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Albrecht F, Johansson H, Ekman U, Poulakis K, Bezuidenhout L, Pereira JB, Franzén E. Investigating underlying brain structures and influence of mild and subjective cognitive impairment on dual-task performance in people with Parkinson's disease. Sci Rep 2024; 14:9513. [PMID: 38664471 PMCID: PMC11045833 DOI: 10.1038/s41598-024-60050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Cognitive impairment can affect dual-task abilities in Parkinson's disease (PD), but it remains unclear whether this is also driven by gray matter alterations across different cognitive classifications. Therefore, we investigated associations between dual-task performance during gait and functional mobility and gray matter alterations and explored whether these associations differed according to the degree of cognitive impairment. Participants with PD were classified according to their cognitive function with 22 as mild cognitive impairment (PD-MCI), 14 as subjective cognitive impairment (PD-SCI), and 20 as normal cognition (PD-NC). Multiple regression models associated dual-task absolute and interference values of gait speed, step-time variability, and reaction time, as well as dual-task absolute and difference values for Timed Up and Go (TUG) with PD cognitive classification. We repeated these regressions including the nucleus basalis of Meynert, dorsolateral prefrontal cortex, and hippocampus. We additionally explored whole-brain regressions with dual-task measures to identify dual-task-related regions. There was a trend that cerebellar alterations were associated with worse TUG dual-task in PD-SCI, but also with higher dual-task gait speed and higher dual-task step-time variability in PD-NC. After multiple comparison corrections, no effects of interest were significant. In summary, no clear set of variables associated with dual-task performance was found that distinguished between PD cognitive classifications in our cohort. Promising but non-significant trends, in particular regarding the TUG dual-task, do however warrant further investigation in future large-scale studies.
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Affiliation(s)
- Franziska Albrecht
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden.
- Medical Unit Occupational Therapy & Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
| | - Urban Ekman
- Division of Neuro, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lucian Bezuidenhout
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden
| | - Joana B Pereira
- Division of Neuro, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
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Mohammadi S, Ghaderi S. Parkinson's disease and Parkinsonism syndromes: Evaluating iron deposition in the putamen using magnetic susceptibility MRI techniques - A systematic review and literature analysis. Heliyon 2024; 10:e27950. [PMID: 38689949 PMCID: PMC11059419 DOI: 10.1016/j.heliyon.2024.e27950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 05/02/2024] Open
Abstract
Magnetic resonance imaging (MRI) techniques, such as quantitative susceptibility mapping (QSM) and susceptibility-weighted imaging (SWI), can detect iron deposition in the brain. Iron accumulation in the putamen (PUT) can contribute to the pathogenesis of Parkinson's disease (PD) and atypical Parkinsonian disorders. This systematic review aimed to synthesize evidence on iron deposition in the PUT assessed by MRI susceptibility techniques in PD and Parkinsonism syndromes. The PubMed and Scopus databases were searched for relevant studies. Thirty-four studies from January 2007 to October 2023 that used QSM, SWI, or other MRI susceptibility methods to measure putaminal iron in PD, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and healthy controls (HCs) were included. Most studies have found increased putaminal iron levels in PD patients versus HCs based on higher quantitative susceptibility. Putaminal iron accumulation correlates with worse motor scores and cognitive decline in patients with PD. Evidence regarding differences in susceptibility between PD and atypical Parkinsonism is emerging, with several studies showing greater putaminal iron deposition in PSP and MSA than in PD patients. Alterations in putaminal iron levels help to distinguish these disorders from PD. Increased putaminal iron levels appear to be associated with increased disease severity and progression. Thus, magnetic susceptibility MRI techniques can detect abnormal iron accumulation in the PUT of patients with Parkinsonism. Moreover, quantifying putaminal susceptibility may serve as an MRI biomarker to monitor motor and cognitive changes in PD and aid in the differential diagnosis of Parkinsonian disorders.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Maggi G, Giacobbe C, Vitale C, Amboni M, Obeso I, Santangelo G. Theory of mind in mild cognitive impairment and Parkinson's disease: The role of memory impairment. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:156-170. [PMID: 38049608 PMCID: PMC10827829 DOI: 10.3758/s13415-023-01142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Social cognition is impaired in Parkinson's disease (PD). Whether social cognitive impairment (iSC) is a by-product of the underlying cognitive deficits in PD or a process independent of cognitive status is unknown. To this end, the present study was designed to investigate the weight of specific cognitive deficits in social cognition, considering different mild cognitive impairment subtypes of PD (PD-MCI). METHODS Fifty-eight PD patients underwent a neuropsychological battery assessing executive functions, memory, language, and visuospatial domains, together with social cognitive tests focused on theory of mind (ToM). Patients were divided into subgroups according to their clinical cognitive status: amnestic PD-MCI (PD-aMCI, n = 18), non-amnestic PD-MCI (PD-naMCI, n = 16), and cognitively unimpaired (PD-CU, n = 24). Composite scores for cognitive and social domains were computed to perform mediation analyses. RESULTS Memory and language impairments mediated the effect of executive functioning in social cognitive deficits in PD patients. Dividing by MCI subgroups, iSC occurred more frequently in PD-aMCI (77.8%) than in PD-naMCI (18.8%) and PD-CU (8.3%). Moreover, PD-aMCI performed worse than PD-CU in all social cognitive measures, whereas PD-naMCI performed worse than PD-CU in only one subtype of the affective and cognitive ToM tests. CONCLUSIONS Our findings suggest that ToM impairment in PD can be explained by memory dysfunction that mediates executive control. ToM downsides in the amnesic forms of PD-MCI may suggest that subtle changes in social cognition could partly explain future transitions into dementia. Hence, the evaluation of social cognition in PD is critical to characterize a possible behavioral marker of cognitive decline.
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Affiliation(s)
- Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, 81100, Caserta, Italy.
| | - Chiara Giacobbe
- Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, 81100, Caserta, Italy
| | - Carmine Vitale
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
- Department of Motor Sciences and Wellness, University "Parthenope, Naples, Italy
| | - Marianna Amboni
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Ignacio Obeso
- HM Hospitales - Centro Integral de Neurociencias AC HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Avda. Carlos V, 70. 28938, Móstoles, Madrid, Spain.
- Department of Psychobiology and Methods on Behavioural Sciences, Complutense University of Madrid, Madrid, Spain.
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, 81100, Caserta, Italy.
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Hajebrahimi F, Budak M, Saricaoglu M, Temel Z, Demir TK, Hanoglu L, Yildirim S, Bayraktaroglu Z. Functional neural networks stratify Parkinson's disease patients across the spectrum of cognitive impairment. Brain Behav 2024; 14:e3395. [PMID: 38376051 PMCID: PMC10808882 DOI: 10.1002/brb3.3395] [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: 07/28/2023] [Revised: 11/23/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Cognitive impairment (CI) is a significant non-motor symptoms in Parkinson's disease (PD) that often precedes the emergence of motor symptoms by several years. Patients with PD hypothetically progress from stages without CI (PD-normal cognition [NC]) to stages with Mild CI (PD-MCI) and PD dementia (PDD). CI symptoms in PD are linked to different brain regions and neural pathways, in addition to being the result of dysfunctional subcortical regions. However, it is still unknown how functional dysregulation correlates to progression during the CI. Neuroimaging techniques hold promise in discriminating CI stages of PD and further contribute to the biomarker formation of CI in PD. In this study, we explore disparities in the clinical assessments and resting-state functional connectivity (FC) among three CI stages of PD. METHODS We enrolled 88 patients with PD and 26 healthy controls (HC) for a cross sectional clinical study and performed intra- and inter-network FC analysis in conjunction with comprehensive clinical cognitive assessment. RESULTS Our findings underscore the significance of several neural networks, namely, the default mode network (DMN), frontoparietal network (FPN), dorsal attention network, and visual network (VN) and their inter-intra-network FC in differentiating between PD-MCI and PDD. Additionally, our results showed the importance of sensory motor network, VN, DMN, and salience network (SN) in the discriminating PD-NC from PDD. Finally, in comparison to HC, we found DMN, FPN, VN, and SN as pivotal networks for further differential diagnosis of CI stages of PD. CONCLUSION We propose that resting-state networks (RSN) can be a discriminating factor in distinguishing the CI stages of PD and progressing from PD-NC to MCI or PDD. The integration of clinical and neuroimaging data may enhance the early detection of PD in clinical settings and potentially prevent the disease from advancing to more severe stages.
