Differential Gene Expression in Sporadic and Genetic Forms of Alzheimer's Disease and Frontotemporal Dementia in Brain Tissue and Lymphoblastoid Cell Lines.

Sporadic early-onset Alzheimer's disease (EOAD) and autosomal dominant Alzheimer's disease (ADAD) provide the opportunity to investigate the physiopathological mechanisms in the absence of aging, present in late-onset forms. Frontotemporal dementia (FTD) causes early-onset dementia associated to tau or TDP43 protein deposits. A 15% of FTD cases are caused by mutations in C9orf72, GRN, or MAPT genes. Lymphoblastoid cell lines (LCLs) have been proposed as an alternative to brain tissue for studying earlier phases of neurodegenerative diseases. The aim of this study is to investigate the expression profile in EOAD, ADAD, and sporadic and genetic FTD (sFTD and gFTD, respectively), using brain tissue and LCLs. Sixty subjects of the following groups were included: EOAD, ADAD, sFTD, gFTD, and controls. Gene expression was analyzed with Clariom D microarray (Affymetrix). Brain tissue pairwise comparisons revealed six common differentially expressed genes (DEG) for all the patients' groups compared with controls: RGS20, WIF1, HSPB1, EMP3, S100A11 and GFAP. Common up-regulated biological pathways were identified both in brain and LCLs (including inflammation and glial cell differentiation), while down-regulated pathways were detected mainly in brain tissue (including synaptic signaling, metabolism and mitochondrial dysfunction). CD163, ADAMTS9 and LIN7A gene expression disruption was validated by qPCR in brain tissue and NrCAM in LCLs in their respective group comparisons. In conclusion, our study highlights neuroinflammation, metabolism and synaptic signaling disturbances as common altered pathways in different AD and FTD forms. The use of LCLs might be appropriate for studying early immune system and inflammation, and some neural features in neurodegenerative dementias.

Projecting Burden of Dementia in Spain, 2010-2050: Impact of Modifying Risk Factors.

Risk and protective factors such as obesity, hypercholesterolemia, physical activity, and hypertension can play a role in the development of dementia. Our objective was to measure the effect of modification of risk and protective factors on the prevalence and economic burden of dementia in the aging Spanish population during 2010-2050. A discrete event simulation model including risk and protective factors according to CAIDE (Cardiovascular Risk Factors, Aging and Incidence of Dementia) Risk Score was built to represent the natural history of dementia. Prevalence of dementia was calculated from 2010 to 2050 according to different scenarios of risk factor prevalence to assess the annual social and health care costs of dementia. The model also supplied hazard ratios for dementia. Aging will increase between 49% and 16% each decade in the number of subjects with dementia. The number of working-age individuals per person with dementia will decrease to a quarter by 2050. An intervention leading to a 20% change in risk and protective factors would reduce dementia by 9% , prevent over 100,000 cases, and save nearly 4,900 million euros in 2050. Switching individuals from a group with a specific risk factor to one without it nearly halved the risk of the development of dementia. Dementia prevalence will grow unmanageable if effective prevention strategies are not developed. Interventions aiming to reduce modifiable risk factor prevalence represent valid and effective alternatives to reduce dementia burden. However, further research is needed to identify causal relationships between dementia and risk factors.

Fitting the epidemiology and neuropathology of the early stages of Alzheimer's disease to prevent dementia.

