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Bhome R, Thomas GEC, Zarkali A, Weil RS. Structural and Functional Imaging Correlates of Visual Hallucinations in Parkinson's Disease. Curr Neurol Neurosci Rep 2023; 23:287-299. [PMID: 37126201 PMCID: PMC10257588 DOI: 10.1007/s11910-023-01267-1] [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] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE OF REVIEW To review recent structural and functional MRI studies of visual hallucinations in Parkinson's disease. RECENT FINDINGS Previously, neuroimaging had shown inconsistent findings in patients with Parkinson's hallucinations, especially in studies examining grey matter volume. However, recent advances in structural and functional MRI techniques allow better estimates of structural connections, as well as the direction of connectivity in functional MRI. These provide more sensitive measures of changes in structural connectivity and allow models of the changes in directional functional connectivity to be tested. We identified 27 relevant studies and found that grey matter imaging continues to show heterogeneous findings in Parkinson's patients with visual hallucinations. Newer approaches in diffusion imaging and functional MRI are consistent with emerging models of Parkinson's hallucinations, suggesting shifts in attentional networks. In particular, reduced bottom-up, incoming sensory information, and over-weighting of top-down signals appear to be important drivers of visual hallucinations in Parkinson's disease.
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Affiliation(s)
- Rohan Bhome
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK.
| | | | - Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Rimona Sharon Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
- Movement Disorders Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3AR, UK
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2
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Montaser-Kouhsari L, Young CB, Poston KL. Neuroimaging approaches to cognition in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:257-286. [PMID: 35248197 DOI: 10.1016/bs.pbr.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While direct visualization of Lewy body accumulation within the brain is not yet possible in living Parkinson's disease patients, brain imaging studies offer insights into how the buildup of Lewy body pathology impacts different regions of the brain. Unlike biological biomarkers and purely behavioral research, these brain imaging studies therefore offer a unique opportunity to relate brain localization to cognitive function and dysfunction in living patients. Magnetic resonance imaging studies can reveal physical changes in brain structure as they relate to different cognitive domains and task specific impairments. Functional imaging studies use a combination of task and resting state magnetic resonance imaging, as well as positron emission tomography and single photon emission computed tomography, and can be used to determine changes in blood flow, neuronal activation and neurochemical changes in the brain associated with PD cognition and cognitive impairments. Other unique advantages to brain imaging studies are the ability to monitor changes in brain structure and function longitudinally as patients progress and the ability to study changes in brain function when patients are exposed to different pharmacological manipulations. This is particularly true when assessing the effects of dopaminergic replacement therapy on cognitive function in Parkinson's disease patients. Together, this chapter will describe imaging studies that have helped identify structural and functional brain changes associated with cognition, cognitive impairment, and dementia in Parkinson's disease.
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Affiliation(s)
- Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Christina B Young
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States; Department of Neurosurgery, Stanford University, Stanford, CA, United States.
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3
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Younes K, Rojas JC, Wolf A, Sheng‐Yang GM, Paoletti M, Toller G, Caverzasi E, Luisa Mandelli M, Illán‐Gala I, Kramer JH, Cobigo Y, Miller BL, Rosen HJ, Geschwind MD. Selective vulnerability to atrophy in sporadic Creutzfeldt-Jakob disease. Ann Clin Transl Neurol 2021; 8:1183-1199. [PMID: 33949799 PMCID: PMC8164858 DOI: 10.1002/acn3.51290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Identification of brain regions susceptible to quantifiable atrophy in sporadic Creutzfeldt-Jakob disease (sCJD) should allow for improved understanding of disease pathophysiology and development of structural biomarkers that might be useful in future treatment trials. Although brain atrophy is not usually present by visual assessment of MRIs in sCJD, we assessed whether using voxel-based morphometry (VBM) can detect group-wise brain atrophy in sCJD. METHODS 3T brain MRI data were analyzed with VBM in 22 sCJD participants and 26 age-matched controls. Analyses included relationships of regional brain volumes with major clinical variables and dichotomization of the cohort according to expected disease duration based on prion molecular classification (i.e., short-duration/Fast-progressors (MM1, MV1, and VV2) vs. long-duration/Slow-progressors (MV2, VV1, and MM2)). Structural equation modeling (SEM) was used to assess network-level interactions of atrophy between specific brain regions. RESULTS sCJD showed selective atrophy in cortical and subcortical regions overlapping with all but one region of the default mode network (DMN) and the insulae, thalami, and right occipital lobe. SEM showed that the effective connectivity model fit in sCJD but not controls. The presence of visual hallucinations correlated with right fusiform, bilateral thalami, and medial orbitofrontal atrophy. Interestingly, brain atrophy was present in both Fast- and Slow-progressors. Worse cognition was associated with bilateral mesial frontal, insular, temporal pole, thalamus, and cerebellum atrophy. INTERPRETATION Brain atrophy in sCJD preferentially affects specific cortical and subcortical regions, with an effective connectivity model showing strength and directionality between regions. Brain atrophy is present in Fast- and Slow-progressors, correlates with clinical findings, and is a potential biomarker in sCJD.
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Affiliation(s)
- Kyan Younes
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Julio C. Rojas
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Amy Wolf
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Goh M. Sheng‐Yang
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Matteo Paoletti
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
- Advanced Imaging and Radiomics CenterNeuroradiology DepartmentIRCCS Mondino FoundationPaviaItaly
| | - Gianina Toller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Eduardo Caverzasi
- Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Maria Luisa Mandelli
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Ignacio Illán‐Gala
- Department of NeurologyHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Joel H. Kramer
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Yann Cobigo
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Bruce L. Miller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Howard J. Rosen
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Michael D. Geschwind
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
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Yuki N, Yoshioka A, Mizuhara R, Kimura T. Visual hallucinations and inferior longitudinal fasciculus in Parkinson's disease. Brain Behav 2020; 10:e01883. [PMID: 33078912 PMCID: PMC7749587 DOI: 10.1002/brb3.1883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION We investigated whether disruption of the inferior longitudinal fasciculus and inferior fronto-occipital fasciculus are associated with visual hallucinations in Parkinson's disease (PD). METHODS Sixty consecutive right-handed patients with PD with and without visual hallucinations were enrolled in this cross-sectional study. Diffusion tensor imaging was acquired by 3.0 T magnetic resonance imaging. We measured fractional anisotropy and mean diffusivity of the bilateral inferior longitudinal fasciculus and inferior fronto-occipital fasciculus using diffusion tensor tractography analysis software. RESULTS Seventeen patients with PD had visual hallucinations; these patients tended to have lower fractional anisotropy and higher mean diffusivity values in all fasciculi than did patients without visual hallucinations. A univariate logistic analysis showed that the presence of visual hallucinations was significantly associated with lower fractional anisotropy and higher mean diffusivity of the left inferior longitudinal fasciculus, and lower Mini-Mental State Examination (MMSE) scores. A multivariable logistic analysis adjusted by MMSE scores and disease duration showed a significant association between the presence of visual hallucinations and fractional anisotropy and mean diffusivity values of the left inferior longitudinal fasciculus. CONCLUSIONS Our results suggest that disruption of left inferior longitudinal fasciculus integrity is associated with visual hallucinations in patients with PD, independent of cognitive impairment and disease duration.
