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WriteClick Editor’s Choice
Robert C. Griggs, MD
Editors’ Note: In reference to “Imaging prodromal Parkinson disease: The Parkinson Associated Risk Syndrome Study,” Drs. Mu¨ller et al. point out that hyposmia can be a sign of early neurodegeneration in Alzheimer disease (AD) as well as Parkinson disease. Authors Jennings et al. concur and describe how they are expanding the Parkinson Associated Risk Syndrome Study to look at prodromal AD. Dr. Braillon questions several conclusions made in “Healthy diet and lifestyle and risk of stroke in a prospective cohort of women,” the benefit of modest alcohol consumption in particular. Authors Larsson and A˚kesson discuss the findings in more detail. —Megan Alcauskas, MD, and Robert C. Griggs, MD
IMAGING PRODROMAL PARKINSON DISEASE: THE PARKINSON ASSOCIATED RISK SYNDROME STUDY
Martijn L.T.M. Müller, Roger L. Albin, Nicolaas I. Bohnen, Ann Arbor, MI: Jennings et al.1 reported striatal dopamine transporter SPECT (DAT) findings in hyposmic but otherwise healthy subjects, compared to subjects without hyposmia. These findings suggest that hyposmia, especially in combination with other Parkinson disease (PD) risk factors, may serve as a screening tool to identify subjects with prodromal PD. However, abnormal DAT findings were found in 11% of hyposmic subjects only, and the inclusion of other PD risk factors increased this percentage to only ;40%. A possible explanation may be the presence of Alzheimer-type pathology in the olfactory bulb and its projection areas rather than a-synucleinopathy.2 Olfactory loss is also an early sign of Alzheimer disease (AD).3 We suggest that hyposmia is a sensitive marker of early neurodegeneration. There is a relatively high frequency of a-synucleinopathy and amyloidopathy in relatively healthy cognitively normal older adults.4,5 Present definitions of hyposmia in the elderly—such as the 15th percentile cutoff used in this article—may exclude individuals with mild hyposmia secondary to neurodegeneration. Further studies are required to redefine normative data for hyposmia in older subjects, which should be defined in the absence of prodromal Lewy or Alzheimer-type pathologies. 2292
Neurology 84
Author Response: Danna Jennings, New Haven, CT; Andrew Siderowf, Matthew Stern, Philadelphia, PA; John Seibyl, New Haven, CT; Shirley Eberly, David Oakes, Rochester, NY; Kenneth Marek, New Haven, CT: As Müller et al. noted, it has been shown that hyposmia is a sensitive, but nonspecific marker for PD, AD, and possibly other neurodegenerative disorders. Nearly all patients with PD and AD are hyposmic, yet a small percentage of individuals with hyposmia have a neurologic etiology, with the most common causes being postinfection and posttraumatic disease (70%).6 While the Parkinson Associated Risk Syndrome (PARS) Study was designed to examine hyposmia in combination with DAT imaging as a strategy to identify individuals with prodromal PD, we recognize that the PARS cohort is also enriched for prodromal AD based on their hyposmic status. We have therefore expanded the PARS Study to include extensive cognitive evaluations and amyloid imaging of hyposmic subjects to identify individuals with prodromal AD. In addition, we acknowledge that utilizing the less than 15th percentile cutoff for the University of Pennsylvania Smell Identification Test may have eliminated healthy adults with amyloidopathy or a-synucleinopathy. However, this is of lesser concern as the goal of PARS was to identify individuals with the greatest probability of having a DAT deficit (those with the most severe hyposmia) and ultimately highest likelihood of phenoconversion to PD. © 2015 American Academy of Neurology 1.
2.
3.
4.
5.
6.
Jennings D, Siderowf A, Stern M, et al. Imaging prodromal Parkinson disease: The Parkinson Associated Risk Syndrome Study. Neurology 2014;83:1739–1746. Braak H, Braak E. Staging of Alzheimer’s disease-related neurofibrillary changes. Neurobiol Aging 1995;16:271–278; discussion 278–284. Barresi M, Ciurleo R, Giacoppo S, et al. Evaluation of olfactory dysfunction in neurodegenerative diseases. J Neurol Sci 2012; 323:16–24. Aizenstein HJ, Nebes RD, Saxton JA, et al. Frequent amyloid deposition without significant cognitive impairment among the elderly. Arch Neurol 2008;65:1509–1517. Adler CH, Connor DJ, Hentz JG, et al. Incidental Lewy body disease: clinical comparison to a control cohort. Mov Disord 2010;25:642–646. Fonteyn S, Huart C, Deggouj N, Collet S, Eloy P, Rombaux P. Non-sinonasal-related olfactory dysfunction: a cohort of 496 patients. Eur Ann Otorhinol Head Neck Dis 2014;131:87–91.
June 2, 2015
ª 2015 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
Imaging prodromal Parkinson disease: The Parkinson Associated Risk Syndrome Study Martijn L.T.M. Müller, Danna Jennings, Roger L. Albin, et al. Neurology 2015;84;2292 DOI 10.1212/WNL.0000000000001654 This information is current as of June 1, 2015 Updated Information & Services
including high resolution figures, can be found at: http://www.neurology.org/content/84/22/2292.full.html
References
This article cites 6 articles, 1 of which you can access for free at: http://www.neurology.org/content/84/22/2292.full.html##ref-list-1
Permissions & Licensing
Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions
Reprints
Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus
Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2015 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.
