Search

Alzheimer’s disease and related dementias is a major public health burden – compounding over upcoming years due to longevity. Recently, clinical evidence hinted at the experience of social isolation in expediting dementia onset. In 502,506 UK Biobank participants and 30,097 participants from the Canadian Longitudinal Study of Aging, we revisited traditional risk factors for developing dementia in the context of loneliness and lacking social support. Across these measures of subjective and objective social deprivation, we have identified strong links between individuals’ social capital and various indicators of Alzheimer’s disease and related dementias risk, which replicated across both population cohorts. The quality and quantity of daily social encounters had deep connections with key aetiopathological factors, which represent 1) personal habits and lifestyle factors, 2) physical health, 3) mental health, and 4) societal and external factors. Our population-scale assessment suggest that social lifestyle determinants are linked to most neurodegeneration risk factors, highlighting them promising targets for preventive clinical action.

We present MRI data from a single human volunteer consisting in over 599 multi-contrast MR images (T1-weighted, T2-weighted, proton density, fluid-attenuated inversion recovery, T2* gradient-echo, diffusion, susceptibility-weighted, arterial-spin labelled, and resting state BOLD functional connectivity imaging) acquired in over 73 sessions on 36 different scanners (13 models, three manufacturers) over the course of 15+ years (cf. Data records). Data included planned data collection acquired within the Consortium pour l’identification précoce de la maladie Alzheimer - Québec (CIMA-Q) and Canadian Consortium on Neurodegeneration in Aging (CCNA) studies, as well as opportunistic data collection from various protocols. These multiple within- and between-centre scans over a substantial time course of a single, cognitively healthy volunteer can be useful to answer a number of methodological questions of interest to the community., Measurement(s)brainTechnology Type(s)magnetic resonance imagingSample Characteristic - OrganismHomo sapiens Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.9925037

Alzheimer’s disease (AD) is a complex disease that attacks the brain that mostly affects people 65 years and older. AD affects more and more people each year. A major problem with AD is that it is diagnosed too late. A big goal is to find ways to help doctors identify the disease early, so they can better help AD patients. Biomarkers are something that can tell you if a part of the body is feeling healthy or is being attacked by a disease. This article will describe one exciting new category of biomarkers that carry information from the brain into the blood. These biomarkers can be used to see how healthy the brain is feeling or if it is getting hurt by a disease like AD.

Introduction Brain cells secrete extracellular microvesicles (EVs) that cross the blood‐brain barrier. Involved in cell‐to‐cell communication, EVs contain surface markers and a biologically active cargo of molecules specific to their tissue (and cell) of origin, reflecting the tissue or cell's physiological state. Isolation of brain‐secreted EVs (BEVs) from blood provides a minimally invasive way to sample components of brain tissue in Alzheimer's disease (AD), and is considered a form of “liquid biopsy.” Methods We performed a comprehensive review of the PubMed literature to assess the biomarker and therapeutic potential of blood‐isolated BEVs in AD. Results We summarize methods used for BEV isolation, validation, and novel biomarker discovery, as well as provide insights from 26 studies in humans on the biomarker potential in AD of four cell‐specific BEVs isolated from blood: neuron‐, neural precursor‐, astrocyte‐, and brain vasculature–derived BEVs. Of these, neuron‐derived BEVs has been investigated on several fronts, and these include levels of amyloid‐β and tau proteins, as well as synaptic proteins. In addition, we provide a synopsis of the current landscape of BEV‐based evaluation/monitoring of AD therapeutics based on two published trials and a review of registered clinical trials. Discussion Blood‐isolated BEVs have emerged as a novel player in the study of AD, with enormous potential as a diagnostic, evaluation of therapeutics, and treatment tool. The literature has largely concentrated on neuron‐derived BEVs in the blood in AD. Given the multifactorial pathophysiology of AD, additional studies, in neuron‐derived and other brain cell–specific BEVs are warranted to establish BEVs as a robust blood‐based biomarker of AD.

