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Jellinger KA. Behavioral disorders in dementia with Lewy bodies: old and new knowledge. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02823-w. [PMID: 39237792 DOI: 10.1007/s00702-024-02823-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/07/2024] [Indexed: 09/07/2024]
Abstract
Dementia with Lewy bodies (DLB), the second most common primary degenerative neurocognitive disorder after Alzheimer disease, is frequently preceded by REM sleep behavior disorders (RBD) and other behavioral symptoms, like anxiety, irritability, agitation or apathy, as well as visual hallucinations and delusions, most of which occurring in 40-60% of DLB patients. Other frequent behavioral symptoms like attention deficits contribute to cognitive impairment, while attention-deficit/hyperactivity disorder (ADHD) is a risk factor for DLB. Behavioral problems in DLB are more frequent, more severe and appear earlier than in other neurodegenerative diseases and, together with other neuropsychiatric symptoms, contribute to impairment of quality of life of the patients, but their pathophysiology is poorly understood. Neuroimaging studies displayed deficits in cholinergic brainstem nuclei and decreased metabolism in frontal, superior parietal regions, cingulate gyrus and amygdala in DLB. Early RBD in autopsy-confirmed DLB is associated with lower Braak neuritic stages, whereas those without RBD has greater atrophy of hippocampus and increased tau burden. αSyn pathology in the amygdala, a central region in the fear circuitry, may contribute to the high prevalence of anxiety, while in attention dysfunctions the default mode and dorsal attention networks displayed diverging activity. These changes suggest that behavioral disorders in DLB are associated with marked impairment in large-scale brain structures and functional connectivity network disruptions. However, many pathobiological mechanisms involved in the development of behavioral disorders in DLB await further elucidation in order to allow an early diagnosis and adequate treatment to prevent progression of these debilitating disorders.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Onofrj M, Russo M, Delli Pizzi S, De Gregorio D, Inserra A, Gobbi G, Sensi SL. The central role of the Thalamus in psychosis, lessons from neurodegenerative diseases and psychedelics. Transl Psychiatry 2023; 13:384. [PMID: 38092757 PMCID: PMC10719401 DOI: 10.1038/s41398-023-02691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
The PD-DLB psychosis complex found in Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) includes hallucinations, Somatic Symptom/Functional Disorders, and delusions. These disorders exhibit similar presentation patterns and progression. Mechanisms at the root of these symptoms also share similarities with processes promoting altered states of consciousness found in Rapid Eye Movement sleep, psychiatric disorders, or the intake of psychedelic compounds. We propose that these mechanisms find a crucial driver and trigger in the dysregulated activity of high-order thalamic nuclei set in motion by ThalamoCortical Dysrhythmia (TCD). TCD generates the loss of finely tuned cortico-cortical modulations promoted by the thalamus and unleashes the aberrant activity of the Default Mode Network (DMN). TCD moves in parallel with altered thalamic filtering of external and internal information. The process produces an input overload to the cortex, thereby exacerbating DMN decoupling from task-positive networks. These phenomena alter the brain metastability, creating dreamlike, dissociative, or altered states of consciousness. In support of this hypothesis, mind-altering psychedelic drugs also modulate thalamic-cortical pathways. Understanding the pathophysiological background of these conditions provides a conceptual bridge between neurology and psychiatry, thereby helping to generate a promising and converging area of investigation and therapeutic efforts.
