Decreased and increased cerebral regional homogeneity in early Parkinson's disease

Temporal Dynamic Alterations of Regional Homogeneity in Parkinson's Disease: A Resting-State fMRI Study

Brain activity is time varying and dynamic, even in the resting state. However, little attention has been paid to the dynamic alterations in regional brain activity in Parkinson's disease (PD). We aimed to test for differences in dynamic regional homogeneity (dReHo) between PD patients and healthy controls (HCs) and to further investigate the pathophysiological meaning of this altered dReHo in PD. We included 57 PD patients and 31 HCs with rs-fMRI scans and neuropsychological examinations. Then, ReHo and dReHo were calculated for all subjects. We compared ReHo and dReHo between PD patients and HCs and then analyzed the associations between altered dReHo variability and clinical/neuropsychological measurements. Support vector machines (SVMs) were also used to assist in differentiating PD patients from HCs using the classification values of dReHo. The results showed that PD patients had increased ReHo in the bilateral medial temporal lobe and decreased ReHo in the right posterior cerebellar lobe, right precentral gyrus, and supplementary motor area, compared with controls. The coefficient of variation (CV) of dReHo was considerably higher in the precuneus in PD patients compared with HCs, and the CV of dReHo in the precuneus was found to be highly associated with HAMD, HAMA, and NMSQ scores. Multiple linear regression analysis controlling for demographic, clinical, and neuropsychiatric variables confirmed the association between altered dReHo and HAMD. Using the leave-one-out cross validation procedure, 98% (p < 0.001) of individuals were properly identified using the SVM classifier. These results provide new evidence for the aberrant resting-state brain activity in the precuneus of PD patients and its role in neuropsychiatric symptoms in PD.

The altered spontaneous neural activity in patients with Parkinson's disease and its predictive value for the motor improvement of deep brain stimulation

BACKGROUND

This study aims to investigate the altered spontaneous neural activity in patients with Parkinson's disease (PD) revealed by amplitudes of low-frequency fluctuations (ALFF) of resting-state fMRI, and the feasibility of using ALFF as neuroimaging predictors for motor improvement after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS).

METHODS

Fourty-four patients and 44 healthy controls were included in this study. First, the ALFF of patients with PD was compared with that of controls; then significant clusters were correlated with motor improvement after DBS (unified Parkinson's disease rating scale (UPDRS-III)) and other clinical variables. Second, regression and classification of the machine learning models were conducted to predict motor improvement after DBS. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the classification model.

RESULTS

Compared with healthy controls, patients with PD showed increased ALFF in the bilateral motor area and decreased ALFF in the bilateral temporal cortex and cerebellum. The Hoehn-Yahr stages correlated with ALFF within the bilateral cerebellum (p = 0.021), and UPDRS-III improvement correlated with ALFF in the left (p < 0.001) and right (p = 0.005) motor areas. The regression model showed a significant correlation between the predicted and observed UPDRS-III changes (R = 0.65, p < 0.001). The ROC analysis revealed an area under the curve (AUC) of 0.94 which differentiated moderate and superior DBS responders.

CONCLUSION

The results revealed altered ALFF patterns in patients with PD and their correlations with clinical variables. Both binary and continuous ALFF can potentially serve as predictive biomarkers for DBS response.

Topological patterns of motor networks in Parkinson’s disease with different sides of onset: A resting-state-informed structural connectome study

Parkinson’s disease (PD) has a characteristically unilateral pattern of symptoms at onset and in the early stages; this lateralization is considered a diagnostically important diagnosis feature. We aimed to compare the graph-theoretical properties of whole-brain networks generated by using resting-state functional MRI (rs-fMRI), diffusion tensor imaging (DTI), and the resting-state-informed structural connectome (rsSC) in patients with left-onset PD (LPD), right-onset PD (RPD), and healthy controls (HCs). We recruited 26 patients with PD (13 with LPD and 13 with RPD) as well as 13 age- and sex-matched HCs. Rs-fMRI and DTI were performed in all subjects. Graph-theoretical analysis was used to calculate the local and global efficiency of a whole-brain network generated by rs-fMRI, DTI, and rsSC. Two-sample t-tests and Pearson correlation analysis were conducted. Significantly decreased global and local efficiency were revealed specifically in LPD patients compared with HCs when the rsSC network was used; no significant intergroup difference was found by using rs-fMRI or DTI alone. For rsSC network analysis, multiple network metrics were found to be abnormal in LPD. The degree centrality of the left precuneus was significantly correlated with the Unified Parkinson’s Disease Rating Scale (UPDRS) score and disease duration (p = 0.030, r = 0.599; p = 0.037, r = 0.582). The topological properties of motor-related brain networks can differentiate LPD and RPD. Nodal metrics may serve as important structural features for PD diagnosis and monitoring of disease progression. Collectively, these findings may provide neurobiological insights into the lateralization of PD onset.

Alterations of Regional Homogeneity in Parkinson's Disease with Rapid Eye Movement Sleep Behavior Disorder

OBJECTIVE

Patients with rapid eye movement (REM) sleep behavior disorder (RBD) in Parkinson's disease (PD-RBD) tend to have poor cognitive performance and faster cognitive deterioration, and the potential mechanism is still ambiguous. Therefore, this study aimed to detect the alterations in local brain function in PD-RBD.

METHODS

Fifty patients, including 23 patients with PD-RBD and 27 patients with PD without RBD (PD-nRBD), and 26 healthy controls were enrolled. All subjects were subjected to one-night polysomnography and underwent resting-state functional magnetic resonance imaging (rs-fMRI). The fMRI images of the three groups were analyzed by regional homogeneity (ReHo) to observe the local neural activity. Correlations between altered ReHo values and chin electromyographic (EMG) density scores and cognitive scores in the PD subgroups were assessed.

RESULTS

Compared with the patients with PD-nRBD, the patients with PD-RBD had higher ReHo values in the frontal cortex (the right superior frontal gyrus, the right middle frontal gyrus and the left medial superior frontal gyrus), the right caudate nucleus and the right anterior cingulate gyrus, and compared with the HCs, the patients with PD-RBD had lower ReHo values in the bilateral cuneus, the bilateral precuneus, the left inferior temporal gyrus and the left inferior occipital gyrus. For the patients with PD-RBD, the phasic chin EMG density scores were positively correlated with the ReHo values in the left medial superior frontal gyrus, and the tonic chin EMG density scores were positively correlated with the ReHo values in the right anterior cingulate gyrus.

CONCLUSION

This study indicates that increased ReHo in the frontal cortex, the caudate nucleus and the anterior cingulate gyrus may be linked with the abnormal motor behaviors during REM sleep and that decreased ReHo in the posterior regions may be related to the visuospatial-executive function in patients with PD-RBD.

The amplitude of low-frequency fluctuation predicts levodopa treatment response in patients with Parkinson's disease

INTRODUCTION

Levodopa has become the main therapy for motor symptoms of Parkinson's disease (PD). This study aimed to test whether the amplitude of low-frequency fluctuation (ALFF) computed by fMRI could predict individual patient's response to levodopa treatment.

METHODS

We included 40 patients. Treatment efficacy was defined based on motor symptoms improvement from the state of medication off to medication on, as assessed by the Unified Parkinson's Disease Rating Scale score III. Two machine learning models were constructed to test the prediction ability of ALFF. First, the ensemble method was implemented to predict individual treatment responses. Second, the categorical boosting (CatBoost) classification was used to predict individual levodopa responses in patients classified as moderate and superior responders, according to the 50% threshold of improvement. The age, disease duration and treatment dose were controlled as covariates.

