Pathology of corticobasal syndrome predictable in life?

Here’s an interesting abstract of some research out of the UK. “Twelve patients with CBS [corticobasal syndrome] were followed prospectively; six had AD and six had classic CBD neuropathology.” Clinical records were reviewed for presenting symptoms. “Initial episodic memory complaints and poor performance on the combined orientation-memory subtest of the Addenbrooke’s Cognitive Examination (ACE) reliably predicted AD pathology while varying combinations of early frontal-lobe type behavioral symptoms, nonfluent language disturbance, orobuccal apraxia, and utilization behavior predicted CBD pathology ante-mortem.”
Robin

Movement Disorders. 2009 Jun 16. [Epub ahead of print]

Is the pathology of corticobasal syndrome predictable in life?

Shelley BP, Hodges JR, Kipps CM, Xuereb JH, Bak TH.
Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK.

Corticobasal syndrome (CBS) has been associated with a heterogeneous spectrum of pathologies with an increasing number of reports of Alzheimer’s type pathology. There is, however, no means of predicting pathology of CBS in vivo at present. We compared the clinical features of patients presenting with CBS who have either pathologic changes of classic corticobasal degeneration (CBD) or Alzheimer’s disease (AD) at post-mortem to identify predictors of the specific pathological processes in life. Twelve patients with CBS were followed prospectively; six had AD and six had classic CBD neuropathology. After review of the presenting clinical features, we identified nine potential predictor variables, compared their frequency in the two groups, and performed a discriminant function analysis. Initial episodic memory complaints and poor performance on the combined orientation-memory subtest of the Addenbrooke’s Cognitive Examination (ACE) reliably predicted AD pathology while varying combinations of early frontal-lobe type behavioral symptoms, nonfluent language disturbance, orobuccal apraxia, and utilization behavior predicted CBD pathology ante-mortem. CBS is frequently associated with Alzheimer’s disease pathology. Early episodic memory impairment versus early behavioral symptomatology appears to best predict AD or CBD pathology in life. (c) 2009 Movement Disorder Society.

PubMed ID#: 19533751 (see pubmed.gov for this free abstract only)

orobuccal – “oro” refers to mouth and “buccal” refers to cheek

Severe memory impairment in CBD patient

This article in a Korean-based journal notes that CBD patients typically have “relatively mild motor symptoms. … Our observations indicate that CBD can in rare cases present with severe episodic memory impairment associated with frontal executive dysfunctions in the early stage of illness.” This is a case report on one patient where the diagnosis of CBD has not been confirmed.
Robin

Journal of Clinical Neurology. 2008 Jun;4(2):94-8. Epub 2008 Jun 20.

Severe episodic memory impairment in a patient with clinical features compatible with corticobasal degeneration.

Kim SK, Park KW, Kang DY, Cha JK, Kim SH, Kim JW.
Department of Neurology, Dong-A University College of Medicine, Busan, Korea.

Corticobasal degeneration (CBD) is a progressive neurodegenerative disorder characterized by asymmetric parkinsonism associated with apraxia, cortical sensory loss, and alien-limb phenomenon. Neuropsychological testing in patients with CBD typically shows deficits in executive functions, praxis, language, and visuospatial functioning, but not in memory. We report a CBD patient with severely impaired memory function but relatively mild motor symptoms. Detailed neuropsychological assessment showed significant verbal and visual memory deficits accompanied by frontal executive dysfunctions. Our observations indicate that CBD can in rare cases present with severe episodic memory impairment associated with frontal executive dysfunctions in the early stage of illness.

PubMed ID#: 19513310 (see pubmed.gov for this abstract only; the abstract is available there for free)

Clinical heterogeneity in PSP (7 Japanese autopsy cases)

These Japanese researchers investigated the clinical symptoms of seven autopsy-confirmed PSP cases. Amazingly, “only three patients (42.9%) matched the clinical diagnostic criteria of PSP” at the time of death. “In addition, only one patient (14.3%) matched these criteria at the time of the initial symptoms. Such underdiagnosis of PSP was mainly caused by heterogeneity, variety of the timing, and presence of symptoms in exclusion criteria. The present study also demonstrated that the clinical features of PSP may change dramatically according to the disease stage. Target symptoms should be selected based on time and stage to optimize patient quality of life.”
Robin

Neuropathology. 2009 Jun 7. [Epub ahead of print]

Clinical heterogeneity in progressive supranuclear palsy: Problems of clinical diagnostic criteria of NINDS-SPSP in a retrospective study of seven Japanese autopsy cases.

