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1.
Mov Disord ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31799764

RESUMO

BACKGROUND: A minimally invasive test for early detection and monitoring of Parkinson's disease (PD) is a highly unmet need for drug development and planning of patient care. Blood plasma represents an attractive source of biomarkers. MicroRNAs (miRNAs) are conserved noncoding RNA molecules that serve as posttranscriptional regulators of gene expression. As opposed to ubiquitously expressed miRNAs that control house-keeping processes, brain-enriched miRNAs regulate diverse aspects of neuron development and function. These include neuron-subtype specification, axonal growth, dendritic morphogenesis, and spine density. Backed by a large number of studies, we now know that the differential expression of neuron-enriched miRNAs leads to brain dysfunction. OBJECTIVES: The aim was to identify subsets of brain-enriched miRNAs with diagnostic potential for familial and idiopathic PD as well as specify the molecular pathways deregulated in PD. METHODS: Initially, brain-enriched miRNAs were selected based on literature review and validation studies in human tissues. Subsequently, real-time reverse transcription polymerase chain reaction was performed in the plasma of 100 healthy controls and 99 idiopathic and 53 genetic (26 alpha-synucleinA53T and 27 glucocerebrosidase) patients. Statistical and bioinformatics analyses were carried out to pinpoint the diagnostic biomarkers and deregulated pathways, respectively. RESULTS: An explicit molecular fingerprint for each of the 3 PD cohorts was generated. Although the idiopathic PD fingerprint was different from that of genetic PD, the molecular pathways deregulated converged between all PD subtypes. CONCLUSIONS: The study provides a group of brain-enriched miRNAs that may be used for the detection and differentiation of PD subtypes. It has also identified the molecular pathways deregulated in PD. © 2019 International Parkinson and Movement Disorder Society.

2.
Acta Neurol Scand ; 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856297

RESUMO

INTRODUCTION: Various MRI markers have been applied to support the diagnosis of progressive supranuclear palsy (PSP), such as midbrain diameter and surface, superior cerebellar peduncle (SCP) width, midbrain to pons (m/p) diameter and surface ratio and the Magnetic Resonance Parkinsonism Index (MRPI). These markers provide excellent diagnostic accuracy in discriminating Richardson's syndrome from other causes of Parkinsonism. Idiopathic normal pressure hydrocephalus (iNPH) may mimic Richardson's syndrome, particularly in cases of subtle opthalmokinetic abnormalities. The aim of this study was to compare these MRI markers in PSP and iNPH and examine their diagnostic accuracy. MATERIALS AND METHODS: Forty-three patients with probable PSP, 17 patients with iNPH, and 29 controls were included. Midbrain diameter and surface, SCP width, m/p diameter and surface ratio and the MRPI were recorded. The "hummingbird sign," "morning glory sign" and "mickey mouse sign" were also evaluated. Analysis of covariance, chi-squared test, and ROC curve analysis were used as appropriate. RESULTS: All MRI measurements differed significantly among the three study groups. Comparison of PSP and iNPH patients produced the following significant differences: midbrain diameter (P < .0001), m/p diameter ratio (P < .0001), SCP width (P = .050), and MRPI (P = .049). None of these markers produced combined high (>80%) specificity and sensitivity. Qualitative MRI signs were specific, but lacked sensitivity. DISCUSSION: Midbrain morphology in iNPH may resemble that of PSP. Established MRI markers of midbrain and SCP atrophy cannot confidently differentiate PSP from iNPH. MRI markers do not provide combined high sensitivity and specificity for the differential diagnosis of PSP from iNPH.