RESULTS

No significant difference in clinical data were observed between moderate and superior responders. Using the ensemble method, the regression model showed a significant correlation between the predicted and the observed motor symptoms improvement (r = 0.61, p < 0.01, mean absolute error = 0.11 ± 0.02), measured as a continuous variable. The use of the Catboost algorithm revealed that ALFF was able to differentiate between moderate and superior responders (area under the curve = 0.90). The mainly contributed regions for both models included the bilateral primary motor cortex, the occipital cortex, the cerebellum, and the basal ganglia.

CONCLUSION

Both continuous and binary ALFF values have the potential to serve as promising predictive markers of dopaminergic therapy response in patients with PD.

Alterations of Regional Homogeneity in the Mild and Moderate Stages of Parkinson's Disease

Objectives: This study aimed to investigate alterations in regional homogeneity (ReHo) in early Parkinson's disease (PD) at different Hoehn and Yahr (HY) stages and to demonstrate the relationships between altered brain regions and clinical scale scores. Methods: We recruited 75 PD patients, including 43 with mild PD (PD-mild; HY stage: 1.0-1.5) and 32 with moderate PD (PD-moderate; HY stage: 2.0-2.5). We also recruited 37 age- and sex-matched healthy subjects as healthy controls (HC). All subjects underwent neuropsychological assessments and a 3.0 Tesla magnetic resonance scanning. Regional homogeneity of blood oxygen level-dependent (BOLD) signals was used to characterize regional cerebral function. Correlative relationships between mean ReHo values and clinical data were then explored. Results: Compared to the HC group, the PD-mild group exhibited increased ReHo values in the right cerebellum, while the PD-moderate group exhibited increased ReHo values in the bilateral cerebellum, and decreased ReHo values in the right superior temporal gyrus, the right Rolandic operculum, the right postcentral gyrus, and the right precentral gyrus. Reho value of right Pre/Postcentral was negatively correlated with HY stage. Compared to the PD-moderate group, the PD-mild group showed reduced ReHo values in the right superior orbital gyrus and the right rectus, in which the ReHo value was negatively correlated with cognition. Conclusion: The right superior orbital gyrus and right rectus may serve as a differential indicator for mild and moderate PD. Subjects with moderate PD had a greater scope for ReHo alterations in the cortex and compensation in the cerebellum than those with mild PD. PD at HY stages of 2.0-2.5 may already be classified as Braak stages 5 and 6 in terms of pathology. Our study revealed the different patterns of brain function in a resting state in PD at different HY stages and may help to elucidate the neural function and early diagnosis of patients with PD.

Motor Symptom Lateralization Influences Cortico-Striatal Functional Connectivity in Parkinson's Disease

Objective: The striatum is unevenly impaired bilaterally in Parkinson's disease (PD). Because the striatum plays a key role in cortico-striatal circuits, we assume that lateralization affects cortico-striatal functional connectivity in PD. The present study sought to evaluate the effect of lateralization on various cortico-striatal circuits through resting-state functional magnetic resonance imaging (fMRI). Methods: Thirty left-onset Parkinson's disease (LPD) patients, 27 right-onset Parkinson's disease (RPD) patients, and 32 normal controls with satisfactory data were recruited. Their demographic, clinical, and neuropsychological information was collected. Resting-state fMRI was performed, and functional connectivity changes of seven subdivisions of the striatum were explored in the two PD groups. In addition, the associations between altered functional connectivity and various clinical and neuropsychological characteristics were analyzed by Pearson's or Spearman's correlation. Results: Directly comparing the LPD and RPD patients demonstrated that the LPD patients had lower FC between the left dorsal rostral putamen and the left orbitofrontal cortex than the RPD patients. In addition, the LPD patients showed aberrant functional connectivity involving several striatal subdivisions in the right hemisphere. The right dorsal caudate, ventral rostral putamen, and superior ventral striatum had decreased functional connectivity with the cerebellum and parietal and occipital lobes relative to the normal control group. The comparison between RPD patients and the controls did not obtain significant difference in functional connectivity. The functional connectivity between the left dorsal rostral putamen and the left orbitofrontal cortex was associated with contralateral motor symptom severity in PD patients. Conclusions: Our findings provide new insights into the distinct characteristics of cortico-striatal circuits in LPD and RPD patients. Lateralization of motor symptoms is associated with lateralized striatal functional connectivity.

Common and specific altered amplitude of low-frequency fluctuations in Parkinson's disease patients with and without freezing of gait in different frequency bands

Freezing of gait (FOG), a disabling symptom of Parkinson's disease (PD), severely affects PD patients' life quality. Previous studies found neuropathologies in functional connectivity related to FOG, but few studies detected abnormal regional activities related to FOG in PD patients. In the present study, we analyzed the amplitude of low-frequency fluctuations (ALFF) to detect brain regions showing abnormal activity in PD patients with FOG (PD-with-FOG) and without FOG (PD-without-FOG). As different frequencies of neural oscillations in brain may reflect distinct brain functional and physiological properties, we conducted this study in three frequency bands, slow-5 (0.01-0.027 Hz), slow-4 (0.027-0.073 Hz), and classical frequency band (0.01-0.08 Hz). We acquired rs-fMRI data from 18 PD-with-FOG patients, 18 PD-without-FOG patients, and 17 healthy controls, then calculated voxel-wise ALFF across the whole brain and compared ALFF among the three groups in each frequency band. We found: (1) in slow-5, both PD-with-FOG and PD-without-FOG patients showed lower ALFF in the bilateral putamen compared to healthy controls, (2) in slow-4, PD-with-FOG patients showed higher ALFF in left inferior temporal gyrus (ITG) and lower ALFF in right middle frontal gyrus (MFG) compared to either PD-without-FOG patients or healthy controls, (3) in classical frequency band, PD-with-FOG patients also showed higher ALFF in ITG compared to either PD-without-FOG patients or healthy controls. Furthermore, we found that ALFF in MFG and ITG in slow-4 provided the highest classification accuracy (96.7%) in distinguishing PD-with-FOG from PD-without-FOG patients by using a stepwise multivariate pattern analysis. Our findings indicated frequency-specific regional spontaneous neural activity related to FOG, which may help to elucidate the pathogenesis of FOG.

Altered regional homogeneity and connectivity in cerebellum and visual-motor relevant cortex in Parkinson's disease with rapid eye movement sleep behavior disorder

OBJECTIVE

Rapid eye movement sleep behavior disorder (RBD) frequently occurs in Parkinson's disease (PD), however, the exact pathophysiological mechanism underlying its occurrence is not clear. In this study, we explored whether there is abnormal spontaneous neuronal activities and connectivity maps in some brain areas under resting-state in PD patients with RBD.

METHODS

We recruited 38 PD patients (19 PD with RBD and 19 PD without RBD), and 20 age- and gender-matched normal controls. We used resting-state functional magnetic resonance imaging (RS-fMRI) to analyze regional homogeneity (ReHo) and functional connectivity (FC), and further to reveal the neuronal activity in all subjects.

RESULTS

Compared with the PD without RBD patients, the PD with RBD patients showed a significant increase in regional homogeneity in the left cerebellum, the right middle occipital region and the left middle temporal region, and decreased regional homogeneity in the left middle frontal region. The REM sleep behavioral disorders questionnaire scores were significantly positively correlated with the ReHo values of the left cerebellum. The functional connectivity analysis in which the four regions described above were used as regions of interest revealed increased functional activity between the left cerebellum and bilateral occipital regions, bilateral temporal regions and bilateral supplementary motor area.

CONCLUSION

The pathophysiological mechanism of PD with RBD may be related to abnormal spontaneous neuronal activity patterns with strong synchronization of cerebellar and visual-motor relevant cortex, and the increased connectivity of the cerebellum with the occipital and motor regions.

Regional Neural Activity Changes in Parkinson's Disease-Associated Mild Cognitive Impairment and Cognitively Normal Patients

PURPOSE

The aim of this study was to compare regional homogeneity (ReHo) changes in Parkinson's disease mild cognitive impairment (PD-MCI) patients with respect to normal controls (NC) and those with cognitively normal PD (PD-CN). Further, the study investigated the relationship between ReHo changes in PD patients and neuropsychological variation.

