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Paparella G, Angelini L, Margiotta R, Passaretti M, Birreci D, Costa D, Cannavacciuolo A, De Riggi M, Alunni Fegatelli D, Bologna M. Insight into the Relationship Between Motor and Cognitive Symptoms in Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2024; 23:2050-2059. [PMID: 38748348 PMCID: PMC11489240 DOI: 10.1007/s12311-024-01704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 10/20/2024]
Abstract
Essential tremor (ET) is a heterogeneous disorder characterized by bilateral upper limbs action tremor and, possibly, neurological signs of uncertain significance, including voluntary movement abnormalities and cognitive disturbances, i.e., the so-called 'soft' signs configuring the ET-plus definition. While motor and cognitive disturbances often coexist in ET, their interrelationship remains largely unexplored. Here we aim to further investigate the relationship between motor symptoms, objectively assessed through kinematic analysis, and cognitive dysfunctions in ET. Seventy ET patients underwent clinical examination, as well as kinematic recordings of tremor and finger tapping and a thorough cognitive assessment. We then tested clinic-demographic and kinematic differences between patients with and without cognitive abnormalities, i.e., with mild cognitive impairment (MCI). Correlation analysis served to explore potential associations between kinematic and cognitive data. Forty-three ET patients (61.42%) had MCI. ET-MCI patients exhibited reduced movement velocity during finger tapping compared to those with normal cognition (p < 0.001). Lower movement velocity during finger tapping was associated with poorer cognitive performance. Namely, we observed a correlation between movement velocity and performance on the Babcock Story Immediate and Delayed Recall Test (r = 0.52 and r = 0.45, both p < 0.001), as well as the interference memory task at 10 and 30 s (r = 0.3, p = 0.008 and r = 0.2, p = 0.03). In this study, we have provided data for a better pathophysiological interpretation of motor and cognitive signs in ET, including the role played by the cerebellum or extra-cerebellar areas, which possibly underpin both signs.
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Affiliation(s)
- Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Roberta Margiotta
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
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Lu J, Zhou C, Pu J, Tian J, Yin X, Lv D, Guan X, Guo T, Zhang M, Zhang B, Yan Y, Zhao G. Brain microstructural changes in essential tremor patients and correlations with clinical characteristics: a diffusion kurtosis imaging study. J Neurol 2023; 270:2106-2116. [PMID: 36609498 DOI: 10.1007/s00415-023-11557-w] [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: 09/24/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Essential tremor (ET) is the second most common movement disorder; however, the pathophysiological mechanism of ET is unclear. We aimed to investigate the microstructural degeneration of gray matter (GM) and white matter (WM) and their correlations with cognition and tremor in patients with ET. METHODS The participants were 63 patients with ET and 63 matched healthy controls (HCs) who underwent 3D-T1 weighted and diffusion kurtosis images (DKI). Microstructural degeneration was measured using high-level diffusion parameters derived from DKI. A voxel-wise analysis of the means of the GM-based spatial statistics and tract-based spatial statistics were conducted to assess differences in diffusion parameters between the ET and HC groups. The volume differences between the two groups were also assessed, and tremor severity and multi-domain cognitive performance were evaluated. Finally, the relationship between microstructural degeneration and clinical characteristics were assessed. RESULTS The ET group had significantly lower mean kurtosis of the temporal, parietal, and occipital lobes and the cerebellum and lower radial kurtosis in several tracts. These microstructural changes in GM and WM were correlated with tremor and cognitive scores. However, no significant difference in volume was found between the groups. CONCLUSION Our findings suggest that ET entails extensive GM and WM microstructural alterations, which support the neurodegenerative hypothesis of ET. Our study contributes to a better understanding of the mechanisms underlying tremor and cognitive impairment in ET.
