Roger Gil

Abnormal retinal thickness in patients with mild cognitive impairment and Alzheimer's disease.

In Alzheimers disease (AD), brain lesions are marked by severe neuronal loss and retinal degeneration was previously mentioned in affected patients. Mild cognitive impairment (MCI) is a clinical syndrome that could be an early phase of AD. In this study, using optical coherence tomography (OCT), the retinal nerve fiber layer (RNFL) thickness was assessed in patients with mild AD, moderate to severe AD, amnestic MCI and control subjects. The results show that RNFL thickness is statistically reduced in patients with MCI, mild AD or moderate to severe AD compared to controls. In addition, no statistical difference was found between the results in MCI patients and mild AD patients. The RNFL seems to be involved early during the course of amnestic MCI and OCT tests could be carried out in patients with cognitive troubles.

Functional Recovery and Social Outcome after Cerebral Infarction in Young Adults

This study was designed to assess the return to work, the poststroke depression and the quality of life after a cerebral infarction in young adults and was conducted on 71 consecutive young patients (aged 15–45 years) affected by a cerebral infarct who were hospitalized for the first time and discharged at least 1 year before the study. Data about risk factors, etiology, side and territory of stroke, social characteristics of the patient (age, sex, profession, educational level, family situation), poststroke seizures, recurrent stroke, other vascular events, and deaths were collected. Neurological deficits were graded with the National Institutes of Health (NIH) Stroke Scale. Poststroke depression (PSD) was quantified using the DSM-IIIR criteria and the Montgomery Asberg Depression Rating Scale. Outcomes were rated with the Ranking Scale, the Barthel Index and the Glasgow Outcome Scale. Quality of life was assessed with the Sickness Impact Profile. Follow-up information was obtained by interview and neurological examination. Follow-up information was obtained in 65 patients at a mean of 31.7 ± 13.0 (range 12–59) months, as 2 patients died and 4 were lost to follow-up and were thus excluded from this study. Poststroke seizures occurred in 7 patients (10.8%) and recurrent strokes in 4 patients (6.2%), but none were fatal. The outcome after stroke among survivors was usually good, since more than two-thirds of the patients (69.8%) reported no problem, 11.1% moderate handicap and one-fifth major handicap. Forty-six patients (73%) returned to work; the time period ranging from several days after stroke to 40 months, with a mean of 8 months. However, adjustments in their occupation were necessary for 12 patients (26.1%). PSD was common, since 48.3% of the patients were classified as depressed. PSD was associated with the localization of the infarct (carotid territory), a severe disability, a bad general outcome, and an absence of return to work. Their opinion about their quality of life was negative among approximately 30% of the patients, especially in emotional and alertness behaviors, social interaction, recreation and pastimes.The general outcome after cerebral infarct in young adults is usually good. However, the risk of a PSD is high, and only half of the patients had returned to their previous work. A remaining psychosocial handicap and depression of sexual activity impaired the quality of life. In multivariate analysis, a low NIH score at admission is a significant predictor for return to work, the absence of PSD, and a good quality of life.

mTOR/p70S6k signalling alteration by Aβ exposure as well as in APP‐PS1 transgenic models and in patients with Alzheimer's disease

In Alzheimers disease, neuropathological hallmarks include the accumulation of β‐amyloid peptides (Aβ) in senile plaques, phosphorylated tau in neurofibrillary tangles and neuronal death. Aβ is the major aetiological agent according to the amyloid cascade hypothesis. Translational control includes phosphorylation of the kinases mammalian target of rapamycin (mTOR) and p70S6k which modulate cell growth, proliferation and autophagy. It is mainly part of an anti‐apoptotic cellular signalling. In this study, we analysed modifications of mTOR/p70S6k signalling in cellular and transgenic models of Alzheimers disease, as well as in lymphocytes of patients and control individuals. Aβ 1–42 produced a rapid and persistent down‐regulation of mTOR/p70S6k phosphorylation in murine neuroblastoma cells associated with caspase 3 activation. Using western blottings, we found that phosphorylated forms of mTOR and p70S6k are decreased in the cortex but not in the cerebellum (devoid of plaques) of double APP/PS1 transgenic mice compared with control mice. These results were confirmed by immunohistochemical methods. Finally, the expression of phosphorylated p70S6k was significantly reduced in lymphocytes of Alzheimers patients, and levels of phosphorylated p70S6k were statistically correlated with Mini Mental Status Examination (MMSE) scores. Taken together, these findings demonstrate that the mainly anti‐apoptotic mTOR/p70S6k signalling is altered in cellular and transgenic models of Alzheimers disease and in peripheral cells of patients, and could contribute to the pathogenesis of the disease.

