1
|
Deng X, Saffari SE, Xiao B, Ng SYE, Chia N, Choi X, Heng DL, Xu Z, Tay KY, Au WL, Tan EK, Tan LCS. Disease progression in Parkinson's disease patients with mild cognitive impairment: 5-year longitudinal study from the early Parkinson's disease longitudinal Singapore (PALS) cohort. Aging (Albany NY) 2024; 16:11491-11500. [PMID: 39137312 PMCID: PMC11346777 DOI: 10.18632/aging.206040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/29/2024] [Indexed: 08/15/2024]
Abstract
AIM To investigate motor, non-motor and cognitive progression in early Parkinson's disease (PD) patients with Mild Cognitive Impairment (MCI). METHODS PD patients were recruited within 1 year of diagnosis and were classified into PD-MCI group and PD with normal cognition (PD-NC) group. H&Y staging scale, MDS-UPDRS part III were used to assess disease severity and motor progression. Non-motor symptom scale (NMSS) was used to evaluate the NMS progression. Cognitive progression was assessed from 5 cognitive domains. Annual progression changes in the longitudinal outcomes were examined via linear mixed model with random intercept effect. False discovery rate (FDR) method was performed to control for multiple testing comparison and q-value was calculated. We set the threshold of q-values as 0.1. RESULT A total of 205 PD patients, including 107 PD-MCI and 98 PD-NC patients were assessed prospectively over a 5-year period. PD-MCI patients, compared to PD-NC group, had a significantly higher progression rate in H&Y score (0.11 vs. 0.06, p=0.03, q=0.08), MDS-UPDRS motor score (3.11 vs. 1.90 p<0.001, q=0.06) and postural instability gait difficulty (PIGD) score (0.40 vs. 0.20, p=0.02, q=0.07). PD-MCI group also exhibited significantly faster deterioration in NMSS perceptual domain (PD-MCI vs. PD-NC: 0.38 vs. -0.04, p=0.01, q=0.06) and cognitive visuospatial domain (PD-MCI vs. PD-NC: 0.13 vs. -0.06, p=0.048, q=0.09) after adjustment for confounders and multiple comparisons. CONCLUSIONS PD-MCI patients had faster decline in motor functions, visuo-perceptual and visuospatial performance. These findings provide a more comprehensive prognosis of PD-MCI, which could be helpful for clinician to manage PD-MCI patients.
Collapse
Affiliation(s)
- Xiao Deng
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Seyed Ehsan Saffari
- National Neuroscience Institute, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Bin Xiao
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Nicole Chia
- National Neuroscience Institute, Singapore, Singapore
| | - Xinyi Choi
- National Neuroscience Institute, Singapore, Singapore
| | | | - Zheyu Xu
- National Neuroscience Institute, Singapore, Singapore
| | - Kay-Yaw Tay
- National Neuroscience Institute, Singapore, Singapore
| | - Wing-Lok Au
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eng-King Tan
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Louis CS Tan
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
2
|
Huang M, Yu H, Lyu X, Pu W, Yin J, Gao B. Region-specific Cerebral Metabolic Alterations in Parkinson's Disease Patients With/without Mild Cognitive Impairment. Neuroscience 2024; 551:254-261. [PMID: 38848776 DOI: 10.1016/j.neuroscience.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
N-acetylaspartate (NAA), choline (Cho) and creatine (Cr) are brain metabolites involved in some key neuronal functions within the brain, such as cognitive function. The aim of this study was to investigate whether Parkinson's disease (PD) with different cognitive status induces regional brain metabolite differences. 38 diagnosed PD patients, including 18 PD patients with normal cognitive (PDN), 20 PD subjects with cognitive impairment (PDMCI) and 25 healthy controls (HC) participated in this study. All subjects underwent a single-voxel proton MR spectroscopy (1H-MRS) on a 3T scanner. 1H-MRS were obtained from bilateral PCC, left thalamus and PFC regions in all subjects, respectively. Region-specific cerebral metabolic alterations existed in PD patients with different cognitive status. PDMCI patients showed a significant reduction of NAA, Cho and tCr in the PCC and left thalamus, compared to healthy controls; whereas lower levels of NAA and Cho in thalamus were found in PDN patients. Moreover, Cho and tCr levels were positively correlated with MMSE scores. Both NAA and tCr in PCC levels were positively correlated with MMSE and MoCA scores. The combination of thalamic and PCC metabolites showed a 75.6% accuracy in distinguishing PDMCI patients from PDN patients. This study provides preliminary evidence that thalamic, PCC and PFC neurometabolic alterations occur in PD patients with cognition decline. Findings of this study indicate that NAA and tCr abnormalities in PCC and thalamus might be used as a biomarker to track cognitive decline in Parkinson's disease in clinical settings.
Collapse
Affiliation(s)
- Mingming Huang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China; Key Laboratory of Brain Imaging, Guizhou Medical University, Guiyang, China.
| | - Hui Yu
- Department of Radiology, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Xinyue Lyu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wei Pu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jianhong Yin
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China; Key Laboratory of Brain Imaging, Guizhou Medical University, Guiyang, China.
| |
Collapse
|
3
|
Ribarič S. The Contribution of Type 2 Diabetes to Parkinson's Disease Aetiology. Int J Mol Sci 2024; 25:4358. [PMID: 38673943 PMCID: PMC11050090 DOI: 10.3390/ijms25084358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/29/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Type 2 diabetes (T2D) and Parkinson's disease (PD) are chronic disorders that have a significant health impact on a global scale. Epidemiological, preclinical, and clinical research underpins the assumption that insulin resistance and chronic inflammation contribute to the overlapping aetiologies of T2D and PD. This narrative review summarises the recent evidence on the contribution of T2D to the initiation and progression of PD brain pathology. It also briefly discusses the rationale and potential of alternative pharmacological interventions for PD treatment.
Collapse
Affiliation(s)
- Samo Ribarič
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
| |
Collapse
|
4
|
Jellinger KA. Mild cognitive impairment in Huntington's disease: challenges and outlooks. J Neural Transm (Vienna) 2024; 131:289-304. [PMID: 38265518 DOI: 10.1007/s00702-024-02744-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
Although Huntington's disease (HD) has classically been viewed as an autosomal-dominant inherited neurodegenerative motor disorder, cognitive and/or behavioral changes are predominant and often an early manifestation of disease. About 40% of individuals in the presymptomatic period of HD meet the criteria for mild cognitive impairment, later progressing to dementia. The heterogenous spectrum of cognitive decline is characterized by deficits across multiple domains, particularly executive dysfunctions, but the underlying pathogenic mechanisms are still poorly understood. Investigating the pathophysiology of cognitive changes may give insight into important and early neurodegenerative events. Multimodal imaging revealed circuit-wide gray and white matter degenerative processes in several key brain regions, affecting prefronto-striatal/cortico-basal ganglia circuits and many other functional brain networks. Studies in transgenic animal models indicated early synaptic dysfunction, deficient neurotrophic transport and other molecular changes contributing to neuronal death. Synaptopathy within the cerebral cortex, striatum and hippocampus may be particularly important in mediating cognitive and neuropsychiatric manifestations of HD, although many other neuronal systems are involved. The interaction of mutant huntingtin protein (mHTT) with tau and its implication for cognitive impairment in HD is a matter of discussion. Further neuroimaging and neuropathological studies are warranted to better elucidate early pathophysiological mechanisms and to develop validated biomarkers to detect patients' cognitive status during the early stages of the condition significantly to implement effective preventing or management strategies.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
| |
Collapse
|
5
|
Burgio F, Menardi A, Benavides-Varela S, Danesin L, Giustiniani A, Van den Stock J, De Mitri R, Biundo R, Meneghello F, Antonini A, Vallesi A, de Gelder B, Semenza C. Facial emotion recognition in individuals with mild cognitive impairment: An exploratory study. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024:10.3758/s13415-024-01160-5. [PMID: 38316707 DOI: 10.3758/s13415-024-01160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
Understanding facial emotions is fundamental to interact in social environments and modify behavior accordingly. Neurodegenerative processes can progressively transform affective responses and affect social competence. This exploratory study examined the neurocognitive correlates of face recognition, in individuals with two mild cognitive impairment (MCI) etiologies (prodromal to dementia - MCI, or consequent to Parkinson's disease - PD-MCI). Performance on the identification and memorization of neutral and emotional facial expressions was assessed in 31 individuals with MCI, 26 with PD-MCI, and 30 healthy controls (HC). Individuals with MCI exhibited selective impairment in recognizing faces expressing fear, along with difficulties in remembering both neutral and emotional faces. Conversely, individuals with PD-MCI showed no differences compared with the HC in either emotion recognition or memory. In MCI, no significant association emerged between the memory for facial expressions and cognitive difficulties. In PD-MCI, regression analyses showed significant associations with higher-level cognitive functions in the emotional memory task, suggesting the presence of compensatory mechanisms. In a subset of participants, voxel-based morphometry revealed that the performance on emotional tasks correlated with regional changes in gray matter volume. The performance in the matching of negative expressions was predicted by volumetric changes in brain areas engaged in face and emotional processing, in particular increased volume in thalamic nuclei and atrophy in the right parietal cortex. Future studies should leverage on neuroimaging data to determine whether differences in emotional recognition are mediated by pathology-specific atrophic patterns.
Collapse
Affiliation(s)
| | - Arianna Menardi
- Department of Neuroscience, University of Padova, 35128, Padova, Italy
- Padova Neuroscience Center, University of Padova, 35129, Padova, Italy
| | - Silvia Benavides-Varela
- Padova Neuroscience Center, University of Padova, 35129, Padova, Italy
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | | | | | - Jan Van den Stock
- Department of Neuroscience, Leuven Brain Institute, KU Leuven, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, 3000, Leuven, Belgium
| | | | - Roberta Biundo
- Department of General Psychology (DPG), University of Padua, 35131, Padua, Italy
- Study Center for Neurodegeneration (CESNE), University of Padua, 35131, Padua, Italy
| | - Francesca Meneghello
- Unità Operativa Complessa Cure Primarie Distretto 3 Mirano-Dolo, Aulss 3, Serenissima, Italy
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, Department of Neuroscience, Centre for Rare Neurological Diseases (ERN-RND), University of Padova, Padova, Italy
| | - Antonino Vallesi
- Department of Neuroscience, University of Padova, 35128, Padova, Italy
- Padova Neuroscience Center, University of Padova, 35129, Padova, Italy
| | - Beatrice de Gelder
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, 6200, MD, Maastricht, the Netherlands
| | - Carlo Semenza
- Department of Neuroscience, University of Padova, 35128, Padova, Italy
- Padova Neuroscience Center, University of Padova, 35129, Padova, Italy
| |
Collapse
|
6
|
Shu Z, Wang J, Cheng Y, Lu J, Lin J, Wang Y, Zhang X, Yu Y, Zhu Z, Han J, Wu J, Yu N. fNIRS-based graph frequency analysis to identify mild cognitive impairment in Parkinson's disease. J Neurosci Methods 2024; 402:110031. [PMID: 38040127 DOI: 10.1016/j.jneumeth.2023.110031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Early identification of mild cognitive impairment (MCI) is essential for its treatment and the prevention of dementia in Parkinson's disease (PD). Existing approaches are mostly based on neuropsychological assessments, while brain activation and connection have not been well considered. NEW METHOD This paper presents a neuroimaging-based graph frequency analysis method and the generated features to quantify the brain functional neurodegeneration and distinguish between PD-MCI patients and healthy controls. The Stroop color-word experiment was conducted with 20 PD-MCI patients and 34 healthy controls, and the brain activation was recorded with functional near-infrared spectroscopy (fNIRS). Then, the functional brain network was constructed based on Pearson's correlation coefficient calculation between every two fNIRS channels. Next, the functional brain network was represented as a graph and decomposed in the graph frequency domain through the graph Fourier transform (GFT) to obtain the eigenvector matrix. Total variation and weighted zero crossings of eigenvectors were defined and integrated to quantify functional interaction between brain regions and the spatial variability of the brain network in specific graph frequency ranges, respectively. After that, the features were employed in training a support vector machine (SVM) classifier. RESULTS The presented method achieved a classification accuracy of 0.833 and an F1 score of 0.877, significantly outperforming existing methods and features. COMPARISON WITH EXISTING METHODS Our method provided improved classification performance in the identification of PD-MCI. CONCLUSION The results suggest that the presented graph frequency analysis method well identify PD-MCI patients and the generated features promise functional brain biomarkers for PD-MCI diagnosis.
