Cortical complexity and gyrification patterns in Parkinson's disease

Boundary Complexity of (Sub-) Cortical Areas Predict Deep Brain Stimulation Outcomes in Parkinson's Disease

While deep brain stimulation (DBS) remains an effective therapy for Parkinson's disease (PD), sources of variance in patient outcomes are still not fully understood, underscoring a need for better prognostic criteria. Here we leveraged routinely collected T1-weighted (T1-w) magnetic resonance imaging (MRI) data to derive patient-specific measures of brain structure and evaluate their usefulness in predicting changes in PD medications in response to DBS. Preoperative T1-w MRI data from 231 patients with PD were used to extract regional measures of fractal dimension (FD), sensitive to the structural complexities of cortical and subcortical areas. FD was validated as a biomarker of Parkinson's disease (PD) progression through comparison of patients with PD and healthy controls (HCs). This analysis revealed significant group differences in FD across nine brain regions which supports its utility as a marker of PD. We evaluated the impact of adding imaging features (FD) to a clinical model that included demographics and clinical parameters-age, sex, total number and location of DBS electrodes, and preoperative motor response to levodopa. This model aimed to explain variance and predict changes in medication following DBS. Regression analysis revealed that inclusion of the FD of distributed brain areas correlated with post-DBS reductions in medication burden, explaining an additional 13.6% of outcome variance (R 2 =0.388) compared to clinical features alone (R 2 =0.252). Hypergraph-based classification learning tasks achieved an area under the receiver operating characteristic curve of 0.64 when predicting with clinical features alone, versus 0.76 when combining clinical and imaging features. These findings demonstrate that PD effects on brain morphology linked to disease progression influence DBS outcomes. The work also highlights FD as a potentially useful imaging biomarker to enhance DBS candidate selection criteria for optimized treatment planning.

Cortical complexity alterations in motor subtypes of Parkinson's disease: A surface-based morphometry analysis of fractal dimension

Based on motor symptoms, Parkinson's disease (PD) can be classified into tremor dominant (TD) and postural instability gait difficulty (PIGD) subtypes. Few studies have examined cortical complexity differences in PD motor subtypes. This study aimed to investigate differences in cortical complexity and grey matter volume (GMV) between TD and PIGD. We enrolled 36 TD patients, 27 PIGD patients and 66 healthy controls (HC) from the PPMI (Parkinson's Progression Markers Initiative) database. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were utilized to assess differences in GMV, cortical thickness and cortical complexity. The structural MRI data of participants was analysed using CAT12/SPM12 (p < 0.05, FDR corrected). Additionally, correlations between clinical data and structural changes were examined (p < 0.05, Holm-Bonferroni corrected). In comparison to both HC and TD groups, PIGD patients exhibited a significant fractal dimension (FD) decrease in many cortical regions. A significant negative correlation between age and FD was observed in the left insula for the PIGD patients and in the bilateral insula for the TD patients. However, no significant differences were found in GMV, cortical thickness or other complexity indices. Altered FD in the bilateral insula indicates that postural instability and gait disturbances may result from a failure to integrate information from various structures, whereas parkinsonian rest tremor is not associated with this integration. Also, widespread decreases in cortical FD demonstrate that FD is more sensitive than other complexity measures and can serve as a novel biomarker for identifying subtle changes in cortical morphology in the PIGD subtype.

Risk factors for delirium occurring after deep brain stimulation surgery in patients with Parkinson's disease

OBJECTIVE

Postoperative delirium (POD) may cause cognitive morbidities and prolonged hospital stay. This study aimed to evaluate the risk factors associated with postoperative delirium in patients undergoing deep brain stimulation (DBS) for Parkinson's disease (PD).

METHOD

We retrospectively reviewed 83 patients with idiopathic PD who underwent bilateral DBS between 2016 and 2023. The target of DBS was the globus pallidus interna (Gpi) or the subthalamic nucleus (STN) in 84.3% and 15.7% of patients, respectively. Patients were evaluated using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and categorized into two groups: those with delirium and those without. Demographic features, disease duration, preoperative cognitive status (Mini-Mental State Examination) and silent ischemia, brain atrophy rates, DBS target location, surgical type and duration, Unified PD Rating Scale-3 scores, Hoehn and Yahr scores, postoperative perilead edema, and electrolyte imbalance were compared between patients with and without post-DBS delirium. Apart from univariate analysis, receiver operating characteristic (ROC) curve analysis for disease duration and multivariate logistic regression analyses were used to determine independent risk factors for post-DBS delirium.

