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Wang X, Li Y, Li B, Shang H, Yang J. Gray matter alterations in Huntington's disease: A meta-analysis of VBM neuroimaging studies. J Neurosci Res 2024; 102:e25366. [PMID: 38953592 DOI: 10.1002/jnr.25366] [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: 01/21/2024] [Revised: 05/16/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
Increasing neuroimaging studies have attempted to identify biomarkers of Huntington's disease (HD) progression. Here, we conducted voxel-based meta-analyses of voxel-based morphometry (VBM) studies on HD to investigate the evolution of gray matter volume (GMV) alterations and explore the effects of genetic and clinical features on GMV changes. A systematic review was performed to identify the relevant studies. Meta-analyses of whole-brain VBM studies were performed to assess the regional GMV changes in all HD mutation carriers, in presymptomatic HD (pre-HD), and in symptomatic HD (sym-HD). A quantitative comparison was performed between pre-HD and sym-HD. Meta-regression analyses were used to explore the effects of genetic and clinical features on GMV changes. Twenty-eight studies were included, comparing a total of 1811 HD mutation carriers [including 1150 pre-HD and 560 sym-HD] and 969 healthy controls (HCs). Pre-HD showed decreased GMV in the bilateral caudate nuclei, putamen, insula, anterior cingulate/paracingulate gyri, middle temporal gyri, and left dorsolateral superior frontal gyrus compared with HCs. Compared with pre-HD, GMV decrease in sym-HD extended to the bilateral median cingulate/paracingulate gyri, Rolandic operculum and middle occipital gyri, left amygdala, and superior temporal gyrus. Meta-regression analyses found that age, mean lengths of CAG repeats, and disease burden were negatively associated with GMV atrophy of the bilateral caudate and right insula in all HD mutation carriers. This meta-analysis revealed the pattern of GMV changes from pre-HD to sym-HD, prompting the understanding of HD progression. The pattern of GMV changes may be biomarkers for disease progression in HD.
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Affiliation(s)
- Xi Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuming Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Boyi Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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2
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Bilal H, Harding IH, Stout JC. The relationship between disease-specific psychosocial stressors and depressive symptoms in Huntington's disease. J Neurol 2024; 271:289-299. [PMID: 37695532 PMCID: PMC10769991 DOI: 10.1007/s00415-023-11982-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative disease involving motor abnormalities, cognitive decline, and psychological difficulties. Depression is among the most common psychological difficulties in HD. People with HD encounter numerous stressors related to their diagnosis and the impact of HD on their daily lives. Understanding the relationship between HD-specific psychosocial stressors and depression symptoms is critical for optimising treatment and developing a holistic, disease-specific model of depression in HD. METHODS Fifty-seven adults with the HD gene expansion (33 pre-symptomatic, 24 symptomatic) completed a self-report depression questionnaire and rated how much stress they experienced in relation to 20 psychosocial challenges commonly associated with HD. We examined associations between depression symptoms and each stressor individually, and after clustering using principal components analysis. RESULTS Depression symptoms were significantly associated with most of the psychosocial stressors assessed. Clustering with principal components analysis revealed that higher depression scores had significant independent associations with greater stress related to the future implications of HD (β = .44, p = .001) and sleep and psychological difficulties (β = .28, p = .005), but not with stress related to functional limitations (β = .11, p = .33) or interpersonal issues caused by HD (β = .15, p = .21). CONCLUSIONS Stressful experiences associated with HD constitute an important risk factor for depression in HD. Our findings support the use of more psychologically informed models of depression in HD and necessitate further research on tailored psychosocial interventions for HD patients with depression.
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Affiliation(s)
- Hiba Bilal
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton, VIC, 3800, Australia
| | - Ian H Harding
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Prahran, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton, VIC, 3800, Australia.
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3
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Weiss AR, Liguore WA, Brandon K, Wang X, Liu Z, Kroenke CD, McBride JL. Alterations of fractional anisotropy throughout cortico-basal ganglia gray matter in a macaque model of Huntington's Disease. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 4:100090. [PMID: 37397804 PMCID: PMC10313883 DOI: 10.1016/j.crneur.2023.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
We recently generated a nonhuman primate (NHP) model of the neurodegenerative disorder Huntington's disease (HD) using adeno-associated viral vectors to express a fragment of mutant HTT protein (mHTT) throughout the cortico-basal ganglia circuit. Previous work by our group established that mHTT-treated NHPs exhibit progressive motor and cognitive phenotypes which are accompanied by mild volumetric reductions of cortical-basal ganglia structures and reduced fractional anisotropy (FA) in the white matter fiber pathways interconnecting these regions, mirroring findings observed in early-stage HD patients. Given the mild structural atrophy observed in cortical and sub-cortical gray matter regions characterized in this model using tensor-based morphometry, the current study sought to query potential microstructural alterations in the same gray matter regions using diffusion tensor imaging (DTI), to define early biomarkers of neurodegenerative processes in this model. Here, we report that mHTT-treated NHPs exhibit significant microstructural changes in several cortical and subcortical brain regions that comprise the cortico-basal ganglia circuit; with increased FA in the putamen and globus pallidus and decreased FA in the caudate nucleus and several cortical regions. DTI measures also correlated with motor and cognitive deficits such that animals with increased basal ganglia FA, and decreased cortical FA, had more severe motor and cognitive impairment. These data highlight the functional implications of microstructural changes in the cortico-basal ganglia circuit in early-stage HD.
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Affiliation(s)
- Alison R. Weiss
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
| | - William A. Liguore
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
| | - Kristin Brandon
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA, 97239
| | - Zheng Liu
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA, 97239
| | - Christopher D. Kroenke
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA, 97239
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA, 97239
| | - Jodi L. McBride
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA, 97006
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA, 97239
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Gunn S, Dale M, Ovaska‐Stafford N, Maltby J. Mental health symptoms among those affected by Huntington's disease: A cross-sectional study. Brain Behav 2023; 13:e2954. [PMID: 36880126 PMCID: PMC10097147 DOI: 10.1002/brb3.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Although cognitive and motor symptoms of Huntington's disease (HD) are associated with disease progression, the underlying causes of psychological symptoms are not as clearly understood. Recent evidence suggests that some mental health difficulties experienced by people with HD are shared by noncarriers within HD families. Accordingly, there is a need to evaluate potential systemic contributors to HD mental distress, to support meaningful interventions for psychological symptoms in people with HD and affected families. METHOD We used short-form Problem Behaviors Assessment mental health symptom data from the international Enroll-HD data set to characterize mental health symptoms across eight HD groups: Stages 1-5, premanifest and genotype-negative individuals, and family controls (n = 8567) using chi-square analysis with post hoc comparisons. RESULTS We identified that people with later-stage HD (Stages 2-5) had significantly higher apathy, obsessive-compulsiveness, and (from Stage 3) disorientation than the remaining groups at a medium effect size, and that these findings largely held across three measure administrations over time. CONCLUSIONS These findings highlight the critical symptoms in manifest HD from Stage 2 onward, but also demonstrate that crucial symptoms such as depression, anxiety, and irritability are present across HD-affected groups (including noncarriers of the gene expansion). The outcomes highlight a need for specific clinical management of later-stage HD psychological symptoms, and for systemic support across affected families.
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Affiliation(s)
- Sarah Gunn
- Centre for Psychological Health and Development, Psychology and Vision Sciences, College of Life SciencesUniversity of LeicesterLeicesterUK
| | - Maria Dale
- Mill Lodge Huntington's Disease Inpatient and Community ServiceLeicestershire Partnership NHS TrustLeicesterUK
| | | | - John Maltby
- Centre for Psychological Health and Development, Psychology and Vision Sciences, College of Life SciencesUniversity of LeicesterLeicesterUK
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Weiss AR, Liguore WA, Brandon K, Wang X, Liu Z, Domire JS, Button D, Srinivasan S, Kroenke CD, McBride JL. A novel rhesus macaque model of Huntington's disease recapitulates key neuropathological changes along with motor and cognitive decline. eLife 2022; 11:e77568. [PMID: 36205397 PMCID: PMC9545527 DOI: 10.7554/elife.77568] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
We created a new nonhuman primate model of the genetic neurodegenerative disorder Huntington's disease (HD) by injecting a mixture of recombinant adeno-associated viral vectors, serotypes AAV2 and AAV2.retro, each expressing a fragment of human mutant HTT (mHTT) into the caudate and putamen of adult rhesus macaques. This modeling strategy results in expression of mutant huntingtin protein (mHTT) and aggregate formation in the injected brain regions, as well as dozens of other cortical and subcortical brain regions affected in human HD patients. We queried the disruption of cortico-basal ganglia circuitry for 30 months post-surgery using a variety of behavioral and imaging readouts. Compared to controls, mHTT-treated macaques developed working memory decline and progressive motor impairment. Multimodal imaging revealed circuit-wide white and gray matter degenerative processes in several key brain regions affected in HD. Taken together, we have developed a novel macaque model of HD that may be used to develop disease biomarkers and screen promising therapeutics.
