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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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Martinez‐Horta S, Perez‐Perez J, Perez‐Gonzalez R, Sampedro F, Horta‐Barba A, Campolongo A, Rivas‐Asensio E, Puig‐Davi A, Pagonabarraga J, Kulisevsky J. Cognitive phenotype and neurodegeneration associated with Tau in Huntington's disease. Ann Clin Transl Neurol 2024; 11:1160-1171. [PMID: 38544341 PMCID: PMC11093246 DOI: 10.1002/acn3.52031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 05/15/2024] Open
Abstract
OBJECTIVE The clinical phenotype of Huntington's disease (HD) can be very heterogeneous between patients, even when they share equivalent CAG repeat length, age, or disease burden. This heterogeneity is especially evident in terms of the cognitive profile and related brain changes. To shed light on the mechanisms participating in this heterogeneity, the present study delves into the association between Tau pathology and more severe cognitive phenotypes and brain damage in HD. METHODS We used a comprehensive neuropsychological examination to characterize the cognitive phenotype of a sample of 30 participants with early-to-middle HD for which we also obtained 3 T structural magnetic resonance image (MRI) and cerebrospinal fluid (CSF). We quantified CSF levels of neurofilament light chain (NfL), total Tau (tTau), and phosphorylated Tau-231 (pTau-231). Thanks to the cognitive characterization carried out, we subsequently explored the relationship between different levels of biomarkers, the cognitive phenotype, and brain integrity. RESULTS The results confirmed that more severe forms of cognitive deterioration in HD extend beyond executive dysfunction and affect processes with clear posterior-cortical dependence. This phenotype was in turn associated with higher CSF levels of tTau and pTau-231 and to a more pronounced pattern of posterior-cortical atrophy in specific brain regions closely linked to the cognitive processes affected by Tau. INTERPRETATION Our findings reinforce the association between Tau pathology, cognition, and neurodegeneration in HD, emphasizing the need to explore the role of Tau in the cognitive heterogeneity of the disease.
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Affiliation(s)
- Saul Martinez‐Horta
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Jesús Perez‐Perez
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Rocío Perez‐Gonzalez
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) and Instituto de Neurociencias UMH‐CSICAlicanteSpain
| | - Frederic Sampedro
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Neuroradiology unit, Radiology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Andrea Horta‐Barba
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- European Huntington's Disease Network (EHDN)
| | - Antonia Campolongo
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
| | - Elisa Rivas‐Asensio
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Arnau Puig‐Davi
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Biomedical Research Institute Sant Pau (IIB‐Sant Pau)BarcelonaSpain
- Centro de Investigación Biomédica en Red‐Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- European Huntington's Disease Network (EHDN)
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3
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Considine CM, Rossetti MA, Anderson K, Del Bene VA, Anderson SA, Celka AS, Edmondson MC, Sheese ALN, Piccolino A, Teixeira AL, Stout JC. Huntington study group's neuropsychology working group position on best practice recommendations for the clinical neuropsychological evaluation of patients with Huntington disease. Clin Neuropsychol 2024; 38:984-1006. [PMID: 37849335 DOI: 10.1080/13854046.2023.2267789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
Objective: Neuropsychological evaluation is critical to detection and management of cognitive and neuropsychiatric changes associated with Huntington disease (HD). Accurate assessment of non-motor complications of HD is critical given the prominent impact on functional disability, frequently commensurate with or exceeding that of motor symptoms. The increasing emphasis on developing disease-modifying therapies targeting cognitive decline in HD requires consensus on clinical neuropsychological assessment methods. The Neuropsychology Working Group (NPWG) of the Huntington Study Group (HSG) sought to provide evidence and consensus-based, practical guidelines for the evaluation of cognitive and neuropsychiatric symptoms associated with HD. Method: The NPWG recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to inform best practices in assessing, diagnosing, and treating the non-motor symptoms in HD. A review was circulated among the NPWG, and in an iterative process informed by reviewed literature, best practices in neuropsychological evaluation of patients with HD were identified. Results: A brief review of the available literature and rational for a clinical consensus battery is offered. Conclusion: Clinical neuropsychologists are uniquely positioned to both detect and characterize the non-motor symptoms in HD, and further, provide neurologists and allied health professions with clinically meaningful information that impacts functional outcomes and quality of life. The NPWG provides guidance on best practices to clinical neuropsychologists in this statement. A companion paper operationalizing clinical application of previous research-based non-motor diagnostic criteria for HD is forthcoming, which also advises on non-motor symptom screening methods for the non-neuropsychologist working with HD.
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Affiliation(s)
- Ciaran M Considine
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - M Agustina Rossetti
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kendra Anderson
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Sharlet A Anderson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea S Celka
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | | | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Adam Piccolino
- Psychology, Piccolino Psychological Services, Burnsville, MN, USA
| | - Antonio L Teixeira
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, and School of Psychological Science, Monash University, Melbourne, Australia
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4
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Jellinger KA. Mild cognitive impairment in Huntington's disease: challenges and outlooks. J Neural Transm (Vienna) 2024; 131:289-304. [PMID: 38265518 DOI: 10.1007/s00702-024-02744-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
Although Huntington's disease (HD) has classically been viewed as an autosomal-dominant inherited neurodegenerative motor disorder, cognitive and/or behavioral changes are predominant and often an early manifestation of disease. About 40% of individuals in the presymptomatic period of HD meet the criteria for mild cognitive impairment, later progressing to dementia. The heterogenous spectrum of cognitive decline is characterized by deficits across multiple domains, particularly executive dysfunctions, but the underlying pathogenic mechanisms are still poorly understood. Investigating the pathophysiology of cognitive changes may give insight into important and early neurodegenerative events. Multimodal imaging revealed circuit-wide gray and white matter degenerative processes in several key brain regions, affecting prefronto-striatal/cortico-basal ganglia circuits and many other functional brain networks. Studies in transgenic animal models indicated early synaptic dysfunction, deficient neurotrophic transport and other molecular changes contributing to neuronal death. Synaptopathy within the cerebral cortex, striatum and hippocampus may be particularly important in mediating cognitive and neuropsychiatric manifestations of HD, although many other neuronal systems are involved. The interaction of mutant huntingtin protein (mHTT) with tau and its implication for cognitive impairment in HD is a matter of discussion. Further neuroimaging and neuropathological studies are warranted to better elucidate early pathophysiological mechanisms and to develop validated biomarkers to detect patients' cognitive status during the early stages of the condition significantly to implement effective preventing or management strategies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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5
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Rossetti MA, Anderson KM, Hay KR, Del Bene VA, Celka AS, Piccolino A, Nelson Sheese AL, Huynh M, Zhu L, Claassen DO, Furr Stimming E, Considine CM. An Exploratory Pilot Study of Neuropsychological Performance in Two Huntington Disease Centers of Excellence Clinics. Arch Clin Neuropsychol 2024; 39:24-34. [PMID: 37530515 DOI: 10.1093/arclin/acad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To describe the characteristics of patients receiving a clinical referral for neuropsychological evaluation in two Huntington's Disease Society of America Centers of Excellence (HDSA COE). In this exploratory pilot study, we used an empirically supported clinical neuropsychological battery to assess differences in cognitive performance between premanifest and manifest HD patient groups (compared with each other and normative expectations). METHOD Clinical data from 76 adult genetically confirmed patients referred for neuropsychological evaluations was retrospectively collected from two HDSA COEs. ANOVA and Chi-square tests were used to compare variables between pre-manifest (n = 14) and manifest (n = 62) groups for demographic, cognitive, neuropsychiatric, and disease severity variables. RESULTS Our clinics serviced a disproportionate number of motor manifest patients. Six measures were excluded from analyses due to infrequent administration. The full WAIS-IV Digit Span was disproportionately administered to the manifest group. The premanifest group showed stronger cognitive performance with effect sizes in the large range on subtests of the WAIS-IV Digit Span, HVLT-R, SDMT, and verbal fluency. CONCLUSIONS This is the first study to assess an empirically supported neuropsychological research battery in a clinical setting with a relatively large sample size given the rarity of HD. The battery adequately captured areas of impairment across the disease spectrum. Application of the current battery with larger premanifest samples is warranted.
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Affiliation(s)
- M Agustina Rossetti
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Kendra M Anderson
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health, Science Center, Houston, TX 77054, USA
| | - Kaitlyn R Hay
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35244,USA
| | - Andrea S Celka
- Department of Neurology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL 35244,USA
| | - Adam Piccolino
- Piccolino Psychological Services, Burnsville, MN 55337, USA
| | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE 68198, USA
| | - Melissa Huynh
- Department of Neurology, University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Liang Zhu
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health, Science Center, Houston, TX 77054, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Erin Furr Stimming
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health, Science Center, Houston, TX 77054, USA
| | - Ciaran M Considine
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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6
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Vasilkovska T, Adhikari M, Van Audekerke J, Salajeghe S, Pustina D, Cachope R, Tang H, Liu L, Munoz-Sanjuan I, Van der Linden A, Verhoye M. Resting-state fMRI reveals longitudinal alterations in brain network connectivity in the zQ175DN mouse model of Huntington's disease. Neurobiol Dis 2023; 181:106095. [PMID: 36963694 DOI: 10.1016/j.nbd.2023.106095] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
Huntington's disease is an autosomal, dominantly inherited neurodegenerative disease caused by an expansion of the CAG repeats in exon 1 of the huntingtin gene. Neuronal degeneration and dysfunction that precedes regional atrophy result in the impairment of striatal and cortical circuits that affect the brain's large-scale network functionality. However, the evolution of these disease-driven, large-scale connectivity alterations is still poorly understood. Here we used resting-state fMRI to investigate functional connectivity changes in a mouse model of Huntington's disease in several relevant brain networks and how they are affected at different ages that follow a disease-like phenotypic progression. Towards this, we used the heterozygous (HET) form of the zQ175DN Huntington's disease mouse model that recapitulates aspects of human disease pathology. Seed- and Region-based analyses were performed at different ages, on 3-, 6-, 10-, and 12-month-old HET and age-matched wild-type mice. Our results demonstrate decreased connectivity starting at 6 months of age, most prominently in regions such as the retrosplenial and cingulate cortices, pertaining to the default mode-like network and auditory and visual cortices, part of the associative cortical network. At 12 months, we observe a shift towards decreased connectivity in regions such as the somatosensory cortices, pertaining to the lateral cortical network, and the caudate putamen, a constituent of the subcortical network. Moreover, we assessed the impact of distinct Huntington's Disease-like pathology of the zQ175DN HET mice on age-dependent connectivity between different brain regions and networks where we demonstrate that connectivity strength follows a nonlinear, inverted U-shape pattern, a well-known phenomenon of development and normal aging. Conversely, the neuropathologically driven alteration of connectivity, especially in the default mode and associative cortical networks, showed diminished age-dependent evolution of functional connectivity. These findings reveal that in this Huntington's disease model, altered connectivity starts with cortical network aberrations which precede striatal connectivity changes, that appear only at a later age. Taken together, these results suggest that the age-dependent cortical network dysfunction seen in rodents could represent a relevant pathological process in Huntington's disease progression.