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Affiliation(s)
- Jinyu Lu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Jun Tian
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Xinzhen Yin
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Dayao Lv
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
| | - Yaping Yan
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
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Swytink-Binnema CA, Rockel CP, Martino D, Dukelow SP, Pike GB, Kiss ZHT. Limb Preference Changes after Focused-Ultrasound Thalamotomy for Tremor. Mov Disord 2023. [PMID: 36947685 DOI: 10.1002/mds.29350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused-ultrasound (MRgFUS) thalamotomy is an effective treatment for essential and other tremors. It targets the ventrointermedius (Vim) nucleus, which is the thalamic relay in a proprioceptive pathway, and contains kinesthetic cells. Although MRgFUS thalamotomy reduces some risks associated with more invasive surgeries, it still has side effects, such as balance and gait disturbances; these may be caused by the lesion impacting proprioception. OBJECTIVES Our aim was to quantitatively measure the effects of MRgFUS on proprioception and limb use in essential tremor patients. We hypothesized that this thalamotomy alters proprioception, because the sensorimotor Vim thalamus is lesioned. METHODS Proprioception was measured using the Kinarm exoskeleton robot in 18 patients. Data were collected pre-operatively, and then 1 day, 3 months, and 1 year after surgery. Patients completed four tasks, assessing motor coordination and postural control, goal-directed movement and bimanual planning, position sense, and kinesthesia. RESULTS Immediately after surgery there were changes in posture speed (indicating tremor improvement), and in bimanual hand use, with the untreated limb being preferred. However, these measures returned to pre-operative baseline over time. There were no changes in parameters related to proprioception. None of these measures correlated with lesion size or lesion-overlap with the dentato-rubro-thalamic tract. CONCLUSIONS This is the first quantitative assessment of proprioception and limb preference following MRgFUS thalamotomy. Our results suggest that focused-ultrasound lesioning of the Vim thalamus does not degrade proprioception but alters limb preference. This change may indicate a required "relearning" in the treated limb, because the effect is transient. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Catherine A Swytink-Binnema
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Conrad P Rockel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - G Bruce Pike
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Essential tremor and cognitive impairment: who, how, and why. Neurol Sci 2022; 43:4133-4143. [PMID: 35359213 DOI: 10.1007/s10072-022-06037-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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de Souza NL, Buckman JF, Dennis EL, Parrott JS, Velez C, Wilde EA, Tate DF, Esopenko C. Association between white matter organization and cognitive performance in athletes with a history of sport-related concussion. J Clin Exp Neuropsychol 2021; 43:704-715. [PMID: 34779351 DOI: 10.1080/13803395.2021.1991893] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Impairments in cognitive performance after sport-related concussion (SRC) typically resolve within weeks of the injury, whereas alterations to white matter (WM) organization have been found to persist longer into the chronic injury stage. However, longer-term associations between cognition and WM organization following SRC have not been studied. The objective of this study was to compare WM organization and cognitive performance in collegiate athletes an average of almost 4 years post-SRC to athletes with no history of SRC. METHOD National Collegiate Athletic Association Division III athletes (n = 71, age = 19.3 ± 1.2; 14 with self-reported SRC) completed a neurocognitive assessment and diffusion tensor imaging (DTI). WM organization was assessed by extracting measures of fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) from 20 WM regions of interest (ROIs). Multivariate partial least squares analyses were used to compare athletes with and without a history of SRC and assess relationships between DTI-derived metrics of WM organization and cognitive measures. RESULTS Cognitive performance and ROI metrics did not differ between athletes with and without prior SRC. However, among athletes with a history of SRC, better executive function, processing speed, and memory but worse choice reaction time were associated with higher FA and lower MD and RD in several WM tracts. CONCLUSION Athletes with a history of SRC demonstrated greater associations between cognitive performance and WM organization, but also variability in the domains showing associations. Taken together, the findings demonstrate the importance of examining brain-behavior relationships several years after SRC to better gauge how WM organization supports cognition.
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Affiliation(s)
- Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, Piscataway, NJ, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | | | - Carmen Velez
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.,George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA.,Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
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Pietracupa S, Bologna M, Tommasin S, Berardelli A, Pantano P. The Contribution of Neuroimaging to the Understanding of Essential Tremor Pathophysiology: a Systematic Review. THE CEREBELLUM 2021; 21:1029-1051. [PMID: 34657271 DOI: 10.1007/s12311-021-01335-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/14/2022]
Abstract
Essential tremor (ET) is one of the most common movement disorders. Over the last 10 years, magnetic resonance imaging (MRI) has shed light on the structural and functional abnormalities possibly involved in ET pathophysiology. In this systematic review, we aimed to identify the cortical and subcortical structures involved and the role that different brain areas play in the pathophysiology of motor and non-motor ET features. We found that structural (grey and white matter) cerebellar damage and connectivity alterations between the cerebellum and various cortical areas play a role in both motor and non-motor symptoms of ET. In particular, many studies found an association between MRI findings and non-motor symptoms.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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7
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Hsu CCH, Huang CC, Tsai SJ, Chen LK, Li HC, Lo CYZ, Lin CP. Differential Age Trajectories of White Matter Changes Between Sexes Correlate with Cognitive Performances. Brain Connect 2021; 11:759-771. [PMID: 33858197 DOI: 10.1089/brain.2020.0961] [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: 11/12/2022] Open
Abstract
Background: Aging is accompanied by a gradual deterioration in multiple cognitive abilities and brain structures. Both cognitive function and white matter (WM) structure are found to be associated with neurodegeneration diseases and correlated with sex during aging. However, it is still unclear whether the brain structural change could be attributable to sex, and how sex would affect cognitive performances during aging. Materials and Methods: Diffusion magnetic resonance imaging (MRI) scans were performed on 1127 healthy participants (age range: 21-89) at a single site. The age trajectories of the WM tract microstructure were delineated to estimate the turning age and changing rate between sexes. The canonical correlation analysis and moderated mediation analysis were used to examine the relationship between sex-linked WM tracts and cognitive performances. Results: The axon intactness and demyelination of sex-linked tracts during aging were multifaceted. Sex-linked tracts in females peak around 5 years later than those in males but change significantly faster after the turning age. Projection and association tracts (e.g., corticospinal tracts and parahippocampal cingulum) contributed to a significant decrease in visuospatial functions (VS) and executive functions (E). We discovered that there is a stronger indirect effect of sex-linked tracts on cognitive functions in females than in males. Conclusion: Our findings suggest that the vulnerable projection and association tracts in females may induce negative impacts on integrating multiple functions, which results in a faster decrease in VS and E.