This work was financially supported by the French National Research Agency, the Fondation APICIL, and the Shire International.; International audience; The idea that intelligence is embedded not only in a single brain network, but instead in a complex, well-optimized system of complementary networks, has led to the development of whole brain network analysis. Using graph theory to analyze resting-state functional MRI data, we investigated the brain graph networks (or brain networks) of high intelligence quotient (HIQ) children. To this end, we computed the "hub disruption index κ," an index sensitive to graph network modifications. We found significant topological differences in the integration and segregation properties of brain networks in HIQ compared to standard IQ children, not only for the whole brain graph, but also for each hemispheric graph, and for the homotopic connectivity. Moreover, two profiles of HIQ children, homogenous and heterogeneous, based on the differences between the two main IQ subscales [verbal comprehension index (VCI) and perceptual reasoning index (PRI)], were compared. Brain network changes were more pronounced in the heterogeneous than in the homogeneous HIQ subgroups. Finally, we found significant correlations between the graph networks' changes and the full-scale IQ (FSIQ), as well as the subscales VCI and PRI. Specifically, the higher the FSIQ the greater was the brain organization modification in the whole brain, the left hemisphere, and the homotopic connectivity. These results shed new light on the relation between functional connectivity topology and high intelligence, as well as on different intelligence profiles.

Calibrated fMRI based on arterial spin-labeling (ASL) and blood oxygen-dependent contrast (BOLD), combined with periods of hypercapnia and hyperoxia, can provide information on cerebrovascular reactivity (CVR), resting blood flow (CBF), oxygen extraction fraction (OEF), and resting oxidative metabolism (CMRO2). Vascular and metabolic integrity are believed to be affected in Alzheimer's disease (AD), thus, the use of calibrated fMRI in AD may help understand the disease and monitor therapeutic responses in future clinical trials. In the present work, we applied a calibrated fMRI approach referred to as Quantitative O2 (QUO2) in a cohort of probable AD dementia and age-matched control participants. The resulting CBF, OEF and CMRO2 values fell within the range from previous studies using positron emission tomography (PET) with 15O labeling. Moreover, the typical parietotemporal pattern of hypoperfusion and hypometabolism in AD was observed, especially in the precuneus, a particularly vulnerable region. We detected no deficit in frontal CBF, nor in whole grey matter CVR, which supports the hypothesis that the effects observed were associated specifically with AD rather than generalized vascular disease. Some key pitfalls affecting both ASL and BOLD methods were encountered, such as prolonged arterial transit times (particularly in the occipital lobe), the presence of susceptibility artifacts obscuring medial temporal regions, and the challenges associated with the hypercapnic manipulation in AD patients and elderly participants. The present results are encouraging and demonstrate the promise of calibrated fMRI measurements as potential biomarkers in AD. Although CMRO2 can be imaged with 15O PET, the QUO2 method uses more widely available imaging infrastructure, avoids exposure to ionizing radiation, and integrates with other MRI-based measures of brain structure and function., Highlights • An advanced calibrated fMRI method is employed to explore brain physiology in AD. • A pattern of hypoperfusion and hypometabolism was observed as in PET studies. • The method provides several potential biomarkers of interest in AD. • The technique may help by providing new insights into the pathophysiology of AD.

Introduction: We performed a systematic review and meta-analysis of the Alzheimer’s disease (AD)literature to examine consistency of functional connectivity alterations in AD dementia and mildcognitive impairment, using resting-state functional magnetic resonance imaging.Methods: Studies were screened using a standardized procedure. Multiresolution statistics wereperformed to assess the spatial consistency of findings across studies.Results: Thirty-four studies were included (1363 participants, average 40 per study). Consistentalterations in connectivity were found in the default mode, salience, and limbic networks in patientswith AD dementia, mild cognitive impairment, or in both groups.We also identified a strong tendencyin the literature toward specific examination of the default mode network.Discussion: Convergent evidence across the literature supports the use of resting-state connectivityas a biomarker of AD. The locations of consistent alterations suggest that highly connected hubregions in the brain might be an early target of AD. 2017 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer’s Association. This is anopen access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Keywords: Resting-state fMRI; Functional connectivity; Alzheimer’s disease; Mild cognitive impairment; Meta-analysis1. IntroductionAlzheimer’s disease (AD) exists on a continuumcomprising a