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Affiliation(s)
- Marco Onofrj
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Inserra
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Stefano L Sensi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
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Matsuura K, Ii Y, Maeda M, Tabei K, Satoh M, Umino M, Kajikawa H, Araki T, Nakamura N, Matsuyama H, Shindo A, Tomimoto H. Pulvinar quantitative susceptibility mapping predicts visual hallucinations post-deep brain stimulation in Parkinson's disease. Brain Behav 2023; 13:e3263. [PMID: 37743594 PMCID: PMC10636381 DOI: 10.1002/brb3.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE We have reported the relationship between low pulvinar nuclei (PN) intensity in susceptibility-weighted imaging and the appearance of visual hallucinations and cognitive function. The aim of the study was to examine the changes in the quantitative susceptibility mapping (QSM) in patients with Parkinson's disease (PD) who underwent deep brain stimulation (DBS) and verify whether the PN susceptibility value (SV) on QSM can predict visual hallucination and cognitive changes after DBS. METHODS This study examined 24 patients with PD who underwent DBS along with QSM imaging on magnetic resonance imaging (MRI). All MRIs were performed within 3 months before surgery. The PN SV was further assessed based on the QSM. Then, associations were examined among cognitive changes, hallucination, and PN SV. The cognitive function of the patient was compared immediately before surgery and at 1 year postoperatively. RESULTS Visual hallucinations were observed in seven patients during the follow-up period. The PN SV was ≥0.045 ppm in nine patients with PD, and six of them had visual hallucinations, whereas only one of 15 patients with PD with SV of <0.045 ppm had visual hallucinations (Fisher's exact test, p = .0037). CONCLUSIONS The SV of >0.045 ppm at the PN in QSM in patients with PD may provide useful information suggesting visual hallucination and cognitive deterioration after DBS treatment.
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Affiliation(s)
- Keita Matsuura
- Department of Neurology, Graduate School of MedicineMie UniversityMieJapan
| | - Yuichiro Ii
- Department of Neuroimaging and PathophysiologyMie University School of MedicineMieJapan
| | - Masayuki Maeda
- Department of Neuroradiology, Graduate School of MedicineMie UniversityMieJapan
| | - Ken‐ichi Tabei
- School of Industrial Technology, Advanced Institute of Industrial TechnologyTokyo Metropolitan Public University CorporationTokyoJapan
| | - Masayuki Satoh
- Department of Dementia and Neuropsychology, Advanced Institute of Industrial TechnologyTokyo Metropolitan Public University CorporationTokyoJapan
| | - Maki Umino
- Department of Radiology, Graduate School of MedicineMie UniversityMieJapan
| | | | | | - Naoko Nakamura
- Department of Neurology, Graduate School of MedicineMie UniversityMieJapan
| | - Hirofumi Matsuyama
- Department of Neurology, Graduate School of MedicineMie UniversityMieJapan
| | - Akihiro Shindo
- Department of Neurology, Graduate School of MedicineMie UniversityMieJapan
| | - Hidekazu Tomimoto
- Department of Neurology, Graduate School of MedicineMie UniversityMieJapan
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Matar E, Brooks D, Lewis SJ, Halliday GM. Limbic thalamus atrophy is associated with visual hallucinations in Lewy body disorders. Neurobiol Aging 2022; 112:122-128. [DOI: 10.1016/j.neurobiolaging.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/04/2021] [Accepted: 01/03/2022] [Indexed: 01/22/2023]
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Martins R, Oliveira F, Moreira F, Moreira AP, Abrunhosa A, Januário C, Castelo-Branco M. Automatic classification of idiopathic Parkinson's disease and atypical Parkinsonian syndromes combining [ 11C]raclopride PET uptake and MRI grey matter morphometry. J Neural Eng 2021; 18. [PMID: 33848996 DOI: 10.1088/1741-2552/abf772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/13/2021] [Indexed: 11/12/2022]
Abstract
Objective.To explore the viability of developing a computer-aided diagnostic system for Parkinsonian syndromes using dynamic [11C]raclopride positron emission tomography (PET) and T1-weighted magnetic resonance imaging (MRI) data.Approach.The biological heterogeneity of Parkinsonian syndromes renders their statistical classification a challenge. The unique combination of structural and molecular imaging data allowed different classifier designs to be tested. Datasets from dynamic [11C]raclopride PET and T1-weighted MRI scans were acquired from six groups of participants. There were healthy controls (CTRLn= 15), patients with Parkinson's disease (PDn= 27), multiple system atrophy (MSAn= 8), corticobasal degeneration (CBDn= 6), and dementia with Lewy bodies (DLBn= 5). MSA, CBD, and DLB patients were classified into one category designated as atypical Parkinsonism (AP). The distribution volume ratio (DVR) kinetic parameters obtained from the PET data were used to quantify the reversible tracer binding to D2/D3 receptors in the subcortical regions of interest (ROI). The grey matter (GM) volumes obtained from the MRI data were used to quantify GM atrophy across cortical, subcortical, and cerebellar ROI.Results.The classifiers CTRL vs PD and CTRL vs AP achieved the highest balanced accuracy combining DVR and GM (DVR-GM) features (96.7%, 92.1%, respectively), followed by the classifiers designed with DVR features (93.3%, 88.8%, respectively), and GM features (69.6%, 86.1%, respectively). In contrast, the classifier PD vs AP showed the highest balanced accuracy (78.9%) using DVR features only. The integration of DVR-GM (77.9%) and GM features (72.7%) produced inferior performances. The classifier CTRL vs PD vs AP showed high weighted balanced accuracy when DVR (80.5%) or DVR-GM features (79.9%) were integrated. GM features revealed poorer performance (59.5%).Significance.This work was unique in its combination of structural and molecular imaging features in binary and triple category classifications. We were able to demonstrate improved binary classification of healthy/diseased status (concerning both PD and AP) and equate performance to DVR features in multiclass classifications.
