Publications by authors named "Alex Iranzo"

Unlabelled: In the Chilean pediatric population, to date, there is no validated screening instrument for sleep-related breathing disorders (SRBD).

Objective: to develop and validate a cross-cultural adaptation of the Pediatric Sleep Questionnaire - sleep-related breathing disorder scale (PSQ-SRBD), by creating the Chilean Spanish version (PSQ-CL).

Patients And Method: The PSQ-SRBD was translated from English into Chilean Spanish, obtaining the PSQ-CL, which was subsequently validated.

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Anti-IgLON5 disease was identified 10 years ago, thanks to the discovery of IgLON5 antibodies and the joint effort of specialists in sleep medicine, neuroimmunology, and neuropathology. Without this collaboration, it would have been impossible to untangle fundamental aspects of this disease. After the seminal description in 2014, today there is growing evidence that most patients present a chronic progressive course with gait instability, abnormal movements, bulbar dysfunction, and a sleep disorder characterized by nonrapid eye movement and REM parasomnias, and obstructive sleep apnea with stridor.

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Isolated rapid-eye-movement sleep behavior disorder (iRBD) is a strong predictor of Parkinson's disease and Dementia with Lewy bodies. Previous studies indicate that cortical atrophy in iRBD patients may be linked to cognitive impairment, but the pattern of atrophy is inconsistently reported. This study aimed to elucidate cortical atrophy patterns in a cognitively unimpaired iRBD cohort, focusing on regions associated with cognitive functions, particularly the cuneus/precuneus, and evaluated the predictive value for future phenoconversion.

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Article Synopsis
  • Idiopathic REM sleep behavior disorder (iRBD) is linked to alpha-synucleinopathies, and the study aimed to evaluate autonomic nervous system (ANS) dysfunction in individuals with iRBD and its potential to predict clinical progression.
  • In a study of 25 iRBD patients, 28% developed synucleinopathy, primarily Parkinson's disease, with many exhibiting abnormal ANS test results; those who progressed had significantly higher rates of dysfunction compared to those who did not.
  • Results indicate that both symptomatic and subtle ANS dysfunctions are prevalent in iRBD, and specific adrenergic system issues may signal a higher short-term risk of developing synucleinopathy.
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  • The study examines post-mortem brain tissues from individuals diagnosed with idiopathic REM sleep behavior disorder (IRBD) to investigate its potential link to neurodegenerative diseases, specifically focusing on signs of neuronal loss and the presence of key protein deposits.
  • Researchers analyzed samples from 20 participants, most of whom were diagnosed with Lewy body disease, while a small number had Parkinson's disease-related conditions, revealing significant findings of neuronal damage associated with α-synuclein proteins, particularly in brain regions controlling REM sleep.
  • While the sample size limited the statistical analysis, the outcomes suggest a strong correlation between IRBD and neurodegenerative diseases, emphasizing the importance of these pathological features for understanding the progression
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Anti-IgLON5 disease is a unique condition that bridges autoimmunity and neurodegeneration. Since its initial description 10 years ago, an increasing number of autopsies has led to the observation of a broader spectrum of neuropathologies underlying a particular constellation of clinical symptoms. In this study, we describe the neuropathological findings in 22 patients with anti-IgLON5 disease from 9 different European centers.

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Background And Purpose: Most patients with isolated rapid eye movement sleep behaviour disorder (iRBD) progress to a parkinsonian alpha-synucleinopathy. However, time to phenoconversion shows great variation. The aim of this study was to investigate whether cholinergic and dopaminergic dysfunction in iRBD patients was associated with impending phenoconversion.

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We investigated the biomarker profile of neurodegeneration, Alzheimer's and Lewy body pathology in the CSF of 148 polysomnography-confirmed patients with isolated REM sleep behavior disorder (IRBD), a condition that precedes Parkinson's disease (PD) and dementia with Lewy bodies (DLB). We assessed misfolded α-synuclein (AS) by RT-QuIC assay, amyloid-beta peptides (Aβ and Aβ), phosphorylated tau (p-tau), and total tau (t-tau) by CLEIA and neurofilament light chain (NfL) by ELISA. We detected AS in 75.

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Article Synopsis
  • Early-onset Alzheimer's disease (EOAD) has more severe neuropsychiatric symptoms and lower integrity of the locus coeruleus (LC) compared to late-onset Alzheimer's disease (LOAD).
  • A study involving 104 subjects with AD and 32 healthy controls used MRI and other measurements to analyze the differences in LC integrity and symptoms between EOAD and LOAD.
  • Results showed that EOAD's lower LC integrity correlates with increased neuropsychiatric symptoms, and its greater degeneration may explain these severe symptoms compared to LOAD.
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Synucleinopathies are disorders characterized by the aggregation and deposition of pathological α-synuclein conformers. The underlying neurodegenerative processes begin years or decades before the onset of cardinal motor symptoms. This prodromal phase may manifest with various signs or symptoms.