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Affiliation(s)
- Chih-Chin Heather Hsu
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.,Center of Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Chung Huang
- Key Laboratory of Brain Functional Genomics (MOE & STCSM), Affiliated Mental Health Center (ECNU), Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,Shanghai Changning Mental Health Center, Shanghai, China
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center of Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Hui-Chun Li
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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8
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Gallagher VT, Obolsky MA, Soble JR. "Benign" tremor? A serial case report of 2.5 year progression from mild cognitive impairment to amnestic dementia following deep brain stimulator placement for essential tremor. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1280-1287. [PMID: 33232620 DOI: 10.1080/23279095.2020.1848837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Essential tremor (ET) is a prevalent neurological disorder with associated neuropsychological sequalae. Although cognitive deficits associated with ET are traditionally conceptualized as attention, processing speed, and executive impairments attributed to underlying frontal-subcortical dysfunction, emerging literature highlights the elevated frequency of progressive amnestic memory impairments in patients with ET. This case study centers around a 75-year-old woman with a 15-year history of ET who underwent deep brain stimulation (DBS) as well as three neuropsychological evaluations, one pre-surgically and two post-surgically at one and two-years post successful DBS surgery. Neuropsychological evaluation results revealed circumscribed mild and variable memory deficits pre-surgically and one-year post-surgically, However, two-years post-DBS, reliable change indices revealed significant declines in verbal/visual memory, consistent with an amnestic presentation, in addition to executive functions, aspects of higher-level language abilities, and overall IQ. This case study adds to a growing literature identifying a subset of ET patients with a neurodegenerative cognitive trajectory characterized by progressive, amnestic memory impairment. The case also highlights the importance of serial monitoring of cognition beyond the pre-surgical DBS workup to monitor for clinically significant decline(s).
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Affiliation(s)
- Virginia T Gallagher
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Maximillian A Obolsky
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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Yahya N, Manan HA. Diffusion tensor imaging indices to predict cognitive changes following adult radiotherapy. Eur J Cancer Care (Engl) 2020; 30:e13329. [PMID: 32909654 DOI: 10.1111/ecc.13329] [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: 08/02/2019] [Revised: 05/01/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) can detect changes to white matter tracts following assaults including high dose radiation. This study aimed to systematically evaluate DTI indices to predict cognitive changes following adult radiotherapy. MATERIALS AND METHODS We searched PubMed and Scopus electronic databases to identify eligible studies according to PRISMA guidelines. Studies were extracted for information on demographics, DTI changes and associations to cognitive outcomes. RESULTS Six studies were selected for inclusion with 110 patients (median study size: 20). 5/6 studies found significant cognitive decline and analysed relationships to DTI changes. Decreased fractional anisotropy (FA) was consistently associated with cognitive decline. Associations clustered at specific regions of cingulum and corpus callosum. Only one study conducted multivariable analysis. CONCLUSION Fractional anisotropy is a clinically meaningful biomarker for radiotherapy-related cognitive decline. Studies accruing larger patient cohorts are needed to guide therapeutic changes that can abate the decline.
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Affiliation(s)
- Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hanani A Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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10
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Sengul Y, Temur HO, Corakcı Z, Sengul HS, Dowd H, Ustun I, Alkan A, Louis ED. Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study. Int J Neurosci 2020; 132:154-164. [PMID: 32730718 DOI: 10.1080/00207454.2020.1803859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. OBJECTIVE To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. METHOD Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. RESULTS Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. CONCLUSION These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.
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Affiliation(s)
- Y Sengul
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey.,Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - H O Temur
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Z Corakcı
- Department of Occupational Therapy, Bezmialem Foundation University School of Medical Sciences, Istanbul, Turkey
| | - H S Sengul
- Laboratory of Neuropsychology, Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey
| | - H Dowd
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - I Ustun
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - A Alkan
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - E D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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11
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Radler KH, Zdrodowska MA, Dowd H, Cersonsky TEK, Huey ED, Cosentino S, Louis ED. Rate of progression from mild cognitive impairment to dementia in an essential tremor cohort: A prospective, longitudinal study. Parkinsonism Relat Disord 2020; 74:38-42. [PMID: 32325394 PMCID: PMC7587472 DOI: 10.1016/j.parkreldis.2020.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Essential tremor (ET), among the most common neurological diseases, is associated with cognitive dysfunction. Yet, nearly all knowledge of ET-related cognitive impairment is static and cross-sectional (e.g., prevalence), with virtually no dynamic information (i.e., course and progression, conversion rates, and clinical outcomes). OBJECTIVES To quantify the rate of progression from mild cognitive impairment (MCI) to dementia in a cohort of elderly ET cases. METHODS 167 ET cases, enrolled in a prospective, longitudinal, clinical-pathological study, underwent an extensive neuropsychological testing battery at baseline (T1), 1.5 years (T2), and 3 years (T3). Results of these assessments informed clinical diagnoses of normal cognition (ET-NC), MCI (ET-MCI), and dementia (ET-D). RESULTS At baseline, 26 cases (82.7 ± 7.7 years) were diagnosed with ET-MCI and were available for follow-up at T2. At T2, three of 26 (11.5%) had converted to ET-D. At the start of T2, 23 cases (83.6 ± 7.7 years) were diagnosed with ET-MCI and were available for follow-up at T3. At T3, six of 23 (26.1%) converted to ET-D. The average annual conversion rate from ET-MCI to ET-D was 12.5%. CONCLUSIONS The study of cognitive impairment in ET is a nascent field, with limited data. We show that the conversion rate from ET-MCI to ET-dementia was 12.5%. Available studies on historical controls have reported conversion rates of 2.6-6.3%. Data such as these systematically fill gaps in knowledge, creating a scientifically-derived knowledge base to guide physicians and patients in clinical settings.
