Cognitive function in peripheral autonomic disorders

aims of the current study were 1) to evaluate global cognitive function in patients with autonomic failure (AF) of peripheral origin and 2) to investigate the effect of a documented fall in blood pressure (BP) fulfilling the criteria for orthostatic hypotension (OH) on cognitive performances

The Frailty of the Invincible

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake

How resistant are levodopa-resistant axial symptoms? Response of freezing, posture, and voice to increasing levodopa intestinal infusion rates in Parkinson disease

Background and purpose: Treatment of freezing of gait (FoG) and other Parkinson disease (PD) axial symptoms is challenging. Systematic assessments of axial symptoms at progressively increasing levodopa doses are lacking. We sought to analyze the resistance to high levodopa doses of FoG, posture, speech, and altered gait features presenting in daily-ON therapeutic condition. Methods: We performed a pre-/postinterventional study including patients treated with levodopa/carbidopa intestinal gel infusion (LCIG) with disabling FoG in daily-ON condition. Patients were evaluated at their usual LCIG infusion rate (T1), and 1 h after 1.5× (T2) and 2× (T3) increase of the LCIG infusion rate by quantitative outcome measures. The number of FoG episodes (primary outcome), posture, speech, and gait features were objectively quantified during a standardized test by a blinded rater. Changes in motor symptoms, dyskinesia, and plasma levodopa concentrations were also analyzed. Results: We evaluated 16 patients with a mean age of 69 ± 9.4 years and treated with LCIG for a mean of 2.2 ± 2.1 years. FoG improved in 83.3% of patients by increasing the levodopa doses. The number of FoG episodes significantly decreased (mean = 2.3 at T1, 1.7 at T2, 1.2 at T3; p = 0.013). Posture and speech features did not show significant changes, whereas stride length (p = 0.049), turn duration (p = 0.001), and turn velocity (p = 0.024) significantly improved on doubling the levodopa infusion rate. Conclusions: In a short-term evaluation, the increase of LCIG dose can improve "dopa-resistant" FoG and gait issues in most advanced PD patients with overall good control of motor symptoms in the absence of clinically significant dyskinesia

Diagnostic value of plasma p-tau181, NfL, and GFAP in a clinical setting cohort of prevalent neurodegenerative dementias

Background: Increasing evidence supports the use of plasma biomarkers of neurodegeneration and neuroinflammation to screen and diagnose patients with dementia. However, confirmatory studies are required to demonstrate their usefulness in the clinical setting. Methods: We evaluated plasma and cerebrospinal fluid (CSF) samples from consecutive patients with frontotemporal dementia (FTD) (n = 59), progressive supranuclear palsy (PSP) (n = 31), corticobasal syndrome (CBS) (n = 29), dementia with Lewy bodies (DLB) (n = 49), Alzheimer disease (AD) (n = 97), and suspected non-AD physiopathology (n = 51), as well as plasma samples from 60 healthy controls (HC). We measured neurofilament light chain (NfL), phospho-tau181 (p-tau181), and glial fibrillary acid protein (GFAP) using Simoa (all plasma biomarkers and CSF GFAP), CLEIA (CSF p-tau181), and ELISA (CSF NfL) assays. Additionally, we stratified patients according to the A/T/N classification scheme and the CSF α-synuclein real-time quaking-induced conversion assay (RT-QuIC) results. Results: We found good correlations between CSF and plasma biomarkers for NfL (rho = 0.668, p < 0.001) and p-tau181 (rho = 0.619, p < 0.001). Plasma NfL was significantly higher in disease groups than in HC and showed a greater increase in FTD than in AD [44.9 (28.1–68.6) vs. 21.9 (17.0–27.9) pg/ml, p < 0.001]. Conversely, plasma p-tau181 and GFAP levels were significantly higher in AD than in FTD [3.2 (2.4–4.3) vs. 1.1 (0.7–1.6) pg/ml, p < 0.001; 404.7 (279.7–503.0) vs. 198.2 (143.9–316.8) pg/ml, p < 0.001]. GFAP also allowed discriminating disease groups from HC. In the distinction between FTD and AD, plasma p-tau181 showed better accuracy (AUC 0.964) than NfL (AUC 0.791) and GFAP (AUC 0.818). In DLB and CBS, CSF amyloid positive (A+) subjects had higher plasma p-tau181 and GFAP levels than A− individuals. CSF RT-QuIC showed positive α-synuclein seeding activity in 96% DLB and 15% AD patients with no differences in plasma biomarker levels in those stratified by RT-QuIC result. Conclusions: In a single-center clinical cohort, we confirm the high diagnostic value of plasma p-tau181 for distinguishing FTD from AD and plasma NfL for discriminating degenerative dementias from HC. Plasma GFAP alone differentiates AD from FTD and neurodegenerative dementias from HC but with lower accuracy than p-tau181 and NfL. In CBS and DLB, plasma p-tau181 and GFAP levels are significantly influenced by beta-amyloid pathology