3.
Cells ; 9(1)2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31861253

RESUMO

The hyperechogenicity of the substania nigra (SN) has been established as a valid finding in patients with Parkinson´s disease (PD), probably caused by an increased tissue iron concentration in the SN. The application of transcranial sonography (TCS) has been investigated for further echogenic basal ganglia alterations in patients with extrapyramidal movement disorders. Compared to PD, a hyperechogenic nucleus lentiformis (LN) has been reported to appear more frequently in atypical parkinsonian syndromes (aPS) such as the parkinsonian phenotype of multiple system atrophy (MSA-P) or the progressive supranuclear palsy (PSP). As the evidence providing study sizes are small, we conduct the first meta-analysis of the prevalence of LN hyperechogenicity in PD and aPS. We search for available studies providing prevalence of LN hyperechogenicity in patients with PD and aPS (MSA-P and PSP) detected by TCS in MEDLINE and SCOPUS databases. We calculate the prevalence rates of LN hyperechogenicity detection in patients with clinical diagnosis of PD vs. aPS under the random-effects model. We include a total of 1330 patients, 1091 PD and 239 aPS (MSA-P and PSP). We find a significantly higher prevalence of LN hyperechogenicity in aPS (76%, 95% CI: 0.62-0.88) compared to PD (16%, 95% CI: 0.10-0.23). After proving a higher prevalence of LN hyperechogenicity in aPS compared to PD, its histopathological cause needs to be investigated. Furthermore, its full diagnostic accuracy and the qualification to serve as a risk factor for MSA-P and PSP should also be questioned in future studies.

4.
Postgrad Med ; 131(7): 423-437, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31382796

RESUMO

Hyperglycemia on hospital admission is a common phenomenon in acute ischemic stroke patients and represents an independent predictor of poor clinical outcome with or without acute recanalization therapies (systemic thrombolysis or mechanical thrombectomy). Effective restoration of normoglycemia is considered to be beneficial, but conclusive evidence from randomized controlled clinical trials and specific recommendations are lacking. In addition, aggressive glucose control can be complicated by hypoglycemia leading to early neurological deterioration. We conducted a systematic literature review with the aim of addressing several questions: timing of glucose control, target range, type of insulin delivery, duration and practicability of glucose-lowering protocols. Special issues regarding mechanical thrombectomy and glycemic variability can then be investigated in future trials which are also being considered.


Assuntos
Isquemia Encefálica/terapia , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Acidente Vascular Cerebral/terapia , Glicemia/metabolismo , Isquemia Encefálica/complicações , Isquemia Encefálica/metabolismo , Hospitalização , Humanos , Hiperglicemia/complicações , Hiperglicemia/metabolismo , Hipoglicemia/induzido quimicamente , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/metabolismo , Trombectomia , Terapia Trombolítica
5.
Dement Geriatr Cogn Disord ; 47(4-6): 289-296, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31311013

RESUMO

BACKGROUND: Neuropathological studies indicate concomitant Alzheimer's disease (AD) pathology in patients with dementia with Lewy bodies (DLB). OBJECTIVES: To measure cerebrospinal fluid (CSF) levels of ß-amyloid peptide with 42 amino acids (Aß42), total tau protein (τT), and tau phosphorylated at threonine 181 (τP-181) in 38 patients fulfilling the diagnostic criteria of probable DLB according to the most recent (4th consensus) report. METHODS: Double-sandwich commercial ELISAs (Innotest; Fujirebio, Gent, Belgium) were used for measurements. RESULTS: According to the current cutoff values of our laboratory, 4 biomarker profiles were noted: abnormal levels of Aß42 only (44.7%), full AD profile (39.5%), abnormal levels of τT only (5.3%), and normal levels of all 3 biomarkers (10.5%). AD profile was associated with female sex, older age, lower education, and lower MMSE scores. CONCLUSIONS: Reduction in Αß42 in DLB may be more common (>80% of patients) than previously thought, and ∼40% may have the typical CSF AD biomarker profile. AD biochemistry in DLB may be an evolving process showing increasing frequency with disease progression.