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Affiliation(s)
- Alison R Weiss
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
| | - William A Liguore
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
| | - Kristin Brandon
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
- Advanced Imaging Research Center, Oregon Health and Science UniversityPortlandUnited States
| | - Zheng Liu
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
- Advanced Imaging Research Center, Oregon Health and Science UniversityPortlandUnited States
| | - Jacqueline S Domire
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
| | - Dana Button
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
| | - Sathya Srinivasan
- Imaging and Morphology Support Core, Oregon National Primate Research CenterBeavertonUnited States
| | - Christopher D Kroenke
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
- Advanced Imaging Research Center, Oregon Health and Science UniversityPortlandUnited States
- Department of Behavioral Neuroscience, Oregon Health and Science UniversityPortlandUnited States
| | - Jodi L McBride
- Division of Neuroscience, Oregon National Primate Research CenterBeavertonUnited States
- Department of Behavioral Neuroscience, Oregon Health and Science UniversityPortlandUnited States
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6
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Bilal H, Warren N, Dahanayake P, Kelso W, Sarah F, Stout JC. The Lived Experiences of Depression in Huntington's Disease: A Qualitative Study. J Huntingtons Dis 2022; 11:321-335. [PMID: 35570497 DOI: 10.3233/jhd-220537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression is a common neuropsychiatric syndrome in Huntington's disease (HD) and has debilitating consequences, including poorer sleep, exacerbation of cognitive and functional decline, and suicidality. To date, no published studies have documented the lived experience of depression in HD, despite clinical evidence that depression may be experienced differently in HD compared to the general population. OBJECTIVE The aim of this study was to investigate the lived experiences of depression in people with the CAG expansion for HD using qualitative methods. METHODS We conducted semi-structured interviews with HD CAG expansion carriers who had current or previous experiences of depression, until data saturation was achieved. This resulted in interviews from 17 HD CAG expansion carriers (11 premanifest, 6 manifest) which were analyzed using thematic analysis. RESULTS The four key themes that emerged related to the temporal characteristics of depression in HD, the qualitative changes associated with depression, psychosocial stressors perceived to contribute to depression, and the perception of depression as an endogenous feature of HD. CONCLUSION This study provides an enriched understanding of the unique characteristics of depression in HD, and the attributions that CAG expansion carriers make for their depression symptoms. The themes identified in this study can be used to guide more targeted assessment and treatment of depression in HD.
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Affiliation(s)
- Hiba Bilal
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Narelle Warren
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
| | - Pinithi Dahanayake
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Wendy Kelso
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Farrand Sarah
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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McLauchlan DJ, Lancaster T, Craufurd D, Linden DEJ, Rosser AE. Different depression: motivational anhedonia governs antidepressant efficacy in Huntington's disease. Brain Commun 2022; 4:fcac278. [PMID: 36440100 PMCID: PMC9683390 DOI: 10.1093/braincomms/fcac278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/13/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Depression is more common in neurodegenerative diseases such as Huntington's disease than the general population. Antidepressant efficacy is well-established for depression within the general population: a recent meta-analysis showed serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants and mirtazapine outperformed other antidepressants. Despite the severe morbidity, antidepressant choice in Huntington's disease is based on Class IV evidence. We used complementary approaches to determine treatment choice for depression in Huntington's disease: propensity score analyses of antidepressant treatment outcome using the ENROLL-HD data set, and a dissection of the cognitive mechanisms underlying depression in Huntington's disease using a cognitive battery based on the Research Domain Criteria for Depression. Study 1 included ENROLL-HD 5486 gene-positive adult patients started on an antidepressant medication for depression. Our outcome measures were depression (Hospital Anxiety and Depression Scale or Problem Behaviours Assessment 'Depressed Mood' item) at first follow-up (primary outcome) and all follow-ups (secondary outcome). The intervention was antidepressant class. We used Svyglm&Twang in R to perform propensity scoring, using known variables (disease progression, medical comorbidity, psychiatric morbidity, sedatives, number of antidepressants, demographics and antidepressant contraindications) to determine the probability of receiving different antidepressants (propensity score) and then included the propensity score in a model of treatment efficacy. Study 2 recruited 51 gene-positive adult patients and 26 controls from the South Wales Huntington's Disease Management Service. Participants completed a motor assessment, in addition to measures of depression and apathy, followed by tasks measuring consummatory anhedonia, motivational anhedonia, learning from reward and punishment and reaction to negative outcome. We used generalised linear models to determine the association between task performance and depression scores. Study 1 showed selective serotonin reuptake inhibitors outperformed serotonin norepinephrine reuptake inhibitors on the primary outcome (P = 0.048), whilst both selective serotonin reuptake inhibitors (P = 0.00069) and bupropion (P = 0.0045) were superior to serotonin norepinephrine reuptake inhibitors on the secondary outcome. Study 2 demonstrated an association between depression score and effort for reward that was not explained by apathy. No other mechanisms were associated with depression score. We found that selective serotonin reuptake inhibitors and bupropion outperform serotonin norepinephrine reuptake inhibitors at alleviating depression in Huntington's disease. Moreover, motivational anhedonia appears the most significant mechanism underlying depression in Huntington's disease. Bupropion is improves motivational anhedonia and has a synergistic effect with selective serotonin reuptake inhibitors. This work provides the first large-scale, objective evidence to determine treatment choice for depression in Huntington's disease, and provides a model for determining antidepressant efficacy in other neurodegenerative diseases.
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Affiliation(s)
- Duncan James McLauchlan
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff CF24 4HQ, UK.,Department of Neurology, Morriston Hospital, Swansea Bay University Health Board, Swansea SA6 6NL, UK
| | - Thomas Lancaster
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff CF24 4HQ, UK.,Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff CF24 4HQ, UK.,Department of Psychology, University of Bath, Bath BA2 7AY, UK
| | - David Craufurd
- Manchester Center for Genomic Medicine, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester M13 9PL, UK.,St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester M13 9WL, UK
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff CF24 4HQ, UK.,Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff CF24 4HQ, UK.,Department of Psychology, University of Bath, Bath BA2 7AY, UK.,School for Mental Health and Neuroscience, Fac. Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Anne E Rosser
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff CF24 4HQ, UK.,Department of Neurology, Morriston Hospital, Swansea Bay University Health Board, Swansea SA6 6NL, UK.,School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
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He M, Cheng Y, Chu Z, Wang X, Xu J, Lu Y, Shen Z, Xu X. White Matter Network Disruption Is Associated With Melancholic Features in Major Depressive Disorder. Front Psychiatry 2022; 13:816191. [PMID: 35492691 PMCID: PMC9046786 DOI: 10.3389/fpsyt.2022.816191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The efficacy and prognosis of major depressive disorder (MDD) are limited by its heterogeneity. MDD with melancholic features is an important subtype of MDD. The present study aimed to reveal the white matter (WM) network changes in melancholic depression. MATERIALS AND METHODS Twenty-three first-onset, untreated melancholic MDD, 59 non-melancholic MDD patients and 63 health controls underwent diffusion tensor imaging (DTI) scans. WM network analysis based on graph theory and support vector machine (SVM) were used for image data analysis. RESULTS Compared with HC, small-worldness was reduced and abnormal node attributes were in the right orbital inferior frontal gyrus, left orbital superior frontal gyrus, right caudate nucleus, right orbital superior frontal gyrus, right orbital middle frontal gyrus, left rectus gyrus, and left median cingulate and paracingulate gyrus of MDD patients. Compared with non-melancholic MDD, small-worldness was reduced and abnormal node attributes were in right orbital inferior frontal gyrus, left orbital superior frontal gyrus and right caudate nucleus of melancholic MDD. For correlation analysis, the 7th item score of the HRSD-17 (work and interest) was positively associated with increased node betweenness centrality (aBC) values in right orbital inferior frontal gyrus, while negatively associated with the decreased aBC in left orbital superior frontal gyrus. SVM analysis results showed that abnormal aBC in right orbital inferior frontal gyrus and left orbital superior frontal gyrus showed the highest accuracy of 81.0% (69/83), the sensitivity of 66.3%, and specificity of 85.2% for discriminating MDD patients with or without melancholic features. CONCLUSION There is a significant difference in WM network changes between MDD patients with and without melancholic features.
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Affiliation(s)
- Mengxin He
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Clinical Research Center for Mental Disorders, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Clinical Research Center for Mental Disorders, Kunming, China
| | - Zhaosong Chu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Clinical Research Center for Mental Disorders, Kunming, China
| | - Xin Wang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinlei Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi Lu
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zonglin Shen
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Clinical Research Center for Mental Disorders, Kunming, China.,Mental Health Institute of Yunnan, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Yunnan Clinical Research Center for Mental Disorders, Kunming, China
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9
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Waugh JL, Hassan A, Kuster JK, Levenstein JM, Warfield SK, Makris N, Brüggemann N, Sharma N, Breiter HC, Blood AJ. An MRI method for parcellating the human striatum into matrix and striosome compartments in vivo. Neuroimage 2021; 246:118714. [PMID: 34800665 PMCID: PMC9142299 DOI: 10.1016/j.neuroimage.2021.118714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
The mammalian striatum is comprised of intermingled tissue compartments, matrix and striosome. Though indistinguishable by routine histological techniques, matrix and striosome have distinct embryologic origins, afferent/efferent connections, surface protein expression, intra-striatal location, susceptibilities to injury, and functional roles in a range of animal behaviors. Distinguishing the compartments previously required post-mortem tissue and/or genetic manipulation; we aimed to identify matrix/striosome non-invasively in living humans. We used diffusion MRI (probabilistic tractography) to identify human striatal voxels with connectivity biased towards matrix-favoring or striosome-favoring regions (determined by prior animal tract-tracing studies). Segmented striatal compartments replicated the topological segregation and somatotopic organization identified in animal matrix/striosome studies. Of brain regions mapped in prior studies, our human brain data confirmed 93% of the compartment-selective structural connectivity demonstrated in animals. Test-retest assessment on repeat scans found a voxel classification error rate of 0.14%. Fractional anisotropy was significantly higher in matrix-like voxels, while mean diffusivity did not differ between the compartments. As mapped by the Talairach human brain atlas, 460 regions were significantly biased towards either matrix or striosome. Our method allows the study of striatal compartments in human health and disease, in vivo, for the first time.