The impact of COVID-19 quarantine on patients with dementia and family caregivers: a nation-wide survey.

Quarantine for COVID-19 is associated with an acute worsening of clinical symptoms in patients with dementia as well as increase of caregivers’ burden. These findings emphasize the importance to implement new strategies to mitigate the effects of quarantine in patients with dementia

Early downregulation of hsa-miR-144-3p in serum from drug-naïve Parkinson’s disease patients

open101siThis work was supported by the Horizon 2020 Framework Programme (Grant number 634821, PROPAG-AGING).Advanced age represents one of the major risk factors for Parkinson’s Disease. Recent biomedical studies posit a role for microRNAs, also known to be remodelled during ageing. However, the relationship between microRNA remodelling and ageing in Parkinson’s Disease, has not been fully elucidated. Therefore, the aim of the present study is to unravel the relevance of microRNAs as biomarkers of Parkinson’s Disease within the ageing framework. We employed Next Generation Sequencing to profile serum microRNAs from samples informative for Parkinson’s Disease (recently diagnosed, drug-naïve) and healthy ageing (centenarians) plus healthy controls, age-matched with Parkinson’s Disease patients. Potential microRNA candidates markers, emerging from the combination of differential expression and network analyses, were further validated in an independent cohort including both drug-naïve and advanced Parkinson’s Disease patients, and healthy siblings of Parkinson’s Disease patients at higher genetic risk for developing the disease. While we did not find evidences of microRNAs co-regulated in Parkinson’s Disease and ageing, we report that hsa-miR-144-3p is consistently down-regulated in early Parkinson’s Disease patients. Moreover, interestingly, functional analysis revealed that hsa-miR-144-3p is involved in the regulation of coagulation, a process known to be altered in Parkinson’s Disease. Our results consistently show the down-regulation of hsa-mir144-3p in early Parkinson’s Disease, robustly confirmed across a variety of analytical and experimental analyses. These promising results ask for further research to unveil the functional details of the involvement of hsa-mir144-3p in Parkinson’s Disease.openZago E.; Dal Molin A.; Dimitri G.M.; Xumerle L.; Pirazzini C.; Bacalini M.G.; Maturo M.G.; Azevedo T.; Spasov S.; Gomez-Garre P.; Perinan M.T.; Jesus S.; Baldelli L.; Sambati L.; Calandra Buonaura G.; Garagnani P.; Provini F.; Cortelli P.; Mir P.; Trenkwalder C.; Mollenhauer B.; Franceschi C.; Lio P.; Nardini C.; Adarmes-Gomez A.; Azevedo T.; Bacalini M.G.; Baldelli L.; Bartoletti-Stella A.; Bhatia K.P.; Marta B.-T.; Boninsegna C.; Broli M.; Dolores B.-R.; Calandra-Buonaura G.; Capellari S.; Carrion-Claro M.; Cilea R.; Clayton R.; Cortelli P.; Molin A.D.; De Luca S.; De Massis P.; Dimitri G.M.; Doykov I.; Escuela-Martin R.; Fabbri G.; Franceschi C.; Gabellini A.; Garagnani P.; Giuliani C.; Gomez-Garre P.; Guaraldi P.; Hagg S.; Hallqvist J.; Halsband C.; Heywood W.; Houlden H.; Huertas I.; Jesus S.; Jylhava J.; Labrador-Espinosa M.A.; Licari C.; Lio P.; Luchinat C.; Macias D.; Macri S.; Magrinelli F.; Rodriguez J.F.M.; Massimo D.; Maturo M.G.; Mengozzi G.; Meoni G.; Mignani F.; Milazzo M.; Mills K.; Mir P.; Mollenhauer B.; Nardini C.; Nassetti S.A.; Pedersen N.L.; Perinan-Tocino M.T.; Pirazzini C.; Provini F.; Ravaioli F.; Sala C.; Sambati L.; Scaglione C.L.M.; Schade S.; Schreglmann S.; Spasov S.; Strom S.; Tejera-Parrado C.; Tenori L.; Trenkwalder C.; Turano P.; Valzania F.; Ortega R.V.; Williams D.; Xumerle L.; Zago E.Zago E.; Dal Molin A.; Dimitri G.M.; Xumerle L.; Pirazzini C.; Bacalini M.G.; Maturo M.G.; Azevedo T.; Spasov S.; Gomez-Garre P.; Perinan M.T.; Jesus S.; Baldelli L.; Sambati L.; Calandra Buonaura G.; Garagnani P.; Provini F.; Cortelli P.; Mir P.; Trenkwalder C.; Mollenhauer B.; Franceschi C.; Lio P.; Nardini C.; Adarmes-Gomez A.; Azevedo T.; Bacalini M.G.; Baldelli L.; Bartoletti-Stella A.; Bhatia K.P.; Marta B.-T.; Boninsegna C.; Broli M.; Dolores B.-R.; Calandra-Buonaura G.; Capellari S.; Carrion-Claro M.; Cilea R.; Clayton R.; Cortelli P.; Molin A.D.; De Luca S.; De Massis P.; Dimitri G.M.; Doykov I.; Escuela-Martin R.; Fabbri G.; Franceschi C.; Gabellini A.; Garagnani P.; Giuliani C.; Gomez-Garre P.; Guaraldi P.; Hagg S.; Hallqvist J.; Halsband C.; Heywood W.; Houlden H.; Huertas I.; Jesus S.; Jylhava J.; Labrador-Espinosa M.A.; Licari C.; Lio P.; Luchinat C.; Macias D.; Macri S.; Magrinelli F.; Rodriguez J.F.M.; Massimo D.; Maturo M.G.; Mengozzi G.; Meoni G.; Mignani F.; Milazzo M.; Mills K.; Mir P.; Mollenhauer B.; Nardini C.; Nassetti S.A.; Pedersen N.L.; Perinan-Tocino M.T.; Pirazzini C.; Provini F.; Ravaioli F.; Sala C.; Sambati L.; Scaglione C.L.M.; Schade S.; Schreglmann S.; Spasov S.; Strom S.; Tejera-Parrado C.; Tenori L.; Trenkwalder C.; Turano P.; Valzania F.; Ortega R.V.; Williams D.; Xumerle L.; Zago E

