Autonomic disorders in Parkinson disease: Disrupted hypothalamic connectivity as revealed from resting-state functional magnetic resonance imaging

Multimodal magnetic resonance imaging studies on non-motor symptoms of Parkinson's disease

Objective

This study aims to investigate the diagnostic value of multi-modal magnetic resonance imaging (MRI) utilizing arterial spin labeling (ASL), quantitative susceptibility mapping (QSM), and 3D T1-weighted imaging (3DT1WI) in patients with Parkinson's disease (PD). Additionally, it evaluates the relationship between MRI findings and non-motor symptoms associated with PD.

Methods

ASL, QSM, and 3DT1WI scans were performed on 48 PD patients and 46 healthy controls (HC). We extracted and analyzed differences in regional cerebral blood flow (rCBF), magnetic susceptibility, and gray matter density parameters between the two groups. These MRI parameters were correlated with clinical scale scores assessing non-motor symptoms, including cognitive function, sleep quality, olfaction, autonomic function, anxiety, depression, and fatigue. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracy of each imaging modality in distinguishing PD from HC.

Results

The areas under the ROC curve (AUC) for rCBF, magnetic susceptibility, and gray matter density were 0.941, 0.979, and 0.624, respectively. In PD patients, a negative correlation was found between Unified Parkinson's Disease Rating Scale Part II (UPDRS II) scores and rCBF in the bilateral precuneus. The Pittsburgh Sleep Quality Index (PSQI) scores negatively correlated with rCBF in the left middle temporal gyrus and right middle occipital gyrus. Hamilton Depression Rating Scale (HAMD) scores positively correlated with QSM values in the right supplementary motor area, while scores on the Argentine Smell Identification Test (AHRS) negatively correlated with QSM values in the same area. Disease duration showed a positive correlation with QSM values in the right middle cingulate gyrus. Additionally, PSQI scores positively correlated with QSM values in the left middle cingulate gyrus, and fatigue severity scale (FSS) scores also positively correlated with QSM values in the left middle cingulate gyrus. Gray matter atrophy in the left inferior temporal gyrus was associated with cognitive impairment in PD.

Conclusion

Occipital hypoperfusion and cortical atrophy in the left inferior temporal gyrus may serve as novel imaging biomarkers for PD and are associated with sleep disturbances and cognitive impairment in PD patients. Extensive iron deposition in the bilateral cerebral cortex of PD patients may be a contributing factor to non-motor symptoms such as sleep disturbances and fatigue. Multimodal imaging techniques, including ASL, QSM, and 3DT1WI, can enhance the diagnostic accuracy for PD.

Autonomic failure: Clinicopathologic, physiologic, and genetic aspects

Over the past century, generations of neuroscientists, pathologists, and clinicians have elucidated the underlying causes of autonomic failure found in neurodegenerative, inherited, and antibody-mediated autoimmune disorders, each with pathognomonic clinicopathologic features. Autonomic failure affects central autonomic nervous system components in the α-synucleinopathy, multiple system atrophy, characterized clinically by levodopa-unresponsive parkinsonism or cerebellar ataxia, and pathologically by argyrophilic glial cytoplasmic inclusions (GCIs). Two other central neurodegenerative disorders, pure autonomic failure characterized clinically by deficits in norepinephrine synthesis and release from peripheral sympathetic nerve terminals; and Parkinson's disease, with early and widespread autonomic deficits independent of the loss of striatal dopamine terminals, both express Lewy pathology. The rare congenital disorder, hereditary sensory, and autonomic neuropathy type III (or Riley-Day, familial dysautonomia) causes life-threatening autonomic failure due to a genetic mutation that results in loss of functioning baroreceptors, effectively separating afferent mechanosensing neurons from the brain. Autoimmune autonomic ganglionopathy caused by autoantibodies targeting ganglionic α3-acetylcholine receptors instead presents with subacute isolated autonomic failure affecting sympathetic, parasympathetic, and enteric nervous system function in various combinations. This chapter is an overview of these major autonomic disorders with an emphasis on their historical background, neuropathological features, etiopathogenesis, diagnosis, and treatment.

Diagnosis of Neural Activity among Abnormal Brain Regions in Patients with Major Depressive Disorder by Magnetic Resonance Imaging Features

In order to explore the diagnostic value of magnetic resonance imaging (MRI) for neural activity among abnormal brain regions in patients with major depressive disorder (MDD), thirty patients with MDD (observation group) were selected for comparison with 30 healthy people without MDD (control group). The included subjects were examined by MRI to compare the MRI features and were analyzed for regional homogeneity (ReHo) and amplitude low-frequency fluctuations (ALFF). The results showed that compared with the control group, the brain regions with increased ReHo and ALFF in the observation group were medial frontal gyrus (right), middle temporal lobe (left), inferior parietal lobe (left), and posterior cerebellar lobe (right); the brain region with increased ReHo and ALFF in the observation group was the middle temporal gyrus (right). Compared with the control group, there were significant differences in ReHo and ALFF in the observation group. It was found that the brain function of patients with MDD was abnormal compared with that of the normal subjects, and the brain network activity was also abnormal. MRI features can be used to explore abnormal brain regions in patients with MDD and have positive guiding value.