Exhaustive analysis of BH4 and dopamine biosynthesis genes in patients with Dopa-responsive dystonia

Dopa-responsive dystonia is a childhood-onset dystonic disorder, characterized by a dramatic response to low dose of L-Dopa. Dopa-responsive dystonia is mostly caused by autosomal dominant mutations in the GCH1 gene (GTP cyclohydrolase1) and more rarely by autosomal recessive mutations in the TH (tyrosine hydroxylase) or SPR (sepiapterin reductase) genes. In addition, mutations in the PARK2 gene (parkin) which causes autosomal recessive juvenile parkinsonism may present as Dopa-responsive dystonia. In order to evaluate the relative frequency of the mutations in these genes, but also in the genes involved in the biosynthesis and recycling of BH4, and to evaluate the associated clinical spectrum, we have studied a large series of index patients (n = 64) with Dopa-responsive dystonia, in whom dystonia improved by at least 50% after L-Dopa treatment. Fifty seven of these patients were classified as pure Dopa-responsive dystonia and seven as Dopa-responsive dystonia-plus syndromes. All patients were screened for point mutations and large rearrangements in the GCH1 gene, followed by sequencing of the TH and SPR genes, then PTS (pyruvoyl tetrahydropterin synthase), PCBD (pterin-4a-carbinolamine dehydratase), QDPR (dihydropteridin reductase) and PARK2 (parkin) genes. We identified 34 different heterozygous point mutations in 40 patients, and six different large deletions in seven patients in the GCH1 gene. Except for one patient with mental retardation and a large deletion of 2.3 Mb encompassing 10 genes, all patients had stereotyped clinical features, characterized by pure Dopa-responsive dystonia with onset in the lower limbs and an excellent response to low doses of L-Dopa. Dystonia started in the first decade of life in 40 patients (85%) and before the age of 1 year in one patient (2.2%). Three of the 17 negative GCH1 patients had mutations in the TH gene, two in the SPR gene and one in the PARK2 gene. No mutations in the three genes involved in the biosynthesis and recycling of BH4 were identified. The clinical presentations of patients with mutations in TH and SPR genes were strikingly more complex, characterized by mental retardation, oculogyric crises and parkinsonism and they were all classified as Dopa-responsive dystonia-plus syndromes. Patient with mutation in the PARK2 gene had Dopa-responsive dystonia with a good improvement with L-Dopa, similar to Dopa-responsive dystonia secondary to GCH1 mutations. Although the yield of mutations exceeds 80% in pure Dopa-responsive dystonia and Dopa-responsive dystonia-plus syndromes groups, the genes involved are clearly different: GCH1 in the former and TH and SPR in the later.

Alzheimer's disease and feeling-of-knowing in episodic memory.

Episodic memory feeling-of-knowing (FOK) was examined in 16 patients with Alzheimers disease (AD), 16 elderly participants, and 16 younger adults. Participants were given cued recall and recognition tests of 20 critical cue-target words. Subsequently, they judged their FOK for non-recalled words in terms of how likely they thought they would be to recognize the keywords on a subsequent recognition test. The results indicated dementia-related deficits on both the recall and recognition tests. Compared to older adults, AD patients exhibited impaired FOK accuracy. This pattern of outcome indicates that early AD is associated with a deficit in episodic memory and a deficit in memory monitoring for newly learned information. Furthermore, our observation revealed that in AD, episodic memory may be a more important factor than executive function in explaining the FOK inaccuracy.

Activated mTOR and PKR Kinases in Lymphocytes Correlate with Memory and Cognitive Decline in Alzheimer’s Disease

Background: The control of translation, involving the kinases mTOR (mammalian target of rapamycin) and PKR (double-stranded RNA-dependent protein kinase), modulates cell survival and death and is altered in the brains of patients with Alzheimer’s disease (AD). In AD increased susceptibility of lymphocytes to apoptosis has been reported. Methods: We investigated the level of the kinases mTOR and PKR and the eukaryotic initiation factor 2α (eIF2α) in lymphocytes of patients with AD in comparison with controls. In AD patients we also looked for a correlation between activated proteins and cognitive and memory tests. Results: We report significant alterations of the levels of these kinases and eIF2α in lymphocytes of AD patients that were also significantly correlated with cognitive and memory test scores. Conclusion: These results suggest that the levels of mTOR, PKR and eIF2α in lymphocytes could follow the cognitive decline in AD.