Sakamoto R, Tsuchiya K, Mimura M.
Department of Neuropsychiatry, Showa University School of Medicine, Setagaya-ku, Tokyo, Japan.

Progressive supranuclear palsy (PSP) is known to display variable atypical clinical features. In the absence of clinical markers to diagnose PSP, neuropathological examination is the “gold standard” for diagnosis.

We retrospectively investigated clinical features in seven autopsy-confirmed cases of PSP. Only three patients (42.9%) matched the clinical diagnostic criteria of PSP proposed by the National Institute of Neurological Disorders and Stroke and the Society for PSP (NINDS-SPSP) at the time of death. In addition, only one patient (14.3%) matched these criteria at the time of the initial symptoms. Such underdiagnosis of PSP was mainly caused by heterogeneity, variety of the timing, and presence of symptoms in exclusion criteria. The present study also demonstrated that the clinical features of PSP may change dramatically according to the disease stage. Target symptoms should be selected based on time and stage to optimize patient quality of life.

PubMed ID#: 19508347 (see pubmed.gov for this abstract only; the abstract is available for free there)

Combo CoQ10 + creatine – neuroprotective in PD mouse model

This announcement about an animal study in PD that showed that a combo of CoQ10 and creatine produced “neuroprotective effects” was posted today on the Parkinson Forum.

http://forum.parkinson.org/forum/viewtopic.php?t=7557

Dear Friends, the following is interesting, but bear in mind that it is an animal study, and it’s too early to say whether it will apply to humans. Nonetheless, it may be of interest to some.

Best,
Kathrynne Holden, MS, RD
http://www.nutritionucanlivewith.com/

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Coenzyme Q10 and Creatine Show Potential in the Treatment of Neurodegenerative Diseases

Reference: “Combination therapy with coenzyme Q10 and creatine produces additive neuroprotective effects in models of Parkinson’s and Huntington’s diseases,” Yang L, Calingasan NY, et al, J Neurochem, 2009; 109(5): 1427-39. (Address: M. Flint Beal, MD, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, F610, New York, NY 10021, USA. E-mail: [email protected] ).

Summary: In a study involving a mouse model of Parkinson’s disease, a rat model of Huntington’s disease and a transgenic mouse model of Huntington’s disease, administration of coenzyme Q10 and creatine in combination was found to produce additive neuroprotective effects. Specifically, administration of the 2 agents was found to protect against dopamine depletion in the striatum and loss of tyrosine hydroxylase neurons in the substantia nigra pars compacta. In addition, significant reductions in lipid peroxidation and pathologic alpha-synuclein accumulation in the SNpc neurons was found, as well as reductions in striatal lesion volumes. The treatment was found to significantly block 3-NP-induced impairment of glutathione homeostasis and reduce lipid peroxidation and DNA oxidative damage in the striatum. Moreover, it was found to improve motor performance and extend survival in the mouse model of Huntington’s disease. These results suggest that the combination of co enzyme Q10 and creatine hold potential as therapeutic agents in the treatment of neurodegenerative conditions such as Parkinson’s disease and Huntington’s disease.

“Revealed: how Alzheimer’s infects the brain”(tau)

Here’s an excerpt from a newspaper article on a breakthrough discovery in Alzheimer’s Disease: “It is the first time that scientists have detected infectious properties in the so-called tau protein which causes aggregates of particles known as ‘neurofibrillary tangles’ to build up inside the brain cells of Alzheimer’s patients. The tangles lead to the disease’s symptoms. [The] researchers emphasised that the discovery does not mean that the disease itself is infectious, only that the tau protein seen in Alzheimer’s disease is able to convert otherwise healthy brain proteins into the defective form associated with the disease.”