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Affiliation(s)
- Natsuko Yuki
- Department of Neurology, National Hospital Organization Maizuru Medical Center, Maizuru, Japan.,Department of Neurology, Kyoto Kizugawa Hospital, Joyo, Japan
| | - Akira Yoshioka
- Department of Neurology, Kyoto Kizugawa Hospital, Joyo, Japan.,Department of Clinical Research, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Ryo Mizuhara
- Department of Neurology, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Tadashi Kimura
- Department of Neurology, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
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Díaz-Santos M, Monge ZA, Salazar RD, Gilmore GC, Neargarder S, Cronin-Golomb A. Increasing Contrast Improves Object Perception in Parkinson's Disease with Visual Hallucinations. Mov Disord Clin Pract 2020; 8:51-59. [PMID: 33426159 DOI: 10.1002/mdc3.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background Deficits in basic vision are associated with visual hallucinations in Parkinson's disease. Of particular interest is contrast sensitivity loss in this disorder and its effect on object identification. Objectives Evaluate whether increased contrast improves object perception in persons with Parkinson's disease and visual hallucinations, without dementia. Methods We assessed 26 individuals with mild to moderate idiopathic Parkinson's disease, half of whom reported one or more episodes of hallucinations/unusual perceptual experiences in the past month, with a letter-identification task that determined the contrast level required to achieve 80% accuracy. Contrast sensitivity was further assessed with a chart that presented stimuli at multiple spatial frequencies. The groups were closely matched for demographic and clinical characteristics except for experience of hallucinations. Results Relative to participants without visual hallucinations, those with hallucinations had poorer spatial frequency contrast sensitivity and required significantly greater contrast to correctly identify the letters on the identification task. Specifically, participants with hallucinations required a mean contrast of 52.8%, whereas participants without hallucinations required 35.0%. When given sufficient contrast, the groups with and without hallucinations were equally accurate in letter identification. Conclusions Compared to those without hallucinations, individuals with Parkinson's disease and hallucinations without dementia showed poorer contrast sensitivity. Once contrast was individually enhanced, the groups were equally accurate at object identification. These findings suggest the potential of visual perception tests to predict, and perception-based interventions to reduce, hallucinations in Parkinson's disease.
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Affiliation(s)
- Mirella Díaz-Santos
- Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA
| | - Zachary A Monge
- Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA
| | - Grover C Gilmore
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences Case Western Reserve University Cleveland Ohio USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA.,Department of Psychology Bridgewater State University Bridgewater Massachusetts USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA
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6
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Alipour A, Mozhdehfarahbakhsh A, Nouri S, Petramfar P, Tahamtan M, Kamali AM, Rao KS, Nami M. Studies on the Bottom-Up and Top-Down Neural Information Flow Alterations in Neurodegeneration. J Alzheimers Dis 2020; 78:169-183. [PMID: 32955463 DOI: 10.3233/jad-200590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A proper explanation for perceptual symptoms in neurodegenerative disorders including Alzheimer's disease and Parkinson's disease (PD) is still lacking. OBJECTIVE This study aimed at investigating the imbalance between 'bottom-up' and 'top-down' information flow (IF) and processing in PD in relation with visual hallucination symptoms. METHODS Here, we looked at bottom-up and top-down IF markers using resting state electroencephalographic (EEG) data from PD patients analyzed through three different IF measures (direct Directed Transfer Function (dDTF), full frequency Directed Transfer Function (ff-DTF), and renormalized Partial Directed Coherence (rPDC). RESULTS We observed an increased gamma band IF and a reduced beta band IF in PD patients compared to healthy controls. Additionally, we noticed a reduced theta band IF in PD patients using dDTF as a measure of IF. By source localizing the EEG activity of the PD patients and healthy controls, we looked at the alterations of IF in the prefrontal cortex of PD patients as well. CONCLUSION In line with previous studies, our results suggest that the delicate balance between bottom-up and top-down IF is disrupted in Parkinson's disease potentially contributing to the cognitive symptoms of PD patients.
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Affiliation(s)
- Abolfazl Alipour
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.,Program in Neuroscience, Indiana University, Bloomington, IN, USA
| | - Azadeh Mozhdehfarahbakhsh
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saba Nouri
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Tahamtan
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - Ali-Mohammad Kamali
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - K S Rao
- Centre for Neuroscience, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama
| | - Mohammad Nami
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran.,Centre for Neuroscience, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama.,Institute for Cognitive Science Studies-ICSS, Brain and Cognition Clinic, Tehran, Iran
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7
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Frewen P, Schroeter ML, Riva G, Cipresso P, Fairfield B, Padulo C, Kemp AH, Palaniyappan L, Owolabi M, Kusi-Mensah K, Polyakova M, Fehertoi N, D’Andrea W, Lowe L, Northoff G. Neuroimaging the consciousness of self: Review, and conceptual-methodological framework. Neurosci Biobehav Rev 2020; 112:164-212. [DOI: 10.1016/j.neubiorev.2020.01.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
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Abstract
In addition to motor symptoms, behavioural complications are commonly found in patients with Parkinson's disease (PD). Behavioural complications, including depression, anxiety, apathy, impulse control disorder and psychosis, together have a large impact on PD patient's quality of life. Many neuroimaging studies using PET, SPECT and MRI techniques have been conducted to study the underlying neural mechanisms of PD pathogenesis and pathophysiology in relation to its behavioural complications. This review will survey these PET, SPECT and MRI studies to describe the current understanding of the neuro-chemical, functional and structural changes associated with behavioural complications in PD patients.
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Damasceno Dos Santos EU, Duarte EBC, Miranda LMR, Asano AGC, Asano NMJ, Maia MDMD, de Souza PRE. Pharmacogenetic Profile and the Occurrence of Visual Hallucinations in Patients With Sporadic Parkinson's Disease. J Clin Pharmacol 2019; 59:1006-1013. [PMID: 30794329 DOI: 10.1002/jcph.1394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Visual hallucinations are significant nonmotor symptoms in the course of treatment of Parkinson's disease. Previous studies have shown that the interindividual variability and pharmacogenetic profile of Parkinson's disease patients seem to influence the occurrence of visual hallucinations. In our study, we investigated a possible relationship of sequence variants in DRD1, DRD2, DRD3, DAT1, and COMT genes with the presence of visual hallucinations in Parkinson's disease patients. A total of 224 Brazilian patients from the Pro-Parkinson service at the Clinical Hospital of the University of Pernambuco, diagnosed with sporadic Parkinson's disease, were enrolled. Parkinson's disease patients were divided into 2 groups based on the presence or absence of visual hallucinations. The sequence variants for DRD1, DRD2, DRD3, DAT1, and COMT were determined through the polymerase chain reaction-restriction fragment length polymorphism technique. Multiple Poisson regression analyses showed that individuals carrying the DRD3 Ser/Ser and Ser/Gly genotypes presented increased prevalence ratios of visual hallucinations (9.7-fold and 4.4-fold, respectively; P < .001). Regarding DAT1 rs28363170, there was a 9.82-fold increase in the prevalence ratio in patients with the 10/11 genotype, 8.78-fold for the 10/8 genotype, and 2.44-fold for the 9/8 genotypes (P < .001, for all). In addition, visual hallucinations were also associated with use of transdermal patches with rotigotine (PR, 3.7; 95%CI, 1.2-10.9; P = .017) and rasagiline (PR, 2.8; 95%CI, 1.3-6.0; P = .006). Our results suggest that the genetic variants DRD3 and DAT1, along with other therapeutic confounders, may influence the prevalence ratio of visual hallucinations.