Collapse
Affiliation(s)
- Zhilin Shu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, China
| | - Jin Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China; Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300370, China
| | - Yuanyuan Cheng
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300370, China; Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, China
| | - Jianeng Lin
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, China
| | - Yue Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Xinyuan Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300370, China
| | - Yang Yu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Zhizhong Zhu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300370, China; Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, China; Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, China.
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin 300350, China.
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, China; Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, China.
| |
Collapse
|
7
|
Borghammer P, Okkels N, Weintraub D. Parkinson's Disease and Dementia with Lewy Bodies: One and the Same. JOURNAL OF PARKINSON'S DISEASE 2024; 14:383-397. [PMID: 38640172 DOI: 10.3233/jpd-240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
The question whether Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are expressions of the same underlying disease has been vigorously debated for decades. The recently proposed biological definitions of Lewy body disease, which do not assign any particular importance to the dopamine system over other degenerating neurotransmitter systems, has once more brought the discussion about different types of Lewy body disease to the forefront. Here, we briefly compare PDD and DLB in terms of their symptoms, imaging findings, and neuropathology, ultimately finding them to be indistinguishable. We then present a conceptual framework to demonstrate how one can view different clinical syndromes as manifestations of a shared underlying Lewy body disease. Early Parkinson's disease, isolated RBD, pure autonomic failure and other autonomic symptoms, and perhaps even psychiatric symptoms, represent diverse manifestations of the initial clinical stages of Lewy body disease. They are characterized by heterogeneous and comparatively limited neuronal dysfunction and damage. In contrast, Lewy body dementia, an encompassing term for both PDD and DLB, represents a more uniform and advanced stage of the disease. Patients in this category display extensive and severe Lewy pathology, frequently accompanied by co-existing pathologies, as well as multi-system neuronal dysfunction and degeneration. Thus, we propose that Lewy body disease should be viewed as a single encompassing disease entity. Phenotypic variance is caused by the presence of individual risk factors, disease mechanisms, and co-pathologies. Distinct subtypes of Lewy body disease can therefore be defined by subtype-specific disease mechanisms or biomarkers.
Collapse
Affiliation(s)
- Per Borghammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Okkels
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
8
|
Jellinger KA. Pathobiology of Cognitive Impairment in Parkinson Disease: Challenges and Outlooks. Int J Mol Sci 2023; 25:498. [PMID: 38203667 PMCID: PMC10778722 DOI: 10.3390/ijms25010498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Cognitive impairment (CI) is a characteristic non-motor feature of Parkinson disease (PD) that poses a severe burden on the patients and caregivers, yet relatively little is known about its pathobiology. Cognitive deficits are evident throughout the course of PD, with around 25% of subtle cognitive decline and mild CI (MCI) at the time of diagnosis and up to 83% of patients developing dementia after 20 years. The heterogeneity of cognitive phenotypes suggests that a common neuropathological process, characterized by progressive degeneration of the dopaminergic striatonigral system and of many other neuronal systems, results not only in structural deficits but also extensive changes of functional neuronal network activities and neurotransmitter dysfunctions. Modern neuroimaging studies revealed multilocular cortical and subcortical atrophies and alterations in intrinsic neuronal connectivities. The decreased functional connectivity (FC) of the default mode network (DMN) in the bilateral prefrontal cortex is affected already before the development of clinical CI and in the absence of structural changes. Longitudinal cognitive decline is associated with frontostriatal and limbic affections, white matter microlesions and changes between multiple functional neuronal networks, including thalamo-insular, frontoparietal and attention networks, the cholinergic forebrain and the noradrenergic system. Superimposed Alzheimer-related (and other concomitant) pathologies due to interactions between α-synuclein, tau-protein and β-amyloid contribute to dementia pathogenesis in both PD and dementia with Lewy bodies (DLB). To further elucidate the interaction of the pathomechanisms responsible for CI in PD, well-designed longitudinal clinico-pathological studies are warranted that are supported by fluid and sophisticated imaging biomarkers as a basis for better early diagnosis and future disease-modifying therapies.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150 Vienna, Austria
| |
Collapse
|
9
|
Huang X, He Q, Ruan X, Li Y, Kuang Z, Wang M, Guo R, Bu S, Wang Z, Yu S, Chen A, Wei X. Structural connectivity from DTI to predict mild cognitive impairment in de novo Parkinson's disease. Neuroimage Clin 2023; 41:103548. [PMID: 38061176 PMCID: PMC10755095 DOI: 10.1016/j.nicl.2023.103548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND Early detection of Parkinson's disease (PD) patients at high risk for mild cognitive impairment (MCI) can help with timely intervention. White matter structural connectivity is considered an early and sensitive indicator of neurodegenerative disease. OBJECTIVES To investigate whether baseline white matter structural connectivity features from diffusion tensor imaging (DTI) of de novo PD patients can help predict PD-MCI conversion at an individual level using machine learning methods. METHODS We included 90 de novo PD patients who underwent DTI and 3D T1-weighted imaging. Elastic net-based feature consensus ranking (ENFCR) was used with 1000 random training sets to select clinical and structural connectivity features. Linear discrimination analysis (LDA), support vector machine (SVM), K-nearest neighbor (KNN) and naïve Bayes (NB) classifiers were trained based on features selected more than 500 times. The area under the ROC curve (AUC), accuracy (ACC), sensitivity (SEN) and specificity (SPE) were used to evaluate model performance. RESULTS A total of 57 PD patients were classified as PD-MCI nonconverters, and 33 PD patients were classified as PD-MCI converters. The models trained with clinical data showed moderate performance (AUC range: 0.62-0.68; ACC range: 0.63-0.77; SEN range: 0.45-0.66; SPE range: 0.64-0.84). Models trained with structural connectivity (AUC range, 0.81-0.84; ACC range, 0.75-0.86; SEN range, 0.77-0.91; SPE range, 0.71-0.88) performed similar to models that were trained with both clinical and structural connectivity data (AUC range, 0.81-0.85; ACC range, 0.74-0.85; SEN range, 0.79-0.91; SPE range, 0.70-0.89). CONCLUSIONS Baseline white matter structural connectivity from DTI is helpful in predicting future MCI conversion in de novo PD patients.
Collapse
Affiliation(s)
- Xiaofei Huang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Qing He
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Xiuhang Ruan
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Yuting Li
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China; Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Guangdong, China
| | - Zhanyu Kuang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Mengfan Wang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Riyu Guo
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Shuwen Bu
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Zhaoxiu Wang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Shaode Yu
- School of Information and Communication Engineering, Communication University of China, Beijing, China.
| | - Amei Chen
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China.
| | - Xinhua Wei
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China.
| |
Collapse
|
10
|
Huang M, Yu H, Cai X, Zhang Y, Pu W, Gao B. A comparative study of posterior cingulate metabolism in patients with mild cognitive impairment due to Parkinson's disease or Alzheimer's disease. Sci Rep 2023; 13:14241. [PMID: 37648724 PMCID: PMC10469183 DOI: 10.1038/s41598-023-41569-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
Few comparative studies have assessed metabolic brain changes in cognitive impairment among neurodegenerative disorders, and the posterior cingulate cortex (PCC) is a metabolically active brain region with high involvement in multiple cognitive processes. Therefore, in this study, metabolic abnormalities of the PCC were compared in patients with mild cognitive impairment (MCI) due to Parkinson's disease (PD) or Alzheimer's disease (AD), as examined by proton magnetic resonance spectroscopy (1H-MRS). Thirty-eight patients with idiopathic PD, including 20 with mild cognitive impairment (PDMCI) and 18 with normal cognitive function (PDN), 18 patients with probable mild cognitive impairment (ADMCI), and 25 healthy elderly controls (HCs) were recruited and underwent PCC 1H-MRS scans. Compared with HCs, patients with PDMCI exhibited significantly reduced concentrations of N-acetyl aspartate (NAA), total NAA (tNAA), choline (Cho), glutathione (GSH), glutamate + glutamine (Glx) and total creatine (tCr), while ADMCI cases exhibited significantly elevated levels of myo-inositol (Ins) and Ins/tCr ratio, as well as reduced NAA/Ins ratio. No significant metabolic changes were detected in PDN subjects. Compared with ADMCI, reduced NAA, Ins and tCr concentrations were detected in PDMCI. Besides, ROC curve analysis revealed that tCr concentration could differentiate PDMCI from PDN with an AUC of 0.71, and NAA/Ins ratio could differentiate patients with MCI from controls with normal cognitive function with an AUC of 0.74. Patients with PDMCI and ADMCI exhibited distinct PCC metabolic 1H-MRS profiles. The findings suggested cognitively normal PD patients with low NAA and tCr in the PCC might be at risk of preclinical PDMCI, and Ins and/or NAA/MI ratio in the PCC should be reconsidered a possible biomarker of preclinical MCI in clinical practice. So, comparing PCC's 1H-MRS profiles of cognitive impairment among neurodegenerative illnesses may provide useful information for better defining the disease process and elucidate possible treatment mechanisms.
Collapse
Affiliation(s)
- Mingming Huang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China.
| | - Hui Yu
- General Practice Center and Department of Radiology, The Seventh Affiliated Hospital, Southern Medical University, Foshan, 528200, China
| | - Xi Cai
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Yong Zhang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Wei Pu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China.
| |
Collapse
|
11
|
Jia X, Li Y, Ying Y, Jia X, Tang W, Bian Y, Zhang J, Wang DJJ, Cheng X, Yang Q. Effect of corticosubcortical iron deposition on dysfunction in CADASIL is mediated by white matter microstructural damage. Neuroimage Clin 2023; 39:103485. [PMID: 37542975 PMCID: PMC10407949 DOI: 10.1016/j.nicl.2023.103485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
Iron dysregulation may attenuate cognitive performance in patients with CADASIL. However, the underlying pathophysiological mechanisms remain incompletely understood. Whether white matter microstructural changes mediate these processes is largely unclear. In the present study, 30 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients were confirmed via genetic analysis and 30 sex- and age-matched healthy controls underwent multimodal MRI examinations and neuropsychological assessments. Quantitative susceptibility mapping and peak width of skeletonized mean diffusivity (PSMD) were analyzed. Mediation effect analysis was performed to explore the interrelationship between iron deposition, white matter microstructural changes and cognitive deficits in CADASIL. Cognitive deterioration was most affected in memory and executive function, followed by attention and working memory in CADASIL. Excessive iron in the temporal-precuneus pathway and deep gray matter specific to CADASIL were identified. Mediation analysis further revealed that PSMD mediated the relationship between iron concentration and cognitive profile in CADASIL. The present findings provide a new perspective on iron deposition in the corticosubcortical circuit and its contribution to disease-related selective cognitive decline, in which iron concentration may affect cognition by white matter microstructural changes in CADASIL.
Collapse
Affiliation(s)
- Xiuqin Jia
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100020, China
| | - Yingying Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yunqing Ying
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xuejia Jia
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yueyan Bian
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jiajia Zhang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, United States
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100020, China.
| |
Collapse
|
12
|
Carlisle TC, Fought AJ, Olson KE, Lopez-Esquibel N, Simpson A, Medina LD, Holden SK. Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease. Front Neurosci 2023; 17:1200347. [PMID: 37434765 PMCID: PMC10330725 DOI: 10.3389/fnins.2023.1200347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline. Objective The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD. Methods Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed. Results Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8). Conclusion The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.
Collapse
Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
| | - Angela J. Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Kaitlin E. Olson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | | | - Abigail Simpson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- Movement Disorders Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|
13
|
Resnik Robida K, Politakis VA, Oblak A, Ozimič AS, Burger H, Pirtošek Z, Bon J. Detecting Subtle Cognitive Impairment in Patients with Parkinson's Disease and Normal Cognition: A Novel Cognitive Control Challenge Task (C3T). Brain Sci 2023; 13:961. [PMID: 37371439 DOI: 10.3390/brainsci13060961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Patients with Parkinson's disease (PD) often show early deficits in cognitive control, with primary difficulties in flexibility and relatively intact stable representations. The aim of our study was to assess executive function using an ecologically valid approach that combines measures of stability and flexibility. Fourteen patients without cognitive deficits and sixteen comparable control subjects completed a standardized neuropsychological test battery and a newly developed cognitive control challenge task (C3T). We found that the accuracy of C3T performance decreased with age in healthy participants and remained impaired in PD patients regardless of age. In addition, PD patients showed significantly lower overall performance for cognitive control tasks than healthy controls, even when they scored in the normal range on standardized neuropsychological tests. PD Patients responded significantly faster than healthy control subjects regarding flexible cognitive control tasks due to their impulsivity. Correlations showed that the C3T task targets multiple cognitive systems, including working memory, inhibition, and task switching, providing a reliable measure of complex cognitive control. C3T could be a valuable tool for characterizing cognitive deficits associated with PD and appears to be a more sensitive measure than standardized neuropsychological tests. A different assessment approach could potentially detect early signs of the disease and identify opportunities for early intervention with neuroprotective therapies.