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Affiliation(s)
- Ricardo Martins
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Francisco Oliveira
- Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Fradique Moreira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Neurology, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Ana Paula Moreira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Antero Abrunhosa
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Cristina Januário
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Neurology, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Carrarini C, Russo M, Pagliaccio G, Dono F, Franciotti R, Deluca G, Nanni S, Saracino A, Onofrj M, Bonanni L. Visual evoked potential abnormalities in dementia with Lewy bodies. Neurophysiol Clin 2021; 51:425-431. [PMID: 33653623 DOI: 10.1016/j.neucli.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Visuo-perceptual deficits and visual hallucinations (VHs) are common disturbances in patients with dementia with Lewy bodies (DLB) and those with Parkinson's disease (PD). In particular, delays in visual evoked potential (VEP), reversed by l-dopa administration, have previously been observed in PD patients. Impairment in metabolic functions of dopaminergic amacrine cells within the inner plexiform layer of the retina has been largely documented and has been posited as the underlying cause of visual and retinal alterations in PD. The aims of the present study were to investigate the presence of VEP abnormalities in DLB patients, as compared to a PD control group, and to assess the presence of significant correlations between neurophysiological measures and clinical symptoms (i.e., presence of visuospatial deficits and/or visual hallucinations). METHODS Fifteen DLB patients and fifteen matched PD patients underwent pattern reversal before and after l-dopa administration, and a short neuropsychological assessment. RESULTS In DLB patients, we observed delay of the P100 latency to foveal stimuli in both eyes compared to normative values. Compared to PD, DLB patients showed higher values of the P100 latency for foveal stimulation from the right eye prior to l-dopa administration (p = 0.018). No correlations between VEP alterations, visuo-spatial deficit and visual hallucinations were found. DISCUSSION Our findings demonstrated a longer P100 delay in DLB than in PD patients, especially along the right visual pathway. In contrast to previous studies, which focused on a dopaminergic pre-geniculate impairment of visual pathways, our evidence suggests that other mechanisms, possibly relying on thalamic involvement, which is known to be dysfunctional in DLB, can interfere with VEP abnormalities.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Giulia Deluca
- Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | - Stefania Nanni
- Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | | | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy; Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy; Department of Neurology, SS Annunziata Hospital, Chieti, Italy.
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Dudchenko NG, Vasenina EE. [Fluctuation of cognitive functions in dementia with Lewy bodies]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:89-95. [PMID: 33205936 DOI: 10.17116/jnevro202012010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fluctuations of cognitive function (FCF) is one of the core diagnostic features of dementia with Lewy bodies (DLB). However, identification, pathophysiology, management of this unusual phenomena remain poor understood. The review presents modern ideas about phenomenology, causes, systematization, clinical significance and current methods of diagnosis and treatment of FCF in patients with DLB.