RESULTS

Five out of the 83 patients (6%) developed post-DBS delirium. Age (> 68 years), disease duration, preoperative cerebral atrophy rates, and postoperative perilead edema were significantly higher in patients who developed delirium (p < 0.05 each). The ROC curve analysis revealed disease duration of ≥ 11 years as a risk factor for delirium (p = 0.001; odds ratio, OR: 58.4, 95% confidence interval, CI: 5.45-625.49). Age and disease duration were independent risk factors for post-DBS delirium (OR: 1.243, 95% CI: 1.070-1.592 and OR: 22.52, 95% CI: 1.21-383.96, respectively).

CONCLUSIONS

Older age and longer disease duration are independent risk factors for postoperative delirium in patients with PD. This study highlights the need to identify high-risk patients when undertaking DBS to facilitate early diagnosis and timely management.

Dysfunction of motor cortices in Parkinson's disease

The cerebral cortex has long been thought to be involved in the pathophysiology of motor symptoms of Parkinson's disease. The impaired cortical function is believed to be a direct and immediate effect of pathologically patterned basal ganglia output, mediated to the cerebral cortex by way of the ventral motor thalamus. However, recent studies in humans with Parkinson's disease and in animal models of the disease have provided strong evidence suggesting that the involvement of the cerebral cortex is much broader than merely serving as a passive conduit for subcortical disturbances. In the present review, we discuss Parkinson's disease-related changes in frontal cortical motor regions, focusing on neuropathology, plasticity, changes in neurotransmission, and altered network interactions. We will also examine recent studies exploring the cortical circuits as potential targets for neuromodulation to treat Parkinson's disease.

Impaired topological properties of cortical morphological brain networks correlate with motor symptoms in Parkinson's disease

BACKGROUND

Parkinson's disease (PD) is characterized by loss of selectively vulnerable neurons within the basal ganglia circuit and progressive atrophy in subcortical and cortical regions. However, the impact of neurodegenerative pathology on the topological organization of cortical morphological networks has not been explored. The aims of this study were to investigate altered network patterns of covariance in cortical thickness and complexity, and to evaluate how morphological network integrity in PD is related to motor impairment.

METHODS

Individual morphological networks were constructed for 50 PD patients and 46 healthy controls (HCs) by estimating interregional similarity distributions in surface-based indices. We performed graph theoretical analysis and network-based statistics to detect PD-related alterations and further examined the correlation of network metrics with clinical scores. Furthermore, support vector regression based on topological characteristics was applied to predict the severity of motor impairment in PD.

RESULTS

Compared with HCs, PD patients showed lower local efficiency (p = 0.004), normalized characteristic path length (p = 0.022), and clustering coefficient (p = 0.005) for gyrification index-based morphological brain networks. Nodal topological abnormalities were mainly in the frontal, parietal and temporal regions, and impaired morphological connectivity was involved in the sensorimotor and default mode networks. The support vector regression model using network-based features allowed prediction of motor symptom severity with a correlation coefficient of 0.606.

CONCLUSIONS

This study identified a disrupted topological organization of cortical morphological networks that could substantially advance our understanding of the network degeneration mechanism of PD and might offer indicators for monitoring disease progression.

Alterations in cortical volume and complexity in Parkinson's disease with depression

AIMS

The aim of this study is to investigate differences in gray matter volume and cortical complexity between Parkinson's disease with depression (PDD) patients and Parkinson's disease without depression (PDND) patients.

METHODS

A total of 41 PDND patients, 36 PDD patients, and 38 healthy controls (HC) were recruited and analyzed by Voxel-based morphometry (VBM) and surface-based morphometry (SBM). Differences in gray matter volume and cortical complexity were compared using the one-way analysis of variance (ANOVA) and correlated with the Hamilton Depression Scale-17 (HAMD-17) scores.

RESULTS

PDD patients exhibited significant cortical atrophy in various regions, including bilateral medial parietal-occipital-temporal lobes, right dorsolateral temporal lobes, bilateral parahippocampal gyrus, and bilateral hippocampus, compared to HC and PDND groups. A negative correlation between the GMV of left precuneus and HAMD-17 scores in the PDD group tended to be significant (r = -0.318, p = 0.059). Decreased gyrification index was observed in the bilateral insular and dorsolateral temporal cortex. However, there were no significant differences found in fractal dimension and sulcal depth.

CONCLUSION

Our research shows extensive cortical structural changes in the insular cortex, parietal-occipital-temporal lobes, and hippocampal regions in PDD. This provides a morphological perspective for understanding the pathophysiological mechanism underlying depression in Parkinson's disease.