PATIENTS AND METHODS

Thirty PD-MCI, 19 PD-CN, and 21 NC subjects were enrolled. Resting state functional magnetic resonance imaging data of all subjects were collected, and regional brain activity was measured for ReHo. Analysis of covariance for ReHo was determined between the PD-MCI, PD-CN, and NC groups. Spearman rank correlations were assessed using the ReHo maps and data from the neuropsychological tests.

RESULTS

In comparison with NC, PD-CN patients showed significantly higher ReHo values in the right middle frontal gyrus (MFG) and lower ReHo values in the left supramarginal gyrus, bilateral inferior parietal lobule (IPL), and the right postcentral gyrus (PCG). In comparison with PD-CN patients, PD-MCI patients displayed significantly higher ReHo values in the right PCG, left middle occipital gyrus (MOG) and IPL. No significant correlation between ReHo indices and the neuropsychological scales was observed.

CONCLUSION

Our finding revealed that decreases in ReHo in the default mode network (DMN) may appear before PD-related cognitive impairment. In order to preserve executive attention capacity, ReHo in the right MFG in PD patients lacking cognition impairment increased for compensation. PD-MCI showed increased ReHo in the left MOG, which might have been caused by visual and visual-spatial dysfunction, and increased ReHo in the left IPL, which might reflect network disturbance and induce cognition deficits.

The diagnostic potential of multimodal neuroimaging measures in Parkinson's disease and atypical parkinsonism

INTRODUCTION

For the diagnosis of Parkinson's disease (PD) and atypical parkinsonism (AP) using neuroimaging, structural measures have been largely employed since structural abnormalities are most noticeable in the diseases. Functional abnormalities have been known as well, though less clearly seen, and thus, the addition of functional measures to structural measures is expected to be more informative for the diagnosis. Here, we aimed to assess whether multimodal neuroimaging measures of structural and functional alterations could have potential for enhancing performance in diverse diagnostic classification problems.

METHODS

For 77 patients with PD, 86 patients with AP comprising multiple system atrophy and progressive supranuclear palsy, and 53 healthy controls (HC), structural and functional MRI data were collected. Gray matter (GM) volume was acquired as a structural measure, and GM regional homogeneity and degree centrality were acquired as functional measures. The measures were used as predictors individually or in combination in support vector machine classifiers for different problems of distinguishing between HC and each diagnostic type and between different diagnostic types.

RESULTS

In statistical comparisons of the measures, structural alterations were extensively seen in all diagnostic types, whereas functional alterations were limited to specific diagnostic types. The addition of functional measures to the structural measure generally yielded statistically significant improvements to classification accuracy, compared to the use of the structural measure alone.

CONCLUSION

We suggest the fusion of multimodal neuroimaging measures as an effective strategy that could generally cope with diverse prediction problems of clinical concerns.

A Radiomics Approach to Predicting Parkinson's Disease by Incorporating Whole-Brain Functional Activity and Gray Matter Structure

Parkinson's disease (PD) is a progressive, chronic, and neurodegenerative disorder that is primarily diagnosed by clinical examinations and magnetic resonance imaging (MRI). In this study, we proposed a machine learning based radiomics method to predict PD. Fifty healthy controls (HC) along with 70 PD patients underwent resting-state magnetic resonance imaging (rs-fMRI). For all subjects, we extracted five types of 6664 features, including mean amplitude of low-frequency fluctuation (mALFF), mean regional homogeneity (mReHo), resting-state functional connectivity (RSFC), voxel-mirrored homotopic connectivity (VMHC) and gray matter (GM) volume. After conducting dimension reduction utilizing Least absolute shrinkage and selection operator (LASSO), fifty-three radiomic features including 46 RSFCs, 1 mALFF, 3 mReHos, 1 VMHC, 2 GM volumes and 1 clinical factor were retained. The selected features also indicated the most discriminative regions for PD. We further conducted model fitting procedure for classifying subjects in the training set employing random forest and support volume machine (SVM) to evaluate the performance of the two methods. After cross-validation, both methods achieved 100% accuracy and area under curve (AUC) for distinguishing between PD and HC in the training set. In the testing set, SVM performed better than random forest with the accuracy, true positive rate (TPR) and AUC being 85%, 1 and 0.97, respectively. These findings demonstrate the radiomics technique has the potential to support radiological diagnosis and to achieve high classification accuracy for clinical diagnostic systems for patients with PD.

The Relationship between Side of Onset and Cerebral Regional Homogeneity in Parkinson's Disease: A Resting-State fMRI Study

OBJECTIVE

Motor symptoms are usually asymmetric in Parkinson's disease (PD), and asymmetry in PD may involve widespread brain areas. We sought to evaluate the effect of asymmetry on the whole brain spontaneous activity using the measure regional homogeneity (ReHo) through resting-state functional MRI.

METHODS

We recruited 30 PD patients with left onset (LPD), 27 with right side (RPD), and 32 controls with satisfactory data. Their demographic, clinical, and neuropsychological information were obtained. Resting-state functional MRI was performed, and ReHo was used to determine the brain activity. ANCOVA was utilized to analyze between-group differences in ReHo and the associations between abnormal ReHo, and various clinical and neuropsychological variables were explored by Spearman's correlation.

RESULTS

LPD patients had higher ReHo in the right temporal pole than the controls. RPD patients had increased ReHo in the right temporal pole and decreased ReHo in the primary motor cortex and premotor area, compared with the controls. Directly comparing LPD and RPD patients did not show a significant difference in ReHo. ReHo of the right temporal pole was significantly correlated with depression and anxiety in RPD patients.

CONCLUSIONS

Both LPD and RPD have increased brain activity synchronization in the right temporal pole, and only RPD has decreased brain activity synchronization in the right frontal motor areas. The changed brain activity in the right temporal pole may play a compensatory role for depression and anxiety in PD, and the altered cerebral function in the right frontal motor area in RPD may represent the reorganization of the motor system in RPD.

Neuroprotective effects of Bacopa monnieri in Parkinson's disease model

Parkinson's disease (PD) is a common neurodegenerative disorder characterized by loss of dopaminergic neurons in substantia nigra region and the presence of α-synuclein aggregates in the striatum and surrounding areas of brain. Evidences suggest that neuroinflammation plays a role in the progression of PD. We examined the neuro-protective effects of Bacopa monnieri (BM) in regulating neuroinflammation. Administration of BM suppressed the level of pro-inflammatory cytokines, decreased the levels of α-synuclein, and reduced reactive oxygen species (ROS) generation in PD animal model. Pre-treatment of BM showed more prominent results as compare to co- and post-treatment. Results suggest that Bacopa can limit inflammation in the different areas of brain, thus, offers a promising source of novel therapeutics for the treatment of many CNS disorders.

Changed Resting-State Brain Signal in Parkinson's Patients With Mild Depression

Background: Depression is reported to occur 5–10 years early than the onset of motor symptoms in Parkinson (PD) patients. However, markers for early diagnosis of PD in individuals with sub-clinical depression still remain to be identified.

Purpose: This study utilized Regional Homogeneity (ReHo) to investigate the alterations in resting state brain activities in Parkinson (PD) patients with different degrees of depression.

Methods: Twenty non-depressed PD patients, twenty mild to moderately depressed PD patients, and thirteen severely depressed PD patients were recruited. Hamilton Depression Scale (HDS) and the Beck Depression Inventory (BDI) were assessed depression. Resting-state functional magnetic resonance imaging (rs-MRI) was analyzed with ReHo.

