Vol 9, No 2 - Neuropsychiatric Manifestations of Neurodegenerative Disease
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I n   t h i s   i s s u e... In this issue we depart from the pattern that we set for Dialogues in Clinical Neuroscience (DCNS) in two impor- tant ways. In the first, we rename one of our sections “Translational  Research,”  replacing  the  term  “Basic Research.” Basic science remains the cornerstone of all biomedical research. The theories and models that guide our work, and the tools we use for hypothesis testing, all come from curiosity-driven basic research. In the past few years, a new way of looking at research that is more tar- get-oriented than curiosity-driven has emerged. This is called “translational research,”1  and it emphasizes the complementary nature of research at the bench and research at the bedside or clinic. The task of translation- al science is the development of diagnostic procedures, biomarkers, and surrogate outcomes in the service of dis- coveries that will result in improvements in patient care. Importantly, in translational science the flow of informa- tion between bench and bedside is bidirectional: the clin- ic enriches the laboratory and the laboratory informs the clinic. We believe the term translational research accu- rately captures the spirit of DCNS. We hope our readers agree. The second departure from pattern has to do with the absence of a diagnostic focus for this issue. Most issues of DCNS have addressed a single disease category. In this issue, we depart from the categorical approach to look at psychiatric commonalities in a variety of conditions that are united only by the fact that they are all “brain dis- eases.” This approach is dimensional rather than cate- gorical, and is built upon common underlying patho- physiological processes.2-4  A dimensional approach looks forward to current discussions around the development of DSM-V  and ICD-11.5  It should be noted that other issues of DCNS have contained papers that touch on this topic—readers are encouraged to go to the journal’s Web site—http://www.dialogues-cns.org—and to scan the tables of contents of past issues for relevant material. In this issue we have assembled an outstanding interna- tional roster of investigators from the neurosciences and behavioral sciences. Demonstrating the truly interdiscipli- nary nature of this work, the authors are based in many different types of departments and institutes. We are grateful to them for their contributions. The issue begins with a State of the art paper (p 111) by Prof Lyketsos and colleagues from Baltimore. They rein- troduce us to the classic term “neuropsychiatry” and show how the new models and methodological tools of the field bring a conceptual coherence to a variety of con- ditions that were formerly seen as entirely distinct. They make  the  persuasive  case  that  a  gene-environment approach holds great value in dissecting complex brain- behavior relationships. The mechanisms underlying these brain-behavior relation- ships are discussed in the two papers in the Translational research section. The paper from the laboratory of Prof Kaplin (Pucak et al, p 125) describes the neuroendocrine and neuroinflammatory mechanisms associated with the development of depression in multiple sclerosis (MS). They make a strong case in support of shared pathophysiologi- cal underpinnings in MS and depression, and thereby negate the all-too-common “primary-secondary” distinc- tion or the “reactive depression” rationale (ie, who would not be depressed when they learned they had developed MS?). This important perspective is continued from the neurocircuitry perspective in the paper from Profs Bonelli and Cummings (p 141). They focus on the frontal-subcor- tical circuits that underlie the executive dysfunction, apathy, and impulsivity that so often characterize brain disorders. The next section of this issue, Clinical research, contains papers  on  frontotemporal  dementia  (Silveri,  p  153), Tourette’s syndrome (Müller, p 161), Charles Bonnet syn- drome (ffytche, p 173), Huntington’s disease (Rosenblatt, p 191), and CADASIL (Chabriat and Bousser, p 199). Each disease  has  unique  features  of  clinical  presentation, course, and outcome. None of them represent the “sim- ple” relationship of a single lesion and a specific outcome.   Taking these papers as a set, one cannot help but be impressed with the commonalities in underlying mecha- nisms that can be characterized along dimensions of cog- nition, mood, thought, movement, and circadian disrup- tion. We are also impressed with the general inadequacies of   our   treatments   and   the   need   for   entirely   new approaches based on our deeper understanding of etiol- ogy and pathophysiology. This is the true value of a trans- lational research perspective. This issue contains a Poster from the laboratory of Peter Brugger in Zurich (p 210) and concludes with a Free Paper from the research group of Julio Bobes in Oviedo (p 215). Prof Brugger’s careful work has elucidated fasci-