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Affiliation(s)
- J L Waugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States; Division of Child Neurology, University of Texas Southwestern, Dallas, TX, United States; Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Mood and Motor Control Laboratory, Boston, MA, United States; Martinos Center for Biomedical Imaging, United States; Massachusetts General Hospital, Charlestown, MA, United States.
| | - Aao Hassan
- Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States
| | - J K Kuster
- Mood and Motor Control Laboratory, Boston, MA, United States; Laboratory of Neuroimaging and Genetics, United States; Martinos Center for Biomedical Imaging, United States; Rheumatology, Allergy and Immunology Section, Massachusetts General Hospital, Boston, MA, United States.
| | - J M Levenstein
- Mood and Motor Control Laboratory, Boston, MA, United States; Martinos Center for Biomedical Imaging, United States; Yale School of Medicine, New Haven, CN, United States; Wellcome Centre for Integrative Neuroimaging, National Institutes of Health, Bethesda, MD, United States.
| | - S K Warfield
- Department of Radiology, United States; Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
| | - N Makris
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Center for Morphometric Analysis, United States; Martinos Center for Biomedical Imaging, United States; Departments of Neurology and Psychiatry, Charlestown, MA, United States.
| | - N Brüggemann
- Department of Neurology, University of Oxford, Oxford, United Kingdom; Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
| | - N Sharma
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Charlestown, MA, United States.
| | - H C Breiter
- Laboratory of Neuroimaging and Genetics, United States; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - A J Blood
- Mood and Motor Control Laboratory, Boston, MA, United States; Laboratory of Neuroimaging and Genetics, United States; Martinos Center for Biomedical Imaging, United States; Departments of Neurology and Psychiatry, Charlestown, MA, United States.
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10
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Maltby J, Ovaska-Stafford N, Gunn S. The structure of mental health symptoms in Huntington's disease: Comparisons with healthy populations. J Clin Exp Neuropsychol 2021; 43:737-752. [PMID: 34906020 DOI: 10.1080/13803395.2021.2002824] [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: 10/19/2022]
Abstract
INTRODUCTION Mental health difficulties are common among people with Huntington's disease (HD). However, such difficulties are only weakly associated with HD progression, suggesting their causes may be multifactorial rather than purely disease-related. Genetically unaffected family members have been shown to experience similar levels of mental distress to people with HD, potentially due to systemic stressors and life disruption. These factors may also influence mental wellbeing in people with HD. Accordingly, this study aimed to compare patterns and occurrence of mental distress between people with HD and genetically unaffected control groups, to determine systemic and environmental contributions to HD-related distress. METHOD Exploratory and confirmatory factor analysis was used to compare the structure of mental distress in 5,294 individuals from four groups: manifest or premanifest HD, family control, and genotype-negative. Data were from the Enroll-HD study, using scores from the Problem Behaviors Assessment, the Hospital Anxiety and Depression Scale, and the Snaith Irritability Scale. We then evaluated consistency of the identified constructs over three annual assessments using analysis of variance. RESULTS Four factors consistently emerged across all groups, comprising depression, anxiety, temper and self-harm; these remained stable across time. People with HD did not report significantly different anxiety scores to control groups. The manifest group reported significantly higher depression, temper and self-harm than the genotype-negative group, but only differed in some cases from family-controls. CONCLUSIONS The findings suggest greater similarity in the severity and structure of mental health symptoms between people with and without HD than previously believed. This suggests contributions from systemic as well as genetic factors in families affected by HD, especially in terms of anxiety symptoms.
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Affiliation(s)
- John Maltby
- Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Noora Ovaska-Stafford
- Neuroscience, Psychology and Behaviour, University of Leicester, UK.,Greenwich Neurological Rehabilitation Team, Oxleas NHS Trust, London, UK
| | - Sarah Gunn
- Neuroscience, Psychology and Behaviour, University of Leicester, UK.,Medical Psychology, Leicestershire Partnership NHS Trust Leicester, UK
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11
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Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis. Int J Mol Sci 2021; 22:ijms22094440. [PMID: 33922780 PMCID: PMC8123079 DOI: 10.3390/ijms22094440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer’s disease, fronto-temporal dementia, Parkinson’s disease, Huntington’s disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.
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12
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Sellers J, Ridner SH, Claassen DO. A Systematic Review of Neuropsychiatric Symptoms and Functional Capacity in Huntington's Disease. J Neuropsychiatry Clin Neurosci 2020; 32:109-124. [PMID: 31466515 DOI: 10.1176/appi.neuropsych.18120319] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms are known to increase caregiver burden and decrease patient quality of life among patients with Huntington's disease. Functional capacity is an outcome commonly used in Huntington's disease clinical trials to quantify disease progression or intervention response. Some studies have examined the relationship between neuropsychiatric symptoms and functional capacity; however, this evidence has not been synthesized. The authors reviewed existing evidence on the association between neuropsychiatric symptoms and functional capacity in Huntington's disease. METHODS A systematic review was conducted using PubMed and CINAHL. Articles were included if they described primary research in humans with Huntington's disease, measured one or more neuropsychiatric symptoms and functional capacity, and reported statistical methods to identify associations between the two concepts. Additional eligible articles were identified through reference mining and review of other relevant literature. RESULTS Fourteen articles were eligible for review. Neuropsychiatric symptoms were measured individually, in clusters (i.e., depression, anxiety, and suicide items contributing to a depression cluster score), or with an overall score. Significant associations with decreased functional capacity were found most commonly with depression (N=7, median r=0.48) and apathy (N=5, median r=0.47). Other neuropsychiatric symptoms, clusters, and overall scores were all associated with functional capacity in three or fewer studies. CONCLUSIONS There is some evidence that depression and apathy are associated with decreased functional capacity in Huntington's disease. Other neuropsychiatric symptoms have been infrequently examined. Further knowledge of the relationships between neuropsychiatric symptoms and functional capacity will identify areas for intervention and improvement of outcomes in patients with Huntington's disease.
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Affiliation(s)
- Jessie Sellers
- The Department of Neurology, Vanderbilt University Medical Center, Nashville (Sellers, Claassen); and the School of Nursing, Vanderbilt University, Nashville (Ridner)
| | - Sheila H Ridner
- The Department of Neurology, Vanderbilt University Medical Center, Nashville (Sellers, Claassen); and the School of Nursing, Vanderbilt University, Nashville (Ridner)
| | - Daniel O Claassen
- The Department of Neurology, Vanderbilt University Medical Center, Nashville (Sellers, Claassen); and the School of Nursing, Vanderbilt University, Nashville (Ridner)
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13
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Estevez-Fraga C, Scahill R, Rees G, Tabrizi SJ, Gregory S. Diffusion imaging in Huntington's disease: comprehensive review. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-324377. [PMID: 33033167 PMCID: PMC7803908 DOI: 10.1136/jnnp-2020-324377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022]
Abstract
Huntington's disease (HD) is a monogenic disorder with 100% penetrance. With the advent of genetic testing in adults, disease-related, structural brain changes can be investigated from the earliest, premorbid stages of HD. While examining macrostructural change characterises global neuronal damage, investigating microstructural alterations provides information regarding brain organisation and its underlying biological properties. Diffusion MRI can be used to track the progression of microstructural anomalies in HD decades prior to clinical disease onset, providing a greater understanding of neurodegeneration. Multiple approaches, including voxelwise, region of interest and tractography, have been used in HD cohorts, showing a centrifugal pattern of white matter (WM) degeneration starting from deep brain areas, which is consistent with neuropathological studies. The corpus callosum, longer WM tracts and areas that are more densely connected, in particular the sensorimotor network, also tend to be affected early during premanifest stages. Recent evidence supports the routine inclusion of diffusion analyses within clinical trials principally as an additional measure to improve understanding of treatment effects, while the advent of novel techniques such as multitissue compartment models and connectomics can help characterise the underpinnings of progressive functional decline in HD.