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Affiliation(s)
- N G Dudchenko
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E E Vasenina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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O'Dowd S, Schumacher J, Burn DJ, Bonanni L, Onofrj M, Thomas A, Taylor JP. Fluctuating cognition in the Lewy body dementias. Brain 2020; 142:3338-3350. [PMID: 31411317 DOI: 10.1093/brain/awz235] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023] Open
Abstract
Fluctuating cognition is a core diagnostic feature of dementia with Lewy bodies and is also a key clinical feature of Parkinson's disease dementia. These dementias share common pathological features and are referred to as Lewy body dementias. Whilst highly prevalent in Lewy body dementia, with up to 90% of patients experiencing the symptom at some point in the disease trajectory, clinical identification of fluctuating cognition is often challenging. Furthermore, its underlying pathophysiological processes remain unclear. However, neuroimaging and neurophysiological techniques have recently provided insight into potential drivers of the phenomenon. In this update, we review data pertaining to clinical features and underlying mechanisms of fluctuating cognition in Lewy body dementia. We collate evidence for different proposed aetiologies: fluctuating cognition as an attentional disorder, as a consequence of loss of cholinergic drive, as a manifestation of failure in neuronal efficiency and synchrony, and as a disorder of sleep/arousal. We also review data relating to putative mechanisms that have received less attention to date. Increased understanding of fluctuating cognition may help to illuminate pathophysiological mechanisms in cognitive processing in Lewy body dementia, guide future research, and facilitate the design of targeted therapeutic approaches.
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Affiliation(s)
- Seán O'Dowd
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - David J Burn
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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Chabran E, Noblet V, Loureiro de Sousa P, Demuynck C, Philippi N, Mutter C, Anthony P, Martin-Hunyadi C, Cretin B, Blanc F. Changes in gray matter volume and functional connectivity in dementia with Lewy bodies compared to Alzheimer's disease and normal aging: implications for fluctuations. Alzheimers Res Ther 2020; 12:9. [PMID: 31907068 PMCID: PMC6945518 DOI: 10.1186/s13195-019-0575-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Fluctuations are one of the core clinical features characterizing dementia with Lewy bodies (DLB). They represent a determining factor for its diagnosis and strongly impact the quality of life of patients and their caregivers. However, the neural correlates of this complex symptom remain poorly understood. This study aimed to investigate the structural and functional changes in DLB patients, compared to Alzheimer's disease (AD) patients and healthy elderly subjects, and their potential links with fluctuations. METHODS Structural and resting-state functional MRI data were collected from 92 DLB patients, 70 AD patients, and 22 control subjects, who also underwent a detailed clinical examination including the Mayo Clinic Fluctuation Scale. Gray matter volume changes were analyzed using whole-brain voxel-based morphometry, and resting-state functional connectivity was investigated using a seed-based analysis, with regions of interest corresponding to the main nodes of the salience network (SN), frontoparietal network (FPN), dorsal attention network (DAN), and default mode network (DMN). RESULTS At the structural level, fluctuation scores in DLB patients did not relate to the atrophy of insular, temporal, and frontal regions typically found in this pathology, but instead showed a weak correlation with more subtle volume reductions in different regions of the cholinergic system. At the functional level, the DLB group was characterized by a decreased connectivity within the SN and attentional networks, while the AD group showed decreases within the SN and DMN. In addition, higher fluctuation scores in DLB patients were correlated to a greater connectivity of the SN with the DAN and left thalamus, along with a decreased connectivity between the SN and DMN, and between the right thalamus and both the FPN and DMN. CONCLUSIONS Functional connectivity changes, rather than significant gray matter loss, could play an important role in the emergence of fluctuations in DLB. Notably, fluctuations in DLB patients appeared to be related to a disturbed external functional connectivity of the SN, which may lead to less relevant transitions between different cognitive states in response to internal and environmental stimuli. Our results also suggest that the thalamus could be a key region for the occurrence of this symptom.