Results: PD patients with mild to moderate depression had decreased ReHo in the left dorsal anterior cingulate cortex when compared with PD patients without depression. PD patients with severe depression exhibited increased ReHo in the left inferior prefrontal gyrus and right orbitofrontal area when compared with PD patients with mild to moderate depression. ReHo values in the bilateral supplementary motor area (SMA) in PD patients with severe depression was also increased when compared with PD patients without depression.

Conclusions: This study suggests that rs-MRI with ReHo analysis can detect early changes in brain function that associate with depression in PD patients, which could be biomarkers for early diagnosis and treatment of PD related depression.

Oscillation-specific nodal alterations in early to middle stages Parkinson's disease

BACKGROUND

Different oscillations of brain networks could carry different dimensions of brain integration. We aimed to investigate oscillation-specific nodal alterations in patients with Parkinson's disease (PD) across early stage to middle stage by using graph theory-based analysis.

METHODS

Eighty-eight PD patients including 39 PD patients in the early stage (EPD) and 49 patients in the middle stage (MPD) and 36 controls were recruited in the present study. Graph theory-based network analyses from three oscillation frequencies (slow-5: 0.01-0.027 Hz; slow-4: 0.027-0.073 Hz; slow-3: 0.073-0.198 Hz) were analyzed. Nodal metrics (e.g. nodal degree centrality, betweenness centrality and nodal efficiency) were calculated.

RESULTS

Our results showed that (1) a divergent effect of oscillation frequencies on nodal metrics, especially on nodal degree centrality and nodal efficiency, that the anteroventral neocortex and subcortex had high nodal metrics within low oscillation frequencies while the posterolateral neocortex had high values within the relative high oscillation frequency was observed, which visually showed that network was perturbed in PD; (2) PD patients in early stage relatively preserved nodal properties while MPD patients showed widespread abnormalities, which was consistently detected within all three oscillation frequencies; (3) the involvement of basal ganglia could be specifically observed within slow-5 oscillation frequency in MPD patients; (4) logistic regression and receiver operating characteristic curve analyses demonstrated that some of those oscillation-specific nodal alterations had the ability to well discriminate PD patients from controls or MPD from EPD patients at the individual level; (5) occipital disruption within high frequency (slow-3) made a significant influence on motor impairment which was dominated by akinesia and rigidity.

CONCLUSIONS

Coupling various oscillations could provide potentially useful information for large-scale network and progressive oscillation-specific nodal alterations were observed in PD patients across early to middle stages.

Alterations of Regional Homogeneity in Parkinson's Disease Patients With Freezing of Gait: A Resting-State fMRI Study

Objective

The purposes of this study are to investigate the regional homogeneity (ReHo) of spontaneous brain activities in Parkinson’s disease (PD) patients with freeze of gait (FOG) and to investigate the neural correlation of movement function through resting-state functional magnetic resonance imaging (RS-fMRI).

Methods

A total of 35 normal controls (NC), 33 PD patients with FOG (FOG+), and 35 PD patients without FOG (FOG−) were enrolled. ReHo was applied to evaluate the regional synchronization of spontaneous brain activities. Analysis of covariance (ANCOVA) was performed on ReHo maps of the three groups, followed by post hoc two-sample t-tests between every two groups. Moreover, the ReHo signals of FOG+ and FOG− were extracted across the whole brain and correlated with movement scores (FOGQ, FOG questionnaire; GFQ, gait and falls questionnaire).

Results

Significant ReHo differences were observed in the left cerebrum. Compared to NC subjects, the ReHo of PD subjects was increased in the left angular gyrus (AG) and decreased in the left rolandic operculum/postcentral gyrus (Rol/PostC), left inferior opercular-frontal cortex, left middle occipital gyrus, and supramarginal gyrus (SMG). Compared to that of FOG−, the ReHo of FOG+ was increased in the left caudate and decreased in the left Rol/PostC. Within the significant regions, the ReHo of FOG+ was negatively correlated with FOGQ in the left SMG/PostC (r = −0.39, p < 0.05). Negative correlations were also observed between ReHo and GFQ/FOGQ (r = −0.36/−0.38, p < 0.05) in the left superior temporal gyrus (STG) of the whole brain analysis based on AAL templates.

Conclusion

The ReHo analysis suggested that the regional signal synchronization of brain activities in FOG+ subjects was most active in the left caudate and most hypoactive in the left Rol/PostC. It also indicated that ReHo in the left caudate and left Rol/PostC was critical for discriminating the three groups. The correlation between ReHo and movement scores (GFQ/FOGQ) in the STG has the potential to differentiate FOG+ from FOG−. This study provided new insight into the understanding of PD with and without FOG.

Overlapping and distinct neural metabolic patterns related to impulsivity and hypomania in Parkinson's disease

Impulsivity and hypomania are common non-motor features in Parkinson's disease (PD). The aim of this study was to find the overlapping and distinct neural correlates of these symptoms in PD. Symptoms of impulsivity and hypomania were assessed in 24 PD patients using the Barratt Impulsiveness Scale (BIS-11) and Self-Report Manic Inventory (SRMI), respectively. In addition, fluorodeoxyglucose positron emission tomography (FDG-PET) imaging for each individual was performed. We conducted two separate multiple regression analyses for BIS-11 and SRMI scores with FDG-PET data to identify the brain regions that are associated with both impulsivity and hypomania scores, as well as those exclusive to each symptom. Then, seed-based functional connectivity analyses on healthy subjects identified the areas connected to each of the exclusive regions and the overlapping region, used as seeds. We observed a positive association between BIS-11 and SRMI scores and neural metabolism only in the prefrontal areas. Conjunction analysis revealed an overlapping region in the middle frontal gyrus. Regions exclusive to impulsivity were found in the medial part of the right superior frontal gyrus and regions exclusive to hypomania were in the right superior frontal gyrus, right precentral gyrus and right paracentral lobule. Connectivity patterns of seeds exclusively related to impulsivity were different from those for hypomania in healthy brains. These results provide evidence of both overlapping and distinct regions linked with impulsivity and hypomania scores in PD. The exclusive regions for each characteristic are connected to specific intrinsic functional networks.

Abnormal spontaneous neural activity of brain regions in patients with primary blepharospasm at rest

BACKGROUND

Primary blepharospasm (BSP) is characterized by excessive involuntary eyelid spasms without significant morphological brain abnormalities. Its neural bases remain unclear. Resting-state functional magnetic resonance imaging (rs-fMRI) is a powerful tool for exploring cerebral function mechanisms in BSP.

METHODS

Two subject groups (24 patients with BSP and 24 healthy controls) underwent rs-fMRI scans. The rs-fMRI images were analyzed using the regional homogeneity (ReHo) method to assess the local features of spontaneous brain activity. Correlation analysis was carried out to explore the relationship between the ReHo values of abnormal brain areas and clinical variables including illness duration, symptom severity, and depression/anxiety symptoms.

RESULTS

Relative to healthy controls, patients with BSP showed significantly decreased ReHo in the left superior temporal pole/left insula, left calcarine cortex, and bilateral superior medial frontal gyrus (mSFG), and increased ReHo in the bilateral supplementary motor area (SMA). There were no significant correlations between ReHo values in these brain regions and clinical variables in the patients.

CONCLUSIONS

Our results suggest that abnormal spontaneous brain activity in multiple brain regions not limited to the basal ganglia may be trait alterations in the patients, which provides more insights into the pathogenesis of BSP.