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Affiliation(s)
- Tamara Vasilkovska
- Bio-Imaging Lab, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; μNEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Mohit Adhikari
- Bio-Imaging Lab, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; μNEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Johan Van Audekerke
- Bio-Imaging Lab, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; μNEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Somaie Salajeghe
- Bio-Imaging Lab, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | | | | | - Haiying Tang
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Longbin Liu
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | | | - Annemie Van der Linden
- Bio-Imaging Lab, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; μNEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Marleen Verhoye
- Bio-Imaging Lab, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; μNEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium
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7
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Horta-Barba A, Martinez-Horta S, Sampedro F, Pérez-Pérez J, Pagonabarraga J, Kulisevsky J. Structural and metabolic brain correlates of arithmetic word-problem solving in Huntington's disease. J Neurosci Res 2023; 101:990-999. [PMID: 36807154 DOI: 10.1002/jnr.25174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 02/22/2023]
Abstract
Individuals with pre-manifest and early symptomatic Huntington's disease (HD) have shown deficits in solving arithmetic word-problems. However, the neural correlates of these deficits in HD are poorly understood. We explored the structural (gray-matter volume; GMV) and metabolic (18F-FDG PET; SUVr) brain correlates of arithmetic performance using the recently developed HD-word problem arithmetic task (HD-WPA) in seventeen preHD and sixteen HD individuals. Symptomatic participants showed significantly lower scores in the HD-WPA than preHD participants. Lower performance in the HD-WPA was associated with reduced GMV in subcortical, medial frontal, and several posterior-cortical clusters in HD participants. No significant GMV loss was found in preHD participants. 18F-FDG data revealed a widespread pattern of hypometabolism in association with lower arithmetic performance in all participants. In preHD participants, this pattern was restricted to the ventrolateral and orbital prefrontal cortex, the insula, and the precentral gyrus. In HD participants, the pattern extended to several parietal-temporal regions. Word-problem solving arithmetic deficits in HD is subserved by a pattern of asynchronous metabolic and structural compromise across the cerebral cortex as a function of disease stage. In preHD individuals, arithmetic deficits were associated with prefrontal alterations, whereas in symptomatic HD patients, more severe arithmetic deficits are associated with the compromise of several frontal-subcortical and temporo-parietal regions. Our results support the hypothesis that cognitive deficits in HD are not exclusively dominated by frontal-striatal dysfunctions but also involve fronto-temporal and parieto-occipital damage.
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Affiliation(s)
- Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.,European Huntington's Disease Network (EHDN), Bellaterra, Spain
| | - Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.,European Huntington's Disease Network (EHDN), Bellaterra, Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jesús Pérez-Pérez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.,European Huntington's Disease Network (EHDN), Bellaterra, Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.,European Huntington's Disease Network (EHDN), Bellaterra, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain.,European Huntington's Disease Network (EHDN), Bellaterra, Spain
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8
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Fitzgerald ES, Stout JC, Glikmann-Johnston Y, Anderson C, Jackson ML. Sleep, Circadian Rhythms, and Cognitive Dysfunction in Huntington's Disease. J Huntingtons Dis 2023; 12:293-304. [PMID: 37599535 DOI: 10.3233/jhd-230578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND In healthy people, sleep and circadian disruption are linked to cognitive deficits. People with Huntington's disease (HD), who have compromised brain function and sleep and circadian disturbances, may be even more susceptible to these cognitive effects. OBJECTIVE To conduct a comprehensive review and synthesis of the literature in HD on the associations of cognitive dysfunction with disturbed sleep and circadian rhythms. METHODS We searched MEDLINE via OVID, CINAHL Plus, EMBASE via OVID, and PubMed in May 2023. The first author then screened by title and abstract and conducted a full review of remaining articles. RESULTS Eight studies investigating the influence of sleep and/or circadian rhythms on cognitive function in HD were found. In manifest HD, poorer sleep was associated with worse cognitive function. For behavioral 24-hour (circadian) rhythms, two studies indicated that later wake times correlated with poorer cognitive function. No reported studies in HD examined altered physiological 24-hour (circadian) rhythms and cognitive impairment. CONCLUSION Some associations exist between poor sleep and cognitive dysfunction in manifest HD, yet whether these associations are present before clinical diagnosis is unknown. Whether circadian disturbances relate to cognitive impairment in HD also remains undetermined. To inform sleep and circadian interventions aimed at improving cognitive symptoms in HD, future research should include a range of disease stages, control for external factors, and utilize robust cognitive batteries targeted to the aspects of cognitive function known to be adversely affected in HD.
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Affiliation(s)
- Emily S Fitzgerald
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Yifat Glikmann-Johnston
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Clare Anderson
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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9
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Sepers MD, Mackay JP, Koch E, Xiao D, Mohajerani MH, Chan AW, Smith-Dijak AI, Ramandi D, Murphy TH, Raymond LA. Altered cortical processing of sensory input in Huntington disease mouse models. Neurobiol Dis 2022; 169:105740. [PMID: 35460870 DOI: 10.1016/j.nbd.2022.105740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/24/2022] Open
Abstract
Huntington disease (HD), a hereditary neurodegenerative disorder, manifests as progressively impaired movement and cognition. Although early abnormalities of neuronal activity in striatum are well established in HD models, there are fewer in vivo studies of the cortex. Here, we record local field potentials (LFPs) in YAC128 HD model mice versus wild-type mice. In multiple cortical areas, limb sensory stimulation evokes a greater change in LFP power in YAC128 mice. Mesoscopic imaging using voltage-sensitive dyes reveals more extensive spread of evoked sensory signals across the cortical surface in YAC128 mice. YAC128 layer 2/3 sensory cortical neurons ex vivo show increased excitatory events, which could contribute to enhanced sensory responses in vivo. Cortical LFP responses to limb stimulation, visual and auditory input are also significantly increased in zQ175 HD mice. Results presented here extend knowledge of HD beyond ex vivo studies of individual neurons to the intact cortical network.
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Affiliation(s)
- Marja D Sepers
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - James P Mackay
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - Ellen Koch
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - Dongsheng Xiao
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - Majid H Mohajerani
- Canadian Center for Behavioural Neuroscience, University of Lethbridge, Lethbridge T1K 3M4, Canada
| | - Allan W Chan
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Amy I Smith-Dijak
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - Daniel Ramandi
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - Timothy H Murphy
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada
| | - Lynn A Raymond
- Department of Psychiatry and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T1Z3, Canada.
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10
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Abstract
OBJECTIVE This study aims to systematically review evidence of the accuracy of the Montreal Cognitive Assessment (MoCA) for evaluating the presence of cognitive impairment in patients with Huntington's disease (HD) and to outline the quality and quantity of research evidence available about the use of the MoCA in this population. METHODS We conducted a systematic literature review, searching four databases from inception until April 2020. RESULTS We identified 26 studies that met the inclusion criteria: two case-control studies comparing the MoCA to a battery of tests, three studies comparing MoCA to Mini-Mental State Examination, two studies estimating the prevalence of cognitive impairment in individuals with HD and 19 studies or clinical trials in which the MoCA was used as an instrument for the cognitive assessment of participants with HD. We found no cross-sectional studies in which participants received the index test (MoCA) and a reference standard diagnostic assessment composed of an extensive neuropsychological battery. The publication period ranged from 2010 to 2020. CONCLUSIONS In patients with HD, the MoCA provides information about disturbances in general cognitive function. Even if the MoCA demonstrated good sensitivity and specificity when used at the recommended threshold score of 26, further cross-sectional studies are required to examine the optimum cutoff score for detecting cognitive impairments in patients with HD. Moreover, more studies are necessary to determine whether the MoCA adequately assesses cognitive status in individuals with HD.