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Affiliation(s)
- Carlos Estevez-Fraga
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rachael Scahill
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Geraint Rees
- Wellcome Centre for Neuroimaging, University College London, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah Gregory
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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14
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Franklin GL, Camargo CHF, Meira AT, Lima NSC, Teive HAG. The Role of the Cerebellum in Huntington's Disease: a Systematic Review. THE CEREBELLUM 2020; 20:254-265. [PMID: 33029762 DOI: 10.1007/s12311-020-01198-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
Huntington's disease (HD) is a rare neurological disorder characterized by progressive motor, cognitive, and psychiatric disturbances. Although striatum degeneration might justify most of the motor symptoms, there is an emerging evidence of involvement of extra-striatal structures, such as the cerebellum. To elucidate the cerebellar involvement and its afferences with motor, psychiatric, and cognitive symptoms in HD. A systematic search in the literature was performed in MEDLINE, LILACS, and Google Scholar databases. The research was broadened to include the screening of reference lists of review articles for additional studies. Studies available in the English language, dating from 1993 through May 2020, were included. Clinical presentation of patients with HD may not be considered as the result of an isolated primary striatal dysfunction. There is evidence that cerebellar involvement is an early event in HD and may occur independently of striatal degeneration. Also, the loss of the compensation role of the cerebellum in HD may be an explanation for the clinical onset of HD. Although more studies are needed to elucidate this association, the current literature supports that the cerebellum may integrate the natural history of neurodegeneration in HD.
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Affiliation(s)
- Gustavo L Franklin
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 1103/102, Centro, Curitiba, Paraná, Brazil.
| | - Carlos Henrique F Camargo
- Neurological Diseases Group, Graduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Alex T Meira
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 1103/102, Centro, Curitiba, Paraná, Brazil
| | - Nayra S C Lima
- Vila Velha University, Vila Velha, Espírito Santo, Brazil
| | - Hélio A G Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 1103/102, Centro, Curitiba, Paraná, Brazil
- Neurological Diseases Group, Graduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
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15
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Galts CP, Bettio LE, Jewett DC, Yang CC, Brocardo PS, Rodrigues ALS, Thacker JS, Gil-Mohapel J. Depression in neurodegenerative diseases: Common mechanisms and current treatment options. Neurosci Biobehav Rev 2019; 102:56-84. [DOI: 10.1016/j.neubiorev.2019.04.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
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16
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Neuroimaging depression and anxiety in essential tremor: A diffusion tensor imaging study. Clin Imaging 2019; 58:96-104. [PMID: 31284179 DOI: 10.1016/j.clinimag.2019.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/26/2019] [Accepted: 06/26/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Patients with essential tremor (ET) may exhibit non-motor features, including those that are neuropsychiatric. Depression and anxiety are the most common among these. This study aims to investigate the possible relationship between microstructural brain changes and symptoms of depression and anxiety in ET. METHODS We assessed 62 ET patients (40 women and 22 men, mean age 46.0 ± 20.4) for symptoms of depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Thirty-two patients had severe or moderate symptoms of anxiety, and 15 patients had severe or moderate depressive symptoms. Microstructural brain changes were evaluated using diffusion tensor imaging (DTI), which was reported using fractional anisotropy (FA), mean diffusivity (MD), apparent diffusion coefficient (ADC), radial diffusivity (RD), and axial diffusivity (AD) values calculated for 17 regions of interest including the prefrontal cortex, paralimbic and limbic structures and cerebellar peduncles. We evaluated the relationship between observed changes in brain regions and symptoms of depression and anxiety. RESULTS Decreased left amygdala FA (p = 0.003) and increased left amygdala RD (p = 0.04) were detected in depressed vs. non-depressed ET patients. Left ventrolateral prefrontal cortex (VLPFC) FA (p = 0.02) and left precuneus FA (p = 0.02) values differed between anxious patients vs. non-anxious ET patients. BDI scores were correlated with left amygdala FA and left RD, while BAI scores were correlated with left VLPFC FA and left precuneus FA. DISCUSSION Our results provide evidence that symptoms of depression and anxiety could be based in structural brain changes observed in patients with ET.
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17
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Garcia-Gorro C, Llera A, Martinez-Horta S, Perez-Perez J, Kulisevsky J, Rodriguez-Dechicha N, Vaquer I, Subira S, Calopa M, Muñoz E, Santacruz P, Ruiz-Idiago J, Mareca C, Beckmann CF, de Diego-Balaguer R, Camara E. Specific patterns of brain alterations underlie distinct clinical profiles in Huntington's disease. Neuroimage Clin 2019; 23:101900. [PMID: 31255947 PMCID: PMC6606833 DOI: 10.1016/j.nicl.2019.101900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Huntington's disease (HD) is a genetic neurodegenerative disease which involves a triad of motor, cognitive and psychiatric disturbances. However, there is great variability in the prominence of each type of symptom across individuals. The neurobiological basis of such variability remains poorly understood but would be crucial for better tailored treatments. Multivariate multimodal neuroimaging approaches have been successful in disentangling these profiles in other disorders. Thus we applied for the first time such approach to HD. We studied the relationship between HD symptom domains and multimodal measures sensitive to grey and white matter structural alterations. Forty-three HD gene carriers (23 manifest and 20 premanifest individuals) were scanned and underwent behavioural assessments evaluating motor, cognitive and psychiatric domains. We conducted a multimodal analysis integrating different structural neuroimaging modalities measuring grey matter volume, cortical thickness and white matter diffusion indices - fractional anisotropy and radial diffusivity. All neuroimaging measures were entered into a linked independent component analysis in order to obtain multimodal components reflecting common inter-subject variation across imaging modalities. The relationship between multimodal neuroimaging independent components and behavioural measures was analysed using multiple linear regression. We found that cognitive and motor symptoms shared a common neurobiological basis, whereas the psychiatric domain presented a differentiated neural signature. Behavioural measures of different symptom domains correlated with different neuroimaging components, both the brain regions involved and the neuroimaging modalities most prominently associated with each type of symptom showing differences. More severe cognitive and motor signs together were associated with a multimodal component consisting in a pattern of reduced grey matter, cortical thickness and white matter integrity in cognitive and motor related networks. In contrast, depressive symptoms were associated with a component mainly characterised by reduced cortical thickness pattern in limbic and paralimbic regions. In conclusion, using a multivariate multimodal approach we were able to disentangle the neurobiological substrates of two distinct symptom profiles in HD: one characterised by cognitive and motor features dissociated from a psychiatric profile. These results open a new view on a disease classically considered as a uniform entity and initiates a new avenue for further research considering these qualitative individual differences.
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Affiliation(s)
- Clara Garcia-Gorro
- Cognition and Brain Plasticity Unit, L'Hospitalet de Llobregat (Barcelona), IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Saul Martinez-Horta
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jesus Perez-Perez
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Irene Vaquer
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat (Barcelona), Spain
| | - Susana Subira
- Hestia Duran i Reynals, Hospital Duran i Reynals, Hospitalet de Llobregat (Barcelona), Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Esteban Muñoz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- Hospital Mare de Deu de la Mercè, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Celia Mareca
- Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Christian F. Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruth de Diego-Balaguer
- Cognition and Brain Plasticity Unit, L'Hospitalet de Llobregat (Barcelona), IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- ICREA (Catalan Institute for Research and Advanced Studies), Barcelona, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit, L'Hospitalet de Llobregat (Barcelona), IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Spain
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Zeun P, Scahill RI, Tabrizi SJ, Wild EJ. Fluid and imaging biomarkers for Huntington's disease. Mol Cell Neurosci 2019; 97:67-80. [PMID: 30807825 DOI: 10.1016/j.mcn.2019.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 01/18/2023] Open
Abstract
Huntington's disease is a chronic progressive neurodegenerative condition for which there is no disease-modifying treatment. The known genetic cause of Huntington's disease makes it possible to identify individuals destined to develop the disease and instigate treatments before the onset of symptoms. Multiple trials are already underway that target the cause of HD, yet clinical measures are often insensitive to change over typical clinical trial duration. Robust biomarkers of drug target engagement, disease severity and progression are required to evaluate the efficacy of treatments and concerted efforts are underway to achieve this. Biofluid biomarkers have potential advantages of direct quantification of biological processes at the molecular level, whilst imaging biomarkers can quantify related changes at a structural level in the brain. The most robust biofluid and imaging biomarkers can offer complementary information, providing a more comprehensive evaluation of disease stage and progression to inform clinical trial design and endpoints.
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Affiliation(s)
- Paul Zeun
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Rachael I Scahill
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Sarah J Tabrizi
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Edward J Wild
- Huntington's Disease Centre, University College London (UCL) Institute of Neurology, London WC1N 3BG, United Kingdom.
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Intrinsic mutant HTT-mediated defects in oligodendroglia cause myelination deficits and behavioral abnormalities in Huntington disease. Proc Natl Acad Sci U S A 2019; 116:9622-9627. [PMID: 31015293 DOI: 10.1073/pnas.1818042116] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
White matter abnormalities are a nearly universal pathological feature of neurodegenerative disorders including Huntington disease (HD). A long-held assumption is that this white matter pathology is simply a secondary outcome of the progressive neuronal loss that manifests with advancing disease. Using a mouse model of HD, here we show that white matter and myelination abnormalities are an early disease feature appearing before the manifestation of any behavioral abnormalities or neuronal loss. We further show that selective inactivation of mutant huntingtin (mHTT) in the NG2+ oligodendrocyte progenitor cell population prevented myelin abnormalities and certain behavioral deficits in HD mice. Strikingly, the improvements in behavioral outcomes were seen despite the continued expression of mHTT in nonoligodendroglial cells including neurons, astrocytes, and microglia. Using RNA-seq and ChIP-seq analyses, we implicate a pathogenic mechanism that involves enhancement of polycomb repressive complex 2 (PRC2) activity by mHTT in the intrinsic oligodendroglial dysfunction and myelination deficits observed in HD. Our findings challenge the long-held dogma regarding the etiology of white matter pathology in HD and highlight the contribution of epigenetic mechanisms to the observed intrinsic oligodendroglial dysfunction. Our results further suggest that ameliorating white matter pathology and oligodendroglial dysfunction may be beneficial for HD.
