A C6orf10/LOC101929163 locus is associated with age of onset in C9orf72 carriers.

The G4C2-repeat expansion in C9orf72 is the most common known cause of amyotrophic lateral sclerosis and frontotemporal dementia. The high phenotypic heterogeneity of C9orf72 patients includes a wide range in age of onset, modifiers of which are largely unknown. Age of onset could be influenced by environmental and genetic factors both of which may trigger DNA methylation changes at CpG sites. We tested the hypothesis that age of onset in C9orf72 patients is associated with some common single nucleotide polymorphisms causing a gain or loss of CpG sites and thus resulting in DNA methylation alterations. Combined analyses of epigenetic and genetic data have the advantage of detecting functional variants with reduced likelihood of false negative results due to excessive correction for multiple testing in genome-wide association studies. First, we estimated the association between age of onset in C9orf72 patients (n = 46) and the DNA methylation levels at all 7603 CpG sites available on the 450 k BeadChip that are mapped to common single nucleotide polymorphisms. This was followed by a genetic association study of the discovery (n = 144) and replication (n = 187) C9orf72 cohorts. We found that age of onset was reproducibly associated with polymorphisms within a 124.7 kb linkage disequilibrium block tagged by top-significant variation, rs9357140, and containing two overlapping genes (LOC101929163 and C6orf10). A meta-analysis of all 331 C9orf72 carriers revealed that every A-allele of rs9357140 reduced hazard by 30% (P = 0.0002); and the median age of onset in AA-carriers was 6 years later than GG-carriers. In addition, we investigated a cohort of C9orf72 negative patients (n = 2634) affected by frontotemporal dementia and/or amyotrophic lateral sclerosis; and also found that the AA-genotype of rs9357140 was associated with a later age of onset (adjusted P = 0.007 for recessive model). Phenotype analyses detected significant association only in the largest subgroup of patients with frontotemporal dementia (n = 2142, adjusted P = 0.01 for recessive model). Gene expression studies of frontal cortex tissues from 25 autopsy cases affected by amyotrophic lateral sclerosis revealed that the G-allele of rs9357140 is associated with increased brain expression of LOC101929163 (a non-coding RNA) and HLA-DRB1 (involved in initiating immune responses), while the A-allele is associated with their reduced expression. Our findings suggest that carriers of the rs9357140 GG-genotype (linked to an earlier age of onset) might be more prone to be in a pro-inflammatory state (e.g. by microglia) than AA-carriers. Further, investigating the functional links within the C6orf10/LOC101929163/HLA-DRB1 pathway will be critical to better define age-dependent pathogenesis of frontotemporal dementia and amyotrophic lateral sclerosis.

Bupropion abuse resulting in hypomania in a geriatric amphetamine user: A case report.

BACKGROUND: Bupropion is a commonly prescribed antidepressant which acts on norepinephrine and dopamine neurotransmission. It is structurally similar to amphetamine. Several cases of recreational bupropion ingestion, insufflation, and injection have been reported in the literature. METHODS: Here we report a case of bupropion abuse in a 79-year-old gentleman with a history of alcohol and amphetamine use disorders, resulting in hypertension and hypomanic symptoms. RESULTS: To our knowledge, this is the first case of bupropion abuse documented in an older adult. The literature with respect to bupropion abuse is reviewed, and the matter of stimulant abuse in older adults is considered. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This case emphasizes the need to consider bupropion's abuse potential when prescribing it to older adults with risk factors for substance abuse.

Trajectories of Behavioural Disturbances Across Dementia Types.

OBJECTIVE: To replicate a previous finding that the trajectory of the Neuropsychiatric Inventory (NPI) shifts in the sixth year of behavioural variant frontotemporal dementia (bvFTD). We evaluated longitudinal tracking with both the Frontal Behavioural Inventory (FBI) and NPI, comparing bvFTD against other dementias. METHODS: Chart reviews over two to five years for patients with bvFTD (n=30), primary progressive aphasia (PPA, n=13) and Alzheimer's disease (AD, n=118) at an urban Canadian tertiary clinic specializing in dementia. Linear regressions of the longitudinal data tested predictors of annualized rates of change (ROC) in NPI and FBI total and subscales for apathy and disinhibition among dementia groups. RESULTS: The mode of the overall sample for the most advanced duration of illness observed was 5 years, with the median at 7 years. We did not find a crescendo-decrescendo pattern in scores although, for bvFTD and AD, high initial scores correlated with ensuing downward ROCs on the NPI and FBI. Educational level showed an influence on disinhibition ROCs. The FBI was no more revealing than the NPI for apathy and disinhibition scores in these dementias. CONCLUSIONS: A cognitive reserve effect on behavioural disturbance was supported but it may take longer than our 4 years of observing the clinical sample to record inflection points in the behavioural and psychiatric symptoms seen in bvFTD. The current data only imply that both apathy and disinhibition will diminish over the course of dementia.

Evaluating the affective component of the cerebellar cognitive affective syndrome.

The authors performed a systematic review and meta-analysis of studies evaluating the affective component of the cerebellar cognitive affective syndrome. Depressive and anxiety symptoms and personality changes were more frequent in patients with spinocerebellar ataxia. Patients with cerebellar lesions were more likely to have depression, deficits in the ability to experience emotions, and behavioral difficulties. A meta-analysis revealed modestly higher scores on the Hamilton Depression Rating Scale (HAM-D) among patients with cerebellar disease. This review highlights the need for cohort studies using noncerebellar comparison groups, more sensitive measures, and appropriate-sized populations with isolated cerebellar lesions to thoroughly assess the affective component of the cerebellar cognitive affective syndrome.

Traumatic brain injury, Apolipoprotein E-epsilon4, and cognition in older adults: a two-year longitudinal study.

Patients with mild-to-moderate traumatic brain injury (TBI) (N=69) were compared with age-, gender-, and education-matched healthy control group subjects (N=79) on performance of neuropsychological tests at one and 2 years following injury, and informant-rated functional abilities. All subjects were assessed for the presence of the Apolipoprotein E-epsilon4 (APOE-epsilon4) allele and rated for "mild cognitive impairment" (MCI) or dementia. Traumatic brain injury patients were no different from the comparison group on measures of cognition or functional impairment. Traumatic brain injury was not associated with higher rates of amnestic mild cognitive impairment or dementia, and APOE-epsilon4 was not associated with cognition.