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Affiliation(s)
- Keith H Radler
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maria Anna Zdrodowska
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Hollie Dowd
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Tess E K Cersonsky
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Edward D Huey
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
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12
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Wang YM, Yang ZY, Cai XL, Zhou HY, Zhang RT, Yang HX, Liang YS, Zhu XZ, Madsen KH, Sørensen TA, Møller A, Wang Z, Cheung EFC, Chan RCK. Identifying Schizo-Obsessive Comorbidity by Tract-Based Spatial Statistics and Probabilistic Tractography. Schizophr Bull 2020; 46:442-453. [PMID: 31355879 PMCID: PMC7442329 DOI: 10.1093/schbul/sbz073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A phenomenon in schizophrenia patients that deserves attention is the high comorbidity rate with obsessive-compulsive disorder (OCD). Little is known about the neurobiological basis of schizo-obsessive comorbidity (SOC). We aimed to investigate whether specific changes in white matter exist in patients with SOC and the relationship between such abnormalities and clinical parameters. Twenty-eight patients with SOC, 28 schizophrenia patients, 30 OCD patients, and 30 demographically matched healthy controls were recruited. Using Tract-based Spatial Statistics and Probabilistic Tractography, we examined the pattern of white matter abnormalities in these participants. We also used ANOVA and Support Vector Classification of various white matter indices and structural connection probability to further examine white matter changes among the 4 groups. We found that patients with SOC had decreased fractional anisotropy (FA) and increased radial diffusivity in the right sagittal stratum and the left crescent of the fornix/stria terminalis compared with healthy controls. We also found changed connection probability in the Default Mode Network, the Subcortical Network, the Attention Network, the Task Control Network, the Visual Network, the Somatosensory Network, and the cerebellum in the SOC group compared with the other 3 groups. The classification results further revealed that FA features could differentiate the SOC group from the other 3 groups with an accuracy of .78. These findings highlight the specific white matter abnormalities found in patients with SOC.
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Affiliation(s)
- Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Zhuo-Ya Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Rui-Ting Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Han-Xue Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Yun-Si Liang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Xiong-Zhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China,Medical Psychological Institute of Central South University, Changsha, Hunan, PR China
| | - Kristoffer Hougaard Madsen
- Sino-Danish Center for Education and Research, Beijing, PR China,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Thomas Alrik Sørensen
- Sino-Danish Center for Education and Research, Beijing, PR China,Centre for Cognitive Neuroscience, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Arne Møller
- Sino-Danish Center for Education and Research, Beijing, PR China,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Zhen Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, PR China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China,To whom correspondence should be addressed: Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, PR China; tel: 86-(0)10-64836274, fax: 86-(0)10-64836274, e-mail:
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13
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Aberrant global and local efficiency of the executive subnetwork in essential tremor. J Neural Transm (Vienna) 2020; 127:385-388. [PMID: 31982937 DOI: 10.1007/s00702-020-02141-x] [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] [Received: 12/25/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
This study aims to use probabilistic tractography to ascertain the global (GE) and local efficiency (LE) of the executive subnetwork in essential tremor (ET). Significantly lower GE of the whole executive subnetwork and lower LE of the left rostral middle frontal gyrus, frontal pole, inferior frontal gyrus, bilateral anterior cingulate cortex, and medial orbitofrontal cortex. These results imply ineffective and inadequate communication of the executive subnetwork, and may be causally associated with the executive dysfunction observed in ET.