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11
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Kaye J, Reisine T, Finkbeiner S. Huntington's disease mouse models: unraveling the pathology caused by CAG repeat expansion. Fac Rev 2021; 10:77. [PMID: 34746930 PMCID: PMC8546598 DOI: 10.12703/r/10-77] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Huntington's disease (HD) is a neurodegenerative disease that results in motor and cognitive dysfunction, leading to early death. HD is caused by an expansion of CAG repeats in the huntingtin gene (HTT). Here, we review the mouse models of HD. They have been used extensively to better understand the molecular and cellular basis of disease pathogenesis as well as to provide non-human subjects to test the efficacy of potential therapeutics. The first and best-studied in vivo rodent model of HD is the R6/2 mouse, in which a transgene containing the promoter and exon 1 fragment of human HTT with 150 CAG repeats was inserted into the mouse genome. R6/2 mice express rapid, robust behavioral pathologies and display a number of degenerative abnormalities in neuronal populations most vulnerable in HD. The first conditional full-length mutant huntingtin (mHTT) mouse model of HD was the bacterial artificial chromosome (BAC) transgenic mouse model of HD (BACHD), which expresses human full-length mHTT with a mixture of 97 CAG-CAA repeats under the control of endogenous HTT regulatory machinery. It has been useful in identifying the role of mHTT in specific neuronal populations in degenerative processes. In the knock-in (KI) model of HD, the expanded human CAG repeats and human exon 1 are inserted into the mouse Htt locus, so a chimera of the full-length mouse protein with the N-terminal human portion is expressed. Many of aspects of the pathology and behavioral deficits in the KI model better mimic disease characteristics found in HD patients than other models. Accordingly, some have proposed that these mice may be preferable models of the disease over others. Indeed, as our understanding of HD advances, so will the design of animal models to test and develop HD therapies.
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Affiliation(s)
- Julia Kaye
- Center for Systems and Therapeutics, Gladstone Institutes, San Francisco, CA, USA
| | - Terry Reisine
- Independent Scientific Consultant, Santa Cruz, CA, USA
| | - Steve Finkbeiner
- Center for Systems and Therapeutics, Gladstone Institutes, San Francisco, CA, USA
- Taube/Koret Center for Neurodegenerative Disease Research, Gladstone Institutes, San Francisco, CA, USA
- Department of Neurology and Physiology, University of California, San Francisco, CA, USA
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12
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Cavallo M, Sergi A, Pagani M. Cognitive and social cognition deficits in Huntington's disease differ between the prodromal and the manifest stages of the condition: A scoping review of recent evidence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:214-241. [PMID: 34651307 DOI: 10.1111/bjc.12337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Huntington's disease (HD) is a dramatic neurodegenerative disorder encompassing severe motor symptoms coupled to significant cognitive and social cognition deficits. However, it is not clear whether and how patients' neuropsychological profile changes between the prodromal and the manifest stages of the condition. The aim of the present in-depth review is to consider cognitive and social cognition impairment in HD patients by differentiating deficits arising before diagnosis from those evident from the manifest phase onwards. METHODS Electronic databases were searched between January 1st , 2010 and December 31st , 2020 by using multiple combinations of keywords related to the investigation of neuropsychological profile in HD for preliminary search, and by defining strict selection criteria for studies to be included. RESULTS Forty-two studies were included. Evidence suggests that the neuropsychological profile in HD reflects a complex pathological spectrum of deficits. It includes impairment in the realms of executive functions, memory, attention, information processing, and social cognition. Interestingly, patients' profiles differ significantly between the manifest and the prodromal stages of their condition, not only in quantitative terms but also from a qualitative point of view. CONCLUSIONS Researchers and clinicians should thus include in clinical routine timely and specific neuropsychological assessments in order to monitor patients' cognitive status as time goes by, with the ultimate goal to implement effective clinical management strategies. PRACTITIONER POINTS The neuropsychological profile in HD encompasses a complex pathological spectrum of deficits. Patients' profiles differ significantly between the manifest and the prodromal stages of their condition. Clinicians should include in everyday practice a timely and specific neuropsychological assessment. Detecting patients' cognitive status during the early stages of the condition already can contribute significantly to implement effective clinical management strategies.
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Affiliation(s)
- Marco Cavallo
- Faculty of Psychology, eCampus University, Novedrate, Italy.,Clinical Psychology Service, Saint George Foundation, Cavallermaggiore, Italy
| | | | - Marco Pagani
- Institute of Cognitive Sciences and Technology, CNR, Rome, Italy.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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13
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Horta-Barba A, Martinez-Horta S, Perez-Perez J, Sampedro F, de Lucia N, De Michele G, Salvatore E, Kehrer S, Priller J, Migliore S, Squitieri F, Castaldo A, Mariotti C, Mañanes V, Lopez-Sendon JL, Rodriguez N, Martinez-Descals A, Júlio F, Janurio C, Delussi M, de Tommaso M, Noguera S, Ruiz-Idiago J, Sitek EJ, Wallner R, Nuzzi A, Pagonabarraga J, Kulisevsky J. Arithmetic Word-Problem Solving as Cognitive Marker of Progression in Pre-Manifest and Manifest Huntington's Disease. J Huntingtons Dis 2021; 10:459-468. [PMID: 34602494 DOI: 10.3233/jhd-210480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Arithmetic word-problem solving depends on the interaction of several cognitive processes that may be affected early in the disease in gene-mutation carriers for Huntington's disease (HD). OBJECTIVE Our goal was to examine the pattern of performance of arithmetic tasks in premanifest and manifest HD, and to examine correlations between arithmetic task performance and other neuropsychological tasks. METHODS We collected data from a multicenter cohort of 165 HD gene-mutation carriers. The sample consisted of 31 premanifest participants: 16 far-from (>12 years estimated time to diagnosis; preHD-A) and 15 close-to (≤12 years estimated time to diagnosis; preHD-B), 134 symptomatic patients (early-mild HD), and 37 healthy controls (HC). We compared performance between groups and explored the associations between arithmetic word-problem solving and neuropsychological and clinical variables. RESULTS Total arithmetic word-problem solving scores were lower in preHD-B patients than in preHD-A (p < 0.05) patients and HC (p < 0.01). Early-mild HD patients had lower scores than preHD patients (p < 0.001) and HC (p < 0.001). Compared to HC, preHD and early-mild HD participants made more errors as trial complexity increased. Moreover, arithmetic word-problem solving scores were significantly associated with measures of global cognition (p < 0.001), frontal-executive functions (p < 0.001), attention (p < 0.001) visual working memory (p < 0.001), mental rotation (p < 0.001), and confrontation naming (p < 0.05). CONCLUSION Arithmetic word-problem solving is affected early in the course of HD and is related to deficient processes in frontal-executive and mentalizing-related processes.
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Affiliation(s)
- Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Natascia de Lucia
- European Huntington's Disease Network (EHDN).,University of Naples "Federico II", Naples, Italy
| | - Giuseppe De Michele
- European Huntington's Disease Network (EHDN).,University of Naples "Federico II", Naples, Italy
| | - Elena Salvatore
- European Huntington's Disease Network (EHDN).,University of Naples "Federico II", Naples, Italy
| | - Stefanie Kehrer
- European Huntington's Disease Network (EHDN).,Department of Neuropsychiatry, Charité - Universitätsmedizin, Berlin, Germany
| | - Josef Priller
- European Huntington's Disease Network (EHDN).,Department of Neuropsychiatry, Charité - Universitätsmedizin, Berlin, Germany
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della, Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della, Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Anna Castaldo
- European Huntington's Disease Network (EHDN).,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Caterina Mariotti
- European Huntington's Disease Network (EHDN).,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Veronica Mañanes
- European Huntington's Disease Network (EHDN).,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jose Luis Lopez-Sendon
- European Huntington's Disease Network (EHDN).,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Noelia Rodriguez
- European Huntington's Disease Network (EHDN).,Department of Neurology. Fundación Jimenez Diaz, Madrid, Spain
| | - Asunción Martinez-Descals
- European Huntington's Disease Network (EHDN).,Department of Neurology. Fundación Jimenez Diaz, Madrid, Spain
| | - Filipa Júlio
- European Huntington's Disease Network (EHDN).,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Cristina Janurio
- European Huntington's Disease Network (EHDN).,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Marianna Delussi
- European Huntington's Disease Network (EHDN).,Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Marina de Tommaso
- European Huntington's Disease Network (EHDN).,Applied Neurophysiology and Pain Unit, Apulian Center for Huntington's Disease SMBNOS Department, "Aldo Moro" University, Bari, Italy
| | - Sandra Noguera
- European Huntington's Disease Network (EHDN).,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- European Huntington's Disease Network (EHDN).,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Emilia J Sitek
- European Huntington's Disease Network (EHDN).,Department of Neurological and Psychiatric Nursing, Faculty of Health Science, Medical University of Gdansk, Gdańsk, Poland.,Department of Neurology, St. Adalbert Hospital, Gdańsk, Poland
| | - Renata Wallner
- Department of Psychiatry, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,European Huntington's Disease Network (EHDN)
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14
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Glikmann-Johnston Y, Mercieca EC, Carmichael AM, Alexander B, Harding IH, Stout JC. Hippocampal and striatal volumes correlate with spatial memory impairment in Huntington's disease. J Neurosci Res 2021; 99:2948-2963. [PMID: 34516012 DOI: 10.1002/jnr.24966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/19/2021] [Accepted: 08/28/2021] [Indexed: 02/06/2023]
Abstract
Spatial memory impairments are observed in people with Huntington's disease (HD), however, the domain of spatial memory has received little focus when characterizing the cognitive phenotype of HD. Spatial memory is traditionally thought to be a hippocampal-dependent function, while the neuropathology of HD centers on the striatum. Alongside spatial memory deficits in HD, recent neurocognitive theories suggest that a larger brain network is involved, including the striatum. We examined the relationship between hippocampal and striatal volumes and spatial memory in 36 HD gene expansion carriers, including premanifest (n = 24) and early manifest HD (n = 12), and 32 matched healthy controls. We assessed spatial memory with Paired Associates Learning, Rey-Osterrieth Complex Figure Test, and the Virtual House task, which assesses three components of spatial memory: navigation, object location, and plan drawing. Caudate nucleus, putamen, and hippocampal volumes were manually segmented on T1-weighted MR images. As expected, caudate nucleus and putamen volumes were significantly smaller in the HD group compared to controls, with manifest HD having more severe atrophy than the premanifest HD group. Hippocampal volumes did not differ significantly between HD and control groups. Nonetheless, on average, the HD group performed significantly worse than controls across all spatial memory tasks. The spatial memory components of object location and recall of figural and topographical drawings were associated with striatal and hippocampal volumes in the HD cohort. We provide a case to include spatial memory impairments in the cognitive phenotype of HD, and extend the neurocognitive picture of HD beyond its primary pathology within the striatum.