A totally data-driven whole-brain multimodal pipeline for the discrimination of Parkinson's disease, multiple system atrophy and healthy control

Parkinson's Disease (PD) and Multiple System Atrophy (MSA) are two parkinsonian syndromes that share many symptoms, albeit having very different prognosis. Although previous studies have proposed multimodal MRI protocols combined with multivariate analysis to discriminate between these two populations and healthy controls, studies combining all MRI indexes relevant for these disorders (i.e. grey matter volume, fractional anisotropy, mean diffusivity, iron deposition, brain activity at rest and brain connectivity) with a completely data-driven voxelwise analysis for discrimination are still lacking. In this study, we used such a complete MRI protocol and adapted a fully-data driven analysis pipeline to discriminate between these populations and a healthy controls (HC) group. The pipeline combined several feature selection and reduction steps to obtain interpretable models with a low number of discriminant features that can shed light onto the brain pathology of PD and MSA. Using this pipeline, we could discriminate between PD and HC (best accuracy = 0.78), MSA and HC (best accuracy = 0.94) and PD and MSA (best accuracy = 0.88). Moreover, we showed that indexes derived from resting-state fMRI alone could discriminate between PD and HC, while mean diffusivity in the cerebellum and the putamen alone could discriminate between MSA and HC. On the other hand, a more diverse set of indexes derived by multiple modalities was needed to discriminate between the two disorders. We showed that our pipeline was able to discriminate between distinct pathological populations while delivering sparse model that could be used to better understand the neural underpinning of the pathologies.

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Structuro-functional MRI can discriminate between parkinsonian syndromes

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Discriminant MRI modalities vary as a function of the discrimination task

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fMRI is crucial in discriminating between Parkinson's disease patients and controls

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Structural MRI discriminate between Multiple System Atrophy patients and controls

Brain Network and Abnormal Hemispheric Asymmetry Analyses to Explore the Marginal Differences in Glucose Metabolic Distributions Among Alzheimer's Disease, Parkinson's Disease Dementia, and Lewy Body Dementia

Facilitating accurate diagnosis and ensuring appropriate treatment of dementia subtypes, including Alzheimer's disease (AD), Parkinson's disease dementia (PDD), and Lewy body dementia (DLB), is clinically important. However, the differences in glucose metabolic distribution among these three dementia subtypes are minor, which can result in difficulties in diagnosis by visual assessment or traditional quantification methods. Here, we explored this issue using novel approaches, including brain network and abnormal hemispheric asymmetry analyses. We generated 18F-labeled fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images from patients with AD, PDD, and DLB, and healthy control (HC) subjects (n = 22, 18, 22, and 22, respectively) from Huashan hospital, Shanghai, China. Brain network properties were measured and between-group differences evaluated using graph theory. We also calculated and explored asymmetry indices for the cerebral hemispheres in the four groups, to explore whether differences between the two hemispheres were characteristic of each group. Our study revealed significant differences in the network properties of the HC and AD groups (small-world coefficient, 1.36 vs. 1.28; clustering coefficient, 1.48 vs. 1.59; characteristic path length, 1.57 vs. 1.64). In addition, differing hub regions were identified in the different dementias. We also identified rightward asymmetry in the hemispheric brain networks of patients with AD and DLB, and leftward asymmetry in the hemispheric brain networks of patients with PDD, which were attributable to aberrant topological properties in the corresponding hemispheres.

Resting-state Functional MRI in Parkinsonian Syndromes

Background

Functional MRI (fMRI) has been widely used to study abnormal patterns of functional connectivity at rest in patients with movement disorders such as idiopathic Parkinson's disease (PD) and atypical parkinsonisms.

Methods

This manuscript provides an educational review of the current use of resting-state fMRI in the field of parkinsonian syndromes.

Results

Resting-state fMRI studies have improved the current knowledge about the mechanisms underlying motor and non-motor symptom development and progression in movement disorders. Even if its inclusion in clinical practice is still far away, resting-state fMRI has the potential to be a promising biomarker for early disease detection and prediction. It may also aid in differential diagnosis and monitoring brain responses to therapeutic agents and neurorehabilitation strategies in different movement disorders.

Conclusions

There is urgent need to identify and validate prodromal biomarkers in PD patients, to perform further studies assessing both overlapping and disease-specific fMRI abnormalities among parkinsonian syndromes, and to continue technical advances to fully realize the potential of fMRI as a tool to monitor the efficacy of chronic therapies.

Consistent decreased activity in the putamen in Parkinson's disease: a meta-analysis and an independent validation of resting-state fMRI

Background

Resting-state functional magnetic resonance imaging (RS-fMRI) has frequently been used to investigate local spontaneous brain activity in Parkinson's disease (PD) in a whole-brain, voxel-wise manner. To quantitatively integrate these studies, we conducted a coordinate-based (CB) meta-analysis using the signed differential mapping method on 15 studies that used amplitude of low-frequency fluctuation (ALFF) and 11 studies that used regional homogeneity (ReHo). All ALFF and ReHo studies compared PD patients with healthy controls. We also performed a validation RS-fMRI study of ALFF and ReHo in a frequency-dependent manner for a novel dataset consisting of 49 PD and 49 healthy controls.

Findings

Decreased ALFF was found in the left putamen in PD by meta-analysis. This finding was replicated in our independent validation dataset in the 0.027-0.073 Hz band but not in the conventional frequency band of 0.01-0.08 Hz.

Conclusions

Findings from the current study suggested that decreased ALFF in the putamen of PD patients is the most consistent finding. RS-fMRI is a promising technique for the precise localization of abnormal spontaneous activity in PD. However, more frequency-dependent studies using the same analytical methods are needed to replicate these results. Trial registration: NCT NCT03439163. Registered 20 February 2018, retrospectively registered.

Functional MRI in Idiopathic Parkinson's Disease

Functional MRI (fMRI) has been widely used to study abnormal patterns of brain connectivity at rest and activation during a variety of tasks in patients with idiopathic Parkinson's disease (PD). fMRI studies in PD have led to a better understanding of many aspects of the disease including both motor and non-motor symptoms. Although its translation into clinical practice is still at an early stage, fMRI measures hold promise for multiple clinical applications in PD, including the early detection, predicting future change in clinical status, and as a marker of alterations in brain physiology related to neurotherapeutic agents and neurorehabilitative strategies.

Frequency specific brain networks in Parkinson's disease and comorbid depression

The topological organization underlying the human brain was extensively investigated using resting-state functional magnetic resonance imaging, focusing on a low frequency of signal oscillation from 0.01 to 0.1 Hz. However, the frequency specificities with regard to the topological properties of the brain networks have not been fully revealed. In this study, a novel complementary ensemble empirical mode decomposition (CEEMD) method was used to separate the fMRI time series into five characteristic oscillations with distinct frequencies. Then, the small world properties of brain networks were analyzed for each of these five oscillations in patients (n = 67) with depressed Parkinson’s disease (DPD, n = 20) , non-depressed Parkinson’s disease (NDPD, n = 47) and healthy controls (HC, n = 46). Compared with HC, the results showed decreased network efficiency in characteristic oscillations from 0.05 to 0.12 Hz and from 0.02 to 0.05 Hz for the DPD and NDPD patients, respectively. Furthermore, compared with HC, the most significant inter-group difference across five brain oscillations was found in the basal ganglia (0.01 to 0.05 Hz) and paralimbic-limbic network (0.02 to 0.22 Hz) for the DPD patients, and in the visual cortex (0.02 to 0.05 Hz) for the NDPD patients. Compared with NDPD, the DPD patients showed reduced efficiency of nodes in the basal ganglia network (0.01 to 0.05 Hz). Our results demonstrated that DPD is characterized by a disrupted topological organization in large-scale brain functional networks. Moreover, the CEEMD analysis suggested a prominent dissociation in the topological organization of brain networks between DPD and NDPD in both space and frequency domains. Our findings indicated that these characteristic oscillatory activities in different functional circuits may contribute to distinct motor and non-motor components of clinical impairments in Parkinson’s disease.