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20
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Structural Magnetic Resonance Imaging in Huntington's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:335-380. [PMID: 30409258 DOI: 10.1016/bs.irn.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder, caused by expansion of the CAG repeat in the huntingtin gene. HD is characterized clinically by progressive motor, cognitive and neuropsychiatric symptoms. There are currently no disease modifying treatments available for HD, and there is a great need for biomarkers to monitor disease progression and identify new targets for therapeutic intervention. Neuroimaging techniques provide a powerful tool for assessing disease pathology and progression in premanifest stages, before the onset of overt motor symptoms. Structural magnetic resonance imaging (MRI) is non-invasive imaging techniques which have been employed to study structural and microstructural changes in premanifest and manifest HD gene carriers. This chapter described structural imaging techniques and analysis methods employed across HD MRI studies. Current evidence for structural MRI abnormalities in HD, and associations between atrophy, structural white matter changes, iron deposition and clinical performance are discussed; together with the use of structural MRI measures as a diagnostic tool, to assess longitudinal changes, and as potential biomarkers and endpoints for clinical trials.
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21
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Mestre TA, van Duijn E, Davis AM, Bachoud-Lévi AC, Busse M, Anderson KE, Ferreira JJ, Mahlknecht P, Tumas V, Sampaio C, Goetz CG, Cubo E, Stebbins GT, Martinez-Martin P. Rating scales for behavioral symptoms in Huntington's disease: Critique and recommendations. Mov Disord 2017; 31:1466-1478. [PMID: 27296904 DOI: 10.1002/mds.26675] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 12/20/2022] Open
Abstract
Behavioral symptoms are an important feature of Huntington's disease and contribute to impairment in quality of life. The Movement Disorder Society commissioned the assessment of the clinimetric properties of rating scales in Huntington's disease to make recommendations regarding their use, following previously used standardized criteria. A systematic literature search was conducted to identify the scales used to assess behavioral symptoms in Huntington's disease. For the purpose of this review, 7 behavioral domains were deemed significant in Huntington's disease: irritability, anxiety, depression, apathy, obsessive-compulsive behaviors, psychosis, and suicidal ideation. We included a total of 27 behavioral rating scales, 19 of which were of a single behavioral domain and the remaining 8 scales included multiple behavioral domains. Three rating scales were classified as "recommended" exclusively for screening purposes: the Irritability Scale for irritability, the Beck Depression Inventory-II, and the Hospital Anxiety and Depression Scale for depression. There were no "recommended" scales for other purposes such as diagnosis, severity, or change in time or to treatment. The main challenges identified for assessment of behavioral symptoms in Huntington's disease are the co-occurrence of multiple behavioral symptoms, the particular features of a behavioral symptom in Huntington's disease, and the need to address stage- and disease-specific features, including cognitive impairment and lack of insight. The committee concluded that there is a need to further validate currently available behavioral rating scales in Huntington's disease to address gaps in scale validation for specific behavioral domains and purpose of use. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
| | - Erik van Duijn
- Psychiatry Department, Leiden University Medical Centre, and Centre for Mental Health Care Delfland, Delft, Netherlands
| | - Aileen M Davis
- Krembil Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation and Rehabilitation Institute, University of Toronto, Ontario, Canada
| | - Anne-Catherine Bachoud-Lévi
- Assistance Publique-Hôpitaux De Paris, National Centre of Reference for Huntington's Disease, Neurology Department, Université Paris Est, Créteil; INSERM U955 E01, Institut Mondor De Recherché Biomédicale, École Normale Supérieure, Créteil-Paris, France
| | - Monica Busse
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Karen E Anderson
- Georgetown University, School of Medicine, Washington, District of Columbia, USA
| | - Joaquim J Ferreira
- Neurology and Clinical Pharmacology, University of Lisbon, Institute of Molecular Medicine, Lisbon, Portugal
| | - Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Vitor Tumas
- Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Chris G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Esther Cubo
- Department of Neurology, Hospital Universitário Hermanos Yagüe, Burgos, Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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22
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Rangel-Barajas C, Rebec GV. Dysregulation of Corticostriatal Connectivity in Huntington's Disease: A Role for Dopamine Modulation. J Huntingtons Dis 2017; 5:303-331. [PMID: 27983564 PMCID: PMC5181679 DOI: 10.3233/jhd-160221] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aberrant communication between striatum, the main information processing unit of the basal ganglia, and cerebral cortex plays a critical role in the emergence of Huntington’s disease (HD), a fatal monogenetic condition that typically strikes in the prime of life. Although both striatum and cortex undergo substantial cell loss over the course of HD, corticostriatal circuits become dysfunctional long before neurons die. Understanding the dysfunction is key to developing effective strategies for treating a progressively worsening triad of motor, cognitive, and psychiatric symptoms. Cortical output neurons drive striatal activity through the release of glutamate, an excitatory amino acid. Striatal outputs, in turn, release γ-amino butyric acid (GABA) and exert inhibitory control over downstream basal ganglia targets. Ample evidence from transgenic rodent models points to dysregulation of corticostriatal glutamate transmission along with corresponding changes in striatal GABA release as underlying factors in the HD behavioral phenotype. Another contributor is dysregulation of dopamine (DA), a modulator of both glutamate and GABA transmission. In fact, pharmacological manipulation of DA is the only currently available treatment for HD symptoms. Here, we review data from animal models and human patients to evaluate the role of DA in HD, including DA interactions with glutamate and GABA within the context of dysfunctional corticostriatal circuitry.
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Affiliation(s)
| | - George V. Rebec
- Correspondence to: George V. Rebec, PhD, Department of Psychological and Brain Sciences, Program in
Neuroscience, Indiana University, 1101 E. 10th Street, Bloomington, IN 47405-7007, USA. Tel.: +1 812 855 4832;
Fax: +1 812 855 4520; E-mail:
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23
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Peall KJ, Lorentzos MS, Heyman I, Tijssen MAJ, Owen MJ, Dale RC, Kurian MA. A review of psychiatric co-morbidity described in genetic and immune mediated movement disorders. Neurosci Biobehav Rev 2017; 80:23-35. [PMID: 28528196 DOI: 10.1016/j.neubiorev.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022]
Abstract
Psychiatric symptoms are an increasingly recognised feature of movement disorders. Recent identification of causative genes and autoantibodies has allowed detailed analysis of aetiologically homogenous subgroups, thereby enabling determination of the spectrum of psychiatric symptoms in these disorders. This review evaluates the incidence and type of psychiatric symptoms encountered in patients with movement disorders. A broad spectrum of psychiatric symptoms was identified across all subtypes of movement disorder, with depression, generalised anxiety disorder and obsessive-compulsive disorder being most common. Psychosis, schizophrenia and attention deficit hyperactivity disorder were also identified, with the psychiatric symptoms often predating onset of the motor disorder. The high incidence of psychiatric symptoms across such a wide range of movement disorders suggests a degree of common or overlapping pathogenic mechanisms. Our review demonstrates the need for increased clinical awareness of such co-morbidities, which should facilitate early neuropsychiatric intervention and allied specialist treatment for patients.
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Affiliation(s)
- K J Peall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis Building, Heath Park, Cardiff, CF24 4HQ, UK.
| | - M S Lorentzos
- Movement Disorders Clinic, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - I Heyman
- Department of Psychological Medicine, Great Ormond Street Hospital, London, UK; Developmental Neurosciences Programme, UCL-Institute of Child Health, London, UK
| | - M A J Tijssen
- Department of Neurology, University of Groningen, Groningen, The Netherlands
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis Building, Heath Park, Cardiff, CF24 4HQ, UK
| | - R C Dale
- Movement Disorders Clinic, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - M A Kurian
- Developmental Neurosciences Programme, UCL-Institute of Child Health, London, UK; Department of Neurology, Great Ormond Street Hospital, London, UK.