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Affiliation(s)
| | | | | | - Amdore Guescel C Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Pro-Parkinson Program of the Clinical Hospital of the Federal University of Pernambuco Recife (HC/UFPE), Recife, PE, Brazil
| | - Nadja Maria Jorge Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Pro-Parkinson Program of the Clinical Hospital of the Federal University of Pernambuco Recife (HC/UFPE), Recife, PE, Brazil
| | | | - Paulo Roberto Eleutério de Souza
- Graduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Recife, PE, Brazil.,Graduate Program in Applied Biology for Health, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Department of Biology, Federal Rural University of Pernambuco (UFRPE), Recife, PE, Brazil
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10
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Gu Q, Zhang H, Xuan M, Luo W, Huang P, Xia S, Zhang M. Automatic Classification on Multi-Modal MRI Data for Diagnosis of the Postural Instability and Gait Difficulty Subtype of Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:545-56. [PMID: 27176623 DOI: 10.3233/jpd-150729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with the postural instability and gait difficulty subtype (PIGD) of Parkinson's disease (PD) are a refractory challenge in clinical practice. Despite previous attempts that have been made at studying subtype-specific brain alterations across PD population, conclusive neuroimaging biomarkers on patients with the PIGD subtype are still lacking. Machine learning-based classifications are a promising tool for differential diagnosis that effectively integrate complex and multivariate data. OBJECTIVE Our present study aimed to introduce the machine learning-based automatic classification for the first time to distinguish patients with the PIGD subtype from those with the non-PIGD subtype of PD at the individual level. METHODS Fifty-two PD patients and forty-five normal controls (NCs) were recruited and underwent multi-modal MRI scans including a set of resting-state functional, 3D T1-weighted and diffusion tensor imaging sequences. By comparing the PD patients with the NCs, features that were not conducive to the subtype-specific classification were ruled out from massive brain features. We applied a support vector machine classifier with the recursive feature elimination method to multi-modal MRI data for selecting features with the best discriminating power, and evaluated the proposed classifier with the leave-one-out cross-validation. RESULTS Using this classifier, we obtained satisfactory diagnostic rates (accuracy = 92.31%, specificity = 96.97%, sensitivity = 84.21% and AUCmax = 0.9585). The diagnostic agreement evaluated by the Kappa test showed an almost perfect agreement with the existing clinical categorization (Kappa value = 0.83). CONCLUSIONS With these favorable results, our findings suggested the machine learning-based classification as an alternative technique to classifying clinical subtypes in PD.
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Affiliation(s)
- Quanquan Gu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huan Zhang
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, China
| | - Min Xuan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Luo
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunren Xia
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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11
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Ffytche DH, Pereira JB, Ballard C, Chaudhuri KR, Weintraub D, Aarsland D. Risk factors for early psychosis in PD: insights from the Parkinson's Progression Markers Initiative. J Neurol Neurosurg Psychiatry 2017; 88:325-331. [PMID: 28315846 PMCID: PMC5362125 DOI: 10.1136/jnnp-2016-314832] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) psychosis refers to the spectrum of illusions, formed hallucinations and delusions that occur in PD. Visual hallucinations and illusions are thought to be caused by specific cognitive and higher visual function deficits and patients who develop such symptoms early in the disease course have greater rates of cognitive decline and progression to dementia. To date, no studies have investigated whether such deficits are found prior to the onset of PD psychosis. METHOD Here we compare baseline cognitive, biomarker (structural imaging and cerebrospinal fluid) and other PD psychosis risk factor data in patients who go on to develop illusions or hallucinations within 3-4 years of follow-up in the Parkinson's Progression Markers Initiative cohort of newly diagnosed PD. RESULTS Of n=423 patients with PD, n=115 (27%) reported predominantly illusions with the median time of onset at 19.5 months follow-up. At study entry these patients had reduced CSF amyloid Aß1-42, lower olfaction scores, higher depression scores and increased REM sleep behaviour disorder symptoms compared to patients without early onset PD psychosis but no differences in cognitive, higher visual or structural imaging measures. A subset of patients with early onset formed hallucinations (n=21) had reduced higher visual function at baseline, cortical thinning in parietal, occipital and frontal cortex and reduced hippocampal volume. CONCLUSIONS The findings suggest early onset illusions and formed hallucinations are linked to amyloid pathology in PD and point to a difference in the underlying pathophysiological mechanism of illusions and formed hallucinations, with implications for their respective links to future cognitive decline.
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Affiliation(s)
- Dominic H Ffytche
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joana B Pereira
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Clive Ballard
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - K Ray Chaudhuri
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Daniel Weintraub
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centres (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Centre, Philadelphia, Pennsylvania, USA
| | - Dag Aarsland
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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12
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Ffytche DH, Creese B, Politis M, Chaudhuri KR, Weintraub D, Ballard C, Aarsland D. The psychosis spectrum in Parkinson disease. Nat Rev Neurol 2017; 13:81-95. [PMID: 28106066 PMCID: PMC5656278 DOI: 10.1038/nrneurol.2016.200] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In 2007, the clinical and research profile of illusions, hallucinations, delusions and related symptoms in Parkinson disease (PD) was raised with the publication of a consensus definition of PD psychosis. Symptoms that were previously deemed benign and clinically insignificant were incorporated into a continuum of severity, leading to the rapid expansion of literature focusing on clinical aspects, mechanisms and treatment. Here, we review this literature and the evolving view of PD psychosis. Key topics include the prospective risk of dementia in individuals with PD psychosis, and the causal and modifying effects of PD medication. We discuss recent developments, including recognition of an increase in the prevalence of psychosis with disease duration, addition of new visual symptoms to the psychosis continuum, and identification of frontal executive, visual perceptual and memory dysfunction at different disease stages. In addition, we highlight novel risk factors - for example, autonomic dysfunction - that have emerged from prospective studies, structural MRI evidence of frontal, parietal, occipital and hippocampal involvement, and approval of pimavanserin for the treatment of PD psychosis. The accumulating evidence raises novel questions and directions for future research to explore the clinical management and biomarker potential of PD psychosis.