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Affiliation(s)
- Eléna Chabran
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Vincent Noblet
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Nathalie Philippi
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Catherine Mutter
- INSERM Centre d’Investigation Clinique 1434, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Anthony
- General Hospital Centre, Geriatrics Department, CM2R, Geriatric Day Hospital, Colmar, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Benjamin Cretin
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
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Botzung A, Philippi N, Noblet V, Loureiro de Sousa P, Blanc F. Pay attention to the basal ganglia: a volumetric study in early dementia with Lewy bodies. Alzheimers Res Ther 2019; 11:108. [PMID: 31864422 PMCID: PMC6925479 DOI: 10.1186/s13195-019-0568-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cortical and subcortical cognitive impairments are usually found in dementia with Lewy bodies (DLB). Roughly, they comprise visuo-constructive/executive function and attention/processing speed impairments, whereas memory would remain relatively spared. In this study, we focused on the neuro-anatomical substrates of attention and processing speed, which is still poorly understood. For the purpose of the study, we examined the correlations between behavioral scores measuring the speed of processing and the degree of cerebral atrophy in patients with prodromal to moderate DLB. METHODS Ninety-three prodromal to moderate DLB patients (mean MMSE = 25.5) were selected to participate in the study as well as 28 healthy elderly subjects (mean MMSE = 28.9), matched in terms of age and educational level. The Trail Making Test A (TMTA) and the Digit Symbol Substitution Test (DSST) were used to assess attention and processing speed. Behavioral performances were compared between patients and healthy control subjects. Three-dimensional MRI images were acquired for all participants, and correlational analyses were performed in the patient group using voxel-based morphometry (VBM). RESULTS The behavioral results on both the TMTA (p = .026) and the DSST (p < .001) showed significantly impaired performances in patients in comparison with control subjects. In addition, correlational analyses using VBM revealed for the TMTA negative correlations in the caudate nucleus (left cluster peak significant at .05 FWE corrected), the putamen, the left thalamus, and the subthalamic nuclei (p < .05 FDR corrected). Some positive correlations associated with the DSST were found in the right inferior frontal gyrus, the left thalamus, and the left cerebellum (p < .001 uncorrected). CONCLUSIONS The behavioral results are in line with the literature on the DLB cognitive profile and confirm the existence of attention and processing speed impairment. Interestingly, VBM analysis revealed the involvement of the basal ganglia, in particular, the left caudate nucleus, which is part of the attention cerebral network, suggesting an important role of this structure for attentional processing speed. This also suggests the clinical implication of damage in this region relatively early in the course of the disease.
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Affiliation(s)
- Anne Botzung
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), Strasbourg University Hospital, Strasbourg, France.
| | - Nathalie Philippi
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), Strasbourg University Hospital, Strasbourg, France
- ICube laboratory (CNRS, UMR 7357) and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France
| | - Vincent Noblet
- ICube laboratory (CNRS, UMR 7357) and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube laboratory (CNRS, UMR 7357) and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France
| | - Frédéric Blanc
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), Strasbourg University Hospital, Strasbourg, France
- ICube laboratory (CNRS, UMR 7357) and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France
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Matsuura K, Maeda M, Satoh M, Tabei KI, Araki T, Umino M, Kajikawa H, Nakamura N, Tomimoto H. Low Pulvinar Intensity in Susceptibility-Weighted Imaging May Suggest Cognitive Worsening After Deep Brain Stimulation Therapy in Patients With Parkinson's Disease. Front Neurol 2019; 10:1158. [PMID: 31736863 PMCID: PMC6834769 DOI: 10.3389/fneur.2019.01158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/15/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose: Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD). However, deteriorating cognitive function after DBS is a considerable problem for affected patients. This study was undertaken to assess whether pulvinar findings in susceptibility-weighted imaging (SWI) can suggest cognitive worsening. Methods: We examined 21 patients with PD who underwent DBS along with SWI and neuromelanin-sensitive MR imaging (NMI). We further assessed pulvinar hypointensity based on the SWI findings and also the area of the substantia nigra (SN) pars compacta in NMI. We then examined associations among cognitive changes, pulvinar hypointensity, and SN area. The cognitive function of the patient immediately before surgery was compared with function at 1 year postoperatively. Results: Pulvinar hypointensity in SWI was found in 11 of 21 patients with PD at baseline. One year postoperatively, six of the 21 patients demonstrated a Mini-Mental State Examination score that was ≥3 points lower than the baseline score. We observed pulvinar hypointensity in SWI before DBS surgery in five of these six patients (p = 0.072). During the first postoperative year, six of 21 patients reported both transient or permanent hallucinations; we observed pulvinar hypointensity in these six patients, while 10 patients without pulvinar hypointensity had no hallucinations. Conclusion: Pulvinar hypointensity in SWI in patients with PD may provide information that is useful for suggesting cognitive deterioration after DBS treatment.
