Epidemiology and Pathophysiology of Parkinsonism in the Caribbeans (CAP)

The primary aim of this study is to estimate the frequency and to characterize clinically atypical parkinsonism in the French West Indies and Guyana.

Study Overview

• Status: Recruiting
• Conditions: Atypical Parkinsonism
• Intervention / Treatment: Other: Clinical and biological exam

Detailed Description

An atypical akineto-rigid parkinsonian syndrome, unresponsive to L-dopa has been evidenced in Guadeloupe. Abnormally frequent, this progressive supranuclear palsy (PSP)-like syndrome represents a new clinical entity. Unlike in classical PSP 70% of patients have myoclonus, 59% hallucinations, 78% REM sleep behavior disorders. Oculomotor pattern differs from classical PSP suggesting that cortical dysfunction predominates over brainstem impairments. Neuropathological examination in four patients has shown a widespread accumulation of the tau protein in the basal ganglia, the midbrain and cortical areas.

This syndrome has been associated to the regular consumption of food products derived from plants of the Annonaceae family, more specifically Annona Muricata (soursop), suggesting a toxic origin. We have already confirmed the neurotoxic potential of the lipophilic mitochondrial complex I inhibitor annonacin, the major acetogenin in Annona muricata. This class of compounds is specific to Annonaceae. Nanomolar concentrations of annonacin induce the death of dopaminergic neurons in culture, by impairment of energy production. Chronic systemic intoxication of rats with annonacin causes neuronal damage in the same brain regions that are damaged in patients with atypical parkinsonism. These results greatly suggest that the consumption of annonacea might contribute to the pathogenesis of the disease. The H1 subhaplotype in tau gene associated with PSP in Caucasians did not confer risk for PSP-like atypical parkinsonism in Guadeloupe.

• Study Type: Interventional
• Enrollment (Anticipated): 550
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Valérie HAMONY SOTER, Project leader; Phone Number: +590 0590 93 46 86; Email: valerie.soter@chu-guadeloupe.fr
• Study Contact Backup: Name: Mélanie PETAPERMAL, Monito manager; Phone Number: +590 0590 93 46 86; Email: melanie.petapermal@chu-guadeloupe.fr

Study Locations

• French Guiana
  • Cayenne, French Guiana, 97306
    • Recruiting
    • University Hospital of Guyana
    • Contact: Dominique MARNET, PH; Phone Number: (+0594) 05 94 39 51 46; Email: domminique.marnet@ch-cayenne.fr
• Martinique
  • Fort-de-France, Martinique, 97261
    • Recruiting
    • University Hospital of Martinique
    • Contact: Régine EDRAGAS, PH; Phone Number: (+596) 05 96 720482; Email: nakapmireil@yahoo.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 17 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Pour les patients :

  1. Patient ou tiers responsable ayant reçu une information sur l'étude et ayant signé le consentement éclairé
  2. Patient âgé de plus de 18 ans
  3. Patient consultant en neurologie ou en gériatrie pour symptomatologie parkinsonienne ou pour troubles cognitifs évocateurs d'une démence à corps de Lewy

  4. Patient domicilié aux Antilles-Guyane

     Pour les témoins :

  5. Conjoint ou accompagnant ayant reçu une information sur l'étude et ayant signé le consentement éclairé
  6. Personne âgée de plus de 18 ans
  7. Personne ne présentant pas de pathologie d'allure neurodégénérative (Parkinson, démence notamment)
  8. Personne domiciliée aux Antilles-Guyane

Exclusion Criteria:

Pour les patients :

1. Syndrome parkinsonien secondaire (post-traumatique, vasculaire, iatrogène, post encéphalitique)
2. Patient non affilié au régime de sécurité sociale
3. En cas de difficulté de suivi le patient sera exclu de l'étude longitudinale

Pour les témoins :