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Affiliation(s)
- Dominic H Ffytche
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology &Neuroscience, King's College London, UK. De Crespigny Park, London SE5 8AF, UK
| | - Byron Creese
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- University of Exeter Medical School, University of Exeter, EX1 2LU, UK
| | - Marios Politis
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology &Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - K Ray Chaudhuri
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, National Parkinson Foundation Centre of Excellence, King's College London/Kings College Hospital, 5 Cutcombe Road, London SE5 9RT, UK
| | - Daniel Weintraub
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania 3615 Chestnut Street, #330, Philadelphia, Pennsylvania 19104, USA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centres (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Centre 3900 Woodland Avenue, Philadelphia, Pennsylvania 19104, USA
| | - Clive Ballard
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- University of Exeter Medical School, University of Exeter, EX1 2LU, UK
| | - Dag Aarsland
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology &Neuroscience, King's College London, UK. De Crespigny Park, London SE5 8AF, UK
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13
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ffytche DH, Aarsland D. Psychosis in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:585-622. [DOI: 10.1016/bs.irn.2017.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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14
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Lefebvre S, Baille G, Jardri R, Plomhause L, Szaffarczyk S, Defebvre L, Thomas P, Delmaire C, Pins D, Dujardin K. Hallucinations and conscious access to visual inputs in Parkinson's disease. Sci Rep 2016; 6:36284. [PMID: 27841268 PMCID: PMC5107911 DOI: 10.1038/srep36284] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
Abstract
The pathophysiology of visual hallucinations in Parkinson’s disease has yet to be characterized. Although stimulus-driven (“bottom-up”) processes are known to be impaired, the role of “top-down” processes remains to be determined. Distinguishing between conscious and non-conscious detections (i.e. access to consciousness) may be a valuable way of monitoring top-down processes. Conscious access to visual inputs was investigated to identify the neural substrates underlying susceptibility to hallucinations in Parkinson’s disease. Seventeen healthy controls, 18 Parkinson’s disease patients with minor visual hallucinations and 16 without were enrolled in the study. During functional magnetic resonance imaging, the participants performed a visual detection task. The detection threshold was significantly higher in each patient group than in healthy controls while the two groups of patients did not differ significantly. Compared with hallucination-free patients, patients with minor hallucinations displayed hyperactivation of prefrontal and right occipital cortices, and hypoactivation of the left cingulate, temporal and occipital cortices. During conscious access to visual inputs, the functional network in patients with visual hallucinations differed from that seen in patients without visual hallucinations. This suggests that the supremacy of top-down processes in visual information processing may enhance susceptibility to hallucinations in Parkinson’s disease.
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Affiliation(s)
- Stéphanie Lefebvre
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.,CHU Lille, Clinique de Psychiatrie, CURE, F-59000 Lille, France
| | - Guillaume Baille
- Department of Neurology and Movement Disorders, Lille University Medical Center, F-59000 Lille, France
| | - Renaud Jardri
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.,CHU Lille, Clinique de Psychiatrie, CURE, F-59000 Lille, France
| | - Lucie Plomhause
- Univ. Lille, Inserm, U1171 - Degenerative &vascular cognitive disorders, F-59000 Lille, France
| | - Sébastien Szaffarczyk
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.,CHU Lille, Clinique de Psychiatrie, CURE, F-59000 Lille, France
| | - Luc Defebvre
- Department of Neurology and Movement Disorders, Lille University Medical Center, F-59000 Lille, France.,Univ. Lille, Inserm, U1171 - Degenerative &vascular cognitive disorders, F-59000 Lille, France
| | - Pierre Thomas
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.,CHU Lille, Clinique de Psychiatrie, CURE, F-59000 Lille, France
| | - Christine Delmaire
- Univ. Lille, Inserm, U1171 - Degenerative &vascular cognitive disorders, F-59000 Lille, France.,Neuroimaging Department, Lille University Medical Center, F-59000 Lille, France
| | - Delphine Pins
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.,CHU Lille, Clinique de Psychiatrie, CURE, F-59000 Lille, France
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders, Lille University Medical Center, F-59000 Lille, France.,Univ. Lille, Inserm, U1171 - Degenerative &vascular cognitive disorders, F-59000 Lille, France
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15
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Zhu J, Shen B, Lu L, Lan W, Pan Y, Zhang L, Dong J, Wang M, Zhang L. Prevalence and risk factors for visual hallucinations in Chinese patients with Parkinson's disease. J Neurol Sci 2016; 372:471-476. [PMID: 27823833 DOI: 10.1016/j.jns.2016.10.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 08/29/2016] [Accepted: 10/15/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Parkinson's disease (PD) patients frequently present visual hallucinations (VHs)·The determinants of VHs in Chinese PD patients remain largely unknown. The aim of this study was to illuminate the prevalence and clinical correlates of VHs in the Chinese population with PD. METHODS A total of 371 consecutive, idiopathic PD patients were recruited into the study. Patients were categorized as hallucinators and nonhallucinators according to Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS VHs were observed in 72 (19.4%) patients. Among them, 26.4% of the hallucinators experienced minor hallucinations, and 73.6% had complex visual hallucinations. The age, disease duration, percentage of patients using dopamine agonists, UPDRS part III, Hoehn and Yahr (H-Y) stage, and Non-Motor Symptoms Questionnaire (NMS-Quest) score in hallucinators were significantly greater than in nonhallucinators (P<0.05). The Montreal Cognitive Assessment (MOCA) and PD Sleep Scale (PDSS) scores in nonhallucinators were significantly higher than in hallucinators (P<0.05). The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores were not different between the hallucinators and nonhallucinators. The forward binary logistic regression model showed that disease duration, dopamine agonist use, sleep quality, and cognition were associated with VHs in PD patients. CONCLUSIONS Our results confirm the high prevalence of VHs in patients with PD. The VHs are associated with duration, dopamine agonist use, sleep quality, and cognition, and should trigger further inquiry by neurologists.
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Affiliation(s)
- Jun Zhu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China; Clinical Medicine School, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Bo Shen
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China; Clinical Medicine School, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Liyu Lu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China; Clinical Medicine School, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Wenya Lan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China; Clinical Medicine School, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Lili Zhang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Jingde Dong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Min Wang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
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16
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Ferrari M, Comi C, Marino F, Magistrelli L, De Marchi F, Cantello R, Riboldazzi G, Bono G, Cosentino M. Polymorphisms of dopamine receptor genes and risk of visual hallucinations in Parkinson's patients. Eur J Clin Pharmacol 2016; 72:1335-1341. [PMID: 27497990 DOI: 10.1007/s00228-016-2111-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Visual hallucinations (VHs) are frequent non-motor complication of Parkinson's disease (PD), associated to a negative prognosis. Previous studies showed an association between dopamine receptor (DR) gene (DR) variants and psychosis in Alzheimer's disease, addictions, schizophrenia, and bipolar disorder. However, there are only a few studies on DR variants and VHs in PD, which did not provide conclusive results. OBJECTIVES The present study aimed to determine whether genetic differences of DR are associated with visual hallucinations (VHs) in a cohort of Parkinson's disease (PD) patients. METHODS A case-control study of 84 PD subjects, 42 with and 42 without VHs,that were matched for age, gender, disease duration, and dopaminergic medication was conducted. Polymerase chain reaction for SNPs in both D1-like (DRD1A-48G [rs4532] and C62T [rs686], DRD5T798C [rs6283]) and D2-like DR (DRD2G2137A [rs1800497] and C957T [rs6277], DRD3G25A [rs6280] and G712C [rs1800828], DRD4C616G [rs747302] and nR VNTR 48bp) analyzed genomic DNA. RESULTS Patients carrying allele T at DRD1C62T had an increased risk of VHs, expressed as OR (95 % CI, p value), of 10.7 (2.9-40, p = 0.0001). Moreover, patients with DRD1-48 GG and 62TT genotype displayed shorter time to VHs, whereas a longer time to VHs was found in subjects carrying the DRD4 CG alleles. CONCLUSIONS PD patients with VHs display higher frequency of DR SNPs associated with increased D1-like activity and decreased D2-like activity. Our data are in line with associations reported in other neurodegenerative and psychiatric conditions. Results likely provide valuable information for personalizing pharmacological therapy in PD patients.