Collapse
Affiliation(s)
- Karmen Resnik Robida
- University Rehabilitation Institute, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Vida Ana Politakis
- University Rehabilitation Institute, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Aleš Oblak
- University Psychiatric Clinic Ljubljana, SI-1260 Ljubljana, Slovenia
| | - Anka Slana Ozimič
- Department of Psychology, Faculty of Arts, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Helena Burger
- University Rehabilitation Institute, University of Ljubljana, SI-1000 Ljubljana, Slovenia
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia
- MRD Center for Active and Healthy Ageing, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Jurij Bon
- University Psychiatric Clinic Ljubljana, SI-1260 Ljubljana, Slovenia
- Department of Neurology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| |
Collapse
|
14
|
Jones JD, Rivas R, Luna K, Ryczek CA, Thomas KR. Subjective cognitive complaints are important in PD-MCI criteria: Associations with CSF markers and cognitive decline. Parkinsonism Relat Disord 2023; 106:105221. [PMID: 36442366 PMCID: PMC10775883 DOI: 10.1016/j.parkreldis.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION According to the Movement Disorder Society (MDS), subjective cognitive complaints (SCC) are a diagnostic criterion for PD-mild cognitive impairment (PD-MCI); however, studies often do not incorporate SCC when classifying PD-MCI. This inconsistent use may reflect mixed findings regarding the association between SCC and objective measures of cognitive impairment. Our study aimed to describe the extent that inclusion/exclusion of SCC affects the occurrence of PD-MCI, and if the inclusion of SCC is associated with faster cognitive decline and cerebrospinal fluid markers (CSF) of alpha-synuclein, amyloid beta, total tau, and phophorylated-tau. METHODS Individuals with PD (N = 358) from the PPMI cohort whom completed measures of neuropsychological performance, subjective cognitive complaints, motor severity, and CSF markers were included. Participants were classified as cognitively normal (CN), PD-MCI with subjective cognitive complaints (PD-MCI + SCC) and PD-MCI without subjective cognitive complaints (PD-MCI -SCC). RESULTS PD-MCI rates were consistently higher (16.5-19.1%) across the 5 years when SCC was not included in the diagnostic criteria as opposed to when SCC was included (4.4-11.0%). PD-MCI + SCC experienced greater cognitive decline and had significantly higher levels of tau/ab and p-tau/ab relative to both the CN and PD-MCI - SCC groups. CONCLUSIONS Inconsistent implementation of an SCC requirement in PD-MCI classifications may have important implications in terms of the occurrence of PD-MCI and its prognostic value. Classifying PD-MCI only using neuropsychological cut-off criterion, without regard to SCC, may lead to higher rates of PD-MCI. Inclusions of SCC in PD-MCI criteria in newly diagnosed PD participants may strengthen the ability to detect individuals at risk for future cognitive decline, though it is possible that this decline is related to Alzheimer's disease changes rather than worse PD pathology.
Collapse
Affiliation(s)
- Jacob D Jones
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA.
| | - Rhiannon Rivas
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Kenya Luna
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Cameron A Ryczek
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Kelsey R Thomas
- Veteran Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
15
|
Pinizzotto CC, Dreyer KM, Aje OA, Caffrey RM, Madhira K, Kritzer MF. Spontaneous Object Exploration in a Recessive Gene Knockout Model of Parkinson's Disease: Development and Progression of Object Recognition Memory Deficits in Male Pink1-/- Rats. Front Behav Neurosci 2022; 16:951268. [PMID: 36560930 PMCID: PMC9763898 DOI: 10.3389/fnbeh.2022.951268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairments appear at or before motor signs in about one third of patients with Parkinson's disease (PD) and have a cumulative prevalence of roughly 80% overall. These deficits exact an unrelenting toll on patients' quality and activities of daily life due in part to a lack of available treatments to ameliorate them. This study used three well-validated novel object recognition-based paradigms to explore the suitability of rats with knockout of the PTEN-induced putative kinase1 gene (Pink1) for investigating factors that induce cognitive decline in PD and for testing new ways to mitigate them. Longitudinal testing of rats from 3-9 months of age revealed significant impairments in male Pink1-/- rats compared to wild type controls in Novel Object Recognition, Novel Object Location and Object-in-Place tasks. Task-specific differences in the progression of object discrimination/memory deficits across age were also seen. Finally, testing using an elevated plus maze, a tapered balance beam and a grip strength gauge showed that in all cases recognition memory deficits preceded potentially confounding impacts of gene knockout on affect or motor function. Taken together, these findings suggest that knockout of the Pink1 gene negatively impacts the brain circuits and/or neurochemical systems that support performance in object recognition tasks. Further investigations using Pink1-/- rats and object recognition memory tasks should provide new insights into the neural underpinnings of the visual recognition memory and visuospatial information processing deficits that are often seen in PD patients and accelerate the pace of discovery of better ways to treat them.
Collapse
Affiliation(s)
- Claudia C. Pinizzotto
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, United States,*Correspondence: Claudia C. Pinizzotto,
| | - Katherine M. Dreyer
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, United States,InSTAR Program, Ward Melville High School, East Setauket, NY, United States
| | - Oluwagbohunmi A. Aje
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, United States
| | - Ryan M. Caffrey
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, United States,Master’s Program in Neuroscience, Stony Brook University, Stony Brook, NY, United States
| | - Keertana Madhira
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, United States,Hauppauge High School Science Research Program, Hauppauge High School, Hauppauge, NY, United States
| | - Mary F. Kritzer
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
16
|
Park SY, Schott N. Which motor-cognitive abilities underlie the digital Trail-Making Test? Decomposing various test scores to detect cognitive impairment in Parkinson's disease-Pilot study. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-15. [PMID: 36412487 DOI: 10.1080/23279095.2022.2147837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since Parkinson's disease (PD) is a heterogeneous disorder with symptoms, such as tremors, gait and speech disturbances, or memory loss, individualized diagnostics are needed to optimize treatment. In their current form, the typical paper-pencil methods traditionally used to track disease progression are too coarse to capture the subtleties of clinical phenomena. For this reason, digital biomarkers that capture, for example, motor function, cognition, and behavior using apps, wearables, and tracking systems are becoming increasingly established. However, given the high prevalence of cognitive impairment in PD, digital cognitive biomarkers to predict mental progression are important in clinical practice. This pilot study aimed to identify those components of our digital version of the TMT (dTMT) that allow discrimination between PD patients with and without cognitive deficits. A total of 30 healthy control (age 66.3 ± 8.61) and 30 participants with PD (age 68.3 ± 9.66) performed the dTMT using a touch-sensitive tablet to capture enhanced performance metrics, such as the speed between and inside circles. The decomposition of cognitive abilities based on integrating additional variables in the dTMT revealed that the Parkinson's disease group was significantly more sensitive to parameters of inhibitory control. In contrast, the mild cognitive impairment group was sensitive to parameters of cognitive flexibility and working memory. The dTMT allows objective, ecologically valid, and long-term cognitive and fine-motor performance tracking, suggesting its potential as a digital biomarker in neurodegenerative disorders.
Collapse
Affiliation(s)
- Soo-Yong Park
- Department of Sport Psychology & Human Movement Performance, Institute of Sport and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Nadja Schott
- Department of Sport Psychology & Human Movement Performance, Institute of Sport and Exercise Science, University of Stuttgart, Stuttgart, Germany
| |
Collapse
|
17
|
Suo X, Lei D, Li N, Peng J, Chen C, Li W, Qin K, Kemp GJ, Peng R, Gong Q. Brain functional network abnormalities in parkinson's disease with mild cognitive impairment. Cereb Cortex 2022; 32:4857-4868. [PMID: 35078209 PMCID: PMC9923713 DOI: 10.1093/cercor/bhab520] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/13/2022] Open
Abstract
Mild cognitive impairment in Parkinson's disease (PD-M) is related to a high risk of dementia. This study explored the whole-brain functional networks in early-stage PD-M. Forty-one patients with PD classified as cognitively normal (PD-N, n = 17) and PD-M (n = 24) and 24 demographically matched healthy controls (HC) underwent clinical and neuropsychological evaluations and resting-state functional magnetic resonance imaging. The global, regional, and modular topological characteristics were assessed in the brain functional networks, and their relationships to cognitive scores were tested. At the global level, PD-M and PD-N exhibited higher characteristic path length and lower clustering coefficient, local and global efficiency relative to HC. At the regional level, PD-M and PD-N showed lower nodal centrality in sensorimotor regions relative to HC. At the modular level, PD-M showed lower intramodular connectivity in default mode and cerebellum modules, and lower intermodular connectivity between default mode and frontoparietal modules than PD-N, correlated with Montreal Cognitive Assessment scores. Early-stage PD patients showed weaker small-worldization of brain networks. Modular connectivity alterations were mainly observed in patients with PD-M. These findings highlight the shared and distinct brain functional network dysfunctions in PD-M and PD-N, and yield insight into the neurobiology of cognitive decline in PD.
Collapse
Affiliation(s)
- Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Du Lei
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH 45227, USA
| | - Nannan Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiaxin Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Chaolan Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Kun Qin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3GE, UK
| | - Rong Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.,Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian 361022, China
| |
Collapse
|
18
|
Byeon H. Can the prediction model using regression with optimal scale improve the power to predict the Parkinson's dementia? World J Psychiatry 2022; 12:1031-1043. [PMID: 36158303 PMCID: PMC9476836 DOI: 10.5498/wjp.v12.i8.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Efficiently detecting Parkinson's disease (PD) with dementia (PDD) as soon as possible is an important issue in geriatric medicine.
AIM To develop a model for predicting PDD based on various neuropsychological tests using data from a nationwide survey conducted by the Korean Centers for Disease Control and Prevention and to present baseline data for the early detection of PDD.
METHODS This study comprised 289 patients who were 60 years or older with PD [110 with PDD and 179 Parkinson's Disease-Mild Cognitive Impairment (PD-MCI)]. Regre-ssion with optimal scaling (ROS) was used to identify independent relationships between the neuropsychological test results and PDD.
RESULTS In the ROS analysis, Korean version of mini mental state ex-amination (MMSE) (KOREAN version of MMSE) (b = -0.52, SE = 0.16) and Hoehn and Yahr staging (b = 0.44, SE = 0.19) were significantly effective models for distinguishing PDD from PD-MCI (P < 0.05), even after adjusting for all of the Parkinson's motor symptom and neuropsychological test results. The optimal number of categories (scaling factors) for KOREAN version of MMSE and Hoehn and Yahr Scale was 10 and 7, respectively.
CONCLUSION The results of this study suggest that among the various neuropsychological tests conducted, the optimal classification scores for KOREAN version of MMSE and Hoehn and Yahr Scale could be utilized as an effective screening test for the early discrimination of PDD from PD-MCI.
Collapse
Affiliation(s)
- Haewon Byeon
- Department of Medical Big Data, Inje University, Gimhae 50834, South Korea
| |
Collapse
|
19
|
Pinizzotto CC, Patwardhan A, Aldarondo D, Kritzer MF. Task-specific effects of biological sex and sex hormones on object recognition memories in a 6-hydroxydopamine-lesion model of Parkinson's disease in adult male and female rats. Horm Behav 2022; 144:105206. [PMID: 35653829 DOI: 10.1016/j.yhbeh.2022.105206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023]
Abstract
Many patients with Parkinson's disease (PD) experience cognitive or memory impairments with few therapeutic options available to mitigate them. This has fueled interest in determining how factors including sex and sex hormones modulate higher order function in this disease. The objective of this study was to use the Novel Object Recognition (NOR) and Object-in-Place (OiP) paradigms to compare the effects of a bilateral neostriatal 6-hydroxydopamine (6-OHDA) lesion model of PD in gonadally intact male and female rats, in orchidectomized male rats and in orchidectomized males supplemented with 17β-estradiol or testosterone propionate on measures of recognition memory similar to those at risk in PD. These studies showed that 6-ODHA lesions impaired discrimination in both tasks in males but not females. Further, 6-OHDA lesions disrupted NOR performance similarly in all males regardless of whether they were gonadally intact, orchidectomized or hormone-supplemented. In contrast, OiP performance was disrupted in males that were orchidectomized or 6-OHDA-lesioned but was spared in orchidectomized and orchidectomized, 6-OHDA lesioned males supplemented with 17β-estradiol. The distinct effects that sex and/or sex hormones have on 6-OHDA lesion-induced NOR vs. OiP deficits identified here also differ from corresponding impacts recently described for 6-OHDA lesion-induced deficits in spatial working memory and episodic memory. Together, the collective data provide strong evidence for effects of sex and sex hormones on cognition and memory in PD as being behavioral task and behavioral domain specific. This specificity could explain why a cohesive clinical picture of endocrine impacts on higher order function in PD has remained elusive.