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The NCAM1 gene set is linked to depressive symptoms and their brain structural correlates in healthy individuals. J Psychiatr Res 2017; 91:116-123. [PMID: 28334615 DOI: 10.1016/j.jpsychires.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 11/21/2022]
Abstract
Depressive symptoms exist on a continuum, the far end of which is found in depressive disorders. Utilizing the continuous spectrum of depressive symptoms may therefore contribute to the understanding of the biological underpinnings of depression. Gene set enrichment analysis (GSEA) is an important tool for the identification of gene groups linked to complex traits, and was applied in the present study on genome-wide association study (GWAS) data of depression scores and their brain-level structural correlates in healthy young individuals. On symptom level (i.e. depression scores), robust enrichment was identified for two gene sets: NCAM1 Interactions and Collagen Formation. Depression scores were also associated with decreased fractional anisotropy (FA) - a brain white matter property - within the forceps minor and the left superior temporal longitudinal fasciculus. Within each of these tracts, mean FA value of depression score-associated voxels was used as a phenotype in a subsequent GSEA. The NCAM1 Interactions gene set was significantly enriched in these tracts. By linking the NCAM1 Interactions gene set to depression scores and their structural brain correlates in healthy participants, the current study contributes to the understanding of the molecular underpinnings of depressive symptomatology.
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McColgan P, Razi A, Gregory S, Seunarine KK, Durr A, A.C. Roos R, Leavitt BR, Scahill RI, Clark CA, Langbehn DR, Rees G, Tabrizi SJ. Structural and functional brain network correlates of depressive symptoms in premanifest Huntington's disease. Hum Brain Mapp 2017; 38:2819-2829. [PMID: 28294457 PMCID: PMC5434856 DOI: 10.1002/hbm.23527] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/25/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022] Open
Abstract
Depression is common in premanifest Huntington's disease (preHD) and results in significant morbidity. We sought to examine how variations in structural and functional brain networks relate to depressive symptoms in premanifest HD and healthy controls. Brain networks were constructed using diffusion tractography (70 preHD and 81 controls) and resting state fMRI (92 preHD and 94 controls) data. A sub-network associated with depression was identified in a data-driven fashion and network-based statistics was used to investigate which specific connections correlated with depression scores. A replication analysis was then performed using data from a separate study. Correlations between depressive symptoms with increased functional connectivity and decreased structural connectivity were seen for connections in the default mode network (DMN) and basal ganglia in preHD. This study reveals specific connections in the DMN and basal ganglia that are associated with depressive symptoms in preHD. Hum Brain Mapp 38:2819-2829, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Peter McColgan
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyLondonWC1N 3BGUnited Kingdom
| | - Adeel Razi
- Wellcome Trust Centre for Neuroimaging, UCL Institute of NeurologyLondonWC1N 3BGUnited Kingdom
- Department of Electronic Engineering, NED University of Engineering and TechnologyKarachiPakistan
| | - Sarah Gregory
- Wellcome Trust Centre for Neuroimaging, UCL Institute of NeurologyLondonWC1N 3BGUnited Kingdom
| | - Kiran K. Seunarine
- Developmental Imaging and Biophysics SectionUCL Institute of Child HealthLondonWC1N 1EHUnited Kingdom
| | - Alexandra Durr
- APHP Department of Genetics, Groupe Hospitalier Pitié‐Salpêtrière, and Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités – UPMC Université Paris VI UMR_S1127ParisFrance
| | - Raymund A.C. Roos
- Department of NeurologyLeiden University Medical Centre2300RC LeidenThe Netherlands
| | - Blair R. Leavitt
- Centre for Molecular Medicine and TherapeuticsDepartment of Medical Genetics, University of British Columbia950 West 28th AvenueVancouverBritish ColumbiaV5Z 4H4Canada
| | - Rachael I. Scahill
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyLondonWC1N 3BGUnited Kingdom
| | - Chris A. Clark
- Developmental Imaging and Biophysics SectionUCL Institute of Child HealthLondonWC1N 1EHUnited Kingdom
| | | | - Geraint Rees
- Wellcome Trust Centre for Neuroimaging, UCL Institute of NeurologyLondonWC1N 3BGUnited Kingdom
| | - Sarah J. Tabrizi
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyLondonWC1N 3BGUnited Kingdom
- National Hospital for Neurology and NeurosurgeryQueen Square, LondonWC1N 3BGUnited Kingdom
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Besteher B, Gaser C, Langbein K, Dietzek M, Sauer H, Nenadić I. Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects. J Affect Disord 2017; 215:111-117. [PMID: 28319687 DOI: 10.1016/j.jad.2017.03.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dimensional approaches in highly prevalent psychiatric disorders like depression or anxiety could lead to a better understanding of pathogenesis and advantages in early detection and prevention. In an effort to better understand associations of brain structural variation across the depression/anxiety spectra, we investigated minor subclinical symptoms in a non-clinical healthy population. METHODS We studied 177 healthy subjects from the community, who underwent high-resolution T1-weighted 3T MRI and completed the symptom-checklist-90 (SCL-90-R). Using voxel-based morphometry (VBM) analysis with CAT12 software, we correlated SCL-90-R-subscales for depression, anxiety, and somatization with gray matter across the brain. RESULTS Significant positive gray matter correlations emerged across all three scales in different areas: the depression subscale correlated positively with gray matter in the Rolandic operculum, superior temporal gyrus (left) and postcentral gyrus (bilateral), the anxiety subscale correlated positively with middle temporal gyrus, Rolandic operculum, middle cingular gyrus and precuneus bilaterally, and the somatization subscale with left inferior prefrontal cortex. Somatization also showed negative correlations with cerebellar vermis and right supplementary motor area. LIMITATIONS Our study is limited to VBM and does not include surface-based measures. It also only contains subjects with very small psychological distress by partly overlapping symptoms. CONCLUSION Our findings are consistent with a non-linear relationship between symptom severity and cortical volume in several brain areas involved in both emotion regulation as well as altered in clinically manifest depressive/anxiety disorders.
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Affiliation(s)
- Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Department of Neurology, Jena University Hospital, Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Maren Dietzek
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Heinrich Sauer
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Department of Psychiatry and Psychotherapy, Philipps-University Marburg/Marburg University Hospital - UKGM, Marburg, Germany
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Neuroimaging as a tool to study the sources of phenotypic heterogeneity in Huntington's disease. Curr Opin Neurol 2017; 30:398-404. [PMID: 28509681 DOI: 10.1097/wco.0000000000000461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Huntington's disease is a neurodegenerative disorder characterized by a triad of motor, cognitive and psychiatric disturbances. There is great variability regarding the prominence and evolution of each type of clinical sign. One possible source of phenotypic heterogeneity could be the more prominent degeneration of specific brain circuits. The scope of this review is to highlight the most recent neuroimaging studies that have analysed the relationship between brain changes and motor, cognitive and psychiatric alterations in Huntington's disease. RECENT FINDINGS The results from recent neuroimaging studies are heterogeneous. Although there is a great overlap between the different regions associated with each symptomatic domain, there is some degree of differentiation. For example, the motor network is associated with motor impairment, whereas the ventral striatum is especially involved in emotional deficits related with psychiatric problems. SUMMARY Motor, cognitive and psychiatric impairments are associated with structural and functional brain biomarkers. However, the specificity of the regions involved remains unknown, because these studies focused on specific regions and symptoms. In order to tease apart the neural substrates that underlie the phenotypic heterogeneity in Huntington's disease, multivariate approaches combining brain and behavioural measures related to all symptomatic domains should be considered in the future.
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Maltby J, Dale M, Underwood M, Simpson J. Irritability in Huntington's Disease: Factor Analysis of Snaith's Irritability Scale. Mov Disord Clin Pract 2017; 4:342-348. [PMID: 30363422 PMCID: PMC6174383 DOI: 10.1002/mdc3.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Elevated levels of irritability are reported to occur in a number of neurological conditions, including Huntington's disease (HD), a genetic neurodegenerative disorder. Snaith's Irritability Scale (SIS) is used within HD research, but no psychometric evaluation of this instrument has previously been undertaken. Therefore, the current study aimed to analyze the factor structure of this scale among an HD population. METHODS Exploratory and confirmatory factor analysis were used to examine the structural properties of SIS using responses from 1,264 HD gene expansion carriers, across 15 European countries, who were engaged in the REGISTRY 3 study. RESULTS An exploratory factor analysis of a subsample of the data suggested a two-factor interpretation of the data comprising "temper" and "self-harm." Eight possible models were tested for goodness of fit using confirmatory factor analysis. Two bifactor models, testing general and group factors in the structure of the scale, provided an equivocal "good" fit to the data. The first comprised a general irritability factor and two group factors (as originally proposed using SIS): outward irritability and inward irritability. The second comprised a general irritability factor and two group factors (as proposed by the exploratory factor analysis): temper and self-harm. The findings from both models suggested that the loadings of items were higher on the general factor. CONCLUSIONS Bifactor models are proposed to best consider the structure of the SIS, with findings suggesting that an overall score should be used to measure irritability within HD populations.