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Affiliation(s)
- Keita Matsuura
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Japan.,Department of Neurology, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Masayuki Satoh
- Dementia Prevention and Therapeutics, Mie University, Tsu, Japan
| | - Ken-Ichi Tabei
- Dementia Prevention and Therapeutics, Mie University, Tsu, Japan
| | - Tomohiro Araki
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Maki Umino
- Department of Radiology, Graduate School of Medicine, Mie University, Tsu, Japan
| | | | - Naoko Nakamura
- Department of Neurology, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Japan
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12
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Matar E, Shine JM, Halliday GM, Lewis SJG. Cognitive fluctuations in Lewy body dementia: towards a pathophysiological framework. Brain 2019; 143:31-46. [DOI: 10.1093/brain/awz311] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 08/16/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Fluctuating cognition is a complex and disabling symptom that is seen most frequently in the context of Lewy body dementias encompassing dementia with Lewy bodies and Parkinson’s disease dementia. In fact, since their description over three decades ago, cognitive fluctuations have remained a core diagnostic feature of dementia with Lewy bodies, the second most common dementia in the elderly. In the absence of reliable biomarkers for Lewy body pathology, the inclusion of such patients in therapeutic trials depends on the accurate identification of such core clinical features. Yet despite their diagnostic relevance, cognitive fluctuations remain poorly understood, in part due to the lack of a cohesive clinical and scientific explanation of the phenomenon itself. Motivated by this challenge, the present review examines the history, clinical phenomenology and assessment of cognitive fluctuations in the Lewy body dementias. Based on these data, the key neuropsychological, neurophysiological and neuroimaging correlates of cognitive fluctuations are described and integrated into a novel testable heuristic framework from which new insights may be gained.
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Affiliation(s)
- Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - James M Shine
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Glenda M Halliday
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
| | - Simon J G Lewis
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
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13
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Schumacher J, Peraza LR, Firbank M, Thomas AJ, Kaiser M, Gallagher P, O’Brien JT, Blamire AM, Taylor JP. Dysfunctional brain dynamics and their origin in Lewy body dementia. Brain 2019; 142:1767-1782. [PMID: 30938426 PMCID: PMC6536851 DOI: 10.1093/brain/awz069] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/06/2019] [Accepted: 01/27/2019] [Indexed: 01/08/2023] Open
Abstract
Lewy body dementia includes dementia with Lewy bodies and Parkinson's disease dementia and is characterized by transient clinical symptoms such as fluctuating cognition, which might be driven by dysfunction of the intrinsic dynamic properties of the brain. In this context we investigated whole-brain dynamics on a subsecond timescale in 42 Lewy body dementia compared to 27 Alzheimer's disease patients and 18 healthy controls using an EEG microstate analysis in a cross-sectional design. Microstates are transiently stable brain topographies whose temporal characteristics provide insight into the brain's dynamic repertoire. Our additional aim was to explore what processes in the brain drive microstate dynamics. We therefore studied associations between microstate dynamics and temporal aspects of large-scale cortical-basal ganglia-thalamic interactions using dynamic functional MRI measures given the putative role of these subcortical areas in modulating widespread cortical function and their known vulnerability to Lewy body pathology. Microstate duration was increased in Lewy body dementia for all microstate classes compared to Alzheimer's disease (P < 0.001) and healthy controls (P < 0.001), while microstate dynamics in Alzheimer's disease were largely comparable to healthy control levels, albeit with altered microstate topographies. Correspondingly, the number of distinct microstates per second was reduced in Lewy body dementia compared to healthy controls (P < 0.001) and Alzheimer's disease (P < 0.001). In the dementia with Lewy bodies group, mean microstate duration was related to the severity of cognitive fluctuations (ρ = 0.56, PFDR = 0.038). Additionally, mean microstate duration was negatively correlated with dynamic functional connectivity between the basal ganglia (r = - 0.53, P = 0.003) and thalamic networks (r = - 0.38, P = 0.04) and large-scale cortical networks such as visual and motor networks in Lewy body dementia. The results indicate a slowing of microstate dynamics and disturbances to the precise timing of microstate sequences in Lewy body dementia, which might lead to a breakdown of the intricate dynamic properties of the brain, thereby causing loss of flexibility and adaptability that is crucial for healthy brain functioning. When contrasted with the largely intact microstate dynamics in Alzheimer's disease, the alterations in dynamic properties in Lewy body dementia indicate a brain state that is less responsive to environmental demands and might give rise to the apparent slowing in thinking and intermittent confusion which typify Lewy body dementia. By using Lewy body dementia as a probe pathology we demonstrate a potential link between dynamic functional MRI fluctuations and microstate dynamics, suggesting that dynamic interactions within the cortical-basal ganglia-thalamic loop might play a role in the modulation of EEG dynamics.