Assuntos
Doença de Alzheimer/metabolismo , Biomarcadores/análise , Doença por Corpos de Lewy/metabolismo , Fatores Etários , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Escolaridade , Feminino , Humanos , Doença por Corpos de Lewy/psicologia , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Estudos Retrospectivos , Fatores Sexuais , Proteínas tau/análise
6.
Brain Sci ; 9(7)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31277472

RESUMO

BACKGROUND: Cerebral amyloid angiopathy (CAA) is characterized by deposition of amyloid in small/medium size brain vessels, and may coexist with Alzheimer's disease or dementia with Lewy bodies (DLB). We describe a patient with a clinical diagnosis of DLB and imaging/biochemical characteristics suggestive of mixed small vessel disease (both CAA and non-amyloid microangiopathy). METHODS: Clinical evaluation according to recent diagnostic criteria, magnetic resonance imaging, dopamine-transporter scan (DAT-scan) and cerebrospinal fluid (CSF) analysis for dementia biomarkers were all performed. RESULTS: The patient is a 71-year-old male, fulfilling criteria for probable DLB, with a positive DAT-scan, but with multiple microbleeds in a cortical-subcortical location suggestive of CAA, some microbleeds in deep brain nuclei suggestive of non-amyloid microangiopathy and abnormal levels of only amyloid-beta (Aß42) in CSF. CONCLUSION: Coexistent mixed vascular and neurodegenerative disorders are frequent in older subjects with dementia and each one of the underlying pathologies may contribute to, or modify the clinical presentation.

7.
Ther Adv Neurol Disord ; 12: 1756286419851381, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205494

RESUMO

In 2014, the definition of embolic strokes of undetermined source (ESUS) emerged as a new clinical construct to characterize cryptogenic stroke (CS) patients with complete vascular workup to determine nonlacunar, nonatherosclerotic strokes of presumable embolic origin. NAVIGATE ESUS, the first phase III randomized-controlled, clinical trial (RCT) comparing rivaroxaban (15 mg daily) with aspirin (100 mg daily), was prematurely terminated for lack of efficacy after enrollment of 7213 patients. Except for the lack of efficacy in the primary outcome, rivaroxaban was associated with increased risk of major bleeding and hemorrhagic stroke compared with aspirin. RE-SPECT ESUS was the second phase III RCT that compared the efficacy and safety of dabigatran (110 or 150 mg, twice daily) to aspirin (100 mg daily). The results of this trial have been recently presented and showed similar efficacy and safety outcomes between dabigatran and aspirin. Indirect analyses of these trials suggest similar efficacy on the risk of ischemic stroke (IS) prevention, but higher intracranial hemorrhage risk in ESUS patients receiving rivaroxaban compared to those receiving dabigatran (indirect HR = 6.63, 95% CI: 1.38-31.76). ESUS constitute a heterogeneous group of patients with embolic cerebral infarction. Occult AF represents the underlying mechanism of cerebral ischemia in the minority of ESUS patients. Other embolic mechanisms (paradoxical embolism via patent foramen ovale, aortic plaque, nonstenosing unstable carotid plaque, etc.) may represent alternative mechanisms of cerebral embolism in ESUS, and may mandate different management than oral anticoagulation. The potential clinical utility of ESUS may be challenged since the concept failed to identify patients who would benefit from anticoagulation therapy. Compared with the former diagnosis of CS, ESUS patients required thorough investigations; more comprehensive diagnostic work-up than is requested in current ESUS diagnostic criteria may assist clinicians in uncovering the source of brain embolism in CS patients and individualize treatment approaches.

8.
Hell J Nucl Med ; 22 Suppl: 95-101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30877727

RESUMO

Hereditary types of ischemic cerebral subcortical small vessel disease (SSVD) are rare, usually autosomal dominant, diseases, due to an abnormality in vessel wall synthesis. They may present with various combinations of migraine with aura, ischemic events (transient ischemic attacks, lacunar strokes) and progressively worsening ischemic lesion load in brain imaging. Eventually, vascular cognitive impairment (usually of the frontal-subcortical type) develops, frequently accompanied by behavioral-psychiatric symptoms and bilateral pyramidal and pseudobulbar signs leading to severe disability and premature death. In some patients, microbleeds and hemorrhagic strokes may be present. Despite their rarity, these disorders offer a statistically homogeneous population (usually without additional pathology such as Alzheimer's disease), suitable for the study of vascular cognitive impairment. The few studies on the relative frequency of these disorders indicate that the most frequent (or rather the least rare), accounting for more than half of patients, is CADASIL, due to mutations of the NOTCH3 gene, followed by COL4A1/A2-related disease, autosomal dominant forms of HTRA1-related disease and leucoencephalopathies with calcifications and cysts. Mutations of TREX1, GLA, FOXC1 and CARASIL are less frequent. Despite the genetic nature of these disorders, their phenotype, severity and rate of progression may be adversely affected by classical cardiovascular risk factors such as hypertension, diabetes, dyslipidemia and smoking and control of these risk factors is strongly advised for all patients.