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Affiliation(s)
- John Maltby
- College of Medicine, Biological Sciences and PsychologyUniversity of LeicesterLeicesterUnited Kingdom
| | - Maria Dale
- College of Medicine, Biological Sciences and PsychologyUniversity of LeicesterLeicesterUnited Kingdom
- Leicestershire Partnership NHS TrustAdult Mental Health PsychologyLeicesterUnited Kingdom
| | - Mandy Underwood
- College of Medicine, Biological Sciences and PsychologyUniversity of LeicesterLeicesterUnited Kingdom
| | - Jane Simpson
- Division of Health ResearchLancaster UniversityLancasterUnited Kingdom
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The Complexity of Clinical Huntington's Disease: Developments in Molecular Genetics, Neuropathology and Neuroimaging Biomarkers. ADVANCES IN NEUROBIOLOGY 2017; 15:129-161. [PMID: 28674980 DOI: 10.1007/978-3-319-57193-5_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder characterised by extensive neuronal loss in the striatum and cerebral cortex, and a triad of clinical symptoms affecting motor, cognitive/behavioural and mood functioning. The mutation causing HD is an expansion of a CAG tract in exon 1 of the HTT gene. This chapter provides a multifaceted overview of the clinical complexity of HD. We explore recent directions in molecular genetics including the identification of loci that are genetic modifiers of HD that could potentially reveal therapeutic targets beyond the HTT gene transcript and protein. The variability of clinical symptomatology in HD is considered alongside recent findings of variability in cellular and neurochemical changes in the striatum and cerebral cortex in human brain. We review evidence from structural neuroimaging methods of progressive changes of striatum, cerebral cortex and white matter in pre-symptomatic and symptomatic HD, with a particular focus on the potential identification of neuroimaging biomarkers that could be used to test promising disease-specific and modifying treatments. Finally we provide an overview of completed clinical trials in HD and future therapeutic developments.
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The neuropsychology of first impressions: Evidence from Huntington's disease. Cortex 2016; 85:100-115. [PMID: 27852003 DOI: 10.1016/j.cortex.2016.10.006] [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: 05/02/2016] [Revised: 08/16/2016] [Accepted: 10/12/2016] [Indexed: 11/20/2022]
Abstract
Impairments of emotion recognition have been widely documented in Huntington's disease (HD), but little is known concerning how these relate to other aspects of social cognition, including first impressions of traits such as trustworthiness and dominance. Here, we introduce a novel and sensitive method to investigate the ability to evaluate trustworthiness and dominance from facial appearance, with control tasks measuring ability to perceive differences between comparable stimuli. We used this new method together with standard tests of face perception to investigate social cognition in HD. We found that a subgroup of people with HD was impaired at perceiving trustworthiness and dominance, and that perceiving trustworthiness and dominance were correlated with impaired facial expression recognition. In addition, we used diffusion tensor imaging (DTI) to provisionally identify candidate brain regions associated with social cognition by contrasting regional functional anisotropy (FA) measures between subgroups of HD participants showing normal or impaired perception of trustworthiness and dominance, and by correlating these regional brain abnormalities with behavioural performance on tests of emotion recognition. In this way we show for the first time alterations in perception of trustworthiness and dominance in people with HD and link these to regions which may map the boundaries of the social brain. The pattern of breakdown seen in this neurodegenerative disease can thus be used to explore potential inter-relationships between different components of social cognition.
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Liu W, Yang J, Burgunder J, Cheng B, Shang H. Diffusion imaging studies of Huntington's disease: A meta-analysis. Parkinsonism Relat Disord 2016; 32:94-101. [PMID: 27624391 DOI: 10.1016/j.parkreldis.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/21/2016] [Accepted: 09/05/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) could detect abnormal brain microstructural alterations. DTI studies of Huntington's Disease(HD) have yielded inconsistent results. OBJECTIVE To integrate the existing DTI studies of HD and explore the validity of DTI to detect microstructural damages in HD brain via meta-analysis. METHODS Systematic and comprehensive searches of the databases were performed for DTI studies of HD. The data from the studies that met our inclusion criteria were extracted and analyzed using the CMA2 software. Random effect models were utilized to minimize the potential between-study heterogeneity. One-way sensitivity analysis was conducted to test the robustness of the results. RESULTS The meta-analysis included 140 pre-symptomatic HD (PreHD), 235 symptomatic HD (SymHD) patients and 302 controls, revealing significantly increased fractional anisotropy (FA) in the caudate, putamen, and globus pallidus, while decreased FA in the corpus callosum of both PreHD and SymHD patients compared with controls. In addition, significantly increased mean diffusivity (MD) was identified in the putamen and thalamus of both PreHD and SymHD patients, and in the caudate of SymHD patients, while no significant difference in MD in the caudate of PreHD patients. In the corpus callosum, there was a significant increase of radial diffusivity and axial diffusivity in SymHD patients compared with controls. Meta-regression showed gender-based difference in MD values of the caudate. CONCLUSIONS Our meta-analysis provides further evidence that DTI detects microstructural damage of both white matter and gray matter even in PreHD gene carriers. MD is less sensitive than FA in detecting structural changes in PreHD.
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Affiliation(s)
- Wanglin Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Bochao Cheng
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Neurochemical correlation between major depressive disorder and neurodegenerative diseases. Life Sci 2016; 158:121-9. [DOI: 10.1016/j.lfs.2016.06.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
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Teo RTY, Hong X, Yu-Taeger L, Huang Y, Tan LJ, Xie Y, To XV, Guo L, Rajendran R, Novati A, Calaminus C, Riess O, Hayden MR, Nguyen HP, Chuang KH, Pouladi MA. Structural and molecular myelination deficits occur prior to neuronal loss in the YAC128 and BACHD models of Huntington disease. Hum Mol Genet 2016; 25:2621-2632. [PMID: 27126634 PMCID: PMC5181633 DOI: 10.1093/hmg/ddw122] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/10/2016] [Accepted: 04/18/2016] [Indexed: 11/22/2022] Open
Abstract
White matter (WM) atrophy is a significant feature of Huntington disease (HD), although its aetiology and early pathological manifestations remain poorly defined. In this study, we aimed to characterize WM-related features in the transgenic YAC128 and BACHD models of HD. Using diffusion tensor magnetic resonance imaging (DT-MRI), we demonstrate that microstructural WM abnormalities occur from an early age in YAC128 mice. Similarly, electron microscopy analysis of myelinated fibres of the corpus callosum indicated that myelin sheaths are thinner in YAC128 mice as early as 1.5 months of age, well before any neuronal loss can be detected. Transcript levels of myelin-related genes in striatal and cortical tissues were significantly lower in YAC128 mice from 2 weeks of age, and these findings were replicated in differentiated primary oligodendrocytes from YAC128 mice, suggesting a possible mechanistic explanation for the observed structural deficits. Concordant with these observations, we demonstrate reduced expression of myelin-related genes at 3 months of age and WM microstructural abnormalities using DT-MRI at 12 months of age in the BACHD rats. These findings indicate that WM deficits in HD are an early phenotype associated with cell-intrinsic effects of mutant huntingtin on myelin-related transcripts in oligodendrocytes, and raise the possibility that WM abnormalities may be an early contributing factor to the pathogenesis of HD.
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Affiliation(s)
- Roy Tang Yi Teo
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore (A*STAR), Singapore 138648, Singapore
| | - Xin Hong
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Libo Yu-Taeger
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, 72076 Tuebingen, Germany
- Centre for Rare Diseases, University of Tuebingen, 72076 Tuebingen, Germany
| | - Yihui Huang
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore (A*STAR), Singapore 138648, Singapore
| | - Liang Juin Tan
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore (A*STAR), Singapore 138648, Singapore
| | - Yuanyun Xie
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Xuan Vinh To
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Ling Guo
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Reshmi Rajendran
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Arianna Novati
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, 72076 Tuebingen, Germany
- Centre for Rare Diseases, University of Tuebingen, 72076 Tuebingen, Germany
| | - Carsten Calaminus
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, University of Tuebingen, 72076 Tuebingen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, 72076 Tuebingen, Germany
- Centre for Rare Diseases, University of Tuebingen, 72076 Tuebingen, Germany
| | - Michael R Hayden
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore (A*STAR), Singapore 138648, Singapore
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Huu P Nguyen
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, 72076 Tuebingen, Germany
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Mahmoud A Pouladi
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore (A*STAR), Singapore 138648, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Neuropsychiatric symptoms are very common in premanifest and early stage Huntington's Disease. Parkinsonism Relat Disord 2016; 25:58-64. [PMID: 26898966 DOI: 10.1016/j.parkreldis.2016.02.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/28/2016] [Accepted: 02/05/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms are common features of Huntington's disease (HD). Whereas most studies have focused on cognitive and neuroimaging markers of disease progression, little is known about the prevalence of neuropsychiatric symptoms in premanifest mutation carriers far-from and close-to disease onset. METHODS We obtained neurological, cognitive and behavioral data from 230 participants classified as premanifest far-from (preHD-A) and close-to (preHD-B) motor-based disease onset, early-symptomatic (early-HD), and healthy controls. Frequency and severity of neuropsychiatric symptoms were assessed with the short Problem Behaviors Assessment for HD (PBA-s). The odds-ratio (OR) to present symptoms in the clinical range was calculated using the control group as reference. Logistic regression analysis was used to explore relationships between neuropsychiatric symptoms and medication use. RESULTS Prevalence of depression was similar in all groups. Apathy was already present in 32% of preHD-A increasing to 62% of early-HD patients. The probability of presenting apathetic symptoms was 15-88 times higher in preHD-A and preHD-B respectively than in healthy controls. Irritability and executive dysfunction were present in both preHD-B and early-HD. CONCLUSION Neuropsychiatric symptoms are highly prevalent in HD, already in the premanifest stage, with increasing prevalence of irritability, apathy and executive dysfunction closer to onset. Compared to controls, HD mutation carriers have the highest probability to develop apathy, with an increasing prevalence along disease stages. Our findings confirm the high prevalence of neuropsychiatric symptoms in HD, already many years before the onset of motor symptoms, with apathy as an early manifestation and core neuropsychiatric feature of the disease.