Introduction: Although age is a major risk factor for Alzheimer’s disease (AD), it is not an inevitable consequence of aging nor is it exclusively an old-age disease. Several other major risk factors for AD are strongly associated with metabolism and include lack of exercise, obesity, diabetes, high blood pressure and cholesterol, over-consumption of alcohol and depression in addition to low educational level, social isolation, and cognitive inactivity. Approaches for Alzheimer prevention and treatment through manipulation of metabolism and utilization of active metabolites have great potential either as a primary or secondary treatment avenue or as a preventative strategy in high-risk individuals. Areas covered: This review outlines the current knowledge concerning the relationship between AD and metabolism and the novel treatments attempting to correct changes in AD patients determined through metabolomics or lipidomic analyses. Expert opinion: Metabolites are one of the main driving factors and indicators of AD and can offer many possible avenues for prevention and treatment. However, with the highly interconnected effects of metabolites and metabolism, as well as the many different routes for metabolism dysfunction, successful treatment would have to include the correction of metabolic errors as well as errors in transport and metabolite processing in order to affect and revert AD progression.

Aetiological and clinical heterogeneity is increasingly recognized as a common characteristic of Alzheimer’s disease and related dementias. This heterogeneity complicates diagnosis, treatment, and the design and testing of new drugs. An important line of research is discovery of multimodal biomarkers that will facilitate the targeting of subpopulations with homogeneous pathophysiological signatures. High-throughput ‘omics’ are unbiased data-driven techniques that probe the complex aetiology of Alzheimer’s disease from multiple levels (e.g. network, cellular, and molecular) and thereby account for pathophysiological heterogeneity in clinical populations. This review focuses on data reduction analyses that identify complementary disease-relevant perturbations for three omics techniques: neuroimaging-based subtypes, metabolomics-derived metabolite panels, and genomics-related polygenic risk scores. Neuroimaging can track accrued neurodegeneration and other sources of network impairments, metabolomics provides a global small-molecule snapshot that is sensitive to ongoing pathological processes, and genomics characterizes relatively invariant genetic risk factors representing key pathways associated with Alzheimer’s disease. Following this focused review, we present a roadmap for assembling these multiomics measurements into a diagnostic tool highly predictive of individual clinical trajectories, to further the goal of personalized medicine in Alzheimer’s disease.

Automatic alignment of brain anatomy in a standard space is a key step when processing magnetic resonance imaging for group analyses. Such brain registration is prone to failure, and the results are therefore typically reviewed visually to ensure quality. There is however no standard, validated protocol available to perform this visual quality control (QC). We propose here a standardized QC protocol for brain registration, with minimal training overhead and no required knowledge of brain anatomy. We validated the reliability of three-level QC ratings (OK, Maybe, Fail) across different raters. Nine experts each rated N = 100 validation images, and reached moderate to good agreement (kappa from 0.4 to 0.68, average of 0.54 ± 0.08), with the highest agreement for "Fail" images (Dice from 0.67 to 0.93, average of 0.8 ± 0.06). We then recruited volunteers through the Zooniverse crowdsourcing platform, and extracted a consensus panel rating for both the Zooniverse raters (N = 41) and the expert raters. The agreement between expert and Zooniverse panels was high (kappa = 0.76). Overall, our protocol achieved a good reliability when performing a two level assessment (Fail vs. OK/Maybe) by an individual rater, or aggregating multiple three-level ratings (OK, Maybe, Fail) from a panel of experts (3 minimum) or non-experts (15 minimum). Our brain registration QC protocol will help standardize QC practices across laboratories, improve the consistency of reporting of QC in publications, and will open the way for QC assessment of large datasets which could be used to train automated QC systems.