Collapse
Affiliation(s)
- Claudia C Pinizzotto
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York 11794, USA.
| | - Aishwarya Patwardhan
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York 11794, USA.
| | - Daniel Aldarondo
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York 11794, USA.
| | - Mary F Kritzer
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York 11794, USA.
| |
Collapse
|
20
|
Deng S, Dong Z, Pan L, Liu Y, Ye Z, Qin L, Liu Q, Qin C. Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta-analysis. Brain Behav 2022; 12:e2697. [PMID: 35862217 PMCID: PMC9392523 DOI: 10.1002/brb3.2697] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is acknowledged to be crucial to manage freezing of gait (FOG) and cognitive impairment for patients with Parkinson's disease (PD), but its effectiveness is unclear. OBJECTIVE To determine the effects of rTMS on FOG and cognitive function in people with PD and to investigate potential factors that modulate the rTMS effects. METHODS Databases searched included PubMed, Web of Science, EMBASE, and the Cochrane Library from inception to December 31, 2021. Eligible studies include a controlled randomized clinical trial of rTMS intervention for FOG and cognitive dysfunction in PD patients. The weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated with fixed-effects models. The outcome of the study included gait and cognitive assessments. RESULTS Sixteen studies with a total of 419 patients were included. Fixed-effects analysis revealed that rTMS was effective in improving freezing of gait questionnaire scores (short-term effect: WMD = -0.925, 95% CI: -1.642 to -0.209, p = .011; long-term effect: WMD = -2.120, 95% CI: -2.751 to -1.489, p = .000), 10-m walking time (short-term effect: WMD = -0.456, 95% CI: -0.793 to -0.119, p = .008; long-term effect: WMD = -0.526, 95% CI: -0.885 to -0.167, p = .004), Timed Up-and-Go scores (short-term effect: WMD = -1.064, 95% CI: -1.555 to -0.572, p = .000; long-term effect: WMD = -1.097, 95% CI: -1.422 to -0.772, p = .000), Montreal cognitive assessment (WMD = 3.714, 95% CI: 2.567 to 4.861, p = .000), and frontal assessment battery (WMD = -0.584, 95% CI: -0.934 to -0.234, p = .001). CONCLUSIONS RTMS showed a beneficial effect on FOG and cognitive dysfunction in parkinsonism. However, the optimal rTMS protocol has not been determined and further high-quality studies are needed.
Collapse
Affiliation(s)
- Shan Deng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhimei Dong
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liya Pan
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Ying Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Qin
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Qianqian Liu
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
21
|
Wal P, Dwivedi J, Wal A, Vig H, Singh Y. Detailed insight into the pathophysiology and the behavioral complications associated with the Parkinson's disease and its medications. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2022. [DOI: 10.1186/s43094-022-00425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The loss of dopamine neurons in the substantia nigra, as well as other mostly catecholaminergic neurons, causes many of the motor symptoms that define Parkinson's disease. Parkinson's disease is commonly thought of as a movement disorder, the significant prevalence of psychiatric complications such as cognitive impairment, and psychosis suggests it should be considered a neuropsychiatric illness, and all behavioral complications are linked to growing disability and the medication.
Main body
Apart from the disease-induced abnormalities, there are several other side effects of the disease and also from the medication used to prevent the disease. This article focuses on the pathogenesis of Parkinson’s disease and also the behavioral abnormalities caused by the disease and its medication. The study's data were gathered by searching several review articles and research papers from a variety of sources, including Elsevier, PubMed, Research Gate, Journal of Pharmaceutical Science, etc., from the year 1985 to 2021. Parkinson's disease is a neurodegenerative disease caused by a variety of complex processes. It is responsible not just for motor symptoms, but also for a variety of behavioral symptoms that can arise as a result of the disease and/or medication.
Conclusion
Only symptomatic drugs are available; thus, finding treatments that directly address the disease mechanisms causing Parkinson’s disease is essential. To alleviate the disease's burden on patients and their families, better treatments for the neuropsychiatric repercussions of Parkinson's disease are required.
Graphical Abstract
Collapse
|
22
|
Guglietti B, Hobbs DA, Wesson B, Ellul B, McNamara A, Drum S, Collins-Praino LE. Development and Co-design of NeuroOrb: A Novel “Serious Gaming” System Targeting Cognitive Impairment in Parkinson’s Disease. Front Aging Neurosci 2022; 14:728212. [PMID: 35422697 PMCID: PMC9002613 DOI: 10.3389/fnagi.2022.728212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Whilst Parkinson’s disease (PD) is typically thought of as a motor disease, a significant number of individuals also experience cognitive impairment (CI), ranging from mild-CI to dementia. One technique that may prove effective in delaying the onset of CI in PD is cognitive training (CT); however, evidence to date is variable. This may be due to the implementation of CT in this population, with the motor impairments of PD potentially hampering the ability to use standard equipment, such as pen-and-paper or a computer mouse. This may, in turn, promote negative attitudes toward the CT paradigm, which may correlate with poorer outcomes. Consequently, optimizing a system for the delivery of CT in the PD population may improve the accessibility of and engagement with the CT paradigm, subsequently leading to better outcomes. To achieve this, the NeuroOrb Gaming System was designed, coupling a novel accessible controller, specifically developed for use with people with motor impairments, with a “Serious Games” software suite, custom-designed to target the cognitive domains typically affected in PD. The aim of the current study was to evaluate the usability of the NeuroOrb through a reiterative co-design process, in order to optimize the system for future use in clinical trials of CT in individuals with PD. Individuals with PD (n = 13; mean age = 68.15 years; mean disease duration = 8 years) were recruited from the community and participated in three co-design loops. After implementation of key stakeholder feedback to make significant modifications to the system, system usability was improved and participant attitudes toward the NeuroOrb were very positive. Taken together, this provides rationale for moving forward with a future clinical trial investigating the utility of the NeuroOrb as a tool to deliver CT in PD.
Collapse
Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - David A. Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Bradley Wesson
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
| | - Benjamin Ellul
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Angus McNamara
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Simon Drum
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Lyndsey E. Collins-Praino,
| |
Collapse
|
23
|
Bock MA, Tanner CM. The epidemiology of cognitive function in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:3-37. [PMID: 35248199 DOI: 10.1016/bs.pbr.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiology is the study of the distribution of disease in human populations, which is important in evaluating burden of illness, identifying modifiable risk factors, and planning for current and projected needs of the health care system. Parkinson's disease (PD) is the second most common serious neurodegenerative illness and is expected to further increase in prevalence. Cognitive changes are increasingly viewed as an integral non-motor feature in PD, emerging even in the prodromal phase of the disease. The prevalence of PD-MCI ranges from 20% to 40% depending on the population studied. The incidence of PD-dementia increases with duration of disease, with estimates growing from 3% to 30% of individuals followed for 5 years or less to over 80% after 20 years. There are several challenges in estimating the frequency of cognitive change, including only recently standardized diagnostic criteria, variation depending on exact neuropsychological evaluations performed, and differences in population sampling. Clinical features associated with cognitive decline include older age, increased disease duration and severity, early gait dysfunction, dysautonomia, hallucinations and other neuropsychiatric features, the presence of REM behavior disorder, and posterior predominant dysfunction on neuropsychological testing. There is increasing evidence that genetic risk factors, in particular GBA and MAPT mutations, contribute to cognitive change. Possible protective factors include higher cognitive reserve and regular exercise. Important sequelae of cognitive decline in PD include higher caregiver burden, decreased functional status, and increased risk of institutionalization and mortality. Many remaining uncertainties regarding the epidemiology of cognitive change in PD require future research, with improved biomarkers and more sensitive and convenient outcome measures.
Collapse
Affiliation(s)
- Meredith A Bock
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
| |
Collapse
|
24
|
Cavanagh JF, Ryman S, Richardson SP. Cognitive control in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:137-152. [PMID: 35248192 DOI: 10.1016/bs.pbr.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive control is the ability to act according to plan. Problems with cognitive control are a primary symptom and a major decrement of quality of life in Parkinson's disease (PD). Individuals with PD have problems with seemingly different controlled processes (e.g., task switching, impulsivity, gait disturbance, apathetic motivation). We review how these varied processes all rely upon disease-related alteration of common neural substrates, particularly due to dopaminergic imbalance. A comprehensive understanding of the neural systems underlying cognitive control will hopefully lead to more concise and reliable explanations of distributed deficits. However, high levels of clinical heterogeneity and medication-invariant control deficiencies suggest the need for increasingly detailed elaboration of the neural systems underlying control in PD.
Collapse
Affiliation(s)
- James F Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States.
| | - Sephira Ryman
- Mind Research Network, Albuquerque, NM, United States
| | - Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States; Neurology Service, New Mexico Veterans Affairs Healthcare System, Albuquerque, NM, United States
| |
Collapse
|
25
|
Devignes Q, Lopes R, Dujardin K. Neuroimaging outcomes associated with mild cognitive impairment subtypes in Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2022; 95:122-137. [DOI: 10.1016/j.parkreldis.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
|
26
|
Steiner O, de Zeeuw J, Stotz S, Bes F, Kunz D. Post-Illumination Pupil Response as a Biomarker for Cognition in α-Synucleinopathies. JOURNAL OF PARKINSON'S DISEASE 2022; 12:593-598. [PMID: 34806618 DOI: 10.3233/jpd-212775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Neurodegenerative processes in the brain are reflected by structural retinal changes. As a possible biomarker of cognitive state in prodromal α-synucleinopathies, we compared melanopsin-mediated post-illumination pupil response (PIPR) with cognition (CERAD-plus) in 69 patients with isolated REM-sleep behavior disorder. PIPR was significantly correlated with cognitive domains, especially executive functioning (r = 0.417, p < 0.001), which was more pronounced in patients with lower dopamine-transporter density, suggesting advanced neurodegenerative state (n = 26; r = 0.575, p = 0.002). Patients with mild neurocognitive disorder (n = 10) had significantly reduced PIPR (smaller melanopsin-mediated response) compared to those without (p = 0.001). Thus, PIPR may be a functional-possibly monitoring-marker for impaired cognitive state in (prodromal) α-synucleinopathies.