1. Personnes présentant des troubles cognitifs ou un syndrome parkinsonien diagnostiqué.
2. Patient non affilié au régime de sécurité sociale -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Patients; Parkinson's patient	Other: Clinical and biological exam; The study will include a clinical, neuropsychological, oculomotor, food intake and environmental exposure assessment. Blood samples will be taken to constitute a library of plasma, DNA and serum. The harvesting of samples will be part of a subsequent study. Consent for possible post-mortem neuropathological analysis will be proposed. All the patients accepting it will be followed by a 5-year longitudinal follow-up. The longitudinal follow-up bi-annual and then annual will include a clinical evaluation, a questionnaire of dependence and a questionnaire of monitoring of exposure to certain environmental factors All controls must answer a questionnaire of environmental exposure factors, oculomotor test, and blood sample (3 collections: DNA, serum, plasma).
Other: witnesses: without parkinson's disease; Subjects without parkinson's disease	Other: Clinical and biological exam; The study will include a clinical, neuropsychological, oculomotor, food intake and environmental exposure assessment. Blood samples will be taken to constitute a library of plasma, DNA and serum. The harvesting of samples will be part of a subsequent study. Consent for possible post-mortem neuropathological analysis will be proposed. All the patients accepting it will be followed by a 5-year longitudinal follow-up. The longitudinal follow-up bi-annual and then annual will include a clinical evaluation, a questionnaire of dependence and a questionnaire of monitoring of exposure to certain environmental factors All controls must answer a questionnaire of environmental exposure factors, oculomotor test, and blood sample (3 collections: DNA, serum, plasma).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
to estimate the frequency and to characterize clinically atypical parkinsonism in the French West Indies and Guyana	Collection of : administrative and socioeconomic data, medical consultation with video recording , recording oculomotor to the atypical	At the end of the Period of inclusion, around 5-6 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
to compare the proportion of atypical forms within parkinsonian syndromes;	Collection of : administrative and socioeconomic data, medical consultation with video recording , recording oculomotor to the atypical neuropsychological balance assessment ,; Clinical diagnostic criteria; Compilation of functional indicators of motor and cognitive autonomy and Collection of intercurrent medical events; Food and exposure questionnaire; Neuropsychological assessment; Recording of oculomotor movements and Post-mortem analysis; biological collection (plasma, DNA, serum)	At the end of the Period of inclusion, around 5-6 years
to characterize the entity "Parkinson-dementia complex" described in Guadeloupe ; to characterize the entity "Parkinson-dementia complex" described in Guadeloupe ;	Compilation of functional indicators of motor and cognitive autonomy and Collection of intercurrent medical events. Collection of : administrative and socioeconomic data, medical consultation with video recording , recording oculomotor to the atypical neuropsychological balance assessment ,	Through study completion, an average of 11 years
to determine the natural history of typical and atypical forms of parkinsonism by following a cohort of the incident cases only;	Neuropsychological assessment Food and exposure survey	Through study completion, an average of 11 years
to determine the implication of a toxic alimentary factor in the etiopathogenesis of atypical forms and compare the results in the 3 areas (Guadeloupe, Guyane, Martinique);	Neuropsychological assessment Food and exposure survey	Through study completion, an average of 11 years
to determine the latency of cognitive decline in idiopathic Parkinson's disease in the 3 areas ;	Recording of oculomotor movements and Post-mortem analysis (sampling of blood and cutaneous biopsy to establish a collection of biological samples)	Through study completion, an average of 11 years, post-mortem analysis after death if applicable
to constitute a biological collection (plasma, DNA, serum).	biological collection (plasma, DNA, serum)	At the end of the Period of inclusion, around 5-6 years

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Pointe-a-Pitre
• Investigators: Principal Investigator: Dominique MARNET, PH, : University Hospital of Guyana

Study record dates

Study Major Dates

• Study Start (Actual): August 3, 2012
• Primary Completion (Anticipated): August 3, 2018
• Study Completion (Anticipated): August 3, 2023

Study Registration Dates

• First Submitted: November 24, 2017
• First Submitted That Met QC Criteria: December 5, 2017
• First Posted (Actual): December 11, 2017

Study Record Updates

• Last Update Posted (Actual): December 11, 2017
• Last Update Submitted That Met QC Criteria: December 5, 2017
• Last Verified: November 1, 2017

More Information

Terms related to this study

• Keywords: progressive supranuclear palsy; Caribbean atypical Parkinsonism; Annona Muricata
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Basal Ganglia Diseases; Movement Disorders; Parkinsonian Disorders
• Other Study ID Numbers: RBM-PAP-2011/86

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No