The immunosuppressant rapamycin exacerbates neurotoxicity of Aβ peptide

Alzheimers disease (AD) is a neurodegenerative disease of the central nervous system characterized by two major lesions: extracellular senile plaques and intraneuronal neurofibrillary tangles. β‐Amyloid (Aβ) is known to play a major role in the pathogenesis of AD. Protein synthesis and especially translation initiation are modulated by different factors, including the PKR/eIF2 and the mTOR/p70S6K pathways. mRNA translation is altered in the brain of AD patients. Very little is known about the translation control mediated by mTOR in AD, although mTOR is a central regulator of translation initiation and also ribosome biogenesis and cell growth and proliferation. In this study, by using Western blotting, we show that mTOR pathway is down‐regulated by Aβ treatment in human neuroblastoma cells, and the underlying mechanism explaining a transient activation of p70S6K is linked to cross‐talk between mTOR and ERK1/2 at this kinase level. This phenomenon is associated with caspase‐3 activation, and inhibition of mTOR by the inhibitor rapamycin enhances Aβ‐induced cell death. Moreover, in our cell model, insulin‐like growth factor‐1 is able to increase markedly the p70S6K phosphorylation controlled by mTOR and reduces the caspase‐3 activity, but its protective effect on Aβ cell death is mediated via an mTOR‐independent pathway. These results demonstrate that mTOR plays an important role as a cellular survival pathway in Aβ toxicity and could represent a possible target for modulating Aβ toxicity.

Metamemory accuracy in Alzheimer's disease and frontotemporal lobe dementia.

Metamemory is a multifaceted concept, which deals with an individual’s knowledge and control of his or her own memory system. The ability to monitor memory performance accurately was examined in 16 patients with Alzheimer’s disease (AD), 6 patients with frontotemporal lobe dementia (FTD) and 16 elderly subjects. Participants made global memory predictions in a single experimental task, both prior to and after studying 20 critical cue-target words. Prediction accuracy was evaluated with traditional score-difference measures. Our data showed that in the case of the after-study prediction FTD patients were more inaccurate in predicting their memory performance than were the AD patients, suggesting that FTD patients were more impaired than AD patients in monitoring their memory performance. Nevertheless, there seems to be no difference regarding their metacognitive knowledge or beliefs of their own memory, as indicated by the absence of difference in prediction accuracy made before study. Moreover, analyses of covariance showed that the difference in metamemory performance between AD and FTD may be related to the executive differences observed in these two populations. In sum, our results suggest that metamemory evaluation could be useful to distinguish between patients with AD and those with FTD.

Neuropsychological assessment of executive functions in women: effects of age and education.

The cognitive processes underlying age-related alterations in tests assumed to reflect frontal lobe functions were investigated with a card sorting test and an alternate semantic fluency task. The tests were administered to 133 healthy women belonging to 3 age groups (range=50-92 years) classed according to 2 education levels. The results revealed a negative association between total word fluency and perseveration in the sorting test. Aging similarly affected performance in both education groups in some components of the tasks (atypical word fluency and sensitivity to distraction). However, aging did not affect performance to the same extent in each education group in other components (particularly those reflecting switching abilities and strategies). This quasi-experimental approach provides useful tools to identify specific processing mechanisms underlying executive functions in normal aging.

Investigation of Supervisory Attentional System Functions in Patients With Parkinson’s Disease Using the Hayling Task

The study explored executive dysfunction in Parkinson’s disease (PD) by using the Hayling test (Burgess & Shallice, 1996) and verbal fluency tasks (VFTs). PD patients showed longer response latencies than controls in both parts of the Hayling test (Section A/automatic and Section B/inhibition). Patients and controls did not differ in the proportion of errors or number of responses that revealed the use of strategies. PD patients also showed verbal fluency deficits in semantic, phonemic, and alternating fluency tasks. These impairments on tests known to be sensitive to frontal lobe dysfunction confirm executive or Supervisory Attentional System (Norman & Shallice, 1986) deficits and further indicate suppression skills impairments in PD.