®
WriteClick Editor’s Choice
Robert C. Griggs, MD
Editors’ Note: In reference to “Imaging prodromal Parkinson disease: The Parkinson Associated Risk Syndrome Study,” Drs. Mu¨ller et al. point out that hyposmia can be a sign of early neurodegeneration in Alzheimer disease (AD) as well as Parkinson disease. Authors Jennings et al. concur and describe how they are expanding the Parkinson Associated Risk Syndrome Study to look at prodromal AD. Dr. Braillon questions several conclusions made in “Healthy diet and lifestyle and risk of stroke in a prospective cohort of women,” the benefit of modest alcohol consumption in particular. Authors Larsson and A˚kesson discuss the findings in more detail. —Megan Alcauskas, MD, and Robert C. Griggs, MD
IMAGING PRODROMAL PARKINSON DISEASE: THE PARKINSON ASSOCIATED RISK SYNDROME STUDY
Martijn L.T.M. Müller, Roger L. Albin, Nicolaas I. Bohnen, Ann Arbor, MI: Jennings et al.1 reported striatal dopamine transporter SPECT (DAT) findings in hyposmic but otherwise healthy subjects, compared to subjects without hyposmia. These findings suggest that hyposmia, especially in combination with other Parkinson disease (PD) risk factors, may serve as a screening tool to identify subjects with prodromal PD. However, abnormal DAT findings were found in 11% of hyposmic subjects only, and the inclusion of other PD risk factors increased this percentage to only ;40%. A possible explanation may be the presence of Alzheimer-type pathology in the olfactory bulb and its projection areas rather than a-synucleinopathy.2 Olfactory loss is also an early sign of Alzheimer disease (AD).3 We suggest that hyposmia is a sensitive marker of early neurodegeneration. There is a relatively high frequency of a-synucleinopathy and amyloidopathy in relatively healthy cognitively normal older adults.4,5 Present definitions of hyposmia in the elderly—such as the 15th percentile cutoff used in this article—may exclude individuals with mild hyposmia secondary to neurodegeneration. Further studies are required to redefine normative data for hyposmia in older subjects, which should be defined in the absence of prodromal Lewy or Alzheimer-type pathologies. 2292
Neurology 84
Author Response: Danna Jennings, New Haven, CT; Andrew Siderowf, Matthew Stern, Philadelphia, PA; John Seibyl, New Haven, CT; Shirley Eberly, David Oakes, Rochester, NY; Kenneth Marek, New Haven, CT: As Müller et al. noted, it has been shown that hyposmia is a sensitive, but nonspecific marker for PD, AD, and possibly other neurodegenerative disorders. Nearly all patients with PD and AD are hyposmic, yet a small percentage of individuals with hyposmia have a neurologic etiology, with the most common causes being postinfection and posttraumatic disease (70%).6 While the Parkinson Associated Risk Syndrome (PARS) Study was designed to examine hyposmia in combination with DAT imaging as a strategy to identify individuals with prodromal PD, we recognize that the PARS cohort is also enriched for prodromal AD based on their hyposmic status. We have therefore expanded the PARS Study to include extensive cognitive evaluations and amyloid imaging of hyposmic subjects to identify individuals with prodromal AD. In addition, we acknowledge that utilizing the less than 15th percentile cutoff for the University of Pennsylvania Smell Identification Test may have eliminated healthy adults with amyloidopathy or a-synucleinopathy. However, this is of lesser concern as the goal of PARS was to identify individuals with the greatest probability of having a DAT deficit (those with the most severe hyposmia) and ultimately highest likelihood of phenoconversion to PD. © 2015 American Academy of Neurology 1.
2.
3.
4.
5.
6.
Jennings D, Siderowf A, Stern M, et al. Imaging prodromal Parkinson disease: The Parkinson Associated Risk Syndrome Study. Neurology 2014;83:1739–1746. Braak H, Braak E. Staging of Alzheimer’s disease-related neurofibrillary changes. Neurobiol Aging 1995;16:271–278; discussion 278–284. Barresi M, Ciurleo R, Giacoppo S, et al. Evaluation of olfactory dysfunction in neurodegenerative diseases. J Neurol Sci 2012; 323:16–24. Aizenstein HJ, Nebes RD, Saxton JA, et al. Frequent amyloid deposition without significant cognitive impairment among the elderly. Arch Neurol 2008;65:1509–1517. Adler CH, Connor DJ, Hentz JG, et al. Incidental Lewy body disease: clinical comparison to a control cohort. Mov Disord 2010;25:642–646. Fonteyn S, Huart C, Deggouj N, Collet S, Eloy P, Rombaux P. Non-sinonasal-related olfactory dysfunction: a cohort of 496 patients. Eur Ann Otorhinol Head Neck Dis 2014;131:87–91.
June 2, 2015
ª 2015 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
Imaging prodromal Parkinson disease: The Parkinson Associated Risk Syndrome Study Martijn L.T.M. Müller, Danna Jennings, Roger L. Albin, et al. Neurology 2015;84;2292 DOI 10.1212/WNL.0000000000001654 This information is current as of June 1, 2015 Updated Information & Services
including high resolution figures, can be found at: http://www.neurology.org/content/84/22/2292.full.html
References
This article cites 6 articles, 1 of which you can access for free at: http://www.neurology.org/content/84/22/2292.full.html##ref-list-1
Permissions & Licensing
Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions
Reprints
Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus
Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2015 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.