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14
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Tringale KR, Nguyen TT, Karunamuni R, Seibert T, Huynh-Le MP, Connor M, Moiseenko V, Gorman MK, Marshall A, Tibbs MD, Farid N, Simpson D, Sanghvi P, McDonald CR, Hattangadi-Gluth JA. Quantitative Imaging Biomarkers of Damage to Critical Memory Regions Are Associated With Post-Radiation Therapy Memory Performance in Brain Tumor Patients. Int J Radiat Oncol Biol Phys 2019; 105:773-783. [PMID: 31408667 PMCID: PMC6876859 DOI: 10.1016/j.ijrobp.2019.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE We used quantitative magnetic resonance imaging to prospectively analyze the association between microstructural damage to memory-associated structures within the medial temporal lobe and longitudinal memory performance after brain radiation therapy (RT). METHODS AND MATERIALS Patients with a primary brain tumor receiving fractionated brain RT were enrolled on a prospective trial (n = 27). Patients underwent high-resolution volumetric brain magnetic resonance imaging, diffusion-weighted imaging, and neurocognitive testing before and 3, 6, and 12 months post-RT. Medial temporal lobe regions (hippocampus; entorhinal, parahippocampal, and temporal pole white matter [WM]) were autosegmented, quantifying volume and diffusion biomarkers of WM integrity (mean diffusivity [MD]; fractional anisotropy [FA]). Reliable change indices measured changes in verbal (Hopkins Verbal Learning Test-Revised) and visuospatial (Brief Visuospatial Memory Test-Revised [BVMT-R]) memory. Linear mixed-effects models assessed longitudinal associations between imaging parameters and memory. RESULTS Visuospatial memory significantly declined at 6 months post-RT (mean reliable change indices, -1.3; P = .012). Concurrent chemotherapy and seizures trended toward a significant association with greater decline in visuospatial memory (P = .053 and P = .054, respectively). Higher mean dose to the left temporal pole WM was significantly associated with decreased FA (r = -0.667; P = .002). Over all time points, smaller right hippocampal volume (P = .021), lower right entorhinal FA (P = .023), greater right entorhinal MD (P = .047), and greater temporal pole MD (BVMT-R total recall, P = .003; BVMT-R delayed recall, P = .042) were associated with worse visuospatial memory. The interaction between right entorhinal MD (BVMT-R total recall, P = .021; BVMT-R delayed recall, P = .004) and temporal pole FA (BVMT-R delayed recall, P = .024) significantly predicted visuospatial memory performance. CONCLUSIONS Brain tumor patients exhibited visuospatial memory decline post-RT. Microstructural damage to critical memory regions, including the hippocampus and medial temporal lobe WM, were associated with post-RT memory decline. The integrity of medial temporal lobe structures is critical to memory performance post-RT, representing possible avoidance targets for memory preservation.
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Affiliation(s)
- Kathryn R Tringale
- Department of Radiation Medicine and Applied Sciences; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences; Center for Multimodal Imaging and Genetics
| | - Tyler Seibert
- Department of Radiation Medicine and Applied Sciences; Center for Multimodal Imaging and Genetics
| | | | | | | | | | | | | | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, La Jolla, California
| | | | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry; Center for Multimodal Imaging and Genetics
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences; Center for Multimodal Imaging and Genetics.
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15
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Ohoshi Y, Takahashi S, Yamada S, Ishida T, Tsuda K, Tsuji T, Terada M, Shinosaki K, Ukai S. Microstructural abnormalities in callosal fibers and their relationship with cognitive function in schizophrenia: A tract-specific analysis study. Brain Behav 2019; 9:e01357. [PMID: 31283112 PMCID: PMC6710197 DOI: 10.1002/brb3.1357] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/14/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The corpus callosum serves the essential role of relaying cognitive information between the homologous regions in the left and the right hemispheres of the brain. Cognitive impairment is a core dysfunction of schizophrenia, but much of its pathophysiology is unknown. The aim of this study was to elucidate the association between microstructural abnormalities of the corpus callosum and cognitive dysfunction in schizophrenia. METHODS We examined stepwise multiple regression analysis to investigate the relationship of the fractional anisotropy (FA) of callosal fibers in each segment with z-scores of each brief assessment of cognition in schizophrenia subtest and cognitive composite score in all subjects (19 patients with schizophrenia [SZ group] and 19 healthy controls [HC group]). Callosal fibers were separated into seven segments based on their cortical projection using tract-specific analysis of diffusion tensor imaging. RESULTS The FA of callosal fibers in the temporal segment was significantly associated with z-scores of token motor test, Tower of London test, and the composite score. In the SZ group, the FA of callosal fibers in the temporal segment was significantly associated with the z-score of the Tower of London test. In addition, the FA of callosal fibers in temporal segment showed significant negative association with the positive and negative syndrome scale negative score in the SZ group. Compared to the HC group, the FA in temporal segment was significantly decreased in the SZ group. CONCLUSION Our results suggest that microstructural abnormalities in the callosal white matter fibers connecting bilateral temporal lobe cortices contribute to poor executive function and severe negative symptom in patients with schizophrenia.
