[Show abstract][Hide abstract] ABSTRACT: In amyotrophic lateral sclerosis (ALS), prognosis is usually based on death or tracheostomy as outcomes. Nevertheless, the early course is known to be a reliable indicator of the whole course of the disease.1 The identification of outcomes in early stages would determine better planning of interventions and more appropriate stratification of newly diagnosed patients for randomised clinical trials (RCTs). The time of disease spread is probably linked to the rate of progression and the intensity of neuro-axonal degeneration,2 and it has already been related to survival in ALS.3 The aim of the present study was to evaluate if time to generalisation (TTG) may predict survival in ALS.
Journal of neurology, neurosurgery, and psychiatry 05/2015; DOI:10.1136/jnnp-2014-308478 · 5.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Amyotrophic lateral sclerosis (ALS) is a rapidly progressive disorder characterized primarily by selective neurodegeneration of the motor neurons. The basis of diagnosis is the presence of signs of both upper and lower motor neuron involvement in more than one body region. ALS was considered until a few years ago a disease of young adults but recently population-based studies have consistently shown that ALS is an age-related disease with age incidence curve similar to other age-dependent neurodegenerative diseases like Parkinson’s disease and Alzheimer’s disease. The peak of incidence is in the eighth decade and declines thereafter, first in men and then in women. In the majority of cases, ALS is sporadic while 5-10 % of the disease is familiar. After the identification of C9ORF72, it is now recognized that the definition of familial ALS can be enlarged to include family members with frontotemporal dementia considering the tight link between the two nosological entities.
[Show abstract][Hide abstract] ABSTRACT: Presbycusis or age related hearing loss (ARHL) is the most common sensory deficit in the elderly. It is a multifactorial condition that involves a multitude of intrinsic and extrinsic factors acting on the inner ear over a lifetime, which cumulatively lead to impairments in cochlear transduction of acoustic signals. ARHL is characterized by a loss of hearing sensitivity and a decreased ability to understand speech in the presence of background noise. Epidemiological studies have shown that in the USA hearing loss prevalence approximately doubles every decade of life from the second through to the seventh decade. In Europe, approximately 30% of males and 20% of females have a hearing loss of 30dB HL or more at age 70 years, and 55% of males and 45% of females at age 80 years. Central auditory processing disorders (CAPD) refer to an impairment in the central auditory pathways that leads to impaired speech understanding. The prevalence of CAPD in subjects older than 65 years has been reported to be between 9% and 14%. Recent studies have highlighted the strict correlation between ARHL and cognition in older adults; in particular, hearing impairment could precede the onset of mild cognitive impairment and dementia. The use of hearing tests, and the early diagnosis and treatment of ARHL, may potentially represent a way to prevent cognitive impairment and deserves further research.
[Show abstract][Hide abstract] ABSTRACT: Forced vital capacity (FVC) shows limitations in detecting respiratory failure in the early phase of amyotrophic lateral sclerosis (ALS). In fact, mild-to-moderate respiratory muscle weakness may be present even when FVC is normal, and ALS patients with bulbar involvement might not be able to perform correctly the spirometry test. Sniff nasal inspiratory pressure (SNIP) is correlated with transdiaphragmatic strength. We evaluated SNIP at baseline as a prognostic factor of tracheostomy or death in patients with ALS. In a multidisciplinary tertiary care center for motorneuron disease, we enrolled 100 patients with ALS diagnosed with El Escorial criteria in the period between January 2006 and December 2010. Main outcome measures were tracheostomy or death. RECursive Partitioning and AMalgamation (RECPAM) analysis was also used to identify subgroups at different risks for the tracheostomy or death. Twenty-nine patients with ALS reached the outcome (12 died and 17 had tracheostomy). Using a multivariate model SNIP correctly classified the risk of the composite event within 1 year of follow-up with a continuous Net Reclassification Improvement cNRI of 0.58 (p = 0.03). Sex, Amyotrophic Lateral Sclerosis Functional Rating Scale revisited, site of onset, and FVC did not improve the classification of prognostic classes. SNIP ≤18 cmH2O identified the RECPAM class with the highest risk (Class 1, hazard ratio = 9.85, 95 % confidence interval: 2.67–36.29, p
Journal of Neurology 12/2014; DOI:10.1007/s00415-014-7613-3 · 3.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hereditary spastic paraplegia (HSP) includes a group of diseases characterized by progressive spastic weakness of the lower limbs (pure forms) with possible additional signs (complicated forms). The SPG10 form is due to alteration in the kinesin1A gene (KIF5A) that encodes the neuronal kinesin heavy chain, a protein required for the anterograde axonal transport. We performed clinical, neurophysiological and molecular studies in two siblings affected by AD-HSP complicated by deafness. The screening of the KIF5A gene revealed the novel mutation p.Leu259Gln in two affected siblings and in their father with a pure form of HSP.