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Article Synopsis
  • - Alpha-synucleinopathies are neurological disorders that lead to significant disability and are currently treated only with symptoms management, as attempts to modify the disease in later stages have been unsuccessful.
  • - The long prodromal (early) phase of these disorders presents an opportunity for intervention, with REM sleep behavior disorder (RBD) being the most reliable indicator of individuals in this phase.
  • - The paper suggests focusing on idiopathic RBD for clinical trials aimed at disease modification, detailing study designs, patient selection, biomarker identification, and potential treatment targets.
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Sleep disorders are common in people with Parkinson's disease. These disorders, which increase in frequency throughout the course of the neurodegenerative disease and impair quality of life, include insomnia, excessive daytime sleepiness, circadian disorders, obstructive sleep apnoea, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. The causes of these sleep disorders are complex and multifactorial, including the degeneration of the neural structures that modulate sleep, the detrimental effect of some medications on sleep, the parkinsonian symptoms that interfere with mobility and comfort in bed, and comorbidities that disrupt sleep quality and quantity.

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Unlabelled: Brunner syndrome is a recessive X-linked disorder characterized by intellectual disability and impulsive aggressiveness associated with monoamine oxidase A (MAOA) deficiency leading to increased monoaminergic activity. We report the presence of rapid eye movement (REM) sleep behavior disorder in a 46-year-old patient with Brunner syndrome due to a c.1438A > G/iVS14-2 A > G mutation of the gene.

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Several brainstem, subcortical and cortical areas are involved in the generation of rapid eye movement (REM) sleep. The alteration of these structures as a result of a neurodegenerative process may therefore lead to REM sleep anomalies. REM sleep behaviour disorder is associated with nightmares, dream-enacting behaviours and increased electromyographic activity in REM sleep.

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Introduction: Anti-IgLON5 disease is a recently described neurological disorder with multisystemic features. The disease is characterized by the presence of IgLON5 antibodies in serum and cerebrospinal fluid. Our objective is to describe in detail the otorhinolaryngological manifestations of this disease, which are frequent and may include dysphagia, dysarthria, vocal cord paralysis and laryngospasm.

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Article Synopsis
  • Idiopathic rapid eye movement sleep behavior disorder (IRBD) is an early stage of Lewy body disorders like Parkinson's disease and dementia with Lewy bodies, associated with changes in circulating cell-free mitochondrial DNA (cf-mtDNA).
  • *The study assessed cf-mtDNA levels and integrity in cerebrospinal fluid and serum from 71 participants, including IRBD patients (both converters and non-converters) and age-matched controls.
  • *Findings indicated that IRBD patients show altered cf-mtDNA profiles early on, suggesting mitochondrial dysfunction plays a key role in the development of Lewy body disorders before full symptoms appear.*
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Background: Using C-(R)-PK11195-PET, we found increased microglia activation in isolated REM sleep behavior disorder (iRBD) patients. Their role remains to be clarified.

Objectives: The objective is to assess relationships between activated microglia and progression of nigrostriatal dysfunction in iRBD.

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Objective: To apply a machine learning analysis to clinical and presynaptic dopaminergic imaging data of patients with rapid eye movement (REM) sleep behavior disorder (RBD) to predict the development of Parkinson disease (PD) and dementia with Lewy bodies (DLB).

Methods: In this multicenter study of the International RBD study group, 173 patients (mean age 70.5 ± 6.

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Background And Objectives: To develop a composite score to assess the severity of the multiple symptoms present in anti-IgLON5 disease.

Methods: The anti-IgLON5 disease composite score (ICS) was designed to evaluate 17 symptoms divided into 5 clinical domains (bulbar, sleep, movement disorders, cognition, and others). Each symptom was scored from 0 (absent/normal) to 3 or 6 (severe) depending on the contribution of the symptom to neurologic disability with a maximum ICS of 69.

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Background: Evidence regarding cortical atrophy patterns in Parkinson's disease (PD) with probable rapid eye movement sleep behavior disorder (RBD) (PD-pRBD) remains scarce. Cortical mean diffusivity (cMD), as a novel imaging biomarker highly sensitive to detecting cortical microstructural changes in different neurodegenerative diseases, has not been investigated in PD-pRBD yet.

Objectives: The aim was to investigate cMD as a sensitive measure to identify subtle cortical microstructural changes in PD-pRBD and its relationship with cortical thickness (CTh).

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Article Synopsis
  • Anti-IgLON5 disease is an autoimmune encephalitis that often goes undiagnosed, characterized by diverse symptoms affecting sleep, movement, and other functions.
  • A study of 87 patients revealed strong associations between the disease and specific HLA-DQ genotypes, indicating a genetic predisposition to its development.
  • Experiments showed that modified IgLON5 peptides preferentially bind to these HLA-DQ receptors, suggesting that this interaction could trigger T-cell responses involved in initiating the disease.
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Sleep abnormalities may represent an independent risk factor for neurodegeneration. An international expert group convened in 2021 to discuss the state-of-the-science in this domain. The present article summarizes the presentations and discussions concerning the importance of a strategy for studying sleep- and circadian-related interventions for early detection and prevention of neurodegenerative diseases.

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