Assuntos
Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/genética , Isquemia/complicações , Humanos , Mutação , Fatores de Risco
9.
J Neurol Sci ; 398: 142-147, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30711771

RESUMO

BACKGROUND: Corticobasal syndrome (CBS) can harbor diverse pathologies, such as corticobasal degeneration (CBD) and Alzheimer's disease (AD). CSF biochemical analysis in CBS patients can confidently distinguish between an AD (CBS-AD) and a non-AD (CBS-nAD) pathology. OBJECTIVE: We utilized classical CSF biomarkers to make a distinction between the two groups and examine their clinical, neuropsychological, neuropsychiatric and imaging differences. METHODS: Seventeen patients with a CBS phenotype were included. Detailed clinical history, and neurological examination data were recorded. A thorough neuropsychological and neuropsychiatric test battery was performed, including Goldenberg apraxia test. Simple linear MRI measurements and planimetry data were utilized. CSF biomarkers for AD were ascertained. RESULTS: Five of seventeen CBS patients had a CSF AD profile. Patients with a CSF AD profile (CBS-AD; n = 5) were older and had a greater age at disease onset compared to CBS-nAD. CBS-AD patients had more frequently alien hand phenomena at examination and greater hippocampi surface asymmetry at MRI. CBS-nAD patients (n = 12) had lower superior colliculi width values. CONCLUSION: Clinical, neuropsychological and imaging data cannot confidently differentiate CBS-AD from CBS-nAD patients.

10.
Neurol Sci ; 40(5): 929-938, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30715632

RESUMO

OBJECTIVE: To date, there are no definitive biomarkers for diagnose Parkinson's disease (PD). The detection of α-synuclein (α-Syn) in plasma of PD patients has yielded promising but inconclusive results. To determine the performance of α-Syn as a diagnostic biomarker of PD, we used a meta-analysis. METHODS: We identified 173 studies through a systematic literature review. From those, only studies reporting data on total α-Syn levels were included in the meta-analysis (10 publications, 1302 participants). Quality of studies was assessed by Newcastle-Ottawa scale. RESULTS: The α-Syn levels were significantly higher in PD patients than healthy controls (standardized mean difference [SMD] = 0.778, 95% confidence interval = 0.284 to 1.272, p = 0.002). Similar results were found after omitting any individual study from meta-analysis, with SMD ranges from 0.318 (95% CI = 0.064 to 0.572, p = 0.014) to 0.914 (95% CI = 0.349 to 1.480, p = 0.002). According to meta-regression analysis, increased mean patients age (slope = - 0.232, 95% CI = - 0.456 to - 0.008, p = 0.042), increased total number of participants (slope = - 0.007, 95% CI = - 0.013 to - 0.0004, p = 0.038), and increased percentage of males (slope = - 6.444, 95% CI = - 10.841 to - 2.047, p = 0.004) were associated with decreased SMD of α-Syn levels across studies. We did not find any significant association between the SMD in α-Syn levels and disease duration, disease severity, and quality of studies. Most of studies applied ELISA assays. CONCLUSION: Total plasma α-Syn levels were higher in PD patients than controls. Analytical factors were important limitations.


Assuntos
Doença de Parkinson/sangue , alfa-Sinucleína/sangue , Biomarcadores/sangue , Humanos
12.
Neurocase ; 24(4): 188-194, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30293488