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Affiliation(s)
- Yifat Glikmann-Johnston
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Emily-Clare Mercieca
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Anna M Carmichael
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bonnie Alexander
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Neurosurgery, Royal Children's Hospital, Parkville, VIC, Australia
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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15
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Tan B, Shishegar R, Poudel GR, Fornito A, Georgiou-Karistianis N. Cortical morphometry and neural dysfunction in Huntington's disease: a review. Eur J Neurol 2020; 28:1406-1419. [PMID: 33210786 DOI: 10.1111/ene.14648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/22/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023]
Abstract
Numerous neuroimaging techniques have been used to identify biomarkers of disease progression in Huntington's disease (HD). To date, the earliest and most sensitive of these is caudate volume; however, it is becoming increasingly evident that numerous changes to cortical structures, and their interconnected networks, occur throughout the course of the disease. The mechanisms by which atrophy spreads from the caudate to these cortical regions remains unknown. In this review, the neuroimaging literature specific to T1-weighted and diffusion-weighted magnetic resonance imaging is summarized and new strategies for the investigation of cortical morphometry and the network spread of degeneration in HD are proposed. This new avenue of research may enable further characterization of disease pathology and could add to a suite of biomarker/s of disease progression for patient stratification that will help guide future clinical trials.
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Affiliation(s)
- Brendan Tan
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Rosita Shishegar
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Australian e-Health Research Centre, CSIRO, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Melbourne, VIC, Australia
| | - Govinda R Poudel
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Sydney Imaging, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Catholic University, Melbourne, VIC, Australia
| | - Alex Fornito
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Melbourne, VIC, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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16
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Martinez-Horta S, Sampedro F, Horta-Barba A, Perez-Perez J, Pagonabarraga J, Gomez-Anson B, Kulisevsky J. Structural brain correlates of dementia in Huntington's disease. NEUROIMAGE-CLINICAL 2020; 28:102415. [PMID: 32979842 PMCID: PMC7519361 DOI: 10.1016/j.nicl.2020.102415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023]
Abstract
Dementia may occur in the early stages of HD and with independence of disease burden. More severe posterior-cortical atrophy is associated with dementia in HD. Neuropsychological alterations of dementia in HD extends beyond executive dysfunction. CAG-independent neuropathological mechanisms may contribute to dementia in HD.
Background Huntington’s disease (HD) is a fatal genetic neurodegenerative disorder with no effective treatment currently available. Progressive basal ganglia and whole-brain atrophy and concurrent cognitive deterioration are prototypical aspects of HD. However, the specific patterns of brain atrophy underlying cognitive impairment of different severity in HD are poorly understood. The aim of this study was to investigate the specific structural brain correlates of major cognitive deficits in HD and to explore its association with neuropsychological indicators. Participants Thirty-five symptomatic early-to-mild HD patients and 15 healthy controls (HC) with available T1-MRI imaging were included in this study. Methods In this cross-sectional study, HD patients were classified as patients with (HD-Dem) and without (HD-ND) major cognitive impairment in the range of dementia. This classification was based on previously validated PD-CRS cutoff scores for HD. Differences in brain atrophy across groups were studied by means of grey-matter volume voxel-based morphometry (GMV-VBM) and cortical thickness (Cth). Voxelwise and vertexwise general linear models were used to assess the group comparisons, controlling for the effects of age, sex, education, CAG repeat length and severity of motor symptoms. Clusters surviving p < 0.05 and family-wise error (FWE) correction were considered statistically significant. In order to characterize the impact on cognitive performance of the observed brain differences across groups, GMV and Cth values in the set of significant regions were computed and correlated with specific neuropsychological tests. Results All groups had similar sociodemographic profiles, and the HD groups did not significantly differ in terms of CAG repeat length. Compared to HC, both HD groups exhibited significant atrophy in multiple subcortical and parietal brain regions. However, compared to HC and HD-ND groups, HD-Dem patients showed a more prominent pattern of reduced GMV and cortical thinning. Importantly, this thinning was restricted to regions of the parietal-temporal and occipital cortices. Furthermore, these brain alterations were further associated with poorer cognitive performance in tasks assessing frontal-executive and attention domains as well as memory, language and constructional abilities. Conclusions Major cognitive impairment in the range of dementia in HD is associated with brain and cognitive alterations exceeding the prototypical frontal-executive deficits commonly recognized in HD. The observed posterior-cortical damage identified by MRI and its association with memory, language, and visuoconstructive dysfunction suggest a strong involvement of extra-striatal atrophy in the onset of severe cognitive dysfunction in HD patients. Critically, major cognitive impairment in this sample was not associated with CAG repeat length, age or education. This finding could support a possible involvement of additional neuropathological mechanisms aggravating cognitive deterioration in HD.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; European Huntington's Disease Network (EHDN), Spain
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain
| | - Beatriz Gomez-Anson
- Neuroradiology, Radiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Autonomous University of Barcelona, Department of Medicine, Spain; European Huntington's Disease Network (EHDN), Spain.
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17
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Nasr S, Rosas HD. Impact of Huntington's Disease on Mental Rotation Performance in Motor Pre-Symptomatic Individuals. J Huntingtons Dis 2020; 8:339-356. [PMID: 31306138 DOI: 10.3233/jhd-190348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Huntington's disease (HD) is a genetic disorder known for affecting motor control. Despite evidence for the impact of HD on visual cortico-striatal loops, evidence for impaired visual perception in early symptomatic HD patients is limited; much less is known about what happens during the HD prodrome. OBJECTIVE The goals of this study were to evaluate perceptual processing in motor pre-manifest HD gene-carriers (Pre-HDs) during a visual mental rotation task. METHODS To achieve this goal, 79 participants including 24 Pre-HD participants and 55 healthy matched controls were scanned using functional MRI as they performed a mental rotation task. Another group of 36 subjects including 15 pre-HDs and 21 healthy age/gender matched controls participated in a control behavioral test of judgment of line orientation outside the scanner. RESULTS We found that, although Pre-HDs (in this stage of disease) did not demonstrate slower response times, their response accuracy was lower than controls. On the fMRI task, controls showed a significant decrease in activity in the occipito-temporal (OT) visual network and increase in activity in the caudo-fronto-parietal (CFP) network with mental rotation load. Interestingly, the amount of mental rotation-related activity decrease in the OT network was reduced in Pre-HDs compared to controls while, the level of CFP response remained unchanged between the two groups. Comparing the link between the evoked BOLD activity within these networks and response accuracy (i.e., behavior), we found that the models fit to data from controls were less accurate in predicting response accuracy of Pre-HDs. CONCLUSION These findings provide some of the earliest functional evidence of impaired visual processing and altered neural processing underlying visual perceptual decision making during the HD prodrome.
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Affiliation(s)
- Shahin Nasr
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Herminia D Rosas
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Boston, MA, USA
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18
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Tang BL. Could metformin be therapeutically useful in Huntington's disease? Rev Neurosci 2020; 31:297-317. [PMID: 31751298 DOI: 10.1515/revneuro-2019-0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
Emerging evidence suggest that dimethylbiguanide (metformin), a first-line drug for type 2 diabetes mellitus, could be neuroprotective in a range of brain pathologies, which include neurodegenerative diseases and brain injury. However, there are also contraindications that associate metformin treatment with cognitive impairment as well as adverse outcomes in Alzheimer's disease and Parkinson's disease animal models. Recently, a beneficial effect of metformin in animal models of Huntington's disease (HD) has been strengthened by multiple reports. In this brief review, the findings associated with the effects of metformin in attenuating neurodegenerative diseases are discussed, focusing on HD-associated pathology and the potential underlying mechanisms highlighted by these studies. The mechanism of action of metformin is complex, and its therapeutic efficacy is therefore expected to be dependent on the disease context. The key metabolic pathways that are effectively affected by metformin, such as AMP-activated protein kinase activation, may be altered in the later decades of the human lifespan. In this regard, metformin may nonetheless be therapeutically useful for neurological diseases with early pathological onsets, such as HD.
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Affiliation(s)
- Bor Luen Tang
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, Singapore 117596, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Medical Drive, Singapore 119077, Singapore
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19
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Coppen EM, Jacobs M, van der Zwaan KF, Middelkoop HAM, Roos RAC. Visual Object Perception in Premanifest and Early Manifest Huntington's Disease. Arch Clin Neuropsychol 2020; 34:1320-1328. [PMID: 30796801 PMCID: PMC7227804 DOI: 10.1093/arclin/acz002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/31/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE In Huntington's disease (HD), a hereditary neurodegenerative disorder, cognitive impairment in early disease stages mainly involves executive dysfunction. However, visual cognitive deficits have additionally been reported and are of clinical relevance given their influence on daily life and overall cognitive performance. This study aimed to assess visual perceptual skills in HD gene carriers. METHODS Subtasks of the Visual Object and Space Perception battery and Groningen Intelligence Test were administered in 62 participants (18 healthy controls, 22 participants with a genetic confirmation of HD without symptoms, i.e., premanifest HD, and 22 participants with a genetic confirmation of HD with symptoms, i.e., manifest HD). Group differences in task performance were measured using analysis of covariance with and without correction for age. Receiver Operating Characteristics (ROC) analysis was performed to examine which task best discriminated between groups and cut-off scores were provided. RESULTS Manifest HD performed significantly worse compared to both controls and premanifest HD on all visual perceptional tasks. Premanifest HD did not differ in task performance from controls. Besides the Shape Detection, all tasks were robust in discriminating between groups. The Animal Silhouettes test was most accurate in discriminating manifest HD from premanifest HD (AUC = 0.90, SE = 0.048, p < .001). CONCLUSION Visual perceptual deficits are present in early manifest HD, especially an impaired recognition of animals and objects from sketched silhouettes, and not in premanifest HD. This suggests that decline in visual processing only occurs in clinical disease stages. The visual cognitive battery, especially the Silhouettes tasks used in this study is sensitive in discriminating manifest HD from premanifest HD and controls.