Cerebrovascular insufficiency appears years prior to clinical symptoms in Alzheimer’s disease. The soluble, highly toxic amyloid-β species, generated from the amyloidogenic processing of amyloid precursor protein, are known instigators of the chronic cerebrovascular insufficiency observed in both Alzheimer’s disease patients and transgenic mouse models. We have previously demonstrated that pioglitazone potently reverses cerebrovascular impairments in a mouse model of Alzheimer’s disease overexpressing amyloid-β. In this study, we sought to characterize the effects of amyloid-β overproduction on the cerebrovascular proteome; determine how pioglitazone treatment affected the altered proteome; and analyze the relationship between normalized protein levels and recovery of cerebrovascular function. Three-month-old wildtype and amyloid precursor protein mice were treated with pioglitazone- (20 mg/kg/day, 14 weeks) or control-diet. Cerebral arteries were surgically isolated, and extracted proteins analyzed by gel-free and gel-based mass spectrometry. 193 cerebrovascular proteins were abnormally expressed in amyloid precursor protein mice. Pioglitazone treatment rescued a third of these proteins, mainly those associated with oxidative stress, promotion of cerebrovascular vasocontractile tone, and vascular compliance. Our results demonstrate that amyloid-β overproduction perturbs the cerebrovascular proteome. Recovery of cerebrovascular function with pioglitazone is associated with normalized levels of key proteins in brain vessel function, suggesting that pioglitazone-responsive cerebrovascular proteins could be early biomarkers of Alzheimer’s disease., yes

Studies using resting-state functional magnetic resonance imaging (rsfMRI) are increasingly collecting data at multiple sites in order to speed up recruitment or increase sample size. Multisite studies potentially introduce systematic biases in connectivity measures across sites, which may negatively impact the detection of clinical effects. Long-term multisite biases (i.e. over several years) are still poorly understood. The main objective of this study was to assess the long-term consistency of rsfMRI multisite connectivity measures derived from the harmonized Canadian Dementia Imaging Protocol (CDIP, www.cdip-pcid.ca). Nine to ten minutes of functional BOLD images were acquired from an adult cognitively healthy volunteer scanned repeatedly at 13 Canadian sites on three scanner makes (General Electric, Philips and Siemens) over the course of 2.5 years. RsfMRI connectivity maps were extracted for each session in seven canonical functional networks. The reliability (spatial Pearson’s correlation) of maps was about 0.6, with moderate effects (up to 0.2) of scanner makes and sites. The time elapsed between scans had a negligible effect on the consistency of connectivity maps. To assess the utility of such measures in machine learning models, we pooled the long-term longitudinal data with a single-site, short-term (1 month) data sample acquired on 26 subjects (10 scans per subject), called HNU1. Using randomly selected pairs of scans from each subject, we quantified the ability of a data-driven unsupervised cluster analysis to match the two scans. In this “fingerprinting” experiment, we found that scans from the Canadian subject could be matched with high accuracy (>85% for some networks), and fell in the range of accuracies observed for the HNU1 subjects. Overall, these results support the feasibility of multivariate, machine learning analysis of rsfMRI measures in a multisite study that extends for several years, even with fairly short (approximately ten minutes) time series.

HighlightsReliable functional brain network subtypes accompany cognitive impairment in ADSymptom-related subtypes exist in the default-mode, limbic and salience networksA limbic subtype is associated with a familial risk of AD in healthy older adultsLimbic subtypes also associate with beta amyloid deposition and ApoE4In BriefWe found reliable subtypes of functional brain connectivity networks in older adults, associated with AD-related clinical symptoms in patients as well as several AD risk factors/biomarkers in asymptomatic individuals.SummaryThe heterogeneity of brain degeneration has not been investigated yet for functional brain network connectivity, a promising biomarker of Alzheimer’s disease. We coupled cluster analysis with resting-state functional magnetic resonance imaging to discover connectivity subtypes in healthy older adults and patients with cognitive disorders related to Alzheimer’s disease, noting associations between subtypes and cognitive symptoms in the default-mode, limbic and salience networks. In an independent asymptomatic cohort with a family history of Alzheimer’s dementia, the connectivity subtypes had good test-retest reliability across all tested networks. We found that a limbic subtype was overrepresented in these individuals, which was previously associated with symptoms. Other limbic subtypes showed associations with cerebrospinal fluid Aβ1-42levels and ApoE4 genotype. Our results demonstrate the existence of reliable subtypes of functional brain networks in older adults and support future investigations in limbic connectivity subtypes as early biomarkers of Alzheimer’s degeneration.