RESUMO

Anti-NMDA receptor (NMDA-r) encephalitis is a relatively rare cause of autoimmune encephalitis with divergent clinical presentations. We report a case of an adult patient with anti-NMDA-r encephalitis presenting with isolated, abrupt-onset aphasia. Her condition remained unaltered over a period of 6 months. The patients' electroencephalogram findings were typical for NMDA-r encephalitis; however, her magnetic resonance imaging and cerebrospinal fluid analysis were normal. She responded well to immunotherapy, and aphasia eventually resolved. The natural course of the present case contradicts the rapidly progressive nature of typical NMDA-r encephalitis. Furthermore, it broadens the clinical spectrum of anti-NMDA-r encephalitis, to incorporate isolated, nonprogressive aphasia.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Afasia/complicações , Afasia/diagnóstico , Adulto , Encéfalo/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Testes Neuropsicológicos
13.
J Neurol ; 265(10): 2295-2301, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30083953

RESUMO

INTRODUCTION: Given the overlapping of neuropathological, neurochemical and neuropsychiatric profiles of Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), their differential diagnosis is challenging. Specific neuropsychiatric features or biomarkers, such as cerebrospinal fluid (CSF) α-Synuclein (α-Syn), may aid in differential diagnosis. This study aims to compare the neuropsychiatric and CSF α-Syn profiles in these conditions, and to investigate the possible association between CSF α-Syn levels and neuropsychiatric symptoms. METHODS: We conducted a prospective cross-sectional study, between January 2013 and January 2015, with 16 PDD, 28 DLB and 19 AD patients. All participants underwent a detailed clinical, neuropsychological, neuropsychiatric [Neuropsychiatric Inventory (NPI)] and CSF α-Syn analysis. RESULTS: Significantly greater NPI Hallucinations Subitem score was found in the PDD and DLB groups compared to AD (both p < 0.001). NPI Agitation score was greater in the DLB compared to PDD group (p = 0.012). NPI Sleep score was greater in the DLB compared to AD group (p = 0.001). Total NPI score was greater in the DLB compared to AD and PDD groups. To discriminate between the DLB and AD and between DLB and PDD groups, logistic regression analysis showed that both NPI scores and α-Syn levels were independently associated. There was no correlation between NPI scores and α-Syn levels. Increased NPI scores and α-Syn levels are associated with greater likelihood for being in DLB than in PDD or AD groups. ROC analysis showed that the combination of NPI and α-Syn increases the discriminative ability of each marker alone (p < 0.001) with AUC equal to 0.95 (95% CI 0.91-0.99). CONCLUSION: NPI scores and CSF α-Syn levels were useful as independent variables to differentiate DLB from PDD and AD.


Assuntos
Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/psicologia , Doença por Corpos de Lewy/líquido cefalorraquidiano , Doença por Corpos de Lewy/psicologia , Doença de Parkinson/líquido cefalorraquidiano , Doença de Parkinson/psicologia , Idoso , Biomarcadores/líquido cefalorraquidiano , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , alfa-Sinucleína/líquido cefalorraquidiano
14.
J Stroke Cerebrovasc Dis ; 27(9): e191-e195, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29706439

RESUMO

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) due to mutations of the NOTCH3 gene is the most common cause of inherited cerebral small-vessel disease and one of the genetic causes of migraine with aura. The so-called CADASIL scale has been proposed as a clinical screening tool, and a score of 15 or higher seems useful in identifying patients with high probability of carrying NOTCH3 mutations. We studied a novel Greek family with clinical features compatible with CADASIL. Genetic analysis of NOTCH3 in the 2 living patients revealed the R182C mutation. Both patients had low scores (12 and 14) in the CADASIL scale, probably due to their relatively young age (38 and 37 years, respectively) at which cognitive decline and external capsule involvement have not developed yet. Another unusual feature in the second patient was a venous dysplasia in the parietal lobe. Observations presented here add to the notion that the CADASIL scale, although useful, probably needs a revision, taking into account the patient's age at which the score is calculated.