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Affiliation(s)
- Yuji Ohoshi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Yamada
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Takuya Ishida
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Kumi Tsuda
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | | | - Kazuhiro Shinosaki
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan.,Asakayama General Hospital, Osaka, Japan
| | - Satoshi Ukai
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
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16
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Pietracupa S, Bologna M, Bharti K, Pasqua G, Tommasin S, Elifani F, Paparella G, Petsas N, Grillea G, Berardelli A, Pantano P. White matter rather than gray matter damage characterizes essential tremor. Eur Radiol 2019; 29:6634-6642. [PMID: 31139970 DOI: 10.1007/s00330-019-06267-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated changes in gray matter (GM) and white matter (WM) in the whole brain, including both cortical and subcortical structures, and their relationship with tremor severity, psychiatric symptoms, and cognitive impairment in patients affected by essential tremor (ET). METHODS We studied 19 ET patients and 15 healthy subjects (HS). All the subjects underwent a 3-T MRI study based on 3D-T1 and diffusion tensor images. For the GM analysis, cortical thickness was assessed by using the Computational Anatomy Tool, basal ganglia and thalamus volumes by using the FMRIB software library, and cerebellum lobular volumes by using the spatial unbiased atlas template. For the WM assessment, we performed a voxel-wise analysis by means of tract-based spatial statistics. Patients' tremor severity and psychiatric and cognitive disorders were evaluated by means of standard clinical scales. Neuroimaging data were correlated with clinical scores. RESULTS We found significantly smaller right and left thalamic volumes in ET patients than in HS, which correlated with cognitive scores. We did not observe any significant differences either in cortical thickness or in cerebellar lobular volumes between patients and HS. WM abnormalities were detected in most hemisphere bundles, particularly in the corticospinal tract, cerebellar peduncles, and corpus callosum. The WM abnormalities significantly correlated with tremor severity, cognitive profile, and depression. CONCLUSION Our study indicates that ET is characterized by several GM and WM changes of both infra- and supratentorial brain structures. The results may help to better understand mechanisms underlying tremor severity and psychiatric and cognitive impairment in ET. KEY POINTS • We performed a comprehensive evaluation of gray and white matter in the same sample of patients with essential tremor using recently developed data analysis methods. • Essential tremor is characterized by widespread gray and white matter changes in both infra- and supratentorial brain structures. The results may help to better understand motor and non-motor symptoms in patients with essential tremor.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Komal Bharti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Gabriele Pasqua
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | | | | | | | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Pozzilli (IS), Italy. .,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
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17
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Abnormal hippocampal subfields are associated with cognitive impairment in Essential Tremor. J Neural Transm (Vienna) 2019; 126:597-606. [PMID: 30888510 DOI: 10.1007/s00702-019-01992-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/11/2019] [Indexed: 01/14/2023]
Abstract
Multi-domain cognitive impairment (CI) has been frequently described in patients with essential tremor (ET). However, the exact neuroanatomical basis for this impairment is uncertain. This study aims to ascertain the role of the hippocampal formation in cognitive impairment in ET. Forty patients with ET and 40 age, gender and education matched healthy controls (HC) were enrolled. Cognition was assessed using a structured neuropsychological battery and patients were categorized as ET with CI (ETCI) and ET without CI (ETNCI). Automatic segmentation of hippocampal subfields was performed using FreeSurfer 6.0. The obtained volumes were correlated with scores of neuropsychological tests. Significant atrophy of the left subiculum, CA4, granule-cell layer of dentate gyrus, right molecular layer, and hypertrophy of bilateral parasubiculum, right hippocampus-amygdala-transition-area, bilateral hippocampal tail (HT) and widening of right hippocampal fissure was observed in ET. Trends toward atrophy of right subiculum, and widening of left HF was also observed. Comparison of HC and ETCI revealed atrophy of right subiculum, hypertrophy of bilateral parasubiculum, HT, and widening of left HF. ETCI showed a trend toward widening of right HF. ETNCI had isolated left parasubicular hypertrophy and in comparison, to ETNCI the ETCI subgroup had atrophy of bilateral fimbria. Significant correlations were observed between the volumes of HT, HF, fimbria and scores of tests for executive function, working and verbal memory. Patients with ET have significant volumetric abnormalities of several hippocampal subfields and these abnormalities may be important contributors for some forms of cognitive impairment observed in ET.
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18
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Mato-Abad V, Labiano-Fontcuberta A, Rodríguez-Yáñez S, García-Vázquez R, Munteanu CR, Andrade-Garda J, Domingo-Santos A, Galán Sánchez-Seco V, Aladro Y, Martínez-Ginés ML, Ayuso L, Benito-León J. Classification of radiologically isolated syndrome and clinically isolated syndrome with machine-learning techniques. Eur J Neurol 2019; 26:1000-1005. [PMID: 30714276 DOI: 10.1111/ene.13923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The unanticipated detection by magnetic resonance imaging (MRI) in the brain of asymptomatic subjects of white matter lesions suggestive of multiple sclerosis (MS) has been named radiologically isolated syndrome (RIS). As the difference between early MS [i.e. clinically isolated syndrome (CIS)] and RIS is the occurrence of a clinical event, it is logical to improve detection of the subclinical form without interfering with MRI as there are radiological diagnostic criteria for that. Our objective was to use machine-learning classification methods to identify morphometric measures that help to discriminate patients with RIS from those with CIS. METHODS We used a multimodal 3-T MRI approach by combining MRI biomarkers (cortical thickness, cortical and subcortical grey matter volume, and white matter integrity) of a cohort of 17 patients with RIS and 17 patients with CIS for single-subject level classification. RESULTS The best proposed models to predict the diagnosis of CIS and RIS were based on the Naive Bayes, Bagging and Multilayer Perceptron classifiers using only three features: the left rostral middle frontal gyrus volume and the fractional anisotropy values in the right amygdala and right lingual gyrus. The Naive Bayes obtained the highest accuracy [overall classification, 0.765; area under the receiver operating characteristic (AUROC), 0.782]. CONCLUSIONS A machine-learning approach applied to multimodal MRI data may differentiate between the earliest clinical expressions of MS (CIS and RIS) with an accuracy of 78%.