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Affiliation(s)
- Emma M Coppen
- Department of Neurology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands
| | - Milou Jacobs
- Department of Neurology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands
| | - Kasper F van der Zwaan
- Department of Neurology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands
| | - Huub A M Middelkoop
- Department of Clinical Neuropsychology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands.,Department of Psychology, Leiden University, 2300 RB, Leiden, the Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, 2333 ZA, Leiden, the Netherlands
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20
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Martinez-Horta S, Horta-Barba A, Perez-Perez J, Sampedro F, de Lucia N, De Michele G, Kehrer S, Priller J, Migliore S, Squitieri F, Castaldo A, Mariotti C, Mañanes V, Lopez-Sendon JL, Rodriguez N, Martinez-Descals A, Garcia-Ruiz P, Júlio F, Januário C, Delussi M, de Tommaso M, Noguera S, Ruiz-Idiago J, Sitek EJ, Nuzzi A, Pagonabarraga J, Kulisevsky J. Utility of the Parkinson's disease-Cognitive Rating Scale for the screening of global cognitive status in Huntington's disease. J Neurol 2020; 267:1527-1535. [PMID: 32030521 DOI: 10.1007/s00415-020-09730-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive impairment is an essential feature of Huntington's disease (HD) and dementia is a predictable outcome in all patients. However, validated instruments to assess global cognitive performance in the field of HD are lacking. OBJECTIVES We aimed to explore the utility of the Parkinson's disease-Cognitive Rating Scale (PD-CRS) for the screening of global cognition in HD. METHODS A multicenter cohort of 132 HD patients at different disease stages and 33 matched healthy controls were classified as having preserved cognition, mild cognitive impairment (HD-MCI) or dementia (HD-Dem) according to the Clinical Dementia Rating and Functional Independence Score. The PD-CRS and the Mini-Mental State Examination were administered. Receiver operating characteristic curve analysis was used to determine optimal cutoffs to differentiate patients according to their cognitive status. RESULTS A PD-CRS cutoff score ≤ 81/82 was optimal to detect HD-MCI (sensitivity = 93%; specificity = 80%; area under the curve (AUC) = 0.940), and ≤ 63/64 was optimal to detect HD-Dem (sensitivity = 90%; specificity = 87%; AUC = 0.933). MMSE scores failed to show robust psychometric properties in this context. DISCUSSION The PD-CRS is a valid and reliable instrument to assess global cognition in HD in routine clinical care and clinical trials.
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Affiliation(s)
- Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Natascia de Lucia
- European Huntington's Disease Network (EHDN), Ulm, Germany.,University of Naples "Federico II", Naples, Italy
| | - Giuseppe De Michele
- European Huntington's Disease Network (EHDN), Ulm, Germany.,University of Naples "Federico II", Naples, Italy
| | - Stefanie Kehrer
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neuropsychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Josef Priller
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neuropsychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Anna Castaldo
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Caterina Mariotti
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Veronica Mañanes
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jose Luis Lopez-Sendon
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Noelia Rodriguez
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Asunción Martinez-Descals
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Pedro Garcia-Ruiz
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurology, Fundación Jimenez Diaz, Madrid, Spain
| | - Filipa Júlio
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal
| | - Cristina Januário
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Neurology Department, Coimbra University Hospital, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research - CIBIT, University of Coimbra, Coimbra, Portugal
| | - Marianna Delussi
- European Huntington's Disease Network (EHDN), Ulm, Germany.,SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- European Huntington's Disease Network (EHDN), Ulm, Germany.,SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Sandra Noguera
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Hospital Mare de Deu de la Mercè, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Emilia J Sitek
- European Huntington's Disease Network (EHDN), Ulm, Germany.,Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland.,Department of Neurology, St. Adalbert Hospital, Copernicus, PL, Gdańsk, Poland
| | - Angela Nuzzi
- European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,European Huntington's Disease Network (EHDN), Ulm, Germany
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain. .,Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain. .,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain. .,Autonomous University of Barcelona, Barcelona, Spain. .,European Huntington's Disease Network (EHDN), Ulm, Germany.
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21
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Martínez-Horta S, Horta-Barba A, Perez-Perez J, Antoran M, Pagonabarraga J, Sampedro F, Kulisevsky J. Impaired face-like object recognition in premanifest Huntington's disease. Cortex 2019; 123:162-172. [PMID: 31794910 DOI: 10.1016/j.cortex.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/02/2019] [Accepted: 10/22/2019] [Indexed: 11/15/2022]
Abstract
Progressive striatal atrophy has long been considered the pathological hallmark of Huntington's disease (HD), but is it now recognized that malfunction and degeneration of posterior-cortical territories are also prominent characteristics of the disease. The limited knowledge about the functional impact of these posterior-cortical changes could be partially attributed to the lack of sensitive measures to capture them. We hypothesized that early malfunction of specific territories of the ventral visual pathway in premanifest HD would lead to difficulties in the recognition of complex stimuli and to differences in their neurophysiological correlates. To test this idea, we used an object, face and face-like object recognition task to be conducted during an electroencephalographic recording. Compared to healthy-matched controls, premanifest participants showed a significantly increased number of recognition errors in the face-like object condition. Moreover, premanifest participants showed a dramatic decrease in the N170 component elicited for the face-like objects. This N170 decrease was significantly associated with the number of recognition errors and with severity of apathy and global cognitive performance. The lack of differences in other clinical and cognitive measures supports a selective deficit in recognition of face-like objects and their neurophysiological correlates in premanifest HD. These deficits occurred in participants up to 15 years before the estimated time to disease onset and correlated strongly with cognitive and behavioral measures known to be sensitive to HD progression. This finding highlights the existence of selective visuoperceptive deficits years before motor-based onset of HD and emphasizes the need to develop sensitive measures to capture early visual system changes in this population. Assessing the integrity of the visual cortex and its related functions in HD could help to identify early markers of disease progression.
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Affiliation(s)
- Saul Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany
| | - Jesús Perez-Perez
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany
| | - Mizar Antoran
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Autonomous University of Barcelona, Spain; European Huntington's Disease Network (EHDN), Germany.
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22
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Julayanont P, McFarland NR, Heilman KM. Mild cognitive impairment and dementia in motor manifest Huntington's disease: Classification and prevalence. J Neurol Sci 2019; 408:116523. [PMID: 31678902 DOI: 10.1016/j.jns.2019.116523] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/11/2019] [Accepted: 10/04/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To identify the characteristics and prevalence of mild cognitive impairment in patients with motor-manifest Huntington's disease (HD) and to propose a new mild cognitive impairment (HD-MCI) classification for HD. METHODS We included 307 motor-manifest HD participants from the ENROLL-HD study who completed the evaluation in four neurocognitive domains including executive functions, processing speed, language, and memory. Cognitive impairment in each domain was determined by age- and education-adjusted cutoffs (> 1.5 standard deviations below the mean). HD-MCI was defined as an impairment in at least one cognitive domain without a loss of functional independence (Function Independence Scale, FIS ≥85). Dementia (HD-Dem) was defined as at least two domains of cognitive impairment with functional impairment (FIS ≤80). RESULTS At the onset of motor symptoms, MCI was present in 84% and dementia in 5% of patients. After 5 years of motor symptoms, 24% of participants met the criteria for MCI and 69% for dementia. Executive dysfunction was the most common impairment, being present in 70% of participants, followed by slowed processing speed in 67%. Language impairment was reported in 55% and memory deficits in 53%. MCI subtypes were classified as "Executive-predominant" (executive impairment and slowed processing speed), "Representational-predominant" (impaired language and memory) and "Mixed Executive-Representational". Executive-predominant MCI comprised 30%, Representational-predominant 15% and Mixed 55% of this cohort. CONCLUSION MCI is highly prevalent in the early stage of motor-manifest HD. Three MCI subgroups are defined suggesting at the earlier stage of this disease the frontal-striatal-executive and/or the temporoparietal-representational functional network can be impaired.
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Affiliation(s)
- Parunyou Julayanont
- Division of Behavioral and Cognitive Neurology, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Nikolaus R McFarland
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Kenneth M Heilman
- Division of Behavioral and Cognitive Neurology, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA.
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23
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Harris KL, Armstrong M, Swain R, Erzinclioglu S, Das T, Burgess N, Barker RA, Mason SL. Huntington's disease patients display progressive deficits in hippocampal-dependent cognition during a task of spatial memory. Cortex 2019; 119:417-427. [PMID: 31499434 DOI: 10.1016/j.cortex.2019.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cognitive disturbances occur early in Huntington's disease (HD) and place a significant burden on the lives of patients and family members. Whilst these impairments are typically attributed to deterioration of the frontal-striatal pathways, accumulating evidence suggests that hippocampal dysfunction may also contribute to such impairments. Here, we employ a novel spatial memory task that has previously been shown to elicit impairments in individuals with focal hippocampal lesions, as a means to further investigate the role of hippocampal dysfunction in HD. METHOD Sixty-four individuals participated in the study, including 32 healthy controls, 11 patients with diagnosed HD and 16 premanifest HD gene carriers. We also included an additional control group of 5 individuals with focal unilateral basal ganglia lesions. Participants undertook a task that measured perception and short-term spatial memory using computer-generated visual scenes. RESULTS HD patients experienced significant impairments in spatial perception and memory, which strongly correlated with disease burden score (DBS). Premanifest gene carriers performed at a similar level to healthy controls throughout all aspects of the task indicating that the effects seen in the HD patients represent a deterioration in function. Interestingly, basal ganglia lesion patients were not impaired in any aspects of the task. CONCLUSION There is evidence of significant deficits in hippocampal-dependent spatial cognition in HD that cannot be explained as a function of degeneration to the basal ganglia. The impairments were greatest in individuals with higher DBSs, suggesting that deficits relate to the disease process in HD.