Longitudinal Alterations of Local Spontaneous Brain Activity in Parkinson's Disease

We used resting-state fMRI to evaluate longitudinal alterations in local spontaneous brain activity in Parkinson's disease (PD) over a 2-year period. Data were acquired from 23 PD patients at baseline and follow-up, and 27 age- and sex-matched normal controls. Regional homogeneity (ReHo) and voxel-based-morphometry (VBM) were used to identify differences in local spontaneous brain activity and grey matter volume. With disease progression, we observed a progressive decrease in ReHo in the sensorimotor cortex, default-mode network, and left cerebellum, but increased ReHo in the supplementary motor area, bilateral temporal gyrus, and hippocampus. Moreover, there was a significant positive correlation between the rates of ReHo change in the left cerebellum and the rates of change in the Unified Parkinson's Disease Rating Scale-III scores. VBM revealed no significant differences in the grey matter volume among the three sets of acquisitions. We conclude that ReHo may be a suitable non-invasive marker of progression in PD.

Alterations in regional homogeneity of resting-state brain activity in fatigue of Parkinson's disease

Fatigue is a common complaint in patients with Parkinson's disease (PD). However, the neural bases of fatigue in PD remain uncertain. In this cross-sectional study, our aim was to study the change of the local brain function in PD patients with fatigue. Among 49 patients with PD, 17 of them had fatigue and the remaining 32 patients without fatigue, and 25 age- and gender-matched healthy controls were enrolled. All subjects were evaluated with Fatigue Severity Scale (FSS) and had a resting-state functional magnetic resonance imaging (rs-fMRI) scan. The fMRI images were analyzed using regional homogeneity (ReHo) to study the change of the local brain function. ReHo analysis controlling for gray matter volume, age, gender, and education showed decreased ReHo in the left anterior cingulate cortex (ACC) and the right superior frontal gyrus (dorsolateral part), and increased ReHo in the left postcentral gyrus and the right inferior frontal gyrus (orbital and triangular part), compared PD-F with PD-NF; In PD patients, the regional activity in the left ACC and the right superior frontal gyrus (dorsolateral part) was negatively correlated with the FSS scores, while that in the left postcentral gyrus, the right inferior frontal gyrus (orbital and triangular part) was positively correlated with the FSS scores. This study demonstrates that brain areas including frontal, postcentral and ACC regions indicative of sensory, motor, and cognitive systems are involved in fatigue in PD patients.

Aberrant Intrinsic Activity and Connectivity in Cognitively Normal Parkinson's Disease

Disturbances in intrinsic activity during resting-state functional MRI (rsfMRI) are common in Parkinson's disease (PD), but have largely been studied in a priori defined subnetworks. The cognitive significance of abnormal intrinsic activity is also poorly understood, as are abnormalities that precede the onset of mild cognitive impairment. To address these limitations, we leveraged three different analytic approaches to identify disturbances in rsfMRI metrics in 31 cognitively normal PD patients (PD-CN) and 30 healthy adults. Subjects were screened for mild cognitive impairment using the Movement Disorders Society Task Force Level II criteria. Whole-brain data-driven analytic approaches first analyzed the amplitude of low-frequency intrinsic fluctuations (ALFF) and regional homogeneity (ReHo), a measure of local connectivity amongst functionally similar regions. We then examined if regional disturbances in these metrics altered functional connectivity with other brain regions. We also investigated if abnormal rsfMRI metrics in PD-CN were related to brain atrophy and executive, visual organization, and episodic memory functioning. The results revealed abnormally increased and decreased ALFF and ReHo in PD-CN patients within the default mode network (posterior cingulate, inferior parietal cortex, parahippocampus, entorhinal cortex), sensorimotor cortex (primary motor, pre/post-central gyrus), basal ganglia (putamen, caudate), and posterior cerebellar lobule VII, which mediates cognition. For default mode network regions, we also observed a compound profile of altered ALFF and ReHo. Most regional disturbances in ALFF and ReHo were associated with strengthened long-range interactions in PD-CN, notably with regions in different networks. Stronger long-range functional connectivity in PD-CN was also partly expanded to connections that were outside the networks of the control group. Abnormally increased activity and functional connectivity appeared to have a pathological, rather than compensatory influence on cognitive abilities tested in this study. Receiver operating curve analyses demonstrated excellent sensitivity (≥90%) of rsfMRI variables in distinguishing patients from controls, but poor accuracy for brain volume and cognitive variables. Altogether these results provide new insights into the topology, cognitive relevance, and sensitivity of aberrant intrinsic activity and connectivity that precedes clinically significant cognitive impairment. Longitudinal studies are needed to determine if these neurocognitive associations presage the development of future mild cognitive impairment or dementia.

Resting-state functional reorganization in Parkinson's disease: An activation likelihood estimation meta-analysis

Parkinson's disease (PD) is a common progressive neurodegenerative disorder. Studies using resting-state functional magnetic resonance imaging (fMRI) to investigate underlying pathophysiology of motor and non-motor symptoms in PD yielded largely inconsistent results. This quantitative neuroimaging meta-analysis aims to identify consistent abnormal intrinsic functional patterns in PD across studies. We used PubMed to retrieve suitable resting-state studies and stereotactic data were extracted from 28 individual between-group comparisons. Convergence across their findings was tested using the activation likelihood estimation (ALE) approach. We found convergent evidence for intrinsic functional disturbances in bilateral inferior parietal lobule (IPL) and the supramarginal gyrus in PD patients compared to healthy subjects. In follow-up task-based and task-independent functional connectivity (FC) analyses using two independent healthy subject data sets, we found that the regions showing convergent aberrations in PD formed an interconnected network mainly with the default mode network (DMN). Behavioral characterization of these regions using the BrainMap database suggested associated dysfunction of perception and executive processes. Taken together, our findings highlight the role of parietal cortex in the pathophysiology of PD.

Altered Brain Functional Activity in Infants with Congenital Bilateral Severe Sensorineural Hearing Loss: A Resting-State Functional MRI Study under Sedation

Early hearing deprivation could affect the development of auditory, language, and vision ability. Insufficient or no stimulation of the auditory cortex during the sensitive periods of plasticity could affect the function of hearing, language, and vision development. Twenty-three infants with congenital severe sensorineural hearing loss (CSSHL) and 17 age and sex matched normal hearing subjects were recruited. The amplitude of low frequency fluctuations (ALFF) and regional homogeneity (ReHo) of the auditory, language, and vision related brain areas were compared between deaf infants and normal subjects. Compared with normal hearing subjects, decreased ALFF and ReHo were observed in auditory and language-related cortex. Increased ALFF and ReHo were observed in vision related cortex, which suggest that hearing and language function were impaired and vision function was enhanced due to the loss of hearing. ALFF of left Brodmann area 45 (BA45) was negatively correlated with deaf duration in infants with CSSHL. ALFF of right BA39 was positively correlated with deaf duration in infants with CSSHL. In conclusion, ALFF and ReHo can reflect the abnormal brain function in language, auditory, and visual information processing in infants with CSSHL. This demonstrates that the development of auditory, language, and vision processing function has been affected by congenital severe sensorineural hearing loss before 4 years of age.

Aberrant regional homogeneity in Parkinson's disease: A voxel-wise meta-analysis of resting-state functional magnetic resonance imaging studies

Studies of abnormal regional homogeneity (ReHo) in Parkinson's disease (PD) have reported inconsistent results. Therefore, we conducted a meta-analysis using the Seed-based d Mapping software package to identify the most consistent and replicable findings. A systematic literature search was performed to identify eligible whole-brain resting-state functional magnetic resonance imaging studies that had measured differences in ReHo between patients with PD and healthy controls between January 2000 and June 4, 2016. A total of ten studies reporting 11 comparisons (212 patients; 182 controls) were included. Increased ReHo was consistently identified in the bilateral inferior parietal lobules, bilateral medial prefrontal cortices, and left cerebellum of patients with PD when compared to healthy controls, while decreased ReHo was observed in the right putamen, right precentral gyrus, and left lingual gyrus. The results of the current meta-analysis demonstrate a consistent and coexistent pattern of impairment and compensation of intrinsic brain activity that predominantly involves the default mode and motor networks, which may advance our understanding of the pathophysiological mechanisms underlying PD.