INTRODUCTIONWe performed a systematic review and meta-analysis of the Alzheimer’s disease (AD) literature to examine consistency of functional connectivity alterations in AD dementia and mild cognitive impairment (MCI), using resting-state functional magnetic resonance imaging (rsfMRI).METHODSStudies were screened using a standardized procedure. Multiresolution statistics were performed to assess the spatial consistency of findings across studies.RESULTSThirty-four studies were included (1,363 participants, average 40 per study). Consistent alterations in connectivity were found in the default-mode, salience and limbic networks in patients with AD dementia, MCI, or in both groups. We also identified a bias in the literature towards specific examination of the default-mode network.DISCUSSIONConvergent evidence across the literature supports the use of resting-state connectivity as a biomarker of AD. The locations of consistent alterations suggest that metabolically expensive hub regions in the brain might be an early target of AD.

Resting-state functional connectivity is a promising biomarker for Alzheimer’s disease. However, previous resting-state functional magnetic resonance imaging studies in Alzheimer’s disease and mild cognitive impairment (MCI) have shown limited reproducibility as they have had small sample sizes and substantial variation in study protocol. We sought to identify functional brain networks and connections that could consistently discriminate normal aging from MCI despite variations in scanner manufacturer, imaging protocol, and diagnostic procedure. We therefore pooled four independent datasets, including 112 healthy controls and 143 patients with MCI, systematically testing multiple brain connections for consistent differences. The largest effects associated with MCI involved the ventromedial and dorsomedial prefrontal cortex, striatum, and middle temporal lobe. Compared with controls, patients with MCI exhibited significantly decreased connectivity within the frontal lobe, between frontal and temporal areas, and between regions of the cortico-striatal-thalamic loop. Despite the heterogeneity of methods among the four datasets, we identified robust MCI-related connectivity changes with small to medium effect sizes and sample size estimates recommending a minimum of 150 to 400 total subjects to achieve adequate statistical power. If our findings can be replicated and associated with other established biomarkers of Alzheimer’s disease (e.g. amyloid and tau quantification), then these functional connections may be promising candidate biomarkers for Alzheimer’s disease.

The cerebral vasculature ensures proper cerebral function by transporting oxygen, nutrients, and other substances to the brain. Distribution of oxygenated blood throughout the neuroaxis takes place at the level of the circle of Willis (CW). While morphologic and functional alterations in CW arteries and its main branches have been reported in cerebrovascular and neurodegenerative diseases, accompanying changes in protein expression profiles remain largely uncharacterized. In this study, we performed proteomics to compile a novel list of proteins present in mouse CW arteries and its ramifications. Circle of Willis arteries were surgically removed from 6-month-old wild-type mice, proteins extracted and analyzed by two proteomics approaches, gel-free nanoLC-mass spectrometry (MS)/MS and gel-based GelLC-MS/MS, using nanoAcquity UPLC coupled with ESI-LTQ Orbitrap XL. The two approaches helped maximize arterial proteome coverage. Six biologic and two technical replicates were performed. In all, 2,188 proteins with at least 2 unique high-scoring peptides were identified (6,630 proteins total). Proteins were classified according to vasoactivity, blood-brain barrier specificity, tight junction and adhesion molecules, membrane transporters/channels, and extracellular matrix/basal lamina proteins. Furthermore, we compared the identified CW arterial proteome with the published brain microvascular proteome. Our database provides a vital resource for the study of CW cerebral arterial protein expression profiles in health and disease. © 2014 ISCBFM All rights reserved.

OBJECTIVE: To report the clinical manifestations and functional aspects of Tuberous Sclerosis Complex (TSC), resulting from Codon 905 mutations in TSC2 gene. METHODS: We performed a detailed study of the TSC phenotype and genotype in a large French-Canadian kindred (Family A). Subsequently, clinical and molecular data on 18 additional TSC families with missense mutations at the same codon of TSC2 were collected. Functional studies were performed on the different missense changes and related to the phenotype. RESULTS: A 2714G>A (R905Q) mutation was identified in Family A. The TSC phenotype in this family was unusually mild and characterized by hypomelanotic macules or focal seizures that remitted spontaneously or were easily controlled with medication. Diagnostic criteria were met in only a minority of mutation carriers. Other families with the R905Q mutation were found to have a similar mild phenotype. In contrast, patients with a 2713C>T (R905W) or a 2713C>G (R905G) mutation had more severe phenotypes. Although all three amino acid substitutions were pathogenic, the R905W and R905G substitutions affected tuberin function more severely than R905Q. INTERPRETATION: Codon 905 missense mutations in TSC2 are relatively common. The TSC2 R905Q mutation is associated with unusually mild disease, consistent with functional studies. Combined with previous reports, it is apparent that certain TSC2 missense mutations are associated with a mild form of tuberous sclerosis, which in many patients does not meet standard diagnostic criteria. These findings have implications for the large number of patients with limited clinical features of TSC and for genetic counseling in these families.