Journal of the Neurological Sciences 06/2014; 343(1-2). DOI:10.1016/j.jns.2014.05.063 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The need for preventing or postponing the onset of Alzheimer’s disease (AD) and delaying or slowing its progression is a direct consequence of the current symptomatic approach of existing drugs for the treatment of AD. Dietary factors may affect the risk of AD and dementia, with a substantial body of evidence suggesting that certain diets have been associated with a lower incidence of AD and late-life cognitive disorders. Among healthy diets, higher adherence to a Mediterranean-type diet and to the Dietary Approaches to Stop Hypertension diet was associated with decreased cognitive decline, although the Mediterranean diet (MeDi) combines several foods, micro-, and macronutrients already separately proposed as potential protective factors against dementia. Higher adherence to the MeDi was associated with a reduced risk of cognitive impairment, MCI, and AD, as well as the transition from MCI to AD, and decreased all-causes mortality in AD patients. Influencing some age-related conditions, such as frailty, may have an impact on the prevention of late-life cognitive decline. Frailty reflects a nonspecific state of vulnerability and a multisystem physiological change and it is a widely recognized risk factor for adverse health outcomes in older persons. At present, no operational definition has been established, although nutritional status, cognition, and mood have been proposed as markers of frailty. Physical frailty may be associated with late-life cognitive impairment/decline, incidence of AD, vascular dementia, non-AD dementias, and AD pathology in older persons with and without dementia, also suggesting the definition of cognitive frailty as a new clinical condition. The reviewed evidence supports the hypothesis that frailty could be important in the prevention of late-life cognitive disorders, and nutritional influences may be of major relevance. Nutritional interventions might be able to address the impaired nutrition and weight loss of frailty. There is a critical need for randomized, controlled trials investigating the role of nutrition on late-life cognitive disorders and frailty that might open new routes for the prevention and management of cognitive decline and AD, supplementing existing symptomatic approaches, also through the nutritional prevention of frailty.
[Show abstract][Hide abstract] ABSTRACT: Background and purposeTo evaluate whether cerebrospinal fluid (CSF) neurofilament light chain (NFL) levels could predict the time to generalization (TTG) in amyotrophic lateral sclerosis (ALS).Methods
Cerebrospinal fluid NFL levels of 37 cases of sporadic ALS were measured and the time of symptom spreading from spinal or bulbar localization to both (TTG) was evaluated in all patients.ResultsKaplan−Meier analysis showed a short TTG in patients with high NFL levels (log-rank test chi-squared = 19.4, P < 0.0001). In a multivariate regression model patients with NFL levels above the median had an eight-fold higher risk of generalization (adjusted hazard ratio 7.9, 95% confidence interval 2.9–21.4, P < 0.0001) compared with those with NFL levels below the median.Conclusions
This study shows that in sporadic ALS NFL, a marker of neurodegeneration, is correlated with TTG, a clinical intermediate parameter of survivorship.
European Journal of Neurology 04/2014; 22(1). DOI:10.1111/ene.12421 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Both active and passive anti-β-amyloid (Aβ) immunotherapies for the treatment of Alzheimer's disease (AD) have demonstrated clearance of brain Aβ deposits. Among passive immunotherapeutics, two Phase III clinical trials in mild-to-moderate AD patients with bapineuzumab, a humanized monoclonal antibody directed at the N-terminal sequence of Aβ, were disappointing. Also solanezumab, directed at the mid-region of Aβ, failed in two Phase III trials in mild-to-moderate AD. Another Phase III trial with solanezumab is ongoing in mildly affected AD patients based on encouraging results in this subgroup. Second-generation active Aβ vaccines (CAD106, ACC-001, and Affitope AD02) and new passive anti-Aβ immunotherapies (gantenerumab and crenezumab) have been developed and are under clinical testing. These new anti-Aβ immunotherapies are being tested in prodromal AD, in presymptomatic subjects with AD-related mutations, or in asymptomatic subjects at risk of developing AD. These primary and secondary prevention trials will definitely test the Aβ cascade hypothesis of AD.