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Affiliation(s)
- Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Andrew M Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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14
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Hansen D, Ling H, Lashley T, Holton JL, Warner TT. Review: Clinical, neuropathological and genetic features of Lewy body dementias. Neuropathol Appl Neurobiol 2019; 45:635-654. [PMID: 30977926 DOI: 10.1111/nan.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
Abstract
Lewy body dementias are the second most common neurodegenerative dementias after Alzheimer's disease and include dementia with Lewy bodies and Parkinson's disease dementia. They share similar clinical and neuropathological features but differ in the time of dementia and parkinsonism onset. Although Lewy bodies are their main pathological hallmark, several studies have shown the emerging importance of Alzheimer's disease pathology. Clinical amyloid-β imaging using Pittsburgh Compound B (PiB) supports neuropathological studies which found that amyloid-β pathology is more common in dementia with Lewy bodies than in Parkinson's disease dementia. Nevertheless, other co-occurring pathologies, such as cerebral amyloid angiopathy, TDP-43 pathology and synaptic pathology may also influence the development of neurodegeneration and dementia. Recent genetic studies demonstrated an important role of APOE genotype and other genes such as GBA and SNCA which seem to be involved in the pathophysiology of Lewy body dementias. The aim of this article is to review the main clinical, neuropathological and genetic aspects of dementia with Lewy bodies and Parkinson's disease dementia. This is particularly relevant as future management for these two conditions may differ.
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Affiliation(s)
- D Hansen
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - H Ling
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - J L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
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15
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Pilotto A, Schiano di Cola F, Premi E, Grasso R, Turrone R, Gipponi S, Scalvini A, Cottini E, Paghera B, Garibotto V, Rizzetti MC, Bonanni L, Borroni B, Morbelli S, Nobili F, Guerra UP, Perani D, Padovani A. Extrastriatal dopaminergic and serotonergic pathways in Parkinson’s disease and in dementia with Lewy bodies: a 123I-FP-CIT SPECT study. Eur J Nucl Med Mol Imaging 2019; 46:1642-1651. [DOI: 10.1007/s00259-019-04324-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/31/2019] [Indexed: 02/07/2023]
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16
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Chin KS, Teodorczuk A, Watson R. Dementia with Lewy bodies: Challenges in the diagnosis and management. Aust N Z J Psychiatry 2019; 53:291-303. [PMID: 30848660 DOI: 10.1177/0004867419835029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dementia with Lewy bodies is the second most common form of neurodegenerative dementia in older age yet is often under-recognised and misdiagnosed. This review aims to provide an overview of the clinical features of dementia with Lewy bodies, discussing the frequent challenges clinicians experience in diagnosing dementia with Lewy bodies, and outlines a practical approach to the clinical management, particularly in the Australian setting. METHODS This paper is a narrative review and a semi-structured database (PubMed and MEDLINE) search strategy was implemented. Articles were screened and clinically relevant studies were selected for inclusion. RESULTS Dementia with Lewy bodies is clinically characterised by complex visual hallucinations, spontaneous motor parkinsonism, prominent cognitive fluctuations and rapid eye movement sleep behaviour disorder. Neuropsychiatric features and autonomic dysfunction are also common. The new diagnostic criteria and specific diagnostic biomarkers help to improve detection rates and diagnostic accuracy, as well as guide appropriate management. Clinical management of dementia with Lewy bodies is challenging and requires an individualised multidisciplinary approach with specialist input. CONCLUSION Dementia with Lewy bodies is a common form of dementia. It often presents as a diagnostic challenge to clinicians, particularly at early stages of disease, and in patients with mixed neuropathological changes, which occur in over 50% of people with dementia with Lewy bodies. Prompt diagnosis and comprehensive treatment strategies are important in improving patients' care.