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Affiliation(s)
- M Ferrari
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, Italy.
| | - C Comi
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F Marino
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, Italy
| | - L Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F De Marchi
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - R Cantello
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - G Riboldazzi
- Departments of Biotechnology and Life Science, University of Insubria, Varese, Italy
| | - G Bono
- Departments of Biotechnology and Life Science, University of Insubria, Varese, Italy
| | - M Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, Via Ottorino Rossi n. 9, 21100, Varese, Italy
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17
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Mathys C, Caspers J, Langner R, Südmeyer M, Grefkes C, Reetz K, Moldovan AS, Michely J, Heller J, Eickhoff CR, Turowski B, Schnitzler A, Hoffstaedter F, Eickhoff SB. Functional Connectivity Differences of the Subthalamic Nucleus Related to Parkinson's Disease. Hum Brain Mapp 2015; 37:1235-53. [PMID: 26700444 DOI: 10.1002/hbm.23099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/12/2015] [Accepted: 12/13/2015] [Indexed: 01/29/2023] Open
Abstract
A typical feature of Parkinson's disease (PD) is pathological activity in the subthalamic nucleus (STN). Here, we tested whether in patients with PD under dopaminergic treatment functional connectivity of the STN differs from healthy controls (HC) and whether some brain regions show (anti-) correlations between functional connectivity with STN and motor symptoms. We used functional magnetic resonance imaging to investigate whole-brain resting-state functional connectivity with STN in 54 patients with PD and 55 HC matched for age, gender, and within-scanner motion. Compared to HC, we found attenuated negative STN-coupling with Crus I of the right cerebellum and with right ventromedial prefrontal regions in patients with PD. Furthermore, we observed enhanced negative STN-coupling with bilateral intraparietal sulcus/superior parietal cortex, right sensorimotor, right premotor, and left visual cortex compared to HC. Finally, we found a decline in positive STN-coupling with the left insula related to severity of motor symptoms and a decline of inter-hemispheric functional connectivity between left and right STN with progression of PD-related motor symptoms. Motor symptom related uncoupling of the insula, a key region in the saliency network and for executive function, from the STN might be associated with well-known executive dysfunction in PD. Moreover, uncoupling between insula and STN might also induce an insufficient setting of thresholds for the discrimination between relevant and irrelevant salient environmental stimuli, explaining observations of disturbed response control in PD. In sum, motor symptoms in PD are associated with a reduced coupling between STN and a key region for executive function.
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Affiliation(s)
- Christian Mathys
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany
| | - Robert Langner
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.,Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Christian Grefkes
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Department of Neurology, Neuromodulation & Neurorehabilitation Group, University of Cologne, Cologne, Germany
| | - Kathrin Reetz
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Department of Neurology and JARA BRAIN, RWTH Aachen University, Aachen, Germany
| | - Alexia-Sabine Moldovan
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Jochen Michely
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Department of Neurology, Neuromodulation & Neurorehabilitation Group, University of Cologne, Cologne, Germany
| | - Julia Heller
- Department of Neurology and JARA BRAIN, RWTH Aachen University, Aachen, Germany
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Bernd Turowski
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.,Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-3, INM-4), Research Centre Jülich, Jülich, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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18
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Shine JM, Keogh R, O'Callaghan C, Muller AJ, Lewis SJG, Pearson J. Imagine that: elevated sensory strength of mental imagery in individuals with Parkinson's disease and visual hallucinations. Proc Biol Sci 2015; 282:20142047. [PMID: 25429016 DOI: 10.1098/rspb.2014.2047] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Visual hallucinations occur when our conscious experience does not accurately reflect external reality. However, these dissociations also regularly occur when we imagine the world around us in the absence of visual stimulation. We used two novel behavioural paradigms to objectively measure visual hallucinations and voluntary mental imagery in 19 individuals with Parkinson's disease (ten with visual hallucinations; nine without) and ten healthy, age-matched controls. We then used this behavioural overlap to interrogate the connectivity both within and between the major attentional control networks using resting-state functional magnetic resonance imaging. Patients with visual hallucinations had elevated mental imagery strength compared with patients without hallucinations and controls. Specifically, the sensory strength of imagery predicted the frequency of visual hallucinations. Together, hallucinations and mental imagery predicted multiple abnormalities in functional connectivity both within and between the attentional control networks, as measured with resting-state functional magnetic resonance imaging. However, the two phenomena were also dissociable at the neural level, with both mental imagery and visual misperceptions associated with specific abnormalities in attentional network connectivity. Our results provide the first evidence of both the shared and unique neural correlates of these two similar, yet distinct phenomena.
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Affiliation(s)
- James M Shine
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Keogh
- School of Psychology, University of NSW, Sydney, New South Wales, Australia
| | - Claire O'Callaghan
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia Neuroscience Research Australia, University of NSW, Sydney, New South Wales, Australia
| | - Alana J Muller
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Pearson
- School of Psychology, University of NSW, Sydney, New South Wales, Australia
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19
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Shine JM, Muller AJ, O’Callaghan C, Hornberger M, Halliday GM, Lewis SJG. Abnormal connectivity between the default mode and the visual system underlies the manifestation of visual hallucinations in Parkinson's disease: a task-based fMRI study. NPJ Parkinsons Dis 2015; 1:15003. [PMID: 28725679 PMCID: PMC5516559 DOI: 10.1038/npjparkd.2015.3] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/06/2015] [Accepted: 03/23/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The neural substrates of visual hallucinations remain an enigma, due primarily to the difficulties associated with directly interrogating the brain during hallucinatory episodes. AIMS To delineate the functional patterns of brain network activity and connectivity underlying visual hallucinations in Parkinson's disease. METHODS In this study, we combined functional magnetic resonance imaging (MRI) with a behavioral task capable of eliciting visual misperceptions, a confirmed surrogate for visual hallucinations, in 35 patients with idiopathic Parkinson's disease. We then applied an independent component analysis to extract time series information for large-scale neuronal networks that have been previously implicated in the pathophysiology of visual hallucinations. These data were subjected to a task-based functional connectivity analysis, thus providing the first objective description of the neural activity and connectivity during visual hallucinations in patients with Parkinson's disease. RESULTS Correct performance of the task was associated with increased activity in primary visual regions; however, during visual misperceptions, this same visual network became actively coupled with the default mode network (DMN). Further, the frequency of misperception errors on the task was positively correlated with the strength of connectivity between these two systems, as well as with decreased activity in the dorsal attention network (DAN), and with impaired connectivity between the DAN and the DMNs, and ventral attention networks. Finally, each of the network abnormalities identified in our analysis were significantly correlated with two independent clinical measures of hallucination severity. CONCLUSIONS Together, these results provide evidence that visual hallucinations are due to increased engagement of the DMN with the primary visual system, and emphasize the role of dysfunctional engagement of attentional networks in the pathophysiology of hallucinations.