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Affiliation(s)
- V Mato-Abad
- ISLA, Computer Science Faculty, A Coruna University, A Coruña
| | | | | | | | - C R Munteanu
- RNASA-IMEDIR, Computer Science Faculty, A Coruna University, A Coruña.,Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), A Coruña
| | - J Andrade-Garda
- ISLA, Computer Science Faculty, A Coruna University, A Coruña
| | - A Domingo-Santos
- Department of Neurology, University Hospital '12 de Octubre', Madrid
| | | | - Y Aladro
- Department of Neurology, Getafe University Hospital, Getafe
| | | | - L Ayuso
- Department of Neurology, University Hospital 'Principe de Asturias', Alcalá de Henares
| | - J Benito-León
- Department of Neurology, University Hospital '12 de Octubre', Madrid.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid.,Department of Medicine, Complutense University, Madrid, Spain
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19
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Louis ED, Joyce JL, Cosentino S. Mind the gaps: What we don't know about cognitive impairment in essential tremor. Parkinsonism Relat Disord 2019; 63:10-19. [PMID: 30876840 DOI: 10.1016/j.parkreldis.2019.02.038] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/18/2019] [Accepted: 02/23/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although the hallmark feature of essential tremor (ET) is tremor, there is growing appreciation that cognitive impairment also occurs, including increased prevalence of mild cognitive impairment (MCI) and increased prevalence and incidence of dementia. With emerging knowledge of ET-cognitive impairment, come fundamental questions regarding its course, bases, predictors and clinical outcomes. Studies in the general population and in Parkinson's disease (PD), a related movement disorder, offer a starting point from which to begin filling these clinically important knowledge gaps. METHODS A PubMed search (June 2018) identified articles for this review. RESULTS Much of our knowledge of cognitive impairment in ET is of the static condition (e.g., prevalence of cognitive impairment in ET), with nearly no information on its bases, predictors and dynamics (i.e., course, and clinical outcomes). In PD, where such data have been published, rates of cognitive decline and conversion to MCI/dementia are higher than in the general population. Predictors of cognitive change in PD and the general population have also been identified, yet they only partially overlap one another. CONCLUSION The predictors and dynamics of cognitive impairment have been investigated fairly extensively in the general population, to a somewhat lesser extent in PD, and are emerging only now in ET. We suggest that longitudinal studies specific to ET are needed, and we outline variables to be considered in these investigations. Increased knowledge of ET-cognitive impairment will facilitate meaningful counseling of patients and their families.
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Affiliation(s)
- Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Jillian L Joyce
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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20
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Nestrasil I, Svatkova A, Rudser KD, Chityala R, Wakumoto A, Mueller BA, Bednařík P, Tuite P, Wu X, Bushara K. White matter measures correlate with essential tremor severity-A pilot diffusion tensor imaging study. Brain Behav 2018; 8:e01039. [PMID: 29964316 PMCID: PMC6085909 DOI: 10.1002/brb3.1039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An evolving pathophysiological concept of essential tremor (ET) points to diffuse brain network involvement, which emphasizes the need to investigate white matter (WM) changes associated with motor symptoms of ET. OBJECTIVES To investigate ET-related WM changes and WM correlates of tremor severity using tremor clinical rating scales and accelerometry. METHODS Tract-based spatial statistics (TBSS) approach was utilized to compare 3 Tesla diffusion tensor imaging (DTI) data from 12 ET patients and 10 age- and gender-matched healthy individuals. Clinical scales, tremor frequency and amplitude as measured by accelerometry were correlated with DTI data. RESULTS ET patients demonstrated mean (MD) and radial diffusivity (RD) abnormalities in tracts involved in primary and associative motor functions such as bilateral corticospinal tracts, the superior longitudinal fascicles, and the corpus callosum but also in nonmotor regions including the inferior fronto-occipital and longitudinal fascicles, cingulum bundles, anterior thalamic radiations, and uncinate fascicles. A combined tremor frequency and amplitude score correlated with RD and MD in extensive WM areas, which partially overlapped the regions that were associated with tremor frequency. No significant relationship was found between DTI measures and clinical rating scales scores. CONCLUSIONS The results show that ET-related diffusion WM changes and their correlates with tremor severity are preferentially located in the primary and associative motor areas. In contrast, a relationship between WM was not detected with clinical rating scales. Accelerometry parameters may, therefore, serve as a potentially useful clinical measures that relate to WM deficits in ET.
