis of NK cells also was examined. The purified NK cells mediated significant levels of lysis against the NK-like cloned line, NK1B6B10, in a 51Cr release assay. Furthermore, the purified blast-NK cells mediated lysis of bound blast-NK cells in a single-cell agarose assay. These results indicate that highly purified blast-NK cells are exceptionally efficient at mediating lysis and suggest that NK cells may act to negatively regulate the proliferation of NK cells by lysing other NK cells.