Summary: Purpose: Choreoacanthocytosis (ChAc) is an autosomal recessive disorder caused by mutations in VPS13A on chromosome 9q21 and characterized by neurodegeneration and red cell acanthocytosis. Seizures are not uncommon in ChAc but have not been well characterized in the literature. We report two ChAc families in which patients presented with temporal lobe epilepsy. Methods: Detailed medical and family histories were obtained. EEG, video-telemetry, brain magnetic resonance imaging (MRI) with volumetric studies of amygdala and hippocampus, as well as neuropsychological testing were performed. Blood smears were examined for acanthocytosis. Mutation analysis of VPS13A was carried out in five patients. Results: Six patients in three sibships were initially seen with seizures. Age at seizure onset ranged from 22 to 38 years. Seizures preceded other clinical manifestations of ChAc by ≤15 years. The epileptic aura consisted of a sensation of deja-vu, fear, hallucinations, palpitations, or vertigo. EEG with video-telemetry showed epileptiform discharges originating either from one or both temporal lobes. Epilepsy was generally well controlled, but some patients had periods of increased seizure frequency requiring treatment with multiple antiepileptic drugs (AEDs). Both families shared a deletion of exons 70–73 of VPS13A, extending to exons 6–7 of GNA14. Conclusions: Temporal lobe epilepsy may be the presenting feature of ChAc and may delay its diagnosis. Epilepsy in ChAc patients represents a challenge, because seizures may at times be difficult to control, and some AEDs may worsen the involuntary movements. Mutations in VPS13A or GNA14 or both may be associated with clinical features of temporal lobe epilepsy.

Action myoclonus-renal failure syndrome (AMRF) is a distinctive form of progressive myoclonus epilepsy associated with renal dysfunction. The syndrome was not recognized prior to the advent of dialysis and renal transplantation because of its rapidly fatal course if renal failure is untreated. The first and only description of AMRF was in four French Canadian patients in three families (Andermann et al., 1986). We now describe 15 individuals with AMRF from five countries, including a follow-up of the four French Canadian patients, allowing a more complete characterization of this disease. Our 15 patients with AMRF belong to nine different families. Segregation analyses were compatible with autosomal recessive inheritance. In addition, our findings show that AMRF can present with either renal or neurological features. Tremor (onset 17-26 years, mean 19.8 years, median 19 years) and progressively disabling action myoclonus (onset 14-29 years, mean 21.7 years, median 21 years), with infrequent generalized seizures (onset 20-28 years, mean 22.7 years, median 22 years) and cerebellar features are characteristic. Proteinuria, detected between ages 9 and 30 years in all cases, progressed to renal failure in 12 out of 15 patients within 0-8 years after proteinuria detection. Brain autopsy in two patients revealed extraneuronal pigment accumulation. Renal biopsies showed collapsing glomerulopathy, a severe variant of focal glomerulosclerosis. This study extends the AMRF phenotype, and demonstrates a more extensive ethnic and geographic distribution of a syndrome originally believed to be confined to individuals of French Canadian ancestry. The independent progression of neurological and renal disorders in AMRF suggests a unitary molecular lesion with pleiotropic effects. Our results demonstrate that the renal lesion in AMRF is a recessive form of collapsing glomerulopathy. Genes identified for focal segmental glomerulosclerosis and involved with the function of the glomerular basement membrane and related proteins are thus good candidates. Treatment can improve quality of life and extend the lifespan of these patients. Dialysis and renal transplantation are effective for the renal but not the neurological features, which continue to progress even in the presence of normalized renal function; the latter can be managed with anti-myoclonic and anti-epileptic drugs.