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Affiliation(s)
- Farzin Hajebrahimi
- Functional Imaging and Cognitive‐Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
- Department of Physical Therapy and Rehabilitation, School of Health SciencesIstanbul Medipol UniversityIstanbulTurkey
- Department of Health Informatics, Rutgers University, School of Health ProfessionsRutgers Biomedical and Health SciencesNewarkNew JerseyUSA
| | - Miray Budak
- Functional Imaging and Cognitive‐Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
- Department of Ergotherapy, School of Health SciencesIstanbul Medipol UniversityIstanbulTurkey
- Center for Molecular and Behavioral NeuroscienceRutgers University‐NewarkNewarkNew JerseyUSA
| | - Mevhibe Saricaoglu
- Functional Imaging and Cognitive‐Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
- Program of Electroneurophysiology, Vocational SchoolIstanbul Medipol UniversityIstanbulTurkey
| | - Zeynep Temel
- Department of PsychologyFatih Sultan Mehmet Vakif UniversityIstanbulTurkey
| | - Tugce Kahraman Demir
- Program of Electroneurophysiology, Vocational SchoolBiruni UniversityIstanbulTurkey
| | - Lutfu Hanoglu
- Department of Neurology, School of MedicineIstanbul Medipol UniversityIstanbulTurkey
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
| | - Suleyman Yildirim
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
- Department of Medical Microbiology, International School of MedicineIstanbul Medipol UniversityIstanbulTurkey
| | - Zubeyir Bayraktaroglu
- Functional Imaging and Cognitive‐Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkey
- Department of Physiology, International School of MedicineIstanbul Medipol UniversityIstanbulTurkey
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Jellinger KA. Pathobiology of Cognitive Impairment in Parkinson Disease: Challenges and Outlooks. Int J Mol Sci 2023; 25:498. [PMID: 38203667 PMCID: PMC10778722 DOI: 10.3390/ijms25010498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Cognitive impairment (CI) is a characteristic non-motor feature of Parkinson disease (PD) that poses a severe burden on the patients and caregivers, yet relatively little is known about its pathobiology. Cognitive deficits are evident throughout the course of PD, with around 25% of subtle cognitive decline and mild CI (MCI) at the time of diagnosis and up to 83% of patients developing dementia after 20 years. The heterogeneity of cognitive phenotypes suggests that a common neuropathological process, characterized by progressive degeneration of the dopaminergic striatonigral system and of many other neuronal systems, results not only in structural deficits but also extensive changes of functional neuronal network activities and neurotransmitter dysfunctions. Modern neuroimaging studies revealed multilocular cortical and subcortical atrophies and alterations in intrinsic neuronal connectivities. The decreased functional connectivity (FC) of the default mode network (DMN) in the bilateral prefrontal cortex is affected already before the development of clinical CI and in the absence of structural changes. Longitudinal cognitive decline is associated with frontostriatal and limbic affections, white matter microlesions and changes between multiple functional neuronal networks, including thalamo-insular, frontoparietal and attention networks, the cholinergic forebrain and the noradrenergic system. Superimposed Alzheimer-related (and other concomitant) pathologies due to interactions between α-synuclein, tau-protein and β-amyloid contribute to dementia pathogenesis in both PD and dementia with Lewy bodies (DLB). To further elucidate the interaction of the pathomechanisms responsible for CI in PD, well-designed longitudinal clinico-pathological studies are warranted that are supported by fluid and sophisticated imaging biomarkers as a basis for better early diagnosis and future disease-modifying therapies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150 Vienna, Austria
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Beyond shallow feelings of complex affect: Non-motor correlates of subjective emotional experience in Parkinson's disease. PLoS One 2023; 18:e0281959. [PMID: 36827296 PMCID: PMC9955984 DOI: 10.1371/journal.pone.0281959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023] Open
Abstract