[Show abstract][Hide abstract] ABSTRACT: Amyotrophic lateral sclerosis (ALS) has heterogeneous clinical features that could be translated into specific patterns of brain atrophy. In the current study we have evaluated the relationship between different clinical expressions of classical ALS and measurements of brain cortical thickness. Cortical thickness analysis was conducted from 3D-MRI using FreeSurfer software in 29 ALS patients and 20 healthy controls. We explored three clinical traits of the disease, subdividing the patients into two groups for each of them: the bulbar or spinal onset, the higher or lower upper motor neuron burden, the faster or slower disease progression. We used both a whole brain vertex-wise analysis and a ROI analysis on primary motor areas. ALS patients showed cortical thinning in bilateral precentral gyrus, bilateral middle frontal gyrus, right superior temporal gyrus and right occipital cortex. ALS patients with higher upper motor neuron burden showed a significant cortical thinning in the right precentral gyrus and in other frontal extra-motor areas, compared to healthy controls. ALS patients with spinal onset showed a significant cortical thinning in the right precentral gyrus and paracentral lobule, compared to healthy controls. ALS patients with faster progressive disease showed a significant cortical thinning in widespread bilateral frontal and temporal areas, including the bilateral precentral gyrus, compared to healthy controls. Focusing on the primary motor areas, the ROI analysis revealed that the mean cortical thickness values were significantly reduced in ALS patients with higher upper motor neuron burden, spinal onset and faster disease progression related to healthy controls. In conclusion, the thickness of primary motor cortex could be a useful surrogate marker of upper motor neuron involvement in ALS; also our results suggest that cortical thinning in motor and non motor areas seem to reflect the clinical heterogeneity of the disease.
PLoS ONE 11/2013; 8(11):e80748. DOI:10.1371/journal.pone.0080748 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Copper-zinc superoxide dismutase-1 (SOD1) is the second most common mutated gene in amyotrophic lateral sclerosis (ALS). To date more than 150 missense mutations of SOD1 have been reported. The objective of this study was to describe a novel SOD1 mutation and its phenotypic expression. We describe a 74-year-old Caucasian man who began to complain of progressive weakness and atrophy of the right hand and over 10 months developed a severe tetraparesis, with atrophies of upper and lower limbs and neck muscles, dysphagia, and dyspnea that led to percutaneous endoscopic gastrostomy and tracheotomy. A diagnosis of ALS was made. Genetic analysis identified a heterozygous mutation in exon 4 of SOD1 that results in the amino acid substitution from arginine to cysteine at position 115 (p.R115C). We identified a novel pathogenic SOD1 mutation in a patient with a very rapid disease progression and aggressive phenotype providing additional information on the wide range of SOD1 mutations in apparently sporadic ALS and confirming the possibility of a strong genotype-phenotype correlation for distinct SOD1 mutations.
Neurobiology of aging 11/2012; 34(6). DOI:10.1016/j.neurobiolaging.2012.10.027 · 4.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: To date there are no biomarkers with proven reliability as measure of disease burden in amyotrophic lateral sclerosis (ALS). The aim of our study is to assess the neurofilament light chain (NFL) in cerebrospinal fluid (CSF) samples as a measure of disease activity and progression in ALS. METHODS: Thirty-seven consecutive patients with ALS, 25 with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and 21 with other neurodegenerative diseases (OND) were evaluated. CSF NFL levels were assayed by two-site solid-phase sandwich ELISA. In patients with ALS, neurological status was assessed by revised ALS Functional Rating Scale (ALSFRS-r) and Medical Research Council (MRC), and the progression of the disease was evaluated using the 'diagnostic delay' and the 'progression rate'. RESULTS: Cerebrospinal fluid NFL levels were higher in ALS cases than in controls (P < 0.0001). Using the Receiver Operating Curve (ROC) analysis, an optimal NFL cut-off of 1981 ng/l discriminated between patients with ALS and neurological controls, with a sensitivity of 78.4% and specificity of 72.5%. Multivariate logistic regression confirmed the association between CSF NFL levels and the presence of ALS (age and sex adjusted odds ratio for ALS 8.9; 95% CI 3.1-25.8; P < 0.0001). In ALS, CSF NFL negatively correlated with the diagnostic delay (P < 0.0001) and the ALSFRS-r (P = 0.014) and positively with the progression rate (P < 0.0001). CONCLUSIONS: High CSF NFL levels were found in patients with ALS, reflecting the burden of neurodegeneration. The significant relation between CSF NFL levels and disease progression suggests that NFL may be a useful marker of disease activity and progression in ALS.