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Affiliation(s)
- Kate L Harris
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
| | - Matthew Armstrong
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Rachel Swain
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Sharon Erzinclioglu
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tilak Das
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Neil Burgess
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK; Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, MRC-WT Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Sarah L Mason
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
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24
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Glikmann-Johnston Y, Carmichael AM, Mercieca EC, Stout JC. 'Real-life' hippocampal-dependent spatial memory impairments in Huntington's disease. Cortex 2019; 119:46-60. [PMID: 31071556 DOI: 10.1016/j.cortex.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/28/2019] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
Hippocampal-dependent spatial memory impairments are seen in Huntington's disease animal models. Similar impairments were recently reported in Huntington's disease participants on analogous spatial memory tasks (e.g., virtual Morris Water Maze), however, these tasks do not translate well to the range of functions involved in day-to-day spatial cognition. In this study we examined 'real-life' hippocampal-dependent spatial memory in Huntington's disease participants. We studied premanifest Huntington's disease (N = 24), early manifest Huntington's disease (N = 14), and matched healthy controls (N = 33) with a virtual environment, which demanded spatial memory function on three levels: navigation, object location, and plan drawing. To examine the case for hippocampal-dependent spatial memory more closely, we compared the performance of our Huntington's disease participants to that of a group of temporal lobe epilepsy patients (N = 30) who were previously tested on the virtual environment. Spatial memory performance was also compared to two common neuropsychological tests of spatial cognition, the Paired Associates Learning from the Cambridge Neuropsychological Automated Test Battery, and the Rey-Osterrieth Complex Figure Test. People with early manifest Huntington's disease were impaired across all spatial memory tasks. Premanifest Huntington's disease participants were most notably impaired on the object location measure of the virtual environment, which is heavily dependent on hippocampal function, but showed no such impairments on the Paired Associates Learning or the Rey-Osterrieth Complex Figure Test. Object location memory and navigation performance did not differ between people with Huntington's disease and temporal lobe epilepsy. Aligned with studies in Huntington's disease animal models, 'real-life' spatial memory is impaired in people with Huntington's disease prior to clinical diagnosis. This alignment has important implications for testing treatments for Huntington's disease. From the standpoint of neurodegeneration, the dependence of our spatial memory measures on hippocampal function extends the focus of cognitive assessment research in Huntington's disease beyond its primary pathology within the striato-frontal circuit.
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Affiliation(s)
- Yifat Glikmann-Johnston
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
| | - Anna M Carmichael
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Emily-Clare Mercieca
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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25
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Espinoza FA, Liu J, Ciarochi J, Turner JA, Vergara VM, Caprihan A, Misiura M, Johnson HJ, Long JD, Bockholt JH, Paulsen JS, Calhoun VD. Dynamic functional network connectivity in Huntington's disease and its associations with motor and cognitive measures. Hum Brain Mapp 2019; 40:1955-1968. [PMID: 30618191 PMCID: PMC6865767 DOI: 10.1002/hbm.24504] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 02/03/2023] Open
Abstract
Dynamic functional network connectivity (dFNC) is an expansion of traditional, static FNC that measures connectivity variation among brain networks throughout scan duration. We used a large resting-state fMRI (rs-fMRI) sample from the PREDICT-HD study (N = 183 Huntington disease gene mutation carriers [HDgmc] and N = 78 healthy control [HC] participants) to examine whole-brain dFNC and its associations with CAG repeat length as well as the product of scaled CAG length and age, a variable representing disease burden. We also tested for relationships between functional connectivity and motor and cognitive measurements. Group independent component analysis was applied to rs-fMRI data to obtain whole-brain resting state networks. FNC was defined as the correlation between RSN time-courses. Dynamic FNC behavior was captured using a sliding time window approach, and FNC results from each window were assigned to four clusters representing FNC states, using a k-means clustering algorithm. HDgmc individuals spent significantly more time in State-1 (the state with the weakest FNC pattern) compared to HC. However, overall HC individuals showed more FNC dynamism than HDgmc. Significant associations between FNC states and genetic and clinical variables were also identified. In FNC State-4 (the one that most resembled static FNC), HDgmc exhibited significantly decreased connectivity between the putamen and medial prefrontal cortex compared to HC, and this was significantly associated with cognitive performance. In FNC State-1, disease burden in HDgmc participants was significantly associated with connectivity between the postcentral gyrus and posterior cingulate cortex, as well as between the inferior occipital gyrus and posterior parietal cortex.
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Affiliation(s)
- Flor A. Espinoza
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Jingyu Liu
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Jennifer Ciarochi
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
| | - Jessica A. Turner
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
| | - Victor M. Vergara
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Arvind Caprihan
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Maria Misiura
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
| | - Hans J. Johnson
- Department of Electrical and Computer EngineeringUniversity of IowaIowa CityIowa
- Department of PsychiatryUniversity of IowaIowa CityIowa
| | - Jeffrey D. Long
- Department of PsychiatryUniversity of IowaIowa CityIowa
- Department of BiostatisticsUniversity of IowaIowa CityIowa
| | - Jeremy H. Bockholt
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | | | - Vince D. Calhoun
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
- Department of Electrical and Computer EngineeringUniversity of New MexicoAlbuquerqueNew Mexico
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26
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Dhalla A, Pallikadavath S, Hutchinson CV. Visual Dysfunction in Huntington's Disease: A Systematic Review. J Huntingtons Dis 2019; 8:233-242. [PMID: 30932892 DOI: 10.3233/jhd-180340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is well-documented that patients with Huntington's disease (HD) exhibit specific deficits in visual cognition. A less well-documented literature also exists that suggests people with HD experience a number of disease-related changes to more rudimentary sensory visual processing. Here, we review evidence for the effects of HD on the integrity of the early visual pathways in humans along with changes to low-level visual sensitivity. We find evidence for reduced structural and functional integrity of the visual pathways, marked by retinal thinning, reduced VEP amplitude, and cell loss and thinning in visual cortex. We also find evidence of visual perceptual deficits, particularly for colour and motion. We suggest that future studies with well-defined HD and HD-related groups in appropriate numbers that systematically examine the relationship between structural changes to the visual system, basic visual perceptual deficits and disease stage/severity are therefore likely to yield promising results.
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Affiliation(s)
- Amit Dhalla
- School of Medicine, College of Life Sciences, University of Leicester, Leicester, UK
| | - Susil Pallikadavath
- School of Medicine, College of Life Sciences, University of Leicester, Leicester, UK
| | - Claire V Hutchinson
- Department of Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
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27
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Purcell NL, Goldman JG, Ouyang B, Bernard B, O'Keefe JA. The Effects of Dual-Task Cognitive Interference and Environmental Challenges on Balance in Huntington's Disease. Mov Disord Clin Pract 2019; 6:202-212. [PMID: 30949551 PMCID: PMC6417749 DOI: 10.1002/mdc3.12720] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Huntington's disease (HD) is characterized by chorea, balance and gait impairments, and cognitive deficits, which increase fall risk. Dual task (DT) and environmentally challenging paradigms reflect balance related to everyday life. Furthermore, the impact of cognitive deficits on balance dysfunction and falls in HD is unknown. OBJECTIVE To determine the impact of DT interference, sensory feedback, and cognitive performance on balance and falls in HD. METHODS Seventeen participants with HD (55 ± 9.7 years) and 17 age-matched controls (56.5 ± 9.3 years) underwent quantitative balance testing with APDM inertial sensors. Postural sway was assessed during conditions of manipulated stance, vision, proprioception, and cognitive demand. The DT was a concurrent verbal fluency task. Neuropsychological assessments testing multiple cognitive domains were also administered. RESULTS HD participants exhibited significantly greater total sway area, jerk, and variability under single-task (ST) and DT conditions compared to controls (P = 0.0002 - < 0.0001). They also demonstrated greater DT interference with vision removed for total sway area (P = 0.01) and variability (P = 0.02). Significantly worse postural control was observed in HD with vision removed and reduced proprioception (P = 0.001 - 0.01). Decreased visuospatial performance correlated with greater total sway and jerk (P = 0.01; 0.009). No balance parameters correlated with retrospective falls in HD. CONCLUSIONS HD participants have worse postural control under DT, limited proprioception/vision, and greater DT interference with a narrowed base and no visual input. These findings may have implications for designing motor and cognitive strategies to improve balance in HD.