Fractal Dimension Studies of the Brain Shape in Aging and Neurodegenerative Diseases

The fractal dimension is a morphometric measure that has been used to investigate the changes of brain shape complexity in aging and neurodegenerative diseases. This chapter reviews fractal dimension studies in aging and neurodegenerative disorders in the literature. Research has shown that the fractal dimension of the left cerebral hemisphere increases until adolescence and then decreases with aging, while the fractal dimension of the right hemisphere continues to increase until adulthood. Studies in neurodegenerative diseases demonstrated a decline in the fractal dimension of the gray matter and white matter in Alzheimer's disease, amyotrophic lateral sclerosis, and spinocerebellar ataxia. In multiple sclerosis, the white matter fractal dimension decreases, but conversely, the fractal dimension of the gray matter increases at specific stages of disease. There is also a decline in the gray matter fractal dimension in frontotemporal dementia and multiple system atrophy of the cerebellar type and in the white matter fractal dimension in epilepsy and stroke. Region-specific changes in fractal dimension have also been found in Huntington's disease and Parkinson's disease. Associations were found between the fractal dimension and clinical scores, showing the potential of the fractal dimension as a marker to monitor brain shape changes in normal or pathological processes and predict cognitive or motor function.

Fractal Dimension Analysis in Neurological Disorders: An Overview

Fractal analysis has emerged as a powerful tool for characterizing irregular and complex patterns found in the nervous system. This characterization is typically applied by estimating the fractal dimension (FD), a scalar index that describes the topological complexity of the irregular components of the nervous system, both at the macroscopic and microscopic levels, that may be viewed as geometric fractals. Moreover, temporal properties of neurophysiological signals can also be interpreted as dynamic fractals. Given its sensitivity for detecting changes in brain morphology, FD has been explored as a clinically relevant marker of brain damage in several neuropsychiatric conditions as well as in normal and pathological cerebral aging. In this sense, evidence is accumulating for decreases in FD in Alzheimer's disease, frontotemporal dementia, Parkinson's disease, multiple sclerosis, and many other neurological disorders. In addition, it is becoming increasingly clear that fractal analysis in the field of clinical neurology opens the possibility of detecting structural alterations in the early stages of the disease, which highlights FD as a potential diagnostic and prognostic tool in clinical practice.

Cortical gyrification pattern of depression in Parkinson's disease: a neuroimaging marker for disease severity?

Background

Although the study of the neuroanatomical correlates of depression in Parkinson's Disease (PD) is gaining increasing interest, up to now the cortical gyrification pattern of PD-related depression has not been reported. This study was conducted to investigate the local gyrification index (LGI) in PD patients with depression, and its associations with the severity of depression.

Methods

LGI values, as measured using FreeSurfer software, were compared between 59 depressed PD (dPD), 27 non-depressed PD (ndPD) patients and 43 healthy controls. The values were also compared between ndPD and mild-depressed PD (mi-dPD), moderate-depressed PD (mo-dPD) and severe-depressed PD (se-dPD) patients as sub-group analyses. Furthermore, we evaluated the correlation between LGI values and depressive symptom scores within dPD group.

Results

Compared to ndPD, the dPD patients exhibited decreased LGI in the left parietal, the right superior-frontal, posterior cingulate and paracentral regions, and the LGI values within these areas negatively correlated with the severity of depression. Specially, reduced gyrification was observed in mo-dPD and involving a larger region in se-dPD, but not in mi-dPD group.

Conclusion

The present study demonstrated that cortical gyrification is decreased within specific brain regions among PD patients with versus without depression, and those changes were associated with the severity of depression. Our findings suggested that cortical gyrification might be a potential neuroimaging marker for the severity of depression in patients with PD.

Evolutionary and genomic perspectives of brain aging and neurodegenerative diseases

This chapter utilizes genomic concepts and evolutionary perspectives to further understand the possible links between typical brain aging and neurodegenerative diseases, focusing on the two most prevalent of these: Alzheimer's disease and Parkinson's disease. Aging is the major risk factor for these neurodegenerative diseases. Researching the evolutionary and molecular underpinnings of aging helps to reveal elements of the typical aging process that leave individuals more vulnerable to neurodegenerative pathologies. Very little is known about the prevalence and susceptibility of neurodegenerative diseases in nonhuman species, as only a few individuals have been observed with these neuropathologies. However, several studies have investigated the evolution of lifespan, which is closely connected with brain size in mammals, and insights can be drawn from these to enrich our understanding of neurodegeneration. This chapter explores the relationship between the typical aging process and the events in neurodegeneration. First, we examined how age-related processes can increase susceptibility to neurodegenerative diseases. Second, we assessed to what extent neurodegeneration is an accelerated form of aging. We found that while at the phenotypic level both neurodegenerative diseases and the typical aging process share some characteristics, at the molecular level they show some distinctions in their profiles, such as variation in genes and gene expression. Furthermore, neurodegeneration of the brain is associated with an earlier onset of cellular, molecular, and structural age-related changes. In conclusion, a more integrative view of the aging process, both from a molecular and an evolutionary perspective, may increase our understanding of neurodegenerative diseases.