Assuntos
CADASIL/diagnóstico por imagem , CADASIL/genética , Veias Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética , Mutação , Lobo Parietal/irrigação sanguínea , Receptor Notch3/genética , Irmãos , Adulto , CADASIL/complicações , Análise Mutacional de DNA , Feminino , Predisposição Genética para Doença , Grécia , Hereditariedade , Humanos , Linhagem , Fenótipo , Valor Preditivo dos Testes , Prognóstico
15.
J Alzheimers Dis ; 62(3): 1417-1441, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29562536

RESUMO

Subcortical small-vessel disease (SSVD) is a disorder well characterized from the clinical, imaging, and neuropathological viewpoints. SSVD is considered the most prevalent ischemic brain disorder, increasing in frequency with age. Vascular risk factors include hypertension, diabetes, hyperlipidemia, elevated homocysteine, and obstructive sleep apnea. Ischemic white matter lesions are the hallmark of SSVD; other pathological lesions include arteriolosclerosis, dilatation of perivascular spaces, venous collagenosis, cerebral amyloid angiopathy, microbleeds, microinfarcts, lacunes, and large infarcts. The pathogenesis of SSVD is incompletely understood but includes endothelial changes and blood-brain barrier alterations involving metalloproteinases, vascular endothelial growth factors, angiotensin II, mindin/spondin, and the mammalian target of rapamycin pathway. Metabolic and genetic conditions may also play a role but hitherto there are few conclusive studies. Clinical diagnosis of SSVD includes early executive dysfunction manifested by impaired capacity to use complex information, to formulate strategies, and to exercise self-control. In comparison with Alzheimer's disease (AD), patients with SSVD show less pronounced episodic memory deficits. Brain imaging has advanced substantially the diagnostic tools for SSVD. With the exception of cortical microinfarcts, all other lesions are well visualized with MRI. Diagnostic biomarkers that separate AD from SSVD include reduction of cerebrospinal fluid amyloid-ß (Aß)42 and of the ratio Aß42/Aß40 often with increased total tau levels. However, better markers of small-vessel function of intracerebral blood vessels are needed. The treatment of SSVD remains unsatisfactory other than control of vascular risk factors. There is an urgent need of finding targets to slow down and potentially halt the progression of this prevalent, but often unrecognized, disorder.


Assuntos
Transtornos Cerebrovasculares , Demência , Animais , Transtornos Cerebrovasculares/classificação , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/genética , Transtornos Cerebrovasculares/patologia , Demência/classificação , Demência/diagnóstico , Demência/genética , Demência/patologia , Humanos
17.
Artigo em Inglês | MEDLINE | ID: mdl-29166782

RESUMO

The C9orf72 repeat expansion is a common genetic cause of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) in European populations. A previous study has reported a high frequency of the expansion in Greek ALS. However, no data have been reported on the frequency of the expansion in Greek FTD. Currently, we investigated the frequency of the C9orfF72 expansion in a well-characterized cohort of 64 Greek FTD patients. We detected the C9orf72 repeat expansion in 9.3% of cases. Overall, 27.7% of familial and 2.2% of sporadic cases were expansion-positive. Five out of 6 cases had a diagnosis of behavioral variant FTD. All expansion-positive cases had fairly typical FTD presentations. Clinical features included motor neuron disease, Parkinsonism and hallucinations. We conclude that the overall frequency of C9orf72-positive cases in Greek FTD is high, comparable to Greek ALS, similar to some Western European, but significantly higher than some Mediterranean FTD populations.


Assuntos
Esclerose Amiotrófica Lateral/genética , Proteína C9orf72/genética , Expansão das Repetições de DNA/genética , Demência Frontotemporal/genética , Predisposição Genética para Doença/genética , Idoso , Estudos de Coortes , Feminino , Grécia , Humanos , Masculino , Pessoa de Meia-Idade
18.
Neurosci Lett ; 672: 136-139, 2018 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-29233723

RESUMO

BACKGROUND: The p. A53T mutation in the alpha-synuclein (SNCA) gene is a rare cause of autosomal dominant Parkinson's disease (PD). Although generally rare, it is particularly common in the Greek population due to a founder effect. A53T-positive PD patients often develop dementia during disease course and may very rarely present with dementia. METHODS: We screened for the p. A53T SNCA mutation a total of 347 cases of Greek origin with parkinsonism and/or dementia, collected over 15 years at the Neurogenetics Unit, Eginition Hospital, University of Athens. Cases were classified into: "pure parkinsonism", "pure dementia" and "parkinsonism plus dementia". RESULTS: In total, 4 p. A53T SNCA mutation carriers were identified. All had autosomal dominant family history and early onset. Screening of the "pure parkinsonism" category revealed 2 cases with typical PD. The other two mutation carriers were identified in the "parkinsonism plus dementia" category. One had a diagnosis of PD dementia and the other of behavioral variant frontotemporal dementia. Screening of patients with "pure dementia" failed to identify any further A53T-positive cases. CONCLUSIONS: Our results confirm that the p. A53T SNCA mutation is relatively common in Greek patients with PD or PD plus dementia, particularly in cases with early onset and/or autosomal dominant family history.