Collapse
Affiliation(s)
- Oliver Steiner
- St. Hedwig-Hospital, Clinic for Sleep- & Chronomedicine, Berlin, Germany
| | - Jan de Zeeuw
- St. Hedwig-Hospital, Clinic for Sleep- & Chronomedicine, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology, Berlin, Germany
| | - Sophia Stotz
- St. Hedwig-Hospital, Clinic for Sleep- & Chronomedicine, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology, Berlin, Germany
| | - Frederik Bes
- St. Hedwig-Hospital, Clinic for Sleep- & Chronomedicine, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology, Berlin, Germany
| | - Dieter Kunz
- St. Hedwig-Hospital, Clinic for Sleep- & Chronomedicine, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology, Berlin, Germany
| |
Collapse
|
27
|
Pan C, Ren J, Hua P, Yan L, Yu M, Wang Y, Zhou G, Zhang R, Chen J, Liu W. Subjective Cognitive Complaints in Newly-Diagnosed Parkinson's Disease With and Without Mild Cognitive Impairment. Front Neurosci 2021; 15:761817. [PMID: 34899165 PMCID: PMC8651703 DOI: 10.3389/fnins.2021.761817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/02/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Subjective cognitive complaints (SCCs) and mild cognitive impairment (MCI) are common among patients with Parkinson's disease (PD). However, the relationship between SCCs and MCI is not well understood. Herein, we aimed to investigate whether there are any differences in the prevalence and risk factors of SCCs between early PD patients with and without MCI. Methods: Overall, 108 newly diagnosed, untreated PD patients underwent comprehensive neuropsychological assessments. PD patients with mild cognitive impairment (PD-MCI) were diagnosed according to the MCI level II criteria. Furthermore, SCCs were measured with the Cognitive Complaints Interview (CCI). Logistic regression analysis, after adjusting for confounding variable, was performed in order to investigate risk factors of SCCs in PD-MCI patients and PD patients with normal cognition (PD-NC). Results: Furthermore, 42 (42.3%) participants reported SCCs and 53 (53.5%) participants were diagnosed with PD-MCI. The prevalence of SCCs in PD-MCI and PD-NC participants was 30.3% and 12.1%, respectively. Logistic regression analyses revealed that the presence of SCCs in PD-MCI group was significantly associated with Non-Motor Symptoms Questionnaire (NMSQ) score (OR = 1.340, 95%CI = 1.115-1.610, p = 0.002), while the presence of SCCs in PD-NC group was significantly associated with time of Stroop Color-Word Test card C (OR = 1.050, 95%CI = 1.009-1.119, p = 0.016). Conclusion: SCCs are frequent among patients with early PD. The prevalence and risk factor of SCCs are distinct in PD with and without MCI. These findings suggest that SCCs in early PD with different cognitive status appear to have different pathogenicity.
Collapse
Affiliation(s)
- Chenxi Pan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Hua
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Yan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yajie Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Gaiyan Zhou
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ronggui Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiu Chen
- Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, China.,Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
28
|
Lin H, Liu Z, Yan W, Zhang D, Liu J, Xu B, Li W, Zhang Q, Cai X. Brain connectivity markers in advanced Parkinson's disease for predicting mild cognitive impairment. Eur Radiol 2021; 31:9324-9334. [PMID: 34109485 DOI: 10.1007/s00330-021-08086-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is a well-defined non-motor manifestation and a harbinger of dementia in Parkinson's disease. This study is to investigate brain connectivity markers of MCI using diffusion tensor imaging and resting-state functional MRI, and help MCI diagnosis in PD patients. METHODS We evaluated 131 advanced PD patients (disease duration > 5 years; 59 patients with MCI) and 48 healthy control subjects who underwent a diffusion-weighted and resting-state functional MRI scanning. The patients were randomly assigned to training (n = 100) and testing (n = 31) groups. According to the Brainnetome Atlas, ROI-based structural and functional connectivity analysis was employed to extract connectivity features. To identify features with significant discriminative power for patient classification, all features were put into an all-relevant feature selection procedure within cross-validation loops. RESULTS Nine features were identified to be significantly relevant to patient classification. They showed significant differences between PD patients with and without MCI and positively correlated with the MoCA score. Five of them did not differ between general MCI subjects and healthy controls from the ADNI database, which suggested that they could uniquely play a part in the MCI diagnosis of PD. On basis of these relevant features, the random forest model constructed from the training group achieved an accuracy of 83.9% in the testing group, to discriminate patients with and without MCI. CONCLUSIONS The results of our study provide preliminary evidence that structural and functional connectivity abnormalities may contribute to cognitive impairment and allow to predict the outcome of MCI diagnosis in PD. KEY POINTS • Nine MCI markers were identified using an all-relevant feature selection procedure. • Five of nine markers differed between MCI and NC in PD, but not in general persons. • A random forest model achieved an accuracy of 83.9% for MCI diagnosis in PD.
Collapse
Affiliation(s)
- Hai Lin
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China
- Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen University School of Medicine, Shenzhen, China
| | - Zesi Liu
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Wei Yan
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Doudou Zhang
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China
- Shenzhen University School of Medicine, Shenzhen, China
| | - Jiali Liu
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China
- Shenzhen University School of Medicine, Shenzhen, China
| | - Bin Xu
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China
- Shenzhen University School of Medicine, Shenzhen, China
| | - Weiping Li
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China
- Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen University School of Medicine, Shenzhen, China
| | - Qiusheng Zhang
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China.
- Shenzhen University School of Medicine, Shenzhen, China.
| | - Xiaodong Cai
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 3002# Sungang West Road, Futian District, Shenzhen, 518035, China.
- Shenzhen University School of Medicine, Shenzhen, China.
| |
Collapse
|
29
|
Pan C, Li Y, Ren J, Li L, Huang P, Xu P, Zhang L, Zhang W, Zhang MM, Chen J, Liu W. Characterizing mild cognitive impairment in prodromal Parkinson's disease: A community-based study in China. CNS Neurosci Ther 2021; 28:259-268. [PMID: 34821045 PMCID: PMC8739042 DOI: 10.1111/cns.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Abstract
Objective The International Parkinson and Movement Disorder Society (MDS) has published research criteria for prodromal Parkinson's disease (pPD), which includes cognitive impairment as a prodromal marker. However, the clinical features of mild cognitive impairment (MCI) in pPD remain unknown. Our study aimed to evaluate the frequency and clinical features of mild cognitive impairment of pPD in the elderly in China. Methods The cross‐sectional community‐based study recruited 2688 participants aged ≥50 years. Subjects were diagnosed with pPD according to the MDS criteria. Overall, 39 pPD and 22 healthy controls underwent comprehensive clinical and neuropsychological assessment. MCI was also diagnosed by the MDS criteria. Next, we investigated the relationship between clinical factors and cognition. Results Among the 2,663 dementia‐free and Parkinson disease (PD)‐free participants, 55 met the criteria for pPD (2.1%) and 23 pPD met the criteria for MCI. Memory, attention/working memory, and executive function were the most frequent impaired domains, and amnestic MCI multidomain phenotype was the most frequent MCI subtype (69.57%) in pPD. Additionally, correlation analysis revealed that the global cognitive performance was negatively related to UPDRS‐III score (r = −0.456, p = 0.004). Conclusion MCI, specifically impairment in memory, attention/working memory, and executive domain, is present at the prodromal stage of PD. In addition, cognitive performance is correlated with motor symptoms in pPD. Our results reflect that cognitive profile, combined with motor symptoms, can help clinicians to identify individuals with pPD early, as those would be the optimal candidates for neuroprotective therapy.
Collapse
Affiliation(s)
- Chenxi Pan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqian Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Lanting Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pingyi Xu
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Zhang
- Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbing Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiu Chen
- Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, China.,Institute of Neuropsychiatry, Fourth Clinical College of Nanjing Medical University, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
30
|
Guglietti B, Hobbs D, Collins-Praino LE. Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions. Front Aging Neurosci 2021; 13:709484. [PMID: 34720988 PMCID: PMC8549481 DOI: 10.3389/fnagi.2021.709484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson’s disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.
Collapse
Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - David Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia.,Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
31
|
Normal cognition in Parkinson's disease may involve hippocampal cholinergic compensation: An exploratory PET imaging study with [ 18F]-FEOBV. Parkinsonism Relat Disord 2021; 91:162-166. [PMID: 34628195 DOI: 10.1016/j.parkreldis.2021.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Severe cholinergic degeneration is known to occur in Parkinson's disease (PD) and is thought to play a primary role in the cognitive decline associated with this disease. Although cholinergic losses occur in all patients with PD, cognitive performance remains normal for many of them, suggesting compensatory mechanisms in those. OBJECTIVES This exploratory study aimed at verifying if normal cognition in PD may involve distinctive features of the brain cholinergic systems. METHODS Following extensive neuropsychological screening in 25 patients with PD, 12 were selected and evenly distributed between a cognitively normal (PD-CN) group, and a mild cognitive impairment (PD-MCI) group. Each group was compared with matched healthy volunteers (HV) on standardized cognitive scales (MoCA, PDCRS), and PET imaging with [18F]-FEOBV, a sensitive measurement of brain cholinergic innervation density. RESULTS [18F]-FEOBV uptake reductions were observed in PD-CN as well as in PD-MCI, with the lowest values located in the posterior cortical areas. However, in PD-CN but not in PD-MCI, there was a significant and bilateral increase of [18F]-FEOBV uptake, exclusively located in the hippocampus. Significant correlations were observed between cognitive performance and hippocampal [18F]-FEOBV uptake. CONCLUSION These findings suggest a compensatory upregulation of the hippocampal cholinergic innervation in PD-CN, which might underly normal cognitive performances in spite of cortical cholinergic denervation in other regions.
Collapse
|
32
|
Di Lazzaro V, Bella R, Benussi A, Bologna M, Borroni B, Capone F, Chen KHS, Chen R, Chistyakov AV, Classen J, Kiernan MC, Koch G, Lanza G, Lefaucheur JP, Matsumoto H, Nguyen JP, Orth M, Pascual-Leone A, Rektorova I, Simko P, Taylor JP, Tremblay S, Ugawa Y, Dubbioso R, Ranieri F. Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia. Clin Neurophysiol 2021; 132:2568-2607. [PMID: 34482205 DOI: 10.1016/j.clinph.2021.05.035] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.
Collapse
Affiliation(s)
- Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Kai-Hsiang S Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Division of Brain, Imaging& Behaviour, Krembil Brain Institute, Toronto, Canada
| | | | - Joseph Classen
- Department of Neurology, University Hospital Leipzig, Leipzig University Medical Center, Germany
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | | | - Jean-Paul Nguyen
- Pain Center, clinique Bretéché, groupe ELSAN, Multidisciplinary Pain, Palliative and Supportive care Center, UIC 22/CAT2 and Laboratoire de Thérapeutique (EA3826), University Hospital, Nantes, France
| | - Michael Orth
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Swiss Huntington's Disease Centre, Siloah, Bern, Switzerland
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Universitat Autonoma Barcelona, Spain
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Patrik Simko
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University (CEITEC MU), Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sara Tremblay
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, ON, Canada; Royal Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
33
|
Zhang Y, Zhou J, Gehl CR, Long JD, Johnson H, Magnotta VA, Sewell D, Shannon K, Paulsen JS. Mild Cognitive Impairment as an Early Landmark in Huntington's Disease. Front Neurol 2021; 12:678652. [PMID: 34305789 PMCID: PMC8292715 DOI: 10.3389/fneur.2021.678652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
As one of the clinical triad in Huntington's disease (HD), cognitive impairment has not been widely accepted as a disease stage indicator in HD literature. This work aims to study cognitive impairment thoroughly for prodromal HD individuals with the data from a 12-year observational study to determine whether Mild Cognitive Impairment (MCI) in HD gene-mutation carriers is a defensible indicator of early disease. Prodromal HD gene-mutation carriers evaluated annually at one of 32 worldwide sites from September 2002 to April 2014 were evaluated for MCI in six cognitive domains. Linear mixed-effects models were used to determine age-, education-, and retest-adjusted cut-off values in cognitive assessment for MCI, and then the concurrent and predictive validity of MCI was assessed. Accelerated failure time (AFT) models were used to determine the timing of MCI (single-, two-, and multiple-domain), and dementia, which was defined as MCI plus functional loss. Seven hundred and sixty-eight prodromal HD participants had completed all six cognitive tasks, had MRI, and underwent longitudinal assessments. Over half (i.e., 54%) of the participants had MCI at study entry, and half of these had single-domain MCI. Compared to participants with intact cognitive performances, prodromal HD with MCI had higher genetic burden, worsened motor impairment, greater brain atrophy, and a higher likelihood of estimated HD onset. Prospective longitudinal study of those without MCI at baseline showed that 48% had MCI in subsequent visits and data visualization suggested that single-domain MCI, two-domain MCI, and dementia represent appropriate cognitive impairment staging for HD gene-mutation carriers. Findings suggest that MCI represents an early landmark of HD and may be a sensitive enrichment variable or endpoint for prodromal clinical trials of disease modifying therapeutics.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Junyi Zhou
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Carissa R Gehl
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Jeffrey D Long
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Hans Johnson
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States
| | - Vincent A Magnotta
- Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Radiology, College of Medicine, University of Iowa, Iowa, City, IA, United States
| | - Daniel Sewell
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Kathleen Shannon
- Department of Neurology, University of Wisconsin, Madison, WI, United States
| | - Jane S Paulsen
- Department of Neurology, University of Wisconsin, Madison, WI, United States
| |
Collapse
|
34
|
Devignes Q, Viard R, Betrouni N, Carey G, Kuchcinski G, Defebvre L, Leentjens AFG, Lopes R, Dujardin K. Posterior Cortical Cognitive Deficits Are Associated With Structural Brain Alterations in Mild Cognitive Impairment in Parkinson's Disease. Front Aging Neurosci 2021; 13:668559. [PMID: 34054507 PMCID: PMC8155279 DOI: 10.3389/fnagi.2021.668559] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
Context: Cognitive impairments are common in patients with Parkinson's disease (PD) and are heterogeneous in their presentation. The "dual syndrome hypothesis" suggests the existence of two distinct subtypes of mild cognitive impairment (MCI) in PD: a frontostriatal subtype with predominant attentional and/or executive deficits and a posterior cortical subtype with predominant visuospatial, memory, and/or language deficits. The latter subtype has been associated with a higher risk of developing dementia. Objective: The objective of this study was to identify structural modifications in cortical and subcortical regions associated with each PD-MCI subtype. Methods: One-hundred and fourteen non-demented PD patients underwent a comprehensive neuropsychological assessment as well as a 3T magnetic resonance imaging scan. Patients were categorized as having no cognitive impairment (n = 41) or as having a frontostriatal (n = 16), posterior cortical (n = 25), or a mixed (n = 32) MCI subtype. Cortical regions were analyzed using a surface-based Cortical thickness (CTh) method. In addition, the volumes, shapes, and textures of the caudate nuclei, hippocampi, and thalami were studied. Tractometric analyses were performed on associative and commissural white matter (WM) tracts. Results: There were no between-group differences in volumetric measurements and cortical thickness. Shape analyses revealed more abundant and more extensive deformations fields in the caudate nuclei, hippocampi, and thalami in patients with posterior cortical deficits compared to patients with no cognitive impairment. Decreased fractional anisotropy (FA) and increased mean diffusivity (MD) were also observed in the superior longitudinal fascicle, the inferior fronto-occipital fascicle, the striato-parietal tract, and the anterior and posterior commissural tracts. Texture analyses showed a significant difference in the right hippocampus of patients with a mixed MCI subtype. Conclusion: PD-MCI patients with posterior cortical deficits have more abundant and more extensive structural alterations independently of age, disease duration, and severity, which may explain why they have an increased risk of dementia.