Heterogeneity of prodromal Parkinson symptoms in siblings of Parkinson disease patients

A prodromal phase of Parkinson’s disease (PD) may precede motor manifestations by decades. PD patients’ siblings are at higher risk for PD, but the prevalence and distribution of prodromal symptoms are unknown. The study objectives were (1) to assess motor and non-motor features estimating prodromal PD probability in PD siblings recruited within the European PROPAG-AGEING project; (2) to compare motor and non-motor symptoms to the well-established DeNoPa cohort. 340 PD siblings from three sites (Bologna, Seville, Kassel/Goettingen) underwent clinical and neurological evaluations of PD markers. The German part of the cohort was compared with German de novo PD patients (dnPDs) and healthy controls (CTRs) from DeNoPa. Fifteen (4.4%) siblings presented with subtle signs of motor impairment, with MDS-UPDRS-III scores not clinically different from CTRs. Symptoms of orthostatic hypotension were present in 47 siblings (13.8%), no different to CTRs (p = 0.072). No differences were found for olfaction and overall cognition; German-siblings performed worse than CTRs in visuospatial-executive and language tasks. 3/147 siblings had video-polysomnography-confirmed REM sleep behavior disorder (RBD), none was positive on the RBD Screening Questionnaire. 173/300 siblings had <1% probability of having prodromal PD; 100 between 1 and 10%, 26 siblings between 10 and 80%, one fulfilled the criteria for prodromal PD. According to the current analysis, we cannot confirm the increased risk of PD siblings for prodromal PD. Siblings showed a heterogeneous distribution of prodromal PD markers and probability. Additional parameters, including strong disease markers, should be investigated to verify if these results depend on validity and sensitivity of prodromal PD criteria, or if siblings’ risk is not elevated