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Affiliation(s)
- James M Shine
- Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, Stanford University, Palo Alto, CA, USA
- Neuroscience Research Australia and The University of New South Wales, Randwick, NSW, Australia
| | - Alana J Muller
- Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Claire O’Callaghan
- Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
- Neuroscience Research Australia and The University of New South Wales, Randwick, NSW, Australia
| | - Michael Hornberger
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Glenda M Halliday
- Neuroscience Research Australia and The University of New South Wales, Randwick, NSW, Australia
| | - Simon JG Lewis
- Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
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20
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On visual hallucinations and cortical networks: a trans-diagnostic review. J Neurol 2015; 262:1780-90. [PMID: 25761375 PMCID: PMC4503861 DOI: 10.1007/s00415-015-7687-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
Our current clinical approach to visual hallucinations is largely derived from work carried out by Georges de Morsier in the 1930s. Now, almost a century after his influential papers, we have the research tools to further explore the ideas he put forward. In this review, we address de Morsier's proposal that visual hallucinations in all clinical conditions have a similar neurological mechanism by comparing structural imaging studies of susceptibility to visual hallucinations in Parkinson's disease, Alzheimer's disease, Dementia with Lewy bodies and schizophrenia. Systematic review of the literature was undertaken using PubMed searches. A total of 18 studies across conditions were identified reporting grey matter differences between patients with and without visual hallucinations. Grey matter changes were categorised into brain regions relevant to current theories of visual hallucinations. The distribution of cortical atrophy supports de Morsier's premise that visual hallucinations are invariably linked to aberrant activity within visual thalamo-cortical networks. Further work is required to determine by what mechanism these networks become predisposed to spontaneous activation, and whether the frontal lobe and hippocampal changes identified are present in all conditions. The findings have implications for the development of effective treatments for visual hallucinations.
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21
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Wood RA, Hopkins SA, Moodley KK, Chan D. Fifty Percent Prevalence of Extracampine Hallucinations in Parkinson's Disease Patients. Front Neurol 2015; 6:263. [PMID: 26733937 PMCID: PMC4685050 DOI: 10.3389/fneur.2015.00263] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/03/2015] [Indexed: 01/18/2023] Open
Abstract
Extracampine hallucinations (EH), the sense of a presence or fleeting movement in the absence of an associated visual percept, have been reported in Parkinson's disease (PD) patients but their prevalence, characteristics, and temporal relationship to visual hallucinations (VH) remain unclear. Given that, VH are predictive of cognitive impairment in PD, improved understanding of EH may have significant prognostic implications. The objective of this study is to evaluate the prevalence and characteristics of EH in a large unselected population with PD and to assess the temporal relationship between EH, VH, and memory decline. Cross-sectional data were collected from 414 PD patients using a questionnaire circulated via an online patient community. Data were obtained regarding the occurrence, timing, and characteristics of VH and EH and symptoms of PD, disease duration, disease severity, and medication history. About 50.4% of respondents reported EH and 15.5% reported VH. EH were typically experienced alongside, rather than behind, the individual (p < 0.001) without clear lateralization (p = 0.438) and were more likely to be of unfamiliar presences (p < 0.001). The occurrence of EH was associated with Hoehn and Yahr score (p = 0.002) but not disease duration (p = 0.158). EH onset was associated with VH onset (p = 0.046) and occurred after the onset of anosmia (p < 0.001), cognitive decline (p = 0.002), and sleep disturbance (p = 0.002). The reported prevalence of EH in PD patients was threefold greater than that of VH, with similar timings of onset, suggesting that EH are under-recognized and under-reported. Further work is needed to determine whether EH are predictive of cognitive decline.
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Affiliation(s)
- Ruth A. Wood
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Sarah A. Hopkins
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge, UK
| | - Kuven K. Moodley
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Dennis Chan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- *Correspondence: Dennis Chan,
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22
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Pyatigorskaya N, Gallea C, Garcia-Lorenzo D, Vidailhet M, Lehericy S. A review of the use of magnetic resonance imaging in Parkinson's disease. Ther Adv Neurol Disord 2014; 7:206-20. [PMID: 25002908 DOI: 10.1177/1756285613511507] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To date, the most frequently used Parkinson's disease (PD) biomarkers are the brain imaging measures of dopaminergic dysfunction using positron emission tomography and single photon emission computed tomography. However, major advances have occurred in the development of magnetic resonance imaging (MRI) biomarkers for PD in the past decade. Although conventional structural imaging remains normal in PD, advanced techniques have shown changes in the substantia nigra and the cortex. The most well-developed MRI markers in PD include diffusion imaging and iron load using T2/T2* relaxometry techniques. Other quantitative biomarkers such as susceptibility-weighted imaging for iron load, magnetization transfer and ultra-high-field MRI have shown great potential. More sophisticated techniques such as tractography and resting state functional connectivity give access to anatomical and functional connectivity changes in the brain, respectively. Brain perfusion can be assessed using non-contrast-agent techniques such as arterial spin labelling and spectroscopy gives access to metabolites concentrations. However, to date these techniques are not yet fully validated and standardized quantitative metrics for PD are still lacking. This review presents an overview of new structural, perfusion, metabolic and anatomo-functional connectivity biomarkers, their use in PD and their potential applications to improve the clinical diagnosis of Parkinsonian syndromes and the quality of clinical trials.