Fractal dimension of the brain in neurodegenerative disease and dementia: A systematic review

Sensitive and specific antemortem biomarkers of neurodegenerative disease and dementia are crucial to the pursuit of effective treatments, required both to reliably identify disease and to track its progression. Atrophy is the structural magnetic resonance imaging (MRI) hallmark of neurodegeneration. However in most cases it likely indicates a relatively advanced stage of disease less susceptible to treatment as some disease processes begin decades prior to clinical onset. Among emerging metrics that characterise brain shape rather than volume, fractal dimension (FD) quantifies shape complexity. FD has been applied in diverse fields of science to measure subtle changes in elaborate structures. We review its application thus far to structural MRI of the brain in neurodegenerative disease and dementia. We identified studies involving subjects who met criteria for mild cognitive impairment, Alzheimer's Disease, Vascular Dementia, Lewy Body Dementia, Frontotemporal Dementia, Amyotrophic Lateral Sclerosis, Parkinson's Disease, Huntington's Disease, Multiple Systems Atrophy, Spinocerebellar Ataxia and Multiple Sclerosis. The early literature suggests that neurodegenerative disease processes are usually associated with a decline in FD of the brain. The literature includes examples of disease-related change in FD occurring independently of atrophy, which if substantiated would represent a valuable advantage over other structural imaging metrics. However, it is likely to be non-specific and to exhibit complex spatial and temporal patterns. A more harmonious methodological approach across a larger number of studies as well as careful attention to technical factors associated with image processing and FD measurement will help to better elucidate the metric's utility.

Machine Learning Models for Diagnosis of Parkinson's Disease Using Multiple Structural Magnetic Resonance Imaging Features

Purpose

This study aimed to develop machine learning models for the diagnosis of Parkinson's disease (PD) using multiple structural magnetic resonance imaging (MRI) features and validate their performance.

Methods

Brain structural MRI scans of 60 patients with PD and 56 normal controls (NCs) were enrolled as development dataset and 69 patients with PD and 71 NCs from Parkinson's Progression Markers Initiative (PPMI) dataset as independent test dataset. First, multiple structural MRI features were extracted from cerebellar, subcortical, and cortical regions of the brain. Then, the Pearson's correlation test and least absolute shrinkage and selection operator (LASSO) regression were used to select the most discriminating features. Finally, using logistic regression (LR) classifier with the 5-fold cross-validation scheme in the development dataset, the cerebellar, subcortical, cortical, and a combined model based on all features were constructed separately. The diagnostic performance and clinical net benefit of each model were evaluated with the receiver operating characteristic (ROC) analysis and the decision curve analysis (DCA) in both datasets.

Results

After feature selection, 5 cerebellar (absolute value of left lobule crus II cortical thickness (CT) and right lobule IV volume, relative value of right lobule VIIIA CT and lobule VI/VIIIA gray matter volume), 3 subcortical (asymmetry index of caudate volume, relative value of left caudate volume, and absolute value of right lateral ventricle), and 4 cortical features (local gyrification index of right anterior circular insular sulcus and anterior agranular insula complex, local fractal dimension of right middle insular area, and CT of left supplementary and cingulate eye field) were selected as the most distinguishing features. The area under the curve (AUC) values of the cerebellar, subcortical, cortical, and combined models were 0.679, 0.555, 0.767, and 0.781, respectively, for the development dataset and 0.646, 0.632, 0.690, and 0.756, respectively, for the independent test dataset, respectively. The combined model showed higher performance than the other models (Delong's test, all p-values < 0.05). All models showed good calibration, and the DCA demonstrated that the combined model has a higher net benefit than other models.

Conclusion

The combined model showed favorable diagnostic performance and clinical net benefit and had the potential to be used as a non-invasive method for the diagnosis of PD.