PSP and CBD, like AD, are tauopathies – disorders of tau protein.

http://www.independent.co.uk/news/scien … 99214.html

Revealed: how Alzheimer’s infects the brain
Breakthrough may lead to new treatments for senile dementia
By Steve Connor, Science Editor
The Independent (UK newspaper)
Monday, 8 June 2009

A scientific breakthrough in the understanding of how Alzheimer’s disease may spread across the brain of elderly patients might lead to novel ways of treating senile dementia, scientists have announced.

A study has discovered that a key brain protein linked with Alzheimer’s disease has infectious properties that allow defects in the protein to be transmitted through the brain and so leads to debilitating neuro-degeneration.

It is the first time that scientists have detected infectious properties in the so-called tau protein which causes aggregates of particles known as “neurofibrillary tangles” to build up inside the brain cells of Alzheimer’s patients. The tangles lead to the disease’s symptoms.

But the researchers emphasised that the discovery does not mean that the disease itself is infectious, only that the tau protein seen in Alzheimer’s disease is able to convert otherwise healthy brain proteins into the defective form associated with the disease.

Alzheimer’s disease is one of the fastest growing and most costly medical conditions. About 700,000 people in the UK have some form of dementia and this will grow to about 940,000 by 2015, rising to more than 1.7 million by 2051 as a result of the demographic time bomb of an ageing population.

Medical researchers believe that the latest findings – which have so far been shown in laboratory mice rather than human patients – could open up new ways of treating Alzheimer’s disease by developing drugs that block the tau’s infectious properties.

The results of the study also show that Alzheimer’s disease has underlying similarities to Creutzfeldt-Jakob disease (CJD), a brain disease that is believed to be caused by other kinds of infectious proteins called “prions” which can, under certain circumstances, be transmitted from one person to another.

Scientists have known for many years that the brain cells of Alzheimer’s patients experience a build up of tau protein in the form of complicated tangles and that these tangles spread in a characteristic fashion through the brain.

The latest study, published in the journal Nature Cell Biology, offers the first proper explanation for how these tangles spread and suggests a possible target for drug companies hoping to develop ways of slowing down the progression of Alzheimer’s disease.

“This opens new avenues in dementia research that will aim to understand how abnormal tau can spread. We can also investigate how diseases caused by tau aggregates and prions are similar,” said Michel Goedert of the Medical Research Council’s Laboratory of Molecular Biology in Cambridge.

“We have looked at whether tau tangles can spread in mice. The injection of brain extract from tangle-bearing mice into animals without tangles caused their tau to tangle and spread from the sites of injection to neighbouring brain regions,” said Dr Goedert, who took part in the study.

The scientists used a strain of genetically modified mouse with a gene for the human form of the defective tau protein. When the tau of this mouse was injected into the brain of ordinary laboratory mice, it caused a build-up of the same sort of tangles seen in Alzheimer’s patients.

“This research in mice does not show that tau pathology is contagious or that it can spread easily from mouse to mouse. What it has revealed is how tau tangles spread within brain tissues of individual mice,” Dr Goedert said.

“It suggests that tangles of proteins that build up in the brain to cause symptoms could have some contagious properties, within brain tissue but not between mice that haven’t been injected with tissue from another mouse and certainly not between people,” he said.

There is no epidemiological evidence that brain diseases like Alzheimer’s or Parkinson’s can spread from one person to another and the latest study does not suggest that such disorders are caused by an infection, said David Allsop, professor of neuroscience at Lancaster University.

“This is interesting because it could explain how tangles spread from one region of the brain to another during the course of Alzheimer’s disease and some other ‘tangle’ diseases,” Professor Allsop said.

Susanne Sorensen, the head of research at the Alzheimer’s Society, said that the study could result in a greater understanding of how tau tangles form and spread through the brain.

“There is still so much we do not understand about the changes in tau that lead to tangle formation in humans and, eventually, widespread cell death,” Dr Sorensen said. “Each new piece of knowledge helps to build a better picture and takes us closer to the point where we can stop loss of brain tissue and dementia for good.”

Rebecca Wood, the chief executive of the Alzheimer’s Research Trust, said: “This greater understanding of how tangles spread in Alzheimer’s may lead to new ways of stopping them and defeating the disease.”