Regional functional synchronizations in dementia with Lewy bodies and Alzheimer's disease

BACKGROUND

Dementia with Lewy bodies (DLB) is a common cause of dementia in the elderly population after Alzheimer's disease (AD), and at early stages differential diagnosis between DLB and AD might be difficult due to their symptomatic overlap, e.g. cognitive and memory impairments. We aimed to investigate functional brain differences between both diseases in patients recently diagnosed.

METHODS

We investigated regional functional synchronizations using regional homogeneity (ReHo) in patients clinically diagnosed with DLB (n = 19) and AD (n = 18), and for comparisons we also included healthy controls (HC, n = 16). Patient groups were matched by age, education, and by the level of cognitive impairment (MMSE p-value = 0.36). Additionally, correlations between ReHo values and clinical scores were investigated.

RESULTS

The DLB group showed lower ReHo in sensory-motor cortices and higher ReHo in left middle temporal gyrus when compared with HCs (p-value < 0.001 uncorrected). The AD group demonstrated lower ReHo in the cerebellum and higher ReHo in the left/right lingual gyri, precuneus cortex, and other occipital and parietal regions (p-value < 0.001 uncorrected).

CONCLUSIONS

Our results agree with previous ReHo investigations in Parkinson's disease (PD), suggesting that functional alterations in motor-related regions might be a characteristic of the Lewy body disease spectrum. However, our results in AD contradict previously reported findings for this disease and ReHo, which we speculate are a reflection of compensatory brain responses at early disease stages. ReHo differences between patient groups were at regions related to the default mode and sensory-motor resting state networks which might reflect the aetiological divergences in the underlying disease processes between AD and DLB.

Altered Spontaneous Brain Activity in Cortical and Subcortical Regions in Parkinson's Disease

Purpose. The present study aimed to explore the changes of amplitude of low-frequency fluctuations (ALFF) at rest in patients with Parkinson's disease (PD). Methods. Twenty-four PD patients and 22 healthy age-matched controls participated in the study. ALFF was measured on the whole brain of all participants. A two-sample t-test was then performed to detect the group differences with age, gender, education level, head motion, and gray matter volume as covariates. Results. It was showed that PD patients had significantly decreased ALFF in the left thalamus/caudate and right insula/inferior prefrontal gyrus, whereas they had increased ALFF in the right medial prefrontal cortex (BA 8/6) and dorsolateral prefrontal cortex (BA 9/10). Conclusions. Our results indicated that significant alterations of ALFF in the subcortical regions and prefrontal cortex have been detected in PD patients, independent of age, gender, education, head motion, and structural atrophy. The current findings further provide insights into the biological mechanism of the disease.

Impaired interhemispheric synchrony in Parkinson's disease with depression

The alterations of interhemispheric resting-state functional connectivity (FC) in Parkinson’s disease (PD) with depression remain unclear, so we aimed to explore the differences of interhemispheric FC between PD with and without depression. Twenty-one depressed PD (DPD) patients, 49 non-depressed PD (NDPD) patients and 50 matched healthy controls (HC) participated in this study. Resting-state functional magnetic resonance imaging (fMRI) data were analyzed with the voxel-mirrored homotopic connectivity (VMHC) approach. The DPD patients showed lower VMHC values in the bilateral dorsolateral prefrontal cortex (DLPFC) and calcarine cortex compared to both NDPD and HC groups, and further receiver operating characteristic curves (ROC) analyses revealed that the VMHC in these two brain areas could be used as biomarkers to distinguish DPD from NDPD and from HC. The pooled PD patients (both DPD and NDPD) exhibited decreased VMHC in the bilateral putamen, middle occipital gyrus (MOG), postcentral gyrus (PoCG), paracentral lobule (PCL) and cerebellum posterior lobe when compared with HC. Decreased VMHC values within the DLPFC and calcarine cortex appeared to be unique features for DPD and might be used as potential neuroimaging markers to distinguish DPD patients from NDPD and HC groups. These findings may underlie the neural mechanisms of depression in PD.

Regional homogeneity alterations differentiate between tremor dominant and postural instability gait difficulty subtypes of Parkinson's disease

Parkinson's disease (PD) can be classified into the tremor dominant (TD) subtype and the postural instability gait difficulty (PIGD) subtype, which present with different clinical courses and prognoses. However, the symptom-specific intrinsic neural mechanisms underlying the subtypes of PD still remain elusive. In the current study, we utilized resting-state fMRI (rs-fMRI) combined with the regional homogeneity (ReHo) method to investigate the modulations of neural activity in 13 patients with predominantly PIGD (p-PIGD) and 15 patients with predominantly TD (p-TD) in the resting state. Compared with healthy controls, the p-PIGD and the p-TD groups both displayed ReHo changes in the default mode network (DMN). By contrast, the p-TD group exhibited more ReHo alterations in the cerebellum involved in the cerebello-thalamo-cortical (CTC) loops, whilst the p-PIGD group in extensive cortical and sub-cortical areas, including the frontal, parietal, occipital, temporal, limbic lobes, basal ganglia and thalamus, which are involved in the striatal-thalamo-cortical (STC) loops. Direct comparison between the two groups showed significant ReHo alterations in the primary visual cortex. Our findings underscore the differential involvement of the STC and CTC circuits underlying the two subtypes of PD. Moreover, relatively widespread neural activity abnormality, especially in the motor-related regions as well as the visual network, is apparently a characteristic feature of PIGD symptoms. This study could shed light on the underlying pathophysiology and clinical heterogeneity of PD presentation.

Abnormal regional homogeneity in Parkinson's disease: a resting state fMRI study

AIM

To examine the functional brain alterations in Parkinson's disease (PD) by measuring blood oxygenation level dependent (BOLD) functional MRI (fMRI) signals at rest while controlling for the structural atrophy.

MATERIALS AND METHODS

Twenty-three PD patients and 20 age, gender, and education level matched normal controls (NC) were included in this study. Resting state fMRI and structural MRI data were acquired. The resting state brain activity was measured by the regional homogeneity (ReHo) method and the grey matter (GM) volume was attained by the voxel-based morphology (VBM) analysis. Two-sample t-test was then performed to detect the group differences with structural atrophy as a covariate.

RESULTS

VBM analysis showed GM volume reductions in the left superior frontal gyrus, left paracentral lobule, and left middle frontal gyrus in PD patients as compared to NC. There were widespread ReHo differences between NC and PD patients. Compared to NC, PD patients showed significant alterations in the motor network, including decreased ReHo in the right primary sensory cortex (S1), while increased ReHo in the left premotor area (PMA) and left dorsolateral prefrontal cortex (DLPFC). In addition, a cluster in the left superior occipital gyrus (SOG) also showed increased ReHo in PD patients.

CONCLUSION

The current findings indicate that significant changes of ReHo in the motor and non-motor cortices have been detected in PD patients, independent of age, gender, education level, and structural atrophy. The present study thus suggests ReHo abnormalities as a potential biomarker for the diagnosis of PD and further provides insights into the biological mechanism of the disease.

Propagation of pathology through brain networks in neurodegenerative diseases: from molecules to clinical phenotypes

The cellular mechanisms underlying the stereotypical progression of pathology in neurodegenerative diseases are incompletely understood, but increasing evidence indicates that misfolded protein aggregates can spread by a self-perpetuating neuron-to-neuron transmission. Novel neuroimaging techniques can help elucidating how these disorders spread across brain networks. Recent knowledge from structural and functional connectivity studies suggests that the relation between neurodegenerative diseases and distinct brain networks is likely to be a strict consequence of diffuse network dynamics. Diffusion tensor magnetic resonance imaging also showed that measurement of white matter tract involvement can be a valid surrogate to assess the in vivo spreading of pathological proteins in these conditions. This review will introduce briefly the main molecular and pathological substrates of the most frequent neurodegenerative diseases and provide a comprehensive overview of neuroimaging findings that support the "network-based neurodegeneration" hypothesis in these disorders. Characterizing network breakdown in neurodegenerative diseases will help anticipate and perhaps prevent the devastating impact of these conditions.