Collapse
Affiliation(s)
- Quentin Devignes
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
| | - Romain Viard
- US 41—UMS 2014—PLBS, Lille University, CNRS, Inserm, Lille University Medical Centre, Pasteur Institute, Lille, France
- Department of Neuroradiology, Lille University Medical Centre, Lille, France
| | - Nacim Betrouni
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
| | - Guillaume Carey
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
| | - Gregory Kuchcinski
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
- US 41—UMS 2014—PLBS, Lille University, CNRS, Inserm, Lille University Medical Centre, Pasteur Institute, Lille, France
- Department of Neuroradiology, Lille University Medical Centre, Lille, France
| | - Luc Defebvre
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
| | | | - Renaud Lopes
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
- US 41—UMS 2014—PLBS, Lille University, CNRS, Inserm, Lille University Medical Centre, Pasteur Institute, Lille, France
- Department of Neuroradiology, Lille University Medical Centre, Lille, France
| | - Kathy Dujardin
- Lille Neuroscience and Cognition, Lille University, Inserm, Lille University Medical Centre, Lille, France
- Neurology and Movement Disorders Department, Lille University Medical Centre, Lille, France
| |
Collapse
|
35
|
Meta-Analysis of Cognition in Parkinson's Disease Mild Cognitive Impairment and Dementia Progression. Neuropsychol Rev 2021; 32:149-160. [PMID: 33860906 DOI: 10.1007/s11065-021-09502-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/24/2021] [Indexed: 12/19/2022]
Abstract
Mild cognitive changes, including executive dysfunction, are seen in Parkinson's Disease (PD). Approximately 30% of individuals with PD develop Parkinson's disease dementia (PDD). Mild cognitive impairment (MCI) has been identified as a transitional state between normal cognition and dementia. Although PD-MCI and its cognitive correlates have been increasingly studied as a risk indicator for development of PDD, investigations into the PD-MCI construct have yielded heterogeneous findings. Thus, a typical PD-MCI cognitive profile remains undefined. The present meta-analysis examined published cross-sectional studies of PD-MCI and cognitively normal PD (PD-CN) groups to provide aggregated effect sizes of group test performance by cognitive domain. Subsequently, longitudinal studies examining PD-MCI to PDD progression were meta-analyzed. Ninety-two cross-sectional articles of PD-MCI vs. PD-CN were included; 5 longitudinal studies of PD-MCI conversion to PDD were included. Random effects meta-analytic models were constructed resulting in effect sizes (Hedges' g) for cognitive domains. Overall performance across all measures produced a large effect size (g = 0.83, 95% CI [0.79, 0.86], t2 = 0.18) in cross-sectional analyses, with cognitive screeners producing the largest effect (g = 1.09, 95% CI [1.00, 1.17], t2 = 0.19). Longitudinally, overall measures produced a moderate effect (g = 0.47, 95% CI [0.40, 0.53], t2 = 0.01), with measures of executive functioning exhibiting the largest effect (g = 0.70, 95% CI [0.51, 0.89], t2 = 0.01). Longitudinal effects were made more robust by low heterogeneity. This report provides the first comprehensive meta-analysis of PD-MCI cognitive outcomes and predictors in PD-MCI conversion to PDD. Limitations include heterogeneity of cross-sectional effect sizes and the potential impact of small-study effects. Areas for continued research include visuospatial skills and visual memory in PD-MCI and longitudinal examination of executive dysfunction in PD-MCI.
Collapse
|
36
|
Pan C, Ren J, Li L, Li Y, Xu J, Xue C, Hu G, Yu M, Chen Y, Zhang L, Zhang W, Hu X, Sun Y, Liu W, Chen J. Differential functional connectivity of insular subdivisions in de novo Parkinson's disease with mild cognitive impairment. Brain Imaging Behav 2021; 16:1-10. [PMID: 33770371 DOI: 10.1007/s11682-021-00471-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/08/2021] [Indexed: 02/01/2023]
Abstract
The insula, consisting of functionally diverse subdivisions, plays a significant role in Parkinson's disease (PD)-related cognitive disorders. However, the functional connectivity (FC) patterns of insular subdivisions in PD remain unclear. Our aim is to investigate the changes in FC patterns of insular subdivisions and their relationships with cognitive domains. Three groups of participants were recruited in this study, including PD patients with mild cognitive impairment (PD-MCI, n = 25), PD patients with normal cognition (PD-NC, n = 13), and healthy controls (HCs, n = 17). Resting-state functional magnetic resonance imaging (rs-fMRI) was used to investigate the FC in insular subdivisions of the three groups. Moreover, all participants underwent a neuropsychological battery to assess cognition so that the relationship between altered FC and cognitive performance could be elucidated. Compared with the PD-NC group, the PD-MCI group exhibited increased FC between the left dorsal anterior insular (dAI) and the right superior parietal gyrus (SPG), and altered FC was negatively correlated with memory and executive function. Compared with the HC group, the PD-MCI group showed significantly increased FC between the right dAI and the right median cingulate and paracingulate gyri (DCG), and altered FC was positively related to attention/working memory, visuospatial function, and language. Our findings highlighted the different abnormal FC patterns of insular subdivisions in PD patients with different cognitive abilities. Furthermore, dysfunction of the dAI may partly contribute to the decline in executive function and memory in early drug-naïve PD patients.
Collapse
Affiliation(s)
- Chenxi Pan
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China
| | - Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China
| | - Lanting Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China
| | - Yuqian Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China
| | - Jianxia Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China
| | - Chen Xue
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Guanjie Hu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China
| | - Yong Chen
- Department of Laboratory Medicine, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Li Zhang
- Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Wenbing Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Xiao Hu
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yu Sun
- School of Biology Science and Medical Engineering, Southeast University, Nanjing, Jiangsu, 210029, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China.
| | - Jiu Chen
- Institute of Brain Functional Imaging, Nanjing Medical University, 210029, Nanjing, Jiangsu, China.
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Fourth Clinical College of Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, 210029, China.
| |
Collapse
|
37
|
The correlation of non-motor symptoms and sleep on balance in Parkinson's disease patients with normal cognition and mild cognitive impairment. Ir J Med Sci 2021; 190:1577-1584. [PMID: 33449322 DOI: 10.1007/s11845-020-02462-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is characterized by non-motor symptoms (NMS) as well as by motor symptoms. Together with the impairment of cognitive functions, NMS and sleep also affect motor symptoms negatively. The aim of our study is to examine the correlation of NMS and sleep on balance in PD patients with normal cognition (PD-NC) and with mild cognitive impairment (PD-MCI). METHODS A total of 69 patients were included in our study. Using the Standardized Mini-Mental State Examination, participants were divided into 2 groups, PD-NC and PD-MCI. Patients were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), the Berg Balance Scale (BBS), the Tinetti Balance Assessment Tool (TBAT), the Non-Motor Symptoms Questionnaire (NMSQ), and the Parkinson's Disease Questionnaire (PDQ-39). RESULTS PD-MCI patients had statistically significant worse motor symptoms and more balance disorder compared to PD-NC (UPDRS: p = 0.009; BBS: p = 0.010; TBAT: p = 0.004). PD-MCI patients had greater severity of non-motor symptoms and worse sleep quality than the PD-NC group (NMSQ-total: p = 0.02; NMSQ-sleep total: p = 0.01). The evaluation has shown that with a diagnosis of MCI, NMS, and sleeping problems were correlated, and the correlation was associated with impairment of the balance function. While being more pronounced in the PD-MCI group, quality of life was affected in both groups (p < 0.05). CONCLUSION Our data demonstrate a negative effect on the balance function in patients with cognitive impairment suffering increased NMS and sleeping disorders. Treatment of these patients needs to concentrate on NMS and cognitive functions as much as on motor symptoms.
Collapse
|
38
|
Begemann MJ, Brand BA, Ćurčić-Blake B, Aleman A, Sommer IE. Efficacy of non-invasive brain stimulation on cognitive functioning in brain disorders: a meta-analysis. Psychol Med 2020; 50:2465-2486. [PMID: 33070785 PMCID: PMC7737055 DOI: 10.1017/s0033291720003670] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/27/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognition is commonly affected in brain disorders. Non-invasive brain stimulation (NIBS) may have procognitive effects, with high tolerability. This meta-analysis evaluates the efficacy of transcranial magnetic stimulation (TMS) and transcranial Direct Current Stimulation (tDCS) in improving cognition, in schizophrenia, depression, dementia, Parkinson's disease, stroke, traumatic brain injury, and multiple sclerosis. METHODS A PRISMA systematic search was conducted for randomized controlled trials. Hedges' g was used to quantify effect sizes (ES) for changes in cognition after TMS/tDCS v. sham. As different cognitive functions may have unequal susceptibility to TMS/tDCS, we separately evaluated the effects on: attention/vigilance, working memory, executive functioning, processing speed, verbal fluency, verbal learning, and social cognition. RESULTS We included 82 studies (n = 2784). For working memory, both TMS (ES = 0.17, p = 0.015) and tDCS (ES = 0.17, p = 0.021) showed small but significant effects. Age positively moderated the effect of TMS. TDCS was superior to sham for attention/vigilance (ES = 0.20, p = 0.020). These significant effects did not differ across the type of brain disorder. Results were not significant for the other five cognitive domains. CONCLUSIONS Our results revealed that both TMS and tDCS elicit a small trans-diagnostic effect on working memory, tDCS also improved attention/vigilance across diagnoses. Effects on the other domains were not significant. Observed ES were small, yet even slight cognitive improvements may facilitate daily functioning. While NIBS can be a well-tolerated treatment, its effects appear domain specific and should be applied only for realistic indications (i.e. to induce a small improvement in working memory or attention).