INTRODUCTION: Recent research on biomarkers has made possible the diagnosis of pre-dementia and even preclinical Alzheimer's disease (AD), thus providing the ideal context for prevention. The aim of this study was to investigate the epidemiology of the early stages of AD by fitting neuropathologic and epidemiological data to assess the feasibility of prevention programs. METHODS: The study addressed primarily the construction of a discrete event simulation model of the stages of dementia. Age was included in the mathematical functions to combine the two competitive risks that determine the epidemiology of AD, that is, time to onset of dementia and time until death by other causes. Subsequently, this model was calibrated to reproduce the prevalence of pathological findings associated with AD. The beginning of the preclinical stage was taken to coincide with Thal phase 1 deposition of amyloid-beta. The duration of the prodromal stage, marked by mild cognitive impairment, was based on a 10% annual conversion rate from this level of impairment to dementia. The validation of prevalence figures also permitted estimation of the incidence and duration of preclinical and prodromal stages. RESULTS: In Spain, half of the nearly 10 million people aged more than 60 years are in the early stages of AD; 35.9% are in a preclinical stage, and up to 14.2% are in a prodromal stage. However, dementia will develop in only 38% of this population. The weighted mean time to dementia was 22.0 years from the start of Thal phase 1 and 9.0 years from the start of phase 2. Results of simulation models showed a lack of correlation between clinical and pathological classifications. CONCLUSIONS: These findings raise questions about the feasibility of drug-based prevention strategies. Currently, screening programs with biomarkers in the early stages of AD cannot be applied to the half of the general population older than 60 years. Hence, intensive research is needed regarding risk factors, so that more affordable strategies may be planned. More efficient criteria are also needed to select those subjects with mild cognitive impairment who have an increased probability of positive screening for biomarkers (prodromal stage).

[Gait analysis in Parkinson's disease and response to dopaminergic treatment]. / Análisis de la marcha en la enfermedad de Parkinson y su respuesta al tratamiento dopaminérgico.

BACKGROUND AND OBJECTIVE: The objective of this study was to analyze the gait abnormalities in patients with idiopathic Parkinson's disease (PD), and their response to dopaminergic treatment. PATIENTS AND METHOD: 15 patients and 15 healthy age-matched subjects were included for comparison between pathologic and "normal" gait, and 24 PD patients were included to assess the effects of treatment. Gait analysis was achieved with a new 3D-photogrammetry system. RESULTS: Patients had significative lower velocity, stride length, step length and hip and knee ranges when compared with control subjects. There were no differences in cadence, step width and relative times of gait-cycle. There were no differences in the patients' gait variables after administration of a dopaminergic medication. CONCLUSIONS: Gait analysis allows quantification of gait disturbances in patients with PD and the potential effects of treatment. The results of this study suggest a certain degree of "levodopa-resistance" in gait in these patients.

Análisis de la marcha en la enfermedad de Parkinson y su respuesta al tratamiento dopaminérgico / Gait analysis in Parkinson’s disease and response to dopaminergic treatment

FUNDAMENTO Y OBJETIVO: Analizar objetivamente las alteraciones de la marcha en pacientes con enfermedad de Parkinson (EP)y los cambios observados tras la administración de medicación dopaminérgica. PACIENTES Y MÉTODO: Se incluyó a 15 pacientes con enfermedad de Parkinson para la comparación de la marcha con un grupo de 15 individuos sanos de la misma edad y a24 pacientes para la comparación antes y después de la administración de la medicación. Se realizó el análisis con un nuevosistema de fotogrametría tridimensional. RESULTADOS: Los pacientes presentaron de forma significativa una menor velocidad, longitud de zancada, de paso y menores amplitudes articulares de cadera y rodillaque el grupo control, sin diferencias en la cadencia, base de sustentación ni en los tiempos relativos del ciclo de la marcha. No se encontraron diferencias significativasen la comparación de la marcha antes y después de la administración de la medicación dopaminérgica. CONCLUSIONES: El análisis de la marcha permite cuantificar las alteraciones de la marcha en pacientes con enfermedad de Parkinson y el potencial efecto de intervenciones terapéuticas. Los resultados indican un cierto grado de resistencia a la levodopa en la marcha de estos pacientes

BACKGROUND AND OBJECTIVE: The objective of this study was to analyze the gait abnormalities in patients with idiopathic Parkinson’s disease(PD), and their response to dopaminergic treatment. PATIENTS AND METHOD: 15 patients and 15 healthyage-matched subjects were included for comparison between pathologic and «normal» gait, and 24 PD patients were included to assess the effects of treatment. Gait analysis was achieved with a new 3D-photogramme try system. RESULTS: Patients had significative lower velocity, stride length, step length and hip and knee ranges when compared with control subjects. There were no differences in cadence, step width and relative times of gait-cycle. There were no differences in the patients’ gait variables after administration of a dopaminergic medication. CONCLUSIONS: Gait analysis allows quantification of gait disturbances in patients with PD and the potential effects of treatment. The results of this study suggest a certain degree of«levodopa-resistance» in gait in these patients