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Affiliation(s)
- Kai Sin Chin
- 1 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Teodorczuk
- 3 School of Medicine, Griffith University, Gold Coast, QLD, Australia.,4 Metro North Mental Health, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rosie Watson
- 1 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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17
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Balážová Z, Nováková M, Minsterová A, Rektorová I. Structural and Functional Magnetic Resonance Imaging of Dementia With Lewy Bodies. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 144:95-141. [PMID: 30638458 DOI: 10.1016/bs.irn.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia after Alzheimer's disease (AD). Although diagnosis may be challenging, there is increasing evidence that the use of biomarkers according to 2017 revised criteria for diagnosis and management of dementia with Lewy bodies can increase diagnostic accuracy. Apart from nuclear medicine techniques, various magnetic resonance imaging (MRI) techniques have been utilized in attempt to enhance diagnostic accuracy. This chapter reviews structural, functional and diffusion MRI studies in DLB cohorts being compared to healthy controls, AD or dementia in Parkinson's disease (PDD). We also included relatively new MRI methods that may have potential to identify early DLB subjects and aim at examining brain iron and neuromelanin.
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Affiliation(s)
- Zuzana Balážová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Brno, Czech Republic
| | - Marie Nováková
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Alžběta Minsterová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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18
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Rahayel S, Postuma RB, Montplaisir J, Génier Marchand D, Escudier F, Gaubert M, Bourgouin PA, Carrier J, Monchi O, Joubert S, Blanc F, Gagnon JF. Cortical and subcortical gray matter bases of cognitive deficits in REM sleep behavior disorder. Neurology 2018; 90:e1759-e1770. [PMID: 29669906 DOI: 10.1212/wnl.0000000000005523] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/20/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate cortical and subcortical gray matter abnormalities underlying cognitive impairment in patients with REM sleep behavior disorder (RBD) with or without mild cognitive impairment (MCI). METHODS Fifty-two patients with RBD, including 17 patients with MCI, were recruited and compared to 41 controls. All participants underwent extensive clinical assessments, neuropsychological examination, and 3-tesla MRI acquisition of T1 anatomical images. Vertex-based cortical analyses of volume, thickness, and surface area were performed to investigate cortical abnormalities between groups, whereas vertex-based shape analysis was performed to investigate subcortical structure surfaces. Correlations were performed to investigate associations between cortical and subcortical metrics, cognitive domains, and other markers of neurodegeneration (color discrimination, olfaction, and autonomic measures). RESULTS Patients with MCI had cortical thinning in the frontal, cingulate, temporal, and occipital cortices, and abnormal surface contraction in the lenticular nucleus and thalamus. Patients without MCI had cortical thinning restricted to the frontal cortex. Lower patient performance in cognitive domains was associated with cortical and subcortical abnormalities. Moreover, impaired performance on olfaction, color discrimination, and autonomic measures was associated with thinning in the occipital lobe. CONCLUSIONS Cortical and subcortical gray matter abnormalities are associated with cognitive status in patients with RBD, with more extensive patterns in patients with MCI. Our results highlight the importance of distinguishing between subgroups of patients with RBD according to cognitive status in order to better understand the neurodegenerative process in this population.
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Affiliation(s)
- Shady Rahayel
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Ronald B Postuma
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Jacques Montplaisir
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Daphné Génier Marchand
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Frédérique Escudier
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Malo Gaubert
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Pierre-Alexandre Bourgouin
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Julie Carrier
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Oury Monchi
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Sven Joubert
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Frédéric Blanc
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France
| | - Jean-François Gagnon
- From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France.
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