Assuntos
Demência/genética , Mutação , Transtornos Parkinsonianos/genética , alfa-Sinucleína/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Expressão Gênica , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo
19.
Neurol Sci ; 39(2): 359-364, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29196955

RESUMO

Differential diagnosis of progressive supranuclear palsy (PSP) and the parkinsonian variant of multiple system atrophy (MSA-P) from Parkinson's disease (PD) can be difficult, particularly in atypical cases or early in the disease course. The Magnetic Resonance Parkinsonism Index (MRPI) utilizes linear and surface (planimetry) measurements and has been proposed as a dual MRI biomarker, with high values indicative of PSP and low values of MSA. The aim of this study was to examine the utility of simple linear MRI brainstem measurements, without the use of MRI planimetry, in the diagnosis of patients with Parkinsonism and compare them to the MRPI. A total of 51 patients (PSP: 24, MSA-P: 9, PD: 18) and 15 healthy controls were included. Simple linear MRI distances of brainstem structures were measured. These included midbrain and pons diameters as well as superior cerebellar peduncle (SCP) and middle cerebellar peduncle (MCP) widths. All relevant indices, including ratios and products, were also calculated. The SCP by midbrain product (SCP × midbrain) provided improved sensitivity (100 vs. 91%) and identical specificity (98%) for the diagnosis of PSP, compared to the MRPI. Neither the MRPI nor any of the linear measurements were able to discriminate MSA-P from PD. The SCP by midbrain product is a novel, potent MRI biomarker for PSP.


Assuntos
Tronco Encefálico/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Idoso , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas
20.
J Neurol Sci ; 382: 91-95, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29111028

RESUMO

INTRODUCTION: Differential diagnosis of Parkinson-plus patients (PSP, CBD, MSA) and Parkinson's disease (PD) patients is often not straightforward, particularly in atypical cases or at the initial stages of the diseases. Classic CSF biomarkers (amyloid-beta - Aß42, tau protein - τT and phosphorylated tau protein - τP-181) are established biomarkers in the diagnosis of Alzheimer's disease (AD). CSF a-synuclein (α-syn) has emerged as a promising biomarker in patients with Parkinsonism. The aim of this study was to analyze the CSF biochemical profile of patients with Parkinsonism. METHODS: We analyzed the CSF biomarker profile (Aß42, τT, τP-181, α-syn) and all relevant ratios in 68 patients with Parkinsonism (19 PSP, 15 MSA, 17 CBD, 17 PD) and 18 controls, diagnosed by latest established diagnostic criteria. RESULTS: CBD patients exhibited elevated τT and decreased Aß42 compared to the other groups. Five CBD, one PSP patient and one control had a typical AD CSF profile. After exclusion of these patients, the τT/Aß42 ratio was significantly elevated in MSA patients compared to PD patients and provided excellent specificity and adequate sensitivity in their differential diagnosis. CONCLUSION: CSF biochemical profile analysis is important in distinguishing AD patients with a CBS phenotype from non-AD CBS patients. The τT/Aß42 ratio is useful in the differential diagnosis of MSA from PD.


Assuntos
Peptídeos beta-Amiloides/líquido cefalorraquidiano , Atrofia de Múltiplos Sistemas/líquido cefalorraquidiano , Doença de Parkinson/líquido cefalorraquidiano , Fragmentos de Peptídeos/líquido cefalorraquidiano , Paralisia Supranuclear Progressiva/líquido cefalorraquidiano , alfa-Sinucleína/líquido cefalorraquidiano , Proteínas tau/líquido cefalorraquidiano , Idoso , Biomarcadores/líquido cefalorraquidiano , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sistema de Registros
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