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Affiliation(s)
- Nadya Pyatigorskaya
- Institut du Cerveau et de la Moelle épinière, Centre de Neuroimagerie de Recherche, Paris, France
| | - Cécile Gallea
- Institut du Cerveau et de la Moelle épinière, Centre de Neuroimagerie de Recherche, Paris, France
| | - Daniel Garcia-Lorenzo
- Institut du Cerveau et de la Moelle épinière, Centre de Neuroimagerie de Recherche, Paris, France
| | - Marie Vidailhet
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Centre de Recherche de l'Institut du Cerveau et de la Moelle epiniere, Paris, France
| | - Stéphane Lehericy
- Service de neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'hopital, 75651 Paris cedex 13, France
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Yao N, Shek‐Kwan Chang R, Cheung C, Pang S, Lau KK, Suckling J, Rowe JB, Yu K, Ka‐Fung Mak H, Chua S, Ho SL, McAlonan GM. The default mode network is disrupted in Parkinson's disease with visual hallucinations. Hum Brain Mapp 2014; 35:5658-66. [PMID: 24985056 PMCID: PMC4657500 DOI: 10.1002/hbm.22577] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/29/2014] [Accepted: 06/24/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Visual hallucinations (VH) are one of the most striking nonmotor symptoms in Parkinson's disease (PD), and predict dementia and mortality. Aberrant default mode network (DMN) is associated with other psychoses. Here, we tested the hypothesis that DMN dysfunction contributes to VH in PD. METHODS Resting state functional data was acquired from individuals with PD with VH (PDVH) and without VH (PDnonVH), matched for levodopa drug equivalent dose, and a healthy control group (HC). Independent component analysis was used to investigate group differences in functional connectivity within the DMN. In addition, we investigated whether the functional changes associated with hallucinations were accompanied by differences in cortical thickness. RESULTS There were no group differences in cortical thickness but functional coactivation within components of the DMN was significantly lower in both PDVH and PDnonVH groups compared to HC. Functional coactivation within the DMN was found to be greater in PDVH group relative to PDnonVH group. CONCLUSION Our study demonstrates, for the first time that, within a functionally abnormal DMN in PD, relatively higher "connectivity" is associated with VH. We postulate that aberrant connectivity in a large scale network affects sensory information processing and perception, and contributes to "positive" symptom generation in PD.
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Affiliation(s)
- Nailin Yao
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong
| | - Richard Shek‐Kwan Chang
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - Charlton Cheung
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong,State Key Laboratory for Cognitive SciencesThe University of Hong KongPokfulamHong Kong
| | - Shirley Pang
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - Kui Kai Lau
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - John Suckling
- Department of Psychiatry and Behavioural and Clinical Neuroscience InstituteUniversity of Cambridge, and Cambridge and Peterborough Foundation NHS TrustCambridgeUnited Kingdom
| | - James B. Rowe
- Department of Clinical Neurosciences and Behavioural and Clinical Neuroscience InstituteUniversity of CambridgeUnited Kingdom and Medical Research Council Cognition and Brain Sciences UnitCambridge, United Kingdom
| | - Kevin Yu
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong
| | - Henry Ka‐Fung Mak
- Department of Diagnostic RadiologyThe University of Hong KongPokfulamHong Kong
| | - Siew‐Eng Chua
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong,State Key Laboratory for Cognitive SciencesThe University of Hong KongPokfulamHong Kong
| | - Shu Leong. Ho
- Division of Neurology, Department of MedicineThe University of Hong Kong, Queen Mary HospitalPokfulamHong Kong
| | - Grainne M. McAlonan
- Department of PsychiatryQueen Mary Hospital, The University of Hong KongPokfulamHong Kong,Department of Forensic and Neurodevelopmental ScienceInstitute of Psychiatry, King's College LondonLondonSE5 8AZUnited Kingdom
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Borek LL, Friedman JH. Treating psychosis in movement disorder patients: a review. Expert Opin Pharmacother 2014; 15:1553-64. [DOI: 10.1517/14656566.2014.918955] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Gama RL, Bruin VMS, Távora DGF, Duran FLS, Bittencourt L, Tufik S. Structural brain abnormalities in patients with Parkinson's disease with visual hallucinations: a comparative voxel-based analysis. Brain Cogn 2014; 87:97-103. [PMID: 24732953 DOI: 10.1016/j.bandc.2014.03.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 03/15/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
The objective is to evaluate clinical characteristics and cerebral alterations in Parkinson's disease (PD) patients with diurnal visual hallucinations (VHs). Assessment was performed using magnetic resonance image (MRI) and voxel-based morphometry (VBM). Thirty-nine patients with PD (53.8%) and ten controls were studied. Voxel based morphology analysis was performed. Eleven patients presented diurnal VHs and among these, six had cognitive dysfunction. Patients with VHs performed worse in the mentation-related UPDRS I (p=0.005) and motor-related UPDRS III (p=0.02). Patients with VHs showed significant clusters of reduced grey matter volume compared to controls in the left opercula frontal gyrus and left superior frontal gyrus. PD without hallucinations demonstrated reduced grey matter volume in the left superior frontal gyrus compared to controls. Comparisons between patients with VHs regarding the presence of cognitive dysfunction showed that cases with cognitive dysfunction as compared to those without cognitive dysfunction showed significant clusters of reduced grey matter volume in the left opercular frontal gyrus. Cases without cognitive dysfunction had reduced grey matter substance in the left insula and left trigonal frontal gyrus. Judging from our findings, an abnormal frontal cortex, particularly left sided insula, frontal opercular, trigonal frontal gyrus and orbital frontal would make PD patients vulnerable to hallucinations. Compromise of the left operculum distinguished cases with VHs and cognitive dysfunction. Our findings reinforce the theoretical concept of a top-down visual processing in the genesis of VHs in PD.
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Affiliation(s)
- Romulo Lopes Gama
- Pós Graduação Ciências Médicas, Universidade Federal do Ceara, Fortaleza, Brazil
| | | | | | - Fábio L S Duran
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
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Shine JM, O'Callaghan C, Halliday GM, Lewis SJG. Tricks of the mind: Visual hallucinations as disorders of attention. Prog Neurobiol 2014; 116:58-65. [PMID: 24525149 DOI: 10.1016/j.pneurobio.2014.01.004] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
Visual hallucinations are common across a number of disorders but to date, a unifying pathophysiology underlying these phenomena has not been described. In this manuscript, we combine insights from neuropathological, neuropsychological and neuroimaging studies to propose a testable common neural mechanism for visual hallucinations. We propose that 'simple' visual hallucinations arise from disturbances within regions responsible for the primary processing of visual information, however with no further modulation of perceptual content by attention. In contrast, 'complex' visual hallucinations reflect dysfunction within and between the Attentional Control Networks, leading to the inappropriate interpretation of ambiguous percepts. The incorrect information perceived by hallucinators is often differentially interpreted depending on the time-course and the neuroarchitecture underlying the interpretation. Disorders with 'complex' hallucinations without retained insight are proposed to be associated with a reduction in the activity within the Dorsal Attention Network. The review concludes by showing that a variety of pathological processes can ultimately manifest in any of these three categories, depending on the precise location of the impairment.
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Affiliation(s)
- James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia.
| | - Claire O'Callaghan
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia; Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia.
| | - Glenda M Halliday
- Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia.
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia.