OBJECTIVES: Anticipation has been linked to unstable trinucleotide repeats in many neurological disorders. We examined the hypothesis of genetic anticipation in familial cavernous angioma (FCA) of the central nervous system. MATERIAL AND METHODS: The mean ASO of affected individuals was compared between successive generations in 55 families. Intergenerational pair-wise comparisons were employed to avoid several ascertainment biases. Regarding severity of disease both type of manifestation and number of cavernous angiomas were compared between generations. RESULTS: The mean ASO decreased significantly both from the first to the second generation (31.6 vs 17.8 years; P = 0.000) and from the second to the third generation (17.8 vs 6.7 years; P = 0.002). The pair-wise comparisons also showed significantly earlier ASO. No clear evidence for anticipation with regard to severity of disease was found. CONCLUSIONS: Molecular genetic studies will determine whether trinucleotide repeats are the underlying mechanism for our observation of anticipation in FCA.

which shows genetic heterogeneity. Candidate genes for this disease have not yet been cloned. Of 116 families with familial cavernous angiomas, followed up in the International Familial Cavernous Angioma Study (IFCAS), we included only families that fulfilled the following criteria: cavernous angiomas proven by neuroradiology, pathology, or both in at least two family members; and symptomatic members in at least two successive generations. We enrolled 52 families with up to three successive symptomatic generations (G1 to G3), that comprised 163 individuals (69 in G1; 80 in G2; 14 in G3). We measured anticipation by intergenerational comparison of mean age at symptom onset (G1 vs G2, G2 vs G3) and by four intergenerational pairwise comparisons used to avoid several ascertainment biases (table). Age at symptom onset referred to the onset of objective manifestations of cavernous angioma, such as epileptic seizures, gross haemorrhages, and focal neurological deficits. To test for anticipation in severity of disease, we compared the number of cavernous angiomas in each generation. The mean age of symptom onset in all 163 individuals was 23·2 years (SD 17·2). This mean decreased across generations from 32·7 years in G1, to 18·0 years in G2, to 7·7 years in G3. The intergenerational differences in age at symptom onset were significant both between G1 and G2 (p=0·0000) and between G2 and G3 (p=0·0014). The differences between pairs of affected individuals in successive generations were significant with all four sampling schemes (table). Age at symptom onset of offspring was significantly related to age of onset in the parents (scheme two, r=0·40, p=0·0024; scheme four, r=0·33, p=0·0032): the earlier (or later, respectively) the parent’s age at onset of symptoms, the earlier (or later, respectively) the age in offspring. We found no anticipation due to the common ascertainment biases such as: exclusion of early-onset parents with late-onset offspring; preponderant inclusion of families with simultaneous onset in parent-offspring pairs; report of later age at symptom onset by G1 members due to forgotten details; earlier diagnosis of cavernous angiomas by the use of magnetic resonance imaging in younger generations; or putative anticipation effect by changing environmental factors. In parent-offspring pairs, the ratio of single to multiple lesions did not differ significantly, nor did predominant type of transmission for number of angiomas cavernous angiomas (eg, single cavernous angiomas in G1 and multiple lesions in G2; p=0·5795). Since the results were significant in all the sampling schemes, our findings support a genetic cause for anticipation in familial cavernous angiomas. The finding Anticipation in familial cavernous angioma: a study of 52 families from International Familial Cavernous Angioma Study

We report on a Friedreich's ataxia (FA) family with 3 affected siblings with markedly different phenotypic presentations, including one with spastic paraplegia. Molecular analysis showed midsize GAA repeat expansion sizes in all 3 individuals. Gait spasticity in FA, although rare, has been described in a few patients who are compound heterozygotes for a point mutation, or who had GAA expansions of less than 200 repeats. The occurrence of spastic paraplegia in our family, in the presence of homozygous midsize GAA repeat expansions, is an unusual finding. Spasticity can be the main feature in both sporadic and familial patients with FA, either as an isolated finding, or in addition to other neurological abnormalities, and should be included as a rare feature in the clinical spectrum of FA. This family also demonstrates that in FA, marked intrafamilial phenotypic variability can arise in the presence of similar GAA expansion sizes. Therefore, in familial FA, the disease course in relatives therefore cannot be predicted solely from repeat length. Factors such as somatic mosaicism, repeat interruptions, modifying mutations and environmental factors must also be considered. 2004 Movement Disorder Society.