Journal
PARKINSONISM & RELATED DISORDERS
Volume 19, Issue 1, Pages 27-31Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.parkreldis.2012.07.005
Keywords
Parkinson's disease; Autonomic nervous system; Alpha-synuclein; Heart
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Funding
- Premio Fin de Residencia Emili Letang
- Hospital Clinic de Barcelona
- Beca de Recerca de l'Academia de Ciencies Mediques de Catalunya
- Distincio per la promocio de la Recerca Universitaria Generalitat de Catalunya [2001SRG00387]
- Spanish network on neurodegenerative diseases CIBERNED
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Background: In Parkinson's disease (PD), alpha-synuclein (AS) aggregates occur frequently in peripheral autonomic nervous system (pANS). Their presence in asymptomatic subjects suggests incidental Lewy-body disease (iLBD) that is thought to reflect pre-clinical PD. Cardiac involvement has been detected in post-mortem studies in both, PD and also in iLBD. In vivo documentation of cardiac AS pathology is lacking. Objective: To prospectively assess the presence of AS aggregates in epicardial fat tissue from living subjects without parkinsonism undergoing elective cardiac surgery. Material and methods: Epicardial fat tissue obtained during cardiac surgery from 91 subjects was studied by histology and immunohistochemistry. Areas more likely to contain pANS elements were selected. PD-related motor and non-motor symptoms (NMS) were assessed immediately before or after surgery. Results: Small autonomic nerves, ganglia and/or tyrosine-hydroxylase positive fibres were identified in epicardial fat in each of the 91 subjects (62 male/29 female, mean age 67 years). AS aggregates were detected in 7 subjects (7.7%), and were more frequent in those aged above 70 years. In AS-positive subjects constipation and acting dreams were significantly more frequent than in the AS-negative ones. Conclusion: AS aggregates occur in epicardial pANS in subjects without parkinsonism, suggesting the diagnosis of iLBD. The presence in some of these subjects of non-motor symptoms such as acting dreams and constipation known to occur in premotor PD supports this interpretation. Adequate follow-up of the subjects in this study will indicate the time, if any, to progression to motor PD. (c) 2012 Published by Elsevier Ltd.
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