Affective disorders in Parkinson's disease (PD) concern several components of emotion. However, research on subjective feeling in PD is scarce and has produced overall varying results. Therefore, in this study, we aimed to evaluate the subjective emotional experience and its relationship with autonomic symptoms and other non-motor features in PD patients. We used a battery of film excerpts to elicit Amusement, Anger, Disgust, Fear, Sadness, Tenderness, and Neutral State, in 28 PD patients and 17 healthy controls. Self-report scores of emotion category, intensity, and valence were analyzed. In the PD group, we explored the association between emotional self-reported scores and clinical scales assessing autonomic dysregulation, depression, REM sleep behavior disorder, and cognitive impairment. Patient clustering was assessed by considering relevant associations. Tenderness occurrence and intensity of Tenderness and Amusement were reduced in the PD patients. Tenderness occurrence was mainly associated with the overall cognitive status and the prevalence of gastrointestinal symptoms. In contrast, the intensity and valence reported for the experience of Amusement correlated with the prevalence of urinary symptoms. We identified five patient clusters, which differed significantly in their profile of non-motor symptoms and subjective feeling. Our findings further suggest the possible existence of a PD phenotype with more significant changes in subjective emotional experience. We concluded that the subjective experience of complex emotions is impaired in PD. Non-motor feature grouping suggests the existence of disease phenotypes profiled according to specific deficits in subjective emotional experience, with potential clinical implications for the adoption of precision medicine in PD. Further research on larger sample sizes, combining subjective and physiological measures of emotion with additional clinical features, is needed to extend our findings.
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Hulzinga F, Seuthe J, D'Cruz N, Ginis P, Nieuwboer A, Schlenstedt C. Split-Belt Treadmill Training to Improve Gait Adaptation in Parkinson's Disease. Mov Disord 2023; 38:92-103. [PMID: 36239376 DOI: 10.1002/mds.29238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gait deficits in people with Parkinson's disease (PD) are triggered by circumstances requiring gait adaptation. The effects of gait adaptation training on a split-belt treadmill (SBT) are unknown in PD. OBJECTIVE We investigated the effects of repeated SBT versus tied-belt treadmill (TBT) training on retention and automaticity of gait adaptation and its transfer to over-ground walking and turning. METHODS We recruited 52 individuals with PD, of whom 22 were freezers, in a multi-center randomized single-blind controlled study. Training consisted of 4 weeks of supervised treadmill training delivered three times per week. Tests were conducted pre- and post-training and at 4-weeks follow-up. Turning (primary outcome) and gait were assessed over-ground and during a gait adaptation protocol on the treadmill. All tasks were performed with and without a cognitive task. RESULTS We found that SBT-training improved gait adaptation with moderate to large effects sizes (P < 0.02) compared to TBT, effects that were sustained at follow-up and during dual tasking. However, better gait adaptation did not transfer to over-ground turning speed. In both SBT- and TBT-arms, over-ground walking and Movement Disorder Society-Unified Parkinson's Disease Rating Scale III (MDS-UPDRS-III scores were improved, the latter of which reached clinically meaningful effects in the SBT-group only. No impact was found on freezing of gait. CONCLUSION People with PD are able to learn and retain the ability to overcome asymmetric gait-speed perturbations on a treadmill remarkably well, but seem unable to generalize these skills to asymmetric gait off-treadmill. Future study is warranted into gait adaptation training to boost the transfer of complex walking skills. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Femke Hulzinga
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium
| | - Jana Seuthe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.,Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Nicholas D'Cruz
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium
| | - Pieter Ginis
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.,Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Zheng J, Jiao Z, Dai J, Liu T, Shi H. Abnormal cerebral micro-structures in end-stage renal disease patients related to mild cognitive impairment. Eur J Radiol 2022; 157:110597. [DOI: 10.1016/j.ejrad.2022.110597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
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