Collapse
Affiliation(s)
- Marieke J. Begemann
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Branislava Ćurčić-Blake
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - André Aleman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris E. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
39
|
Jiang Y, Guo Z, McClure MA, He L, Mu Q. Effect of rTMS on Parkinson's cognitive function: a systematic review and meta-analysis. BMC Neurol 2020; 20:377. [PMID: 33076870 PMCID: PMC7574251 DOI: 10.1186/s12883-020-01953-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the effects and optimal parameters of repetitive transcranial magnetic stimulation (rTMS) on cognition function of patients with Parkinson’s disease (PD) and to estimate which cognitive function may obtain more benefits from rTMS. Method The articles dealing with rTMS on cognitive function of PD patients were retrieved from the databases until April 2019. Outcomes of global cognitive function and different cognitive domains were extracted. The standardized mean differences (SMDs) with 95% confidence interval (CI) of cognitive outcome for different parameters, scales, and cognitive functions were estimated. Results Fourteen studies involving 173 subjects were included in this meta-analysis. A significant effect size was observed with the mini-mental state examination (MMSE) for the global cognitive outcome based on the evidence of four published articles. Further subtests for different cognitive domains demonstrated prominent effect for the executive function. The significant effect sizes for executive function were found with multiple sessions of high-frequency rTMS over frontal cortex; especially over dorsolateral prefrontal cortex (DLPFC). All of the other cognitive domains, which included memory, attention, and language ability, did not obtain significant effects. Conclusions Multiple sessions of high-frequency rTMS over the DLPFC may have positive effect on executive function in PD patients. Further well designed studies with large sample sizes are needed to verify our results and ascertain the long-term effects of rTMS.
Collapse
Affiliation(s)
- Yi Jiang
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Zhiwei Guo
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Morgan A McClure
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Lin He
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Qiwen Mu
- Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China. .,Department of Radiology, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
40
|
Tang H, Xu Y, Liu L, He L, Huang J, Pan J, He W, Wang Y, Yang X, Hou X, Xu K. Nogo-A/S1PR2 Signaling Pathway Inactivation Decreases Microvascular Damage and Enhances Microvascular Regeneration in PDMCI Mice. Neuroscience 2020; 449:21-34. [PMID: 33039527 DOI: 10.1016/j.neuroscience.2020.09.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
The incidence of mild cognitive impairment in Parkinson's disease (PDMCI) is as high as 18-55%. However, the pathological mechanism of PDMCI is not yet clear. Our previous research showed that microvascular pathology and chronic cerebral hypoperfusion participated in the occurrence and development of PDMCI. Nogo-A has been suggested to be a negative regulator of microvascular regeneration in the central nervous system. Moreover, few insights have illuminated the mechanisms of Nogo-A and microvascular pathology in PDMCI. Therefore, we hypothesized that Nogo-A might be involved in the negative regulation of PDMCI angiogenesis. In this study, C57BL/6J mice were injected with Nogo-A-specific short hairpin RNA (shRNA-Nogo-A) in the lateral ventricle and intraperitoneally injected with a combination of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and probenecid. Subjects were classified into the following five groups for the Morris water maze test: control (CON), CON + shRNA-GFP, CON + shRNA-Nogo-A, PDMCI, and PDMCI + shRNA-Nogo-A. Furthermore, blood-brain barrier (BBB) permeability, fluorescein isothiocyanate (FITC)-conjugated dextran, transmission electron microscopy (TEM), immunofluorescence and Western blot analyses were performed. The results showed that MPTP could cause spatial memory and behavioral impairment, significant microvascular impairment and increased Nogo-A expression. When Nogo-A expression was downregulated, the cognitive and microvascular impairments were alleviated, and the expression of sphingosine-1-phosphate receptor 2 (S1PR2) and the RhoA/ROCK signaling pathway were inhibited. These findings suggested that Nogo-A could bind to S1PR2, activate related signaling pathways, and lead to the inhibition of vascular remodeling in PDMCI mice. This study indicated that Nogo-A downregulation could mediate microvascular remodeling and provide further insights into the pathogenesis of PDMCI.
Collapse
Affiliation(s)
- Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Yunxian Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China; Department of Sports and Health, Guangzhou Sport University, Guangzhou 510500, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Jingyu Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Jing Pan
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China; Department of Sports and Health, Guangzhou Sport University, Guangzhou 510500, China
| | - Wenjie He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Yuxin Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China
| | - Xubo Yang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China; School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Xiaohui Hou
- Department of Sports and Health, Guangzhou Sport University, Guangzhou 510500, China; School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China.
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510120, China.
| |
Collapse
|
41
|
Solés-Tarrés I, Cabezas-Llobet N, Vaudry D, Xifró X. Protective Effects of Pituitary Adenylate Cyclase-Activating Polypeptide and Vasoactive Intestinal Peptide Against Cognitive Decline in Neurodegenerative Diseases. Front Cell Neurosci 2020; 14:221. [PMID: 32765225 PMCID: PMC7380167 DOI: 10.3389/fncel.2020.00221] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/22/2020] [Indexed: 12/23/2022] Open
Abstract
Cognitive impairment is one of the major symptoms in most neurodegenerative disorders such as Alzheimer’s (AD), Parkinson (PD), and Huntington diseases (HD), affecting millions of people worldwide. Unfortunately, there is no treatment to cure or prevent the progression of those diseases. Cognitive impairment has been related to neuronal cell death and/or synaptic plasticity alteration in important brain regions, such as the cerebral cortex, substantia nigra, striatum, and hippocampus. Therefore, compounds that can act to protect the neuronal loss and/or to reestablish the synaptic activity are needed to prevent cognitive decline in neurodegenerative diseases. Pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) are two highly related multifunctional neuropeptides widely distributed in the central nervous system (CNS). PACAP and VIP exert their action through two common receptors, VPAC1 and VPAC2, while PACAP has an additional specific receptor, PAC1. In this review article, we first presented evidence showing the therapeutic potential of PACAP and VIP to fight the cognitive decline observed in models of AD, PD, and HD. We also reviewed the main transduction pathways activated by PACAP and VIP receptors to reduce cognitive dysfunction. Furthermore, we identified the therapeutic targets of PACAP and VIP, and finally, we evaluated different novel synthetic PACAP and VIP analogs as promising pharmacological tools.
Collapse
Affiliation(s)
- Irene Solés-Tarrés
- New Therapeutic Targets Group (TargetsLab), Department of Medical Science, Faculty of Medicine, Universitat de Girona, Girona, Spain
| | - Núria Cabezas-Llobet
- New Therapeutic Targets Group (TargetsLab), Department of Medical Science, Faculty of Medicine, Universitat de Girona, Girona, Spain
| | - David Vaudry
- Laboratory of Neuronal and Neuroendocrine Communication and Differentiation, Neuropeptides, Neuronal Death and Cell Plasticity Team, Normandie University, UNIROUEN, Inserm, Rouen, France
| | - Xavier Xifró
- New Therapeutic Targets Group (TargetsLab), Department of Medical Science, Faculty of Medicine, Universitat de Girona, Girona, Spain
| |
Collapse
|
42
|
Tang Y, Liang X, Han L, Peng F, Shen B, Yu H, Shen Y, Shen C, Yu J, Wang J. Cognitive Function and Quality of Life in Parkinson's Disease: A Cross-Sectional Study. JOURNAL OF PARKINSONS DISEASE 2020; 10:1209-1216. [PMID: 32568115 DOI: 10.3233/jpd-202097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinson's disease with mild cognitive impairment (PD-MCI) or dementia (PDD) has been shown to be correlated with poor quality of life (QoL). The association between specific cognitive domains and QoL is less clear. OBJECTIVE To determine how the cognitive domains affect QoL in different cognitive states in PD. METHODS We recruited 600 PD patients, including 185 PD patients with normal cognition (PD-NC), 336 PD-MCI patients, and 79 PDD patients. All patients underwent a scale-based assessment (PDQ-39) for QoL, as well as clinical evaluations and neuropsychological tests. RESULTS Compared to PD-NC group, QoL became more impaired in the PD-MCI and PDD groups. Generalized linear model revealed that no neuropsychological test was significantly associated with QoL in PD-NC group; neuropsychological tests in attention and language domains were significantly associated with QoL in PD-MCI patients; neuropsychological tests in memory and language domains were significantly associated with QoL in PDD patients. CONCLUSIONS Cognitive domains contribute differently to QoL in PD. These findings may prompt clinicians to target specific cognitive domains for improving QoL in the PD patients.
Collapse
Affiliation(s)
- Yilin Tang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Linlin Han
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fang Peng
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Shen
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Huiling Yu
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Shen
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Cong Shen
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jintai Yu
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
43
|
Qin B, Yang MX, Gao W, Zhang JD, Zhao LB, Qin HX, Chen H. Voxel-wise meta-analysis of structural changes in gray matter of Parkinson's disease patients with mild cognitive impairment. ACTA ACUST UNITED AC 2020; 53:e9275. [PMID: 32428131 PMCID: PMC7266500 DOI: 10.1590/1414-431x20209275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/21/2020] [Indexed: 11/25/2022]
Abstract
Evidence from previous voxel-based morphometry (VBM) studies indicates that widespread brain regions are involved in Parkinson’s disease with mild cognitive impairment (PD-MCI). However, the spatial localization reported for gray matter (GM) abnormalities is heterogeneous. The aim of the present study was to quantitatively integrate studies on GM abnormalities observed in PD-MCI in order to determine whether a pattern exists. Eligible whole-brain VBM studies were identified by a systematic search of articles in PubMed and EMBASE databases spanning from 1995 to January 1, 2019. A meta-analysis was performed to investigate regional GM abnormalities in PD-MCI. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of PD-MCI compared with PD patients with normal cognitive function (PD-NC). A total of 12 studies comprising 243 PD-MCI patients and 326 PD-NC were included in the meta-analysis. PD-MCI patients showed a robust GM decrease in the left insula and left superior temporal gyrus. Moreover, meta-regression analysis demonstrated that age, PD duration and stage, and Unified Parkinson’s Disease Rating Scale III and Mini-Mental State Examination scores might be partly correlated with the GM abnormalities observed in PD-MCI patients. The convergent findings of this quantitative meta-analysis revealed a characteristic neuroanatomical pattern in PD-MCI. The findings provide some evidence that MCI in PD may result in the breakdown of the insula and temporal gyrus, which may serve as specific regions of interest for further investigations.
Collapse
Affiliation(s)
- B Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - M X Yang
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - W Gao
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - J D Zhang
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - L B Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - H X Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - H Chen
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| |
Collapse
|
44
|
Cognitive Complaints in Nondemented Parkinson's Disease Patients and Their Close Contacts do not Predict Worse Cognitive Outcome. Alzheimer Dis Assoc Disord 2020; 33:147-153. [PMID: 30958414 DOI: 10.1097/wad.0000000000000301] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The main purpose of this study was to investigate 4 methods of eliciting subjective cognitive complaints (SCCs) in Parkinson's disease (PD) patients without dementia and determine the relationship between their SCC and cognitive performance. DESIGN This study was a retrospective analysis of a prospective cohort study. SETTING Six North American movement disorder clinics. MEASUREMENTS SCCs were elicited through a modified Neurobehavioral Inventory administered to patients and close contacts, a general complaint question, and Movement Disorders Society Unified Parkinson's Disease Rating Scale item question 1.1 administered to patients. Clinical evaluation, formal neuropsychological testing and Disability Assessment for Dementia were conducted in Ontario state. Agreement between SCCs eliciting methods was calculated. Associations between SCC, cognitive testing, and mild cognitive impairment (MCI) were assessed. RESULTS Of 139 participating nondemented PD patients, 42% had PD-MCI at baseline. Agreement between SCC eliciting methods was low. Neither patient-reported nor close contact-reported SCCs were associated with impaired baseline cognitive testing or PD-MCI nor were they associated with cognitive decline over time. In PD patients with normal baseline cognition, 26% of patients with 1-year follow-up and 20% of patients with 2-year follow-up met MCI criteria. CONCLUSIONS Agreement between SCC eliciting methods is poor and no SCC method was associated with cognitive testing or decline over time. With no clear superior method for eliciting SCCs, clinicians should consider performing regular screening.
Collapse
|
45
|
A multifaceted exercise intervention did not alter cognitive function and cerebral perfusion in individuals with Parkinson's disease. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
46
|
Cognition Deficits in Parkinson's Disease: Mechanisms and Treatment. PARKINSONS DISEASE 2020; 2020:2076942. [PMID: 32269747 PMCID: PMC7128056 DOI: 10.1155/2020/2076942] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/08/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder mainly in middle-elderly population, which represents diverse nonmotor symptoms (NMS) besides such well-documented motor symptoms as bradykinesia, resting tremor, rigidity, and postural instability. With the advancement of aging trend worldwide, the global prevalence of PD is mounting up year after year. Nowadays, accumulating lines of studies have given a comprehensive and thorough coverage of motor symptoms in PD. Yet much less attention as compared has been paid to the nonmotor symptoms of PD, such as cognition deficits. Of note, a patient with PD who suffers from cognitive impairment may harbour a statistically significantly higher risk of progressing toward dementia, which negatively affects their life expectancy and daily functioning and overall lowers the global quality of life. Furthermore, it is a widely held view that cognitive dysfunction does not just occur in the late stage of PD. On the basis of numerous studies, mild cognitive impairment (MCI) is a harbinger of dementia in PD, which is observed as an intermediate state with considerable variability; some patients remain stable and some even revert to normal cognition. Considered that the timing, profile, and rate of cognitive impairment vary greatly among PD individuals, it is extremely urgent for researchers and clinicians alike to identify and predict future cognitive decline in this population. Simultaneously, early screening and canonical management of PD with cognitive deficits are very imperative to postpone the disease progression and improve the prognosis of patients. In our review, we focus on a description of cognitive decline in PD, expound emphatically the pathological mechanisms underlying cognition deficits in PD, then give a comprehensive overview of specific therapeutic strategies, and finally dissect what fresh insights may bring new exciting prospect for the subfield.