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Müller HP, Gorges M, Grön G, Kassubek J, Landwehrmeyer GB, Süßmuth SD, Wolf RC, Orth M. Motor network structure and function are associated with motor performance in Huntington's disease. J Neurol 2016; 263:539-49. [PMID: 26762394 DOI: 10.1007/s00415-015-8014-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/25/2015] [Accepted: 12/27/2015] [Indexed: 12/11/2022]
Abstract
In Huntington's disease, the relationship of brain structure, brain function and clinical measures remains incompletely understood. We asked how sensory-motor network brain structure and neural activity relate to each other and to motor performance. Thirty-four early stage HD and 32 age- and sex-matched healthy control participants underwent structural magnetic resonance imaging (MRI), diffusion tensor, and intrinsic functional connectivity MRI. Diffusivity patterns were assessed in the cortico-spinal tract and the thalamus-somatosensory cortex tract. For the motor network connectivity analyses the dominant M1 motor cortex region and for the basal ganglia-thalamic network the thalamus were used as seeds. Region to region structural and functional connectivity was examined between thalamus and somatosensory cortex. Fractional anisotropy (FA) was higher in HD than controls in the basal ganglia, and lower in the external and internal capsule, in the thalamus, and in subcortical white matter. Between-group axial and radial diffusivity differences were more prominent than differences in FA, and correlated with motor performance. Within the motor network, the insula was less connected in HD than in controls, with the degree of connection correlating with motor scores. The basal ganglia-thalamic network's connectivity differed in the insula and basal ganglia. Tract specific white matter diffusivity and functional connectivity were not correlated. In HD sensory-motor white matter organization and functional connectivity in a motor network were independently associated with motor performance. The lack of tract-specific association of structure and function suggests that functional adaptation to structural loss differs between participants.
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Affiliation(s)
- Hans-Peter Müller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45/1, 89081, Ulm, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Oberer Eselsberg 45/1, 89081, Ulm, Germany
| | - Georg Grön
- Section Neuropsychology and Functional Imaging, Department of Psychiatry, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45/1, 89081, Ulm, Germany
| | | | - Sigurd D Süßmuth
- Department of Neurology, University of Ulm, Oberer Eselsberg 45/1, 89081, Ulm, Germany
| | - Robert Christian Wolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Homburg, Germany
| | - Michael Orth
- Department of Neurology, University of Ulm, Oberer Eselsberg 45/1, 89081, Ulm, Germany.
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Viral vector mediated expression of mutant huntingtin in the dorsal raphe produces disease-related neuropathology but not depressive-like behaviors in wildtype mice. Brain Res 2015; 1608:177-90. [PMID: 25732261 DOI: 10.1016/j.brainres.2015.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/10/2015] [Accepted: 02/14/2015] [Indexed: 12/13/2022]
Abstract
Huntington׳s disease (HD) is a neurodegenerative disorder caused by a mutation in the HTT gene (mHTT) encoding the protein huntingtin. An expansion in the gene׳s CAG repeat length renders a misfolded, dysfunctional protein with an abnormally long glutamine (Q) stretch at the N terminus that often incorporates into inclusion bodies and leads to neurodegeneration in many regions of the brain. HD is characterized by motor and cognitive decline as well as mood disorders, with depression being particularly common. Approximately 40% of the HD population suffers from depressive symptoms. Because these symptoms often manifest a decade or more prior to the knowledge that the person is at risk for the disease, a portion of the early depression in HD appears to be a consequence of the pathology arising from expression of the mutant gene. While the depression in HD patients is often treated with serotonin agonists, there is scant experimental evidence that the depression in HD responds well to these serotonin treatments or in a similar manner to how non-HD depression tends to respond. Additionally, at very early sub-threshold depression levels, abnormal changes in several neuronal populations are already detectable in HD patients, suggesting that a variety of brain structures may be involved. Taken together, the serotonin system is a viable candidate. However, at present there is limited evidence of the precise nuclei or circuits that play a role in HD depression. With this in mind, the current study was designed to control for the widespread brain neuropathology that occurs in HD and in transgenic mouse models of HD and focuses specifically on the influence of the midbrain dorsal raphe nucleus (DRN). The DRN provides the majority of the serotonin to the forebrain and exhibits cell loss in non-HD depression. Therefore, we employed a viral vector delivery system to investigate whether the over-expression of mHTT in the DRN׳s ventral sub-nuclei alone is sufficient to produce depressive-like behaviors. Wildtype mice were injected with an adeno-associated virus (AAV2/1) encoding HTT containing either a pathogenic (N171-82Q) or control (N171-16Q) CAG repeat length into the ventral DRN and depressive-like behaviors and motor behaviors were assessed for 12 weeks post-surgery. Quantitative PCR and immunohistochemistry (IHC) verified positive transduction in the ventral aspects of the DRN, including the ventral sub-nucleus (DRv) and interfascicular sub-nucleus (DRif). IHC demonstrated microgliosis in and around the injection site and mHTT-positive inclusions in serotonin-producing neurons and a small percentage of astrocytes in animals injected with N171-82Q compared to controls. Moreover, N171-82Q injected mice showed a 75% reduction in cells that stained positive for the serotonin synthesis enzyme, tryptophan hydroxylase-2 (TPH2) compared to controls (p<0.05). Despite mHTT-mediated pathology in the DRv and DRif, no significant changes in depressive-like behavior were detected. Consequently, we conclude that 12 weeks of N171-82Q expression in the ventral sub-nuclei of the DRN of wildtype mice causes characteristic disease-related cellular neuropathology but is not sufficient to elicit depressive-like behaviors. Ongoing studies are investigating whether a larger injection volume that transfects a larger percentage of the DRN and/or a longer time course of mHTT expression might elicit depressive-like behaviors. Moreover, mHTT expression in other regions of the brain, such as the hippocampal dentate gyrus and/or the frontal cortex might be necessary to elicit HD depression. Together, these results may prove helpful in addressing which therapeutic and/or pharmacological strategies might be most efficacious when treating depressive symptomology in patients suffering from HD.
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Gregory S, Scahill RI, Seunarine KK, Stopford C, Zhang H, Zhang J, Orth M, Durr A, Roos RA, Langbehn DR, Long JD, Johnson H, Rees G, Tabrizi SJ, Craufurd D. Neuropsychiatry and White Matter Microstructure in Huntington's Disease. J Huntingtons Dis 2015; 4:239-49. [PMID: 26443926 PMCID: PMC4684097 DOI: 10.3233/jhd-150160] [Citation(s) in RCA: 29] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms in Huntington's disease (HD) are often evident prior to clinical diagnosis. Apathy is highly correlated with disease progression, while depression and irritability occur at different stages of the disease, both before and after clinical onset. Little is understood about the neural bases of these neuropsychiatric symptoms and to what extent those neural bases are analogous to neuropsychiatric disorders in the general population. OBJECTIVE We used Diffusion Tensor Imaging (DTI) to investigate structural connectivity between brain regions and any putative microstructural changes associated with depression, apathy and irritability in HD. METHODS DTI data were collected from 39 premanifest and 45 early-HD participants in the Track-HD study and analysed using whole-brain Tract-Based Spatial Statistics. We used regression analyses to identify white matter tracts whose structural integrity (as measured by fractional anisotropy, FA) was correlated with HADS-depression, PBA-apathy or PBA-irritability scores in gene-carriers and related to cumulative probability to onset (CPO). RESULTS For those with the highest CPO, we found significant correlations between depression scores and reduced FA in the splenium of the corpus callosum. In contrast, those with lowest CPO demonstrated significant correlations between irritability scores and widespread FA reductions. There was no significant relationship between apathy and FA throughout the whole brain. CONCLUSIONS We demonstrate that white matter changes associated with both depression and irritability in HD occur at different stages of disease progression concomitant with their clinical presentation.
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Affiliation(s)
- Sarah Gregory
- Wellcome Trust Centre for Neuroimaging, UCL, London, UK
- Institute of Cognitive Neuroscience, University College London, UK
| | - Rachael I. Scahill
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Kiran K. Seunarine
- Developmental Imaging and Biophysics Section, UCL Institute of Child Health, London, UK
| | - Cheryl Stopford
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, UCL, London, UK
| | - Jiaying Zhang
- Department of Computer Science and Centre for Medical Image Computing, UCL, London, UK
| | - Michael Orth
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Alexandra Durr
- APHP Department of Genetics, Groupe Hospitalier Pitié-Salpêtrière, and Institut du Cerveau et de la Moelle, INSERM U1127, CNRS UMR7225, Sorbonne Universités – UPMC Université Paris VI UMR_S1127, Paris, France
| | - Raymund A.C. Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Douglas R. Langbehn
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hans Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Geraint Rees
- Wellcome Trust Centre for Neuroimaging, UCL, London, UK
- Institute of Cognitive Neuroscience, University College London, UK
| | - Sarah J. Tabrizi
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - David Craufurd
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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