European Journal of Neurology 06/2012; 19(12). DOI:10.1111/j.1468-1331.2012.03777.x · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: N -acetylaspartate (NAA) level is a biomarker of functional integrity and vitality in neurons. In vivo multisection proton ((1)H)-magnetic resonance spectroscopy studies indicate that NAA level decreases in specific cortical brain areas of patients with amyotrophic lateral sclerosis (ALS).
To study NAA level in serum samples as a possible biomarker of ALS.
Serum NAA assay by liquid chromatography-mass spectrometry in a case-control series.
Department of Neurological and Psychiatric Sciences, Policlinico, University of Bari, Bari, Italy.
One hundred twelve consecutive patients with ALS and 51 age- and sex-matched healthy control subjects.
General estimating equations tested associations between serum NAA level and clinical variables in patients with ALS.
Serum NAA level was significantly higher in ALS cases than in controls. Multivariate logistic regression analysis showed a direct association between serum NAA level and the presence of ALS. After stratifying serum NAA level based on the median value (0.171 mmol/L), the age- and sex-adjusted odds ratio for ALS was 19.97 (95% confidence interval, 7.18-55.55) (P < .001). N -acetylaspartate level did not differ across ALS clinical phenotypes. Riluzole treatment did not affect NAA level. A significant correlation was found between serum NAA level and ALS progression rate.
High serum NAA level was found in patients with ALS, which may relate to greater excretion of NAA into the blood circulation following increased release of this metabolite from damaged neurons. The correlation between serum NAA level and disease progression rate suggests that it may be a useful biomarker of ALS.
Archives of neurology 10/2011; 68(10):1308-12. DOI:10.1001/archneurol.2011.217 · 7.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Urate is a natural antioxidant, and high serum urate levels could be protective against the development of amyotrophic lateral sclerosis (ALS). To determine if serum urate concentrations were lower in ALS patients than in healthy controls, we compared serum urate levels in 132 ALS patients and 337 age/sex-matched controls. Median urate levels were lower in ALS patients compared to controls (4.2mgl/dL [range:1.4-8.2], vs. 4.7 [1.7-13.1]; p = 0.04). In univariate analysis, high urate levels were less likely to be associated with ALS (odds ratio [OR]: 0.53; 95% CI: 0.29-0.97; p = 0.04), but after adjusting for age, sex and kidney function, the association was not statistically significant (OR: 0.63; 95% CI: 0.32-1.24; p = 0.18). Urate levels were lower in bulbar-onset ALS (3.9 mg/dL), compared to limb-onset ALS (4.3; p = 0.001), and in cases with longer disease duration compared to controls (4.1 mg/dL, vs. 4.7; p = 0.01). In this cross-sectional study, lower levels of serum urate were evident in ALS cases with bulbar-onset and longer disease duration, but were likely to be related to the malnutrition induced by ALS.
Journal of Neurology 02/2011; 258(2):238-43. DOI:10.1007/s00415-010-5735-9 · 3.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The pathophysiological mechanism of the pain in ALS is still unclear. The aim of the study was to evaluate the laser evoked potentials (LEPs) in ALS patients in relation to their clinical features. Twenty-four ALS patients were selected. Pain features were assessed and their intensity was measured by a 0-10 VAS. LEPs were recorded in all patients and in 23 healthy subjects. The dorsum of both hands was stimulated, at laser stimuli intensity of 7.5 W, with 10s inter-stimulus interval and 25 ms duration. Four electrodes were placed at Cz, T3, T4 and Fz positions, with the reference electrode at the nasion; T3 and T4 electrodes were referred off-line to Fz, in order to detect the N1 component. Latencies of N2, P2 and N1 waves were significantly higher in ALS than in controls. N1 amplitude was significantly increased in ALS patients compared to controls, with a similar trend for the N2-P2 complex. No correlation was found between LEP abnormalities, pain intensity and clinical features. A degeneration of subcortical structures may subtend a delay in the afferent input to the nociceptive cortex in ALS. On the other hand, an increase of pain processing at the cortical level may derive from a potential sensory compensation to motor cortex dysfunction.
Journal of the neurological sciences 10/2009; 288(1-2):106-11. DOI:10.1016/j.jns.2009.09.023 · 2.26 Impact Factor