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Affiliation(s)
| | - Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
| | - Bichun Ouyang
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
| | - Bryan Bernard
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
| | - Joan A. O'Keefe
- Department of Cell and Molecular MedicineRush University Medical CenterChicagoILUSA
- Department of Neurological Sciences, Section of Parkinson Disease and Movement DisordersRush University Medical CenterChicagoILUSA
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Spatial memory in Huntington’s disease: A comparative review of human and animal data. Neurosci Biobehav Rev 2019; 98:194-207. [DOI: 10.1016/j.neubiorev.2019.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/26/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
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Cortical atrophic-hypometabolic dissociation in the transition from premanifest to early-stage Huntington’s disease. Eur J Nucl Med Mol Imaging 2019; 46:1111-1116. [DOI: 10.1007/s00259-018-4257-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/27/2018] [Indexed: 02/05/2023]
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30
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Neural Correlates of Cognitive Impairment in Parkinson's Disease: A Review of Structural MRI Findings. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 144:1-28. [DOI: 10.1016/bs.irn.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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31
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Coppen EM, van der Grond J, Hafkemeijer A, Barkey Wolf JJH, Roos RAC. Structural and functional changes of the visual cortex in early Huntington's disease. Hum Brain Mapp 2018; 39:4776-4786. [PMID: 30144208 PMCID: PMC6866293 DOI: 10.1002/hbm.24322] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 01/13/2023] Open
Abstract
Huntington's disease (HD) is an autosomal-dominant inherited neurodegenerative disorder characterized by motor disturbances, psychiatric disturbances, and cognitive impairment. Visual cognitive deficits and atrophy of the posterior cerebral cortex are additionally present in early disease stages. This study aimed to assess the extent of structural and functional brain alterations of the visual cortex in HD gene carriers using different neuroimaging modalities. Structural and functional magnetic resonance imaging data were acquired from 18 healthy controls, 21 premanifest, and 20 manifest HD gene carriers. Voxel-based morphometry (VBM) analysis and cortical thickness measurements were performed to assess structural changes in the visual cortex. Brain function was measured by assessing neuronal connectivity changes in response to visual stimulation and at rest in visual resting-state networks. Multiple linear regression analyses were performed to examine the relationship between visual cognitive function and structural imaging measures. Compared to controls, pronounced atrophy and decreased neuronal function at rest were present in associative visual cortices in manifest HD. The primary visual cortex did not show group differences in cortical thickness and in vascular activity after visual stimulation. Thinning of the associative visual cortex was related to worse visual perceptual function. Premanifest HD gene carriers did not show any differences in brain structure or function compared to controls. This study improves the knowledge on posterior brain changes in HD, as our findings suggest that the primary visual cortex remains preserved, both structurally and functionally, while atrophy of associative visual cortices is present in early HD and linked to clinical visual deficits.
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Affiliation(s)
- Emma M. Coppen
- Department of NeurologyLeiden University Medical CenterLeidenthe Netherlands
| | | | - Anne Hafkemeijer
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Methodology and Statistics, Institute of PsychologyLeiden UniversityLeidenthe Netherlands
- Leiden Institute for Brain and CognitionLeiden UniversityLeidenthe Netherlands
| | - Jurriaan J. H. Barkey Wolf
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Molecular EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Raymund A. C. Roos
- Department of NeurologyLeiden University Medical CenterLeidenthe Netherlands
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Arnoux I, Willam M, Griesche N, Krummeich J, Watari H, Offermann N, Weber S, Narayan Dey P, Chen C, Monteiro O, Buettner S, Meyer K, Bano D, Radyushkin K, Langston R, Lambert JJ, Wanker E, Methner A, Krauss S, Schweiger S, Stroh A. Metformin reverses early cortical network dysfunction and behavior changes in Huntington's disease. eLife 2018; 7:38744. [PMID: 30179155 PMCID: PMC6156080 DOI: 10.7554/elife.38744] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/02/2018] [Indexed: 12/25/2022] Open
Abstract
Catching primal functional changes in early, ‘very far from disease onset’ (VFDO) stages of Huntington’s disease is likely to be the key to a successful therapy. Focusing on VFDO stages, we assessed neuronal microcircuits in premanifest Hdh150 knock-in mice. Employing in vivo two-photon Ca2+ imaging, we revealed an early pattern of circuit dysregulation in the visual cortex - one of the first regions affected in premanifest Huntington’s disease - characterized by an increase in activity, an enhanced synchronicity and hyperactive neurons. These findings are accompanied by aberrations in animal behavior. We furthermore show that the antidiabetic drug metformin diminishes aberrant Huntingtin protein load and fully restores both early network activity patterns and behavioral aberrations. This network-centered approach reveals a critical window of vulnerability far before clinical manifestation and establishes metformin as a promising candidate for a chronic therapy starting early in premanifest Huntington’s disease pathogenesis long before the onset of clinical symptoms. Huntington’s disease is a devastating brain disorder that causes severe mood disorders, problems with moving, and dementia. Most people develop the condition between their thirties and fifties, and die a decade or two after the symptoms first appear. The disease emerges because of a mutation in the gene for the Huntingtin protein, which leads to neurons slowly dying in the brain. While genetic testing can reveal who carries the faulty gene, no treatment addresses the root of the disorder or prevents it from appearing. Instead, most therapies for Huntington’s disease aim to reduce brain damage once the telltale symptoms are already present. However, the disease-causing protein is expressed early during the life of a patient, which could give it time to damage the brain long before neurons die and the disorder reveals itself. Treatments that start after the first signs of the disease may be too late to reverse the damage. Detecting and preventing early brain changes in people that carry the mutation may thus help to stop the disease from progressing. Here, Arnoux, Willam, Griesche et al. set out to detect the minute changes that the faulty Huntingtin protein may cause in the brain network of young mice with the mutation. State-of-the-art imaging tools helped to examine individual neurons in the brain area that processes visual information. These experiments revealed that a group of brain cells had become hyperactive; once this change had occurred, the mutant animals were less anxious than is typical for mice. Metformin is a drug used to treat diabetes, but it also interferes with a structure that is required to produce the disease-causing Huntingtin protein. Arnoux et al. therefore explored whether the compound could rescue the early brain alterations observed in mutant mice. Adding metformin in the water of the animals for three weeks halted the production of the mutant protein, reversed the brain changes and stopped the abnormal behavior. Further work is now required in humans to confirm that Huntington’s disease starts with a change in the activity of networks in the brain, and to verify that metformin can stop the disorder in its track.
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Affiliation(s)
- Isabelle Arnoux
- Institute of Pathophysiology, Focus Program Translational Neurosciences, University Medical Center, Mainz, Germany
| | - Michael Willam
- Institute for Human Genetics, University Medical Center, Mainz, Germany
| | - Nadine Griesche
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Hirofumi Watari
- Institute of Pathophysiology, Focus Program Translational Neurosciences, University Medical Center, Mainz, Germany
| | - Nina Offermann
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Stephanie Weber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Changwei Chen
- Division of Neurosciences, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Olivia Monteiro
- Division of Neurosciences, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Sven Buettner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Katharina Meyer
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Daniele Bano
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Rosamund Langston
- Division of Neurosciences, Ninewells Hospital and Medical School, Dundee, United Kingdom.,Mouse Behavior Unit, University Medical Center, Mainz, Germany
| | - Jeremy J Lambert
- Division of Neurosciences, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Erich Wanker
- Department of Neuroproteomics, Max-Delbrück-Center, Berlin, Germany
| | - Axel Methner
- Department for Neurology, University Medical Center, Mainz, Germany
| | - Sybille Krauss
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Susann Schweiger
- Institute for Human Genetics, University Medical Center, Mainz, Germany
| | - Albrecht Stroh
- Institute of Pathophysiology, Focus Program Translational Neurosciences, University Medical Center, Mainz, Germany
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33
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Podvin S, Reardon HT, Yin K, Mosier C, Hook V. Multiple clinical features of Huntington's disease correlate with mutant HTT gene CAG repeat lengths and neurodegeneration. J Neurol 2018; 266:551-564. [PMID: 29956026 DOI: 10.1007/s00415-018-8940-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
Huntington's disease (HD) is a fatal neurodegenerative disease caused by mutant HTT gene expansions of CAG triplet repeat numbers that are inherited in an autosomal dominant manner. HD patients display multiple clinical features that are correlated with HTT CAG repeat numbers that include age of disease onset, motor dysfunction, cognitive deficits, compromised daily living capacity, and brain neurodegeneration. It is important to understand the significant relationships of the multiple HD clinical deficits correlated with the number of mutant HTT CAG expansions that are the genetic basis for HD disabilities. Therefore, this review highlights the significant correlations of the HD clinical features of age of onset, motor and cognitive disabilities, decline in living capabilities, weight loss, risk of death, and brain neurodegeneration with respect to their associations with CAG repeat lengths of the HTT gene. Quantitative HTT gene expression patterns analyzed in normal adult human brain regions demonstrated its distribution in areas known to undergo neurodegeneration in HD, as well as in other brain regions. Future investigation of the relationships of the spectrum of clinical HD features with mutant HTT molecular mechanisms will be important to gain understanding of how mutant CAG expansions of the HTT gene result in the devastating disabilities of HD patients.
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Affiliation(s)
- Sonia Podvin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Holly T Reardon
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Katrina Yin
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Charles Mosier
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA
| | - Vivian Hook
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA.
- Department of Neurosciences, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA.
- Department of Pharmacology, University of California, 9500 Gilman Drive, MC0719, La Jolla, San Diego, CA, 92093-0719, USA.
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34
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Snowden JS. The Neuropsychology of Huntington's Disease. Arch Clin Neuropsychol 2018; 32:876-887. [PMID: 28961886 DOI: 10.1093/arclin/acx086] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/04/2017] [Indexed: 01/24/2023] Open
Abstract
Huntington's disease is an inherited, degenerative brain disease, characterized by involuntary movements, cognitive disorder and neuropsychiatric change. Men and women are affected equally. Symptoms emerge at around 40 years, although there is wide variation. A rare juvenile form has onset in childhood or adolescence. The evolution of disease is insidious and structural and functional brain changes may be present more than a decade before symptoms and signs become manifest. The earliest site of pathology is the striatum and neuroimaging measures of striatal change correlate with neurological and cognitive markers of disease. Chorea and other aspects of the movement disorder are the most visible aspect of the disease. However, non-motor features have greatest affect on functional independence and quality of life, so require recognition and management. The evidence-base for non-pharmacological treatments in Huntington's disease is currently limited, but recent intervention studies are encouraging.