Collapse
|
47
|
Jones JD, Rahmani E, Garcia E, Jacobs JP. Gastrointestinal symptoms are predictive of trajectories of cognitive functioning in de novo Parkinson's disease. Parkinsonism Relat Disord 2020; 72:7-12. [PMID: 32058266 PMCID: PMC7179075 DOI: 10.1016/j.parkreldis.2020.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Non-motor symptoms such as cognitive and gastrointestinal (GI) symptoms are common in Parkinson's disease (PD). In PD, GI-symptoms often present prior to motor symptoms. It is hypothesized that GI-symptoms reflect disruptions of the microbiome-gut-brain axis, which leads to altered immune functioning, chronic neuroinflammation, and subsequent neurodegeneration. Initial evidence links gut-dysbiosis to PD pathology and motor symptom severity. The present study examines the longitudinal relationship between severity of GI-symptoms and cognitive impairment in newly diagnosed PD patients. METHODS A secondary data analysis of the Parkinson's Progression Markers Initiative (PPMI) included 423 newly diagnosed PD patients who were followed for up to 5 years. Participants underwent neuropsychological tests of processing speed, attention, visuospatial functioning, verbal learning and verbal delayed recall. Participant were classified as cognitive intact, mild cognitive impairment or Parkinson's disease dementia. Frequency of GI-symptoms were assessed with the Scales for Outcomes in Parkinson's Disease Autonomic (SCOPA-AUT). Multi-level models (MLM) examined the longitudinal relationship between GI symptoms and cognitive impairment. RESULTS All cognitive outcomes were predicted by the main effect of GI symptoms, or the GI-symptom X Occasion interaction term. Specifically, more severe GI-symptoms were predictive of a less favorable trajectory of performance on tests of letter fluency, visuospatial, learning and memory. Cognitive performance was uniquely associated with GI-symptoms and unrelated to non-GI autonomic symptoms. CONCLUSIONS The presence of GI symptoms may serve as an early marker of cognitive impairment in PD. Future studies should examine specific mechanisms underlying the relationship between gut-dysbiosis and cognitive impairment.
Collapse
Affiliation(s)
- Jacob D Jones
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA.
| | - Elizabeth Rahmani
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Erik Garcia
- Department of Psychology, Center on Aging, California State University San Bernardino, San Bernardino, CA, USA
| | - Jonathan P Jacobs
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
48
|
Orgeta V, McDonald KR, Poliakoff E, Hindle JV, Clare L, Leroi I. Cognitive training interventions for dementia and mild cognitive impairment in Parkinson's disease. Cochrane Database Syst Rev 2020; 2:CD011961. [PMID: 32101639 PMCID: PMC7043362 DOI: 10.1002/14651858.cd011961.pub2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Approximately 60% to 80% of people with Parkinson's disease (PD) experience cognitive impairment that impacts on their quality of life. Cognitive decline is a core feature of the disease and can often present before the onset of motor symptoms. Cognitive training may be a useful non-pharmacological intervention that could help to maintain or improve cognition and quality of life for people with PD dementia (PDD) or PD-related mild cognitive impairment (PD-MCI). OBJECTIVES To determine whether cognitive training (targeting single or multiple domains) improves cognition in people with PDD and PD-MCI or other clearly defined forms of cognitive impairment in people with PD. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group Trials Register (8 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO. We searched reference lists and trial registers, searched relevant reviews in the area and conference proceedings. We also contacted experts for clarifications on data and ongoing trials. SELECTION CRITERIA We included randomised controlled trials where the participants had PDD or PD-MCI, and where the intervention was intended to train general or specific areas of cognitive function, targeting either a single domain or multiple domains of cognition, and was compared to a control condition. Multicomponent interventions that also included motor or other elements were considered eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts, and full-text articles for inclusion in the review. Two review authors also independently undertook extraction of data and assessment of methodological quality. We used GRADE methods to assess the overall quality of the evidence. MAIN RESULTS Seven studies with a total of 225 participants met the inclusion criteria for this review. All seven studies compared the effects of a cognitive training intervention to a control intervention at the end of treatment periods lasting four to eight weeks. Six studies included people with PD living in the community. These six studies recruited people with single-domain (executive) or multiple-domain mild cognitive impairment in PD. Four of these studies identified participants with MCI using established diagnostic criteria, and two included both people with PD-MCI and people with PD who were not cognitively impaired. One study recruited people with a diagnosis of PD dementia who were living in long-term care settings. The cognitive training intervention in three studies targeted a single cognitive domain, whilst in four studies multiple domains of cognitive function were targeted. The comparison groups either received no intervention or took part in recreational activities (sports, music, arts), speech or language exercises, computerised motor therapy, or motor rehabilitation combined with recreational activity. We found no clear evidence that cognitive training improved global cognition. Although cognitive training was associated with higher scores on global cognition at the end of treatment, the result was imprecise and not statistically significant (6 trials, 178 participants, standardised mean difference (SMD) 0.28, 95% confidence interval (CI) -0.03 to 0.59; low-certainty evidence). There was no evidence of a difference at the end of treatment between cognitive training and control interventions on executive function (5 trials, 112 participants; SMD 0.10, 95% CI -0.28 to 0.48; low-certainty evidence) or visual processing (3 trials, 64 participants; SMD 0.30, 95% CI -0.21 to 0.81; low-certainty evidence). The evidence favoured the cognitive training group on attention (5 trials, 160 participants; SMD 0.36, 95% CI 0.03 to 0.68; low-certainty evidence) and verbal memory (5 trials, 160 participants; SMD 0.37, 95% CI 0.04 to 0.69; low-certainty evidence), but these effects were less certain in sensitivity analyses that excluded a study in which only a minority of the sample were cognitively impaired. There was no evidence of differences between treatment and control groups in activities of daily living (3 trials, 67 participants; SMD 0.03, 95% CI -0.47 to 0.53; low-certainty evidence) or quality of life (5 trials, 147 participants; SMD -0.01, 95% CI -0.35 to 0.33; low-certainty evidence). There was very little information on adverse events. We considered the certainty of the evidence for all outcomes to be low due to risk of bias in the included studies and imprecision of the results. We identified six ongoing trials recruiting participants with PD-MCI, but no ongoing trials of cognitive training for people with PDD. AUTHORS' CONCLUSIONS This review found no evidence that people with PD-MCI or PDD who receive cognitive training for four to eight weeks experience any important cognitive improvements at the end of training. However, this conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results. There is a need for more robust, adequately powered studies of cognitive training before conclusions can be drawn about the effectiveness of cognitive training for people with PDD and PD-MCI. Studies should use formal criteria to diagnose cognitive impairments, and there is a particular need for more studies testing the efficacy of cognitive training in people with PDD.
Collapse
Affiliation(s)
- Vasiliki Orgeta
- University College LondonDivision of Psychiatry6th Floor, Maple House,149 Tottenham Court Road,LondonUKW1T 7NF
| | - Kathryn R McDonald
- University of ManchesterDivision of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health3.306, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
| | - Ellen Poliakoff
- Division of Neuroscience and Experimental Psychology, School of Biological SciencesUniversity of ManchesterManchesterUKM13 9PL
| | - John Vincent Hindle
- Llandudno Hospital, Betsi Cadwaladr University Health BoardCare of the Elderly DepartmentHospital RoadLlandudnoConwyUKLL30 1LB
| | - Linda Clare
- University of ExeterREACH: The Centre for Research in Ageing and Cognitive HealthPerry RoadExeterUKEX4 4QG
| | - Iracema Leroi
- Trinity College DublinGlobal Brain Health InstituteDublinIreland
| | | |
Collapse
|
49
|
Betrouni N, Lopes R, Defebvre L, Leentjens AFG, Dujardin K. Texture features of magnetic resonance images: A marker of slight cognitive deficits in Parkinson's disease. Mov Disord 2019; 35:486-494. [PMID: 31758820 DOI: 10.1002/mds.27931] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/23/2019] [Accepted: 11/06/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cognitive impairment is a frequent nonmotor symptom of Parkinson's disease. Depending on severity, patients are considered to have mild cognitive impairment or dementia. However, among the cognitively intact patients, some may have deficits in a less severe range. The early detection of such subtle symptoms may be important for the initiation of care strategies. OBJECTIVE To identify imaging markers of early cognitive symptoms, potentially before usual signs, such as atrophy, become manifest. METHODS A total of 102 patients with Parkinson's disease and 17 age-matched cognitively intact healthy controls underwent extensive neuropsychological assessment and T1-weighted magnetic resonance imaging. Parkinson's disease patients were separated into 3 groups according to their cognitive status: intact, with slight slowing, and with mild deficits in executive functions. Texture features as measured by first-order and second-order statistics were computed in the following 6 brain regions: the hippocampus, thalamus, amygdala, putamen, caudate nucleus, and pallidum. They were tested between the groups, and their correlation with cognition was examined. Volumetric measurements were made for comparison. RESULTS Texture analysis showed significant between-group differences for 2 features-skewness and entropy in the hippocampus, the thalamus, and the amygdala-and the volume analysis revealed no between-group difference. These features were significantly correlated with cognitive performance. CONCLUSION These results support the assumption that signal alterations associated with Parkinson's disease-related cognitive decline can be captured very early by texture analysis. As these changes appear to reflect clinical phenomena, texture analysis may be a promising marker for helping cognitive phenotyping in Parkinson's disease. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Nacim Betrouni
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Lille (CHU Lille), Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Renaud Lopes
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Lille (CHU Lille), Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Luc Defebvre
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Lille (CHU Lille), Degenerative & Vascular Cognitive Disorders, Lille, France.,Neurology and Movement Disorders Department, CHU Lille, Lille, France
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kathy Dujardin
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Lille (CHU Lille), Degenerative & Vascular Cognitive Disorders, Lille, France.,Neurology and Movement Disorders Department, CHU Lille, Lille, France
| |
Collapse
|
50
|
Bernini S, Alloni A, Panzarasa S, Picascia M, Quaglini S, Tassorelli C, Sinforiani E. A computer-based cognitive training in Mild Cognitive Impairment in Parkinson's Disease. NeuroRehabilitation 2019; 44:555-567. [PMID: 31256092 DOI: 10.3233/nre-192714] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no successful pharmacological treatment for cognitive impairment in Parkinson's Disease, therefore treatments capable of slowing down the progression of cognitive dysfunction are needed. OBJECTIVE To evaluate the effectiveness of a cognitive training, supported by the CoRe computerized tool, in patients with Parkinson's Disease Mild Cognitive Impairment. METHODS This is a prospective, open-unblinded, randomized, controlled study. After baseline cognitive assessment (T0), enrolled patients were randomized to receive motor rehabilitation plus cognitive intervention (G1) or motor rehabilitation only (G2). Follow-up assessments were scheduled 4 weeks (T1) and 6 months after (T2). Global cognitive functioning scores (MOCA and MMSE) were considered as primary outcome. Outcome measures at T0, T1 and T2 were compared within- and between-groups. A percentage change score between T0 and next assessments was calculated to identify patients who improved, remain stable or worsened. RESULTS Differently from G2, G1 showed a medium/large effect size improvement in primary (MoCA) and secondary outcome, both between T0 and T1 and T0 and T2. Moreover, within G1, most patients improved their cognitive state compared to the baseline. CONCLUSIONS Patients trained with CoRe showed a better evolution of cognitive decline, while untreated patients tended to get worse over time.
Collapse
Affiliation(s)
- Sara Bernini
- Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Alloni
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Silvia Panzarasa
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Marta Picascia
- Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Sinforiani
- Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|