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Affiliation(s)
- Igor Nestrasil
- Division of Clinical Behavioral NeuroscienceDepartment of PediatricsUniversity of MinnesotaMinneapolisMinnesota
| | - Alena Svatkova
- Division of Clinical Behavioral NeuroscienceDepartment of PediatricsUniversity of MinnesotaMinneapolisMinnesota
- Department of Medicine III, Clinical Division of Endocrinology and MetabolismMedical University of ViennaViennaAustria
- Multimodal and Functional Neuroimaging Research GroupCentral European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Kyle D. Rudser
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMinnesota
| | | | - Amy Wakumoto
- Division of Clinical Behavioral NeuroscienceDepartment of PediatricsUniversity of MinnesotaMinneapolisMinnesota
| | - Bryon A. Mueller
- Department of PsychiatryUniversity of MinnesotaMinneapolisMinnesota
| | - Petr Bednařík
- Multimodal and Functional Neuroimaging Research GroupCentral European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
- Department of RadiologyCenter for Magnetic Resonance ResearchUniversity of MinnesotaMinneapolisMinnesota
- High Field MR CentreDepartment of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Paul Tuite
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesota
| | - Xiang Wu
- Psychology DepartmentSun Yet‐Sen UniversityGuangzhouGuangdongChina
| | - Khalaf Bushara
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesota
- Neurology ServiceVeterans Affairs Medical CenterMinneapolisMinnesota
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21
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Mandarelli G, Moretti G, Pasquini M, Nicolò G, Ferracuti S. Informed Consent Decision-Making in Deep Brain Stimulation. Brain Sci 2018; 8:E84. [PMID: 29751598 PMCID: PMC5977075 DOI: 10.3390/brainsci8050084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.
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Affiliation(s)
- Gabriele Mandarelli
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| | - Germana Moretti
- Department of Mental Health, ASL Roma 5, 00034 Colleferro, Italy.
| | - Massimo Pasquini
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| | - Giuseppe Nicolò
- Department of Mental Health, ASL Roma 5, 00034 Colleferro, Italy.
| | - Stefano Ferracuti
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
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Wu X, Liao X, Zhan Y, Cheng C, Shen W, Huang M, Zhou Z, Wang Z, Qiu Z, Xing W, Liao W, Tang B, Shen L. Microstructural Alterations in Asymptomatic and Symptomatic Patients with Spinocerebellar Ataxia Type 3: A Tract-Based Spatial Statistics Study. Front Neurol 2017; 8:714. [PMID: 29312133 PMCID: PMC5744430 DOI: 10.3389/fneur.2017.00714] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/11/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Spinocerebellar ataxia type 3 (SCA3) is the most commonly occurring type of autosomal dominant spinocerebellar ataxia. The present study aims to investigate progressive changes in white matter (WM) fiber in asymptomatic and symptomatic patients with SCA3. Methods A total of 62 participants were included in this study. Among them, 16 were asymptomatic mutation carriers (pre-SCA3), 22 were SCA3 patients with clinical symptoms, and 24 were normal controls (NC). Group comparison of tract-based spatial statistics was performed to identify microstructural abnormalities at different SCA3 disease stages. Results Decreased fractional anisotropy (FA) and increased mean diffusivity (MD) were found in the left inferior cerebellar peduncle and superior cerebellar peduncle (SCP) in the pre-SCA3 group compared with NC. The symptomatic SCA3 group showed brain-wide WM tracts impairment in both supratentorial and infratentorial networks, and the mean FA value of the WM skeleton showed a significantly negative correlation with the International Cooperative Ataxia Rating Scale (ICARS) scores. Specifically, FA of the bilateral posterior limb of the internal capsule negatively correlated with SCA3 disease duration. We also found that FA values in the right medial lemniscus and SCP negatively correlated with ICARS scores, whereas FA in the right posterior thalamic radiation positively correlated with Montreal Cognitive Assessment scores. In addition, MD in the middle cerebellar peduncle, left anterior limb of internal capsule, external capsule, and superior corona radiate positively correlated with ICARS scores in SCA3 patients. Conclusion WM microstructural changes are present even in the asymptomatic stages of SCA3. In individuals in which the disease has progressed to the symptomatic stage, the integrity of WM fibers across the whole brain is affected. Furthermore, abnormalities in WM tracts are closely related to SCA3 disease severity, including movement disorder and cognitive dysfunction. These findings can deepen our understanding of the neural basis of SCA3 dysfunction.
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Affiliation(s)
- Xinwei Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xinxin Liao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yafeng Zhan
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Cheng Cheng
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Wei Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Mufang Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhifan Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng Wang
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Zilong Qiu
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,State Key Laboratory of Medical Genetics, Changsha, China.,National Clinical Research Center for Geriatric Disease, Changsha, China.,Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China.,Collaboration Innovation Center for Brain Science, Shanghai, China.,Collaboration Innovation Center for Genetics and Development, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.,State Key Laboratory of Medical Genetics, Changsha, China.,National Clinical Research Center for Geriatric Disease, Changsha, China
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