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Affiliation(s)
- Julie S Snowden
- Greater Manchester Neuroscience Centre, Salford Royal NHS Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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35
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Coppen EM, van der Grond J, Hart EP, Lakke EAJF, Roos RAC. The visual cortex and visual cognition in Huntington's disease: An overview of current literature. Behav Brain Res 2018; 351:63-74. [PMID: 29792890 DOI: 10.1016/j.bbr.2018.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/01/2018] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
The processing of visual stimuli from retina to higher cortical areas has been extensively studied in the human brain. In Huntington's disease (HD), an inherited neurodegenerative disorder, it is suggested that visual processing deficits are present in addition to more characteristic signs such as motor disturbances, cognitive dysfunction, and behavioral changes. Visual deficits are clinically important because they influence overall cognitive performance and have implications for daily functioning. The aim of this review is to summarize current literature on clinical visual deficits, visual cognitive impairment, and underlying visual cortical changes in HD patients. A literature search was conducted using the electronic database of PubMed/Medline. This review shows that changes of the visual system in patients with HD were not the primary focus of currently published studies. Still, early atrophy and alterations of the posterior cerebral cortex was frequently observed, primarily in the associative visual cortical areas such as the lingual and fusiform gyri, and lateral occipital cortex. Changes were even present in the premanifest phase, before clinical onset of motor symptoms, suggesting a primary region for cortical degeneration in HD. Although impairments in visuospatial processing and visual perception were reported in early disease stages, heterogeneous cognitive batteries were used, making a direct comparison between studies difficult. The use of a standardized battery of visual cognitive tasks might therefore provide more detailed information regarding the extent of impairments in specific visual domains. Further research could provide more insight into clinical, functional, and pathophysiological changes of the visual pathway in HD.
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Affiliation(s)
- Emma M Coppen
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Ellen P Hart
- Centre for Human Drug Research, Leiden, The Netherlands.
| | - Egbert A J F Lakke
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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36
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Nanetti L, Contarino VE, Castaldo A, Sarro L, Bachoud-Levi AC, Giavazzi M, Frittoli S, Ciammola A, Rizzo E, Gellera C, Bruzzone MG, Taroni F, Grisoli M, Mariotti C. Cortical thickness, stance control, and arithmetic skill: An exploratory study in premanifest Huntington disease. Parkinsonism Relat Disord 2018; 51:17-23. [PMID: 29496355 DOI: 10.1016/j.parkreldis.2018.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Huntington disease (HD) is an inherited neurodegenerative disorder most commonly manifesting in adulthood. Identification of biomarkers tracking neurodegeneration before the onset of motor symptoms is important for future interventional studies. Our study aimed to contribute in the phenotypic characterization of the premanifest HD phase. METHODS 28 premanifest subjects (preHD), 25 age-matched controls, and 12 manifest HD patients were enrolled for the study. The participants underwent a multimodal protocol including cognitive evaluations, arithmetic ability test, posturography, composite cerebellar functional test (CCFS), and brain 3T-MRI. PreHD were divided at the group median for predicted years to expected onset into "far-from-onset" (>15 years, PreHD-far), and "close-to-onset" (≤15 years, preHD-close). Basal ganglia volumes and cortical thickness were computed using FreeSurfer. RESULTS PreHD-close showed significantly lower scores than controls in Symbol Digit Modalities Test (p = 0.017), Arithmetic subtraction task (p = 0.04), and MMSE (p < 0.006). At posturography, preHD-close showed increased sway velocity (<0.04) and distance (p < 0.02) compared to controls. PreHD-close had reduced striatum and globus pallidus volumes and left occipital cortical thinning compared to controls. Compared to PreHD far-from-onset, PreHD-close showed bilateral cortical thinning in occipital and parahippocampal regions, inversely correlating with burden score and prognostic index for HD. CCFS only differed between controls and manifest HD. PreHD far-from-onset did not show significant differences in comparison with controls. CONCLUSIONS We confirmed that quantitative brain MRI represents a valid biomarker of neurodegeneration in preHD. Posturography and Arithmentic tests seem promising tools for detecting early changes in premanifest HD, but need to be further confirmed in large cohorts.
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Affiliation(s)
- Lorenzo Nanetti
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Valeria Elisa Contarino
- Neuroradiology Department, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Anna Castaldo
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Lidia Sarro
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Anne-Catherine Bachoud-Levi
- Equipe neuropsychologie interventionnelle, Département d'études cognitives, École normale supérieure, PSL Research University, Institut Mondor de recherche Biomédicale, Université Paris-Est, INSERM U955 E01, 75005, Paris, Créteil, 94010, France; AP-HP, National Center of Reference for Huntington's Disease, Neurology Department, Henri Mondor Hospital, Créteil, 94010, France
| | - Maria Giavazzi
- Equipe neuropsychologie interventionnelle, Département d'études cognitives, École normale supérieure, PSL Research University, Institut Mondor de recherche Biomédicale, Université Paris-Est, INSERM U955 E01, 75005, Paris, Créteil, 94010, France
| | - Serena Frittoli
- Neurology Department, Movement Disorders, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elena Rizzo
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Cinzia Gellera
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Franco Taroni
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Neuroradiology Department, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Genetics of Neurodegenerative and Metabolic Diseases, IRCCS-Foundation Neurological Institute Carlo Besta, Milan, Italy.
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37
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Zink DN, Miller JB, Caldwell JZK, Bird C, Banks SJ. The relationship between neuropsychological tests of visuospatial function and lobar cortical thickness. J Clin Exp Neuropsychol 2017; 40:518-527. [PMID: 29113534 DOI: 10.1080/13803395.2017.1384799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Tests of visuospatial function are often administered in comprehensive neuropsychological evaluations. These tests are generally considered assays of parietal lobe function; however, the neural correlates of these tests, using modern imaging techniques, are not well understood. In the current study we investigated the relationship between three commonly used tests of visuospatial function and lobar cortical thickness in each hemisphere. METHOD Data from 374 patients who underwent a neuropsychological evaluation and MRI scans in an outpatient dementia clinic were included in the analysis. We examined the relationships between cortical thickness, as assessed with Freesurfer, and performance on three tests: Judgment of Line Orientation (JoLO), Block Design (BD) from the Fourth edition of the Wechsler Adult Intelligence Scale, and Brief Visuospatial Memory Test-Revised Copy Trial (BVMT-R-C) in patients who showed overall average performance on these tasks. Using a series of multiple regression models, we assessed which lobe's overall cortical thickness best predicted test performance. RESULTS Among the individual lobes, JoLO performance was best predicted by cortical thickness in the right temporal lobe. BD performance was best predicted by cortical thickness in the right parietal lobe, and BVMT-R-C performance was best predicted by cortical thickness in the left parietal lobe. CONCLUSIONS Performance on constructional tests of visuospatial function appears to correspond best with underlying cortical thickness of the parietal lobes, while performance on visuospatial judgment tests appears to correspond best to temporal lobe thickness. Future research using voxel-wise and connectivity techniques and including more diverse samples will help further understanding of the regions and networks involved in visuospatial tests.
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Affiliation(s)
- Davor N Zink
- a Department of Psychology , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Justin B Miller
- b Department of Neuropsychology , Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , NV , USA
| | - Jessica Z K Caldwell
- b Department of Neuropsychology , Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , NV , USA
| | - Christopher Bird
- b Department of Neuropsychology , Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , NV , USA
| | - Sarah J Banks
- b Department of Neuropsychology , Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , NV , USA
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38
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Minkova L, Gregory S, Scahill RI, Abdulkadir A, Kaller CP, Peter J, Long JD, Stout JC, Reilmann R, Roos RA, Durr A, Leavitt BR, Tabrizi SJ, Klöppel S. Cross-sectional and longitudinal voxel-based grey matter asymmetries in Huntington's disease. Neuroimage Clin 2017; 17:312-324. [PMID: 29527479 PMCID: PMC5842644 DOI: 10.1016/j.nicl.2017.10.023] [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: 06/06/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/22/2022]
Abstract
Huntington's disease (HD) is a progressive neurodegenerative disorder that can be genetically confirmed with certainty decades before clinical onset. This allows the investigation of functional and structural changes in HD many years prior to disease onset, which may reveal important mechanistic insights into brain function, structure and organization in general. While regional atrophy is present at early stages of HD, it is still unclear if both hemispheres are equally affected by neurodegeneration and how the extent of asymmetry affects domain-specific functional decline. Here, we used whole-brain voxel-based analysis to investigate cross-sectional and longitudinal hemispheric asymmetries in grey matter (GM) volume in 56 manifest HD (mHD), 83 pre-manifest HD (preHD), and 80 healthy controls (HC). Furthermore, a regression analysis was used to assess the relationship between neuroanatomical asymmetries and decline in motor and cognitive measures across the disease spectrum. The cross-sectional analysis showed striatal leftward-biased GM atrophy in mHD, but not in preHD, relative to HC. Longitudinally, no net 36-month change in GM asymmetries was found in any of the groups. In the regression analysis, HD-related decline in quantitative-motor (Q-Motor) performance was linked to lower GM volume in the left superior parietal cortex. These findings suggest a stronger disease effect targeting the left hemisphere, especially in those with declining motor performance. This effect did not change over a period of three years and may indicate a compensatory role of the right hemisphere in line with recent functional imaging studies.
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Affiliation(s)
- Lora Minkova
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Germany; Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany.
| | - Sarah Gregory
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Rachael I Scahill
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Ahmed Abdulkadir
- Department of Computer Science, University of Freiburg, Freiburg, Germany; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph P Kaller
- Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Germany; Department of Neurology, Medical Center - University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Jessica Peter
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Freiburg, Germany; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jeffrey D Long
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA; Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Julie C Stout
- School of Psychology and Psychiatry, Monash University, Victoria, Australia
| | - Ralf Reilmann
- George-Huntington-Institute, Münster, Germany; Department of Radiology, University of Münster, Münster, Germany; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Raymund A Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Alexandra Durr
- APHP Department of Genetics, ICM (Brain and Spine Institute) Pitié-Salpêtrière University Hospital Paris, France
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Freiburg, Germany; University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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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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