Frequency-dependent neural activity in Parkinson's disease

The brainstem and basal ganglia are important in the pathophysiology of Parkinson's disease (PD). Reliable and sensitive detection of neural activity changes in these regions should be helpful in scientific and clinical research on PD. In this study, we used resting state functional MRI and amplitude of low frequency fluctuation (ALFF) methods to examine spontaneous neural activity in 109 patients with PD. We examined activity in two frequency bands, slow-4 (between 0.027 and 0.073 Hz) and slow-5 (0.010-0.027 Hz). Patients had decreased ALFF in the striatum and increased ALFF in the midbrain, and changes were more significant in slow-4. Additionally, changes in slow-4 in both basal ganglia and midbrain correlated with the severity of the parkinsonism. The ALFF in the caudate nucleus positively correlated with the dose of levodopa, while the ALFF in the putamen negatively correlated with the disease duration in both slow-4 and slow-5 bands. In addition, the ALFF in the rostral supplementary motor area negatively correlated with bradykinesia subscale scores. Our findings show that with a large cohort of patients and distinguishing frequency bands, neural modulations in the brainstem and striatum in PD can be detected and may have clinical relevance. The physiological interpretation of these changes needs to be determined.

Complex deregulation and expression of cytokines and mediators of the immune response in Parkinson's disease brain is region dependent

Neuroinflammation is common in neurodegenerative diseases including Parkinson disease (PD). Expression of 25 mRNAs was assessed with TaqMan-PCR including members of the complement system, colony stimulating factors, Toll family, cytokines IL-8, IL-6, IL-6ST, IL-1B, TNF-α family, IL-10, TGFβ family, cathepsins and integrin family, in the substantia nigra pars compacta, putamen, frontal cortex area 8 and angular gyrus area 39, in a total of 43 controls and 56 cases with PD-related pathology covering stages 1-6 of Braak. Up-regulation of IL-6ST was the only change in the substantia nigra at stages 1-2. Down-regulation of the majority of members examined occurred in the substantia nigra from stage 4 onwards. However, region-dependent down- and up-regulation of selected mRNAs occurred in the putamen and frontal cortex, whereas only mRNA up-regulated mRNAs were identified in the angular cortex from stage 3 onwards in PD cases. Protein studies in frontal cortex revealed increased IL6 expression and reduced IL-10 with ELISA, and increased IL-6 with western blotting in PD. Immunohistochemistry revealed localization of IL-5, IL-6 and IL-17 receptors in glial cells, mainly microglia; IL-5, IL-10 and M-CSF in neurons; TNF-α in neurons and microglia; and active NF-κB in the nucleus of subpopulations of neurons and glial cells in PD. Distinct inflammatory responses, involving pro- and anti-inflammatory cytokines, and variegated mediators of the immune response occur in different brain regions at the same time in particular individuals. Available information shows that altered α-synuclein solubility and aggregation, Lewy body formation, oxidative damage and neuroinflammation converge in the pathogenesis of PD.

Akinetic-rigid and tremor-dominant Parkinson's disease patients show different patterns of intrinsic brain activity

BACKGROUND

Parkinson's disease (PD) is a surprisingly heterogeneous neurodegenerative disorder. It is well established that different subtypes of PD present with different clinical courses and prognoses. However, the neural mechanism underlying these disparate presentations is uncertain.

METHODS

Here we used resting-state fMRI (rs-fMRI) and the regional homogeneity (ReHo) method to determine neural activity patterns in the two main clinical subgroups of PD (akinetic-rigid and tremor-dominant).

RESULTS

Compared with healthy controls, akinetic-rigid (AR) subjects had increased ReHo mainly in right amygdala, left putamen, bilateral angular gyrus, bilateral medial prefrontal cortex (MPFC), and decreased ReHo in left post cingulate gyrus/precuneus (PCC/PCu) and bilateral thalamus. In contrast, tremor-dominant (TD) patients showed higher ReHo mostly in bilateral angular gyrus, left PCC, cerebellum_crus1, and cerebellum_6, while ReHo was decreased in right putamen, primary sensory cortex (S1), vermis_3, and cerebellum_4_5. These results indicate that AR and TD subgroups both represent altered spontaneous neural activity in default-mode regions and striatum, and AR subjects exhibit more changed neural activity in the mesolimbic cortex (amygdala) but TD in the cerebellar regions. Of note, direct comparison of the two subgroups revealed a distinct ReHo pattern primarily located in the striatal-thalamo-cortical (STC) and cerebello-thalamo-cortical (CTC) loops.

CONCLUSION

Overall, our findings highlight the involvement of default mode network (DMN) and STC circuit both in AR and TD subtypes, but also underscore the importance of integrating mesolimbic-striatal and CTC loops in understanding neural systems of akinesia and rigidity, as well as resting tremor in PD. This study provides improved understanding of the pathophysiological models of different subtypes of PD.

Reduced topological efficiency in cortical-basal Ganglia motor network of Parkinson's disease: a resting state fMRI study

Parkinson's disease (PD) is mainly characterized by dopamine depletion of the cortico-basal ganglia (CBG) motor circuit. Given that dopamine dysfunction could affect functional brain network efficiency, the present study utilized resting-state fMRI (rs-fMRI) and graph theoretical approach to investigate the topological efficiency changes of the CBG motor network in patients with PD during a relatively hypodopaminergic state (12 hours after a last dose of dopamimetic treatment). We found that PD compared with controls had remarkable decreased efficiency in the CBG motor network, with the most pronounced changes observed in rostral supplementary motor area (pre-SMA), caudal SMA (SMA-proper), primary motor cortex (M1), primary somatosensory cortex (S1), thalamus (THA), globus pallidus (GP), and putamen (PUT). Furthermore, reduced efficiency in pre-SMA, M1, THA and GP was significantly correlated with Unified Parkinson's Disease Rating Scale (UPDRS) motor scores in PD patients. Together, our results demonstrate that individuals with PD appear to be less effective at information transfer within the CBG motor pathway, which provides a novel perspective on neurobiological explanation for the motor symptoms in patients. These findings are in line with the pathophysiology of PD, suggesting that network efficiency metrics may be used to identify and track the pathology of PD.

Cortico-striatal-thalamic network functional connectivity in hemiparkinsonism

Cortico-striatal-thalamic network functional connectivity (FC) and its relationship with levodopa (L-dopa) were investigated in 69 patients with hemiparkinsonism (25 drug-naïve [n-PD] and 44 under stable/optimized dopaminergic treatment [t-PD]) and 27 controls. Relative to controls, n-PD patients showed an increased FC between the left and the right basal ganglia, and a decreased connectivity of the affected caudate nucleus and thalamus with the ipsilateral frontal and insular cortices. Compared with both controls and n-PD patients, t-PD patients showed a decreased FC among the striatal and thalamic regions, and an increased FC between the striatum and temporal cortex, and between the thalamus and several sensorimotor, parietal, temporal, and occipital regions. In both n-PD and t-PD, patients with more severe motor disability had an increased striatal and/or thalamic FC with temporal, parietal, occipital, and cerebellar regions. Cortico-striatal-thalamic functional abnormalities occur in patients with hemiparkinsonism, antecede the onset of the motor symptoms on the opposite body side and are modulated by L-dopa. In patients with hemiparkinsonism, L-dopa is likely to facilitate a compensation of functional abnormalities possibly through an increased thalamic FC.