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Watanabe H, Senda J, Kato S, Ito M, Atsuta N, Hara K, Tsuboi T, Katsuno M, Nakamura T, Hirayama M, Adachi H, Naganawa S, Sobue G. Cortical and subcortical brain atrophy in Parkinson's disease with visual hallucination. Mov Disord 2013; 28:1732-6. [PMID: 24150865 DOI: 10.1002/mds.25641] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/30/2013] [Accepted: 07/15/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the cortical and subcortical brain structures in Parkinson's disease (PD) with visual hallucination (VH), and to elucidate the association between the proposed hypothesis of VH in PD and regional brain volume changes. METHODS We used 3T magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to investigate the brain structures of PD patients with VH (PD-VH; n = 13) and PD patients without VH (PD-C; n = 13). RESULTS The PD-VH patients showed significant cortical atrophy compared to the PD-C patients in the bilateral dorsolateral prefrontal cortex, left rostral region of the prefrontal cortex, left ventral section of the cingulate cortex, bilateral primary visual cortex, and secondary visual cortex including the left inferior occipital gyrus, right lingual cortex, right supramarginal gyrus, and left fusiform gyrus. Significant subcortical atrophic changes were observed in the white matter of the right parahippocampal gyrus, the bilateral posterior part of the cingulate gyrus, the left lingual gyrus, and the right middle occipital gyrus. CONCLUSIONS VH in PD can occur due to distinctive neuroanatomical involvement.
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Affiliation(s)
- Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Polymorphisms in the dopamine transporter gene are associated with visual hallucinations and levodopa equivalent dose in Brazilians with Parkinson's disease. Int J Neuropsychopharmacol 2013; 16:1251-1258. [PMID: 23363854 DOI: 10.1017/s1461145712001666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The requirement for dopaminergic drugs in Parkinson's disease (PD) is highly variable. Visual hallucinations are a frequent and serious complication of chronic levodopa therapy. Polymorphisms in the DAT1 gene might affect the reuptake of dopamine in the synaptic cleft, but the influence of this variability on adverse effects or levodopa equivalent dose on PD patients is still poorly investigated. Therefore, the aim of the present study was to investigate DAT1 gene polymorphisms on levodopa equivalent dose and visual hallucination occurrence in PD patients. Altogether, 196 PD patients in treatment with at least 200 mg levodopa equivalent dose for at least 1 yr were included. These patients were genotyped for the -839 C > T and 3' VNTR DAT1 polymorphisms by PCR-based methodologies. Visual hallucinations occurred in 25.5% of the sample. After controlling for confounders, the dopamine transporter (DAT) -839 C allele was associated with visual hallucinations (prevalence ratio 2.5, 95% confidence intervals 1.13-5.5, p = 0.02). Levodopa equivalent dose was lower in carriers of the nine repeat allele of the DAT 3'UTR VNTR (741.2 ± 355.0 vs. 843.4 ± 445.7), explaining 21% of dose variability (p = 0.01). Our results support an effect of DAT1 polymorphisms in adverse effects of anti-Parkinsonian drugs and in levodopa equivalent dose usage.
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Lin CH, Chen CM, Lu MK, Tsai CH, Chiou JC, Liao JR, Duann JR. VBM Reveals Brain Volume Differences between Parkinson's Disease and Essential Tremor Patients. Front Hum Neurosci 2013; 7:247. [PMID: 23785322 PMCID: PMC3682128 DOI: 10.3389/fnhum.2013.00247] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/19/2013] [Indexed: 01/18/2023] Open
Abstract
Symptoms of essential tremor (ET) are similar to those of Parkinson’s disease (PD) during their initial stages. Presently, there are few stable biomarkers available on a neuroanatomical level for distinguishing between these two diseases. However, few investigations have directly compared the changes in brain volume and assessed the compensatory effects of a change in the parts of the brain associated with PD and with ET. To determine the compensatory and/or degenerative anatomical changes in the brains of PD and ET patients, the present study tested, via two voxel-based morphometry (VBM) approaches (Basic vs. DARTEL VBM processing), the anatomical brain images of 10 PD and 10 ET patients, as well as of 13 age-matched normal controls, obtained through a 3T magnetic resonance scanner. These findings indicate that PD and ET caused specific patterns of brain volume alterations in the brains examined. In addition, our observations also revealed compensatory effects, or self-reorganization, occurring in the thalamus and the middle temporal gyrus in the PD and ET patients, due perhaps in part to the enhanced thalamocortical sensorimotor interaction and the head-eye position readjustment, respectively, in these PD and ET patients. Such a distinction may lend itself to use as a biomarker for differentiating between these two diseases.
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Affiliation(s)
- Ching-Hung Lin
- Biomedical Engineering R&D Center, China Medical University , Taichung , Taiwan ; Biomedical Electronics Translational Research Center, National Chiao Tung University , Hsinchu , Taiwan ; Department of Psychology, Soochow University , Taipei , Taiwan
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Shine JM, Halliday GM, Gilat M, Matar E, Bolitho SJ, Carlos M, Naismith SL, Lewis SJG. The role of dysfunctional attentional control networks in visual misperceptions in Parkinson's disease. Hum Brain Mapp 2013; 35:2206-19. [PMID: 23760982 DOI: 10.1002/hbm.22321] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/01/2013] [Accepted: 04/15/2013] [Indexed: 01/29/2023] Open
Abstract
Visual misperceptions and hallucinations represent a problematic symptom of Parkinson's disease. The pathophysiological mechanisms underlying these symptoms remain poorly understood, however, a recent hypothesis has suggested that visual misperceptions and hallucinations may arise from disrupted processing across attentional networks. To test the specific predictions of this hypothesis, 22 patients with Parkinson's disease underwent 3T fMRI while performing the Bistable Percept Paradigm, a task that has previously been shown to identify patients with hallucinations. Subjects are required to study a battery of randomly assigned "monostable" and "bistable" monochromatic images for the presence or absence of a bistable percept. Those patients who scored a high percentage of misperceptions and missed images on the task were less able to activate frontal and parietal hubs of the putative Dorsal Attention Network. Furthermore, poor performance on the task was significantly correlated with the degree of decreased activation in a number of these hubs. At the group level, the difference between processing a bistable versus a monostable cue was associated with increased recruitment of the anterior insula. In addition, those patients with impaired performance on the paradigm displayed decreased resting state functional connectivity between hubs of the Ventral and Dorsal Attention Networks. These same patients had significantly decreased gray matter in the insula bilaterally. In addition, a combined analysis of the separate neuroimaging approaches revealed significant relationships across the impaired networks. These findings are consistent with specific predictions from a recently proposed hypothesis that implicates dysfunction within attentional networks in Parkinsonian hallucinations.
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Affiliation(s)
- James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, New South Wales, Australia
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Nonmotor symptoms in Parkinson's disease in 2012: relevant clinical aspects. PARKINSONS DISEASE 2012; 2012:198316. [PMID: 22888466 PMCID: PMC3410355 DOI: 10.1155/2012/198316] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/18/2012] [Indexed: 01/19/2023]
Abstract
Nonmotor symptoms (NMSs) of Parkinson's disease (PD) are common, but they are often underrecognized in clinical practice, because of the lack of spontaneous complaints by the patients, and partly because of the absence of systematic questioning by the consulting physician. However, valid specific instruments for identification and assessment of these symptoms are available in 2012. The administration of the self-completed screening tool, NMSQuest, associated with questioning during the consultation, improves the diagnosis of NMSs. NMSs play a large role in degradation of quality of life. More relevant NMSs are described in this review, mood disorders, impulse control disorders, cognitive deficits, hallucinations, pain, sleep disorders, and dysautonomia.
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