Cortical Complexity Estimation Using Fractal Dimension: A Systematic Review of the Literature on Clinical and Nonclinical Samples

Fractal geometry has recently been proposed as a useful tool for characterizing the complexity of the brain cortex, which is likely to derive from the recurrence of sulci–gyri convolution patterns. The index used to describe the cortical complexity is called fractal dimensional (FD) and was employed by different research exploring the neurobiological correlates of distinct pathological and nonpathological conditions. This review aims to describe the literature on the application of this index, summarize the heterogeneities between studies and inform future research on this topic. Sixty‐two studies were included in the systematic review. The main research lines concern neurodevelopment, aging and the neurobiology of specific psychiatric and neurological disorders. Overall, the included papers indicate that cortical complexity is likely to reduce during aging and in various pathological processes affecting the brain. Nevertheless, the high heterogeneity between studies strongly prevents the possibility of drawing conclusions. Further research considering this index besides other morphological values is needed to better clarify the role of FD in characterizing the cortical structure.

Fractal dimension (FD) is a useful tool for the assessment of cortical complexity. In healthy controls, FD is associated with development, aging and cognition. Alterations in FD have been observed in different neurological and psychiatric disorders.

Patterns of Sulcal depth and cortical thickness in Parkinson's disease

Previous voxel-based morphometry (VBM) and cortical thickness (CT) studies on Parkinson's disease (PD) have mainly reported the gray matter size reduction, whereas the shape of cortical surface can also change in PD patients. For the first time, we analyzed sulcal depth (SD) patterns in PD patients by using whole brain region of interest (ROI)-based approach. In a cross-sectional study, high-resolution brain structural MRI images were collected from 60 PD patients without dementia and 56 age-and sex-matched healthy controls (HC). SD and CT were estimated using the Computational Anatomy Toolbox (CAT12) and statistically compared between groups on whole brain ROI-based level using statistical parametric mapping 12 (SPM12). Additionally, correlations between regional brain changes and clinical variables were also examined. Compared to HC, PD patients showed lower SD in widespread regions, including temporal (the bilateral transverse temporal, the left inferior temporal, the right middle temporal and the right superior temporal), insular (the left insula), frontal (the left pars triangularis, the left pars opercularis and the left precentral), parietal (the bilateral superior parietal) and occipital (the right cuneus) regions. For CT, only the left pars opercularis showed lower CT in PD patients compared to HC. No regions showed higher SD or CT in PD patients compared to HC. In PD patients, a significant positive correlation was found between SD of the left pars opercularis and MMSE scores, such that lower MMSE scores were related to lower SD of the left pars opercularis. Our results of widespread lower SD, but relatively localized lower CT, indicate that SD seems to be more sensitive to brain changes than CT and may be mainly affected by white matter damage. Hence, SD may be a more promising indicator to investigate the surface shape changes in PD patients. The significant positive correlation between SD of the left pars opercularis and MMSE scores suggests that SD may be prognostic of future cognitive decline.

Association of Gyrification Pattern, White Matter Changes, and Phenotypic Profile in Patients With Parkinson Disease

OBJECTIVE

To investigate the cortical gyrification changes as well as their relationships with white matter (WM) microstructural abnormalities in the akinetic-rigid (AR) and tremor-dominant (TD) subtypes of Parkinson disease (PD).

METHODS

Sixty-four patients with the AR subtype, 26 patients with the TD subtype, and 56 healthy controls (HCs) were included in this study. High-resolution T1-weighted and diffusion-weighted images were acquired for each participant. We computed local gyrification index (LGI) and fractional anisotropy (FA) to identify the cortical gyrification and WM microstructural changes in the AR and TD subtypes.

RESULTS

Compared with HCs, patients with the AR subtype showed decreased LGI in the precentral, postcentral, inferior and superior parietal, middle and superior frontal/temporal, anterior and posterior cingulate, orbitofrontal, supramarginal, precuneus, and some visual cortices, and decreased FA in the corticospinal tract, inferior and superior longitudinal fasciculus, inferior fronto-occipital fasciculus, forceps minor/major, and anterior thalamic radiation. Decreases in LGI and FA of the AR subtype were found to be tightly coupled. LGIs of the left inferior and middle frontal gyrus correlated with Mini-Mental State Examination and Hoehn & Yahr scores of patients with the AR subtype. Patients with the TD subtype showed no significant change in the LGI and FA compared with patients with the AR subtype and HCs.

CONCLUSIONS

Our results suggest that cortical gyrification changes in PD are motor phenotype-specific and are possibly mediated by the microstructural abnormalities of the underlying WM tracts.

Abnormal Topological Organization of Sulcal Depth-Based Structural Covariance Networks in Parkinson's Disease

Recent research on Parkinson's disease (PD) has demonstrated the topological abnormalities of structural covariance networks (SCNs) using various morphometric features from structural magnetic resonance images (sMRI). However, the sulcal depth (SD)-based SCNs have not been investigated. In this study, we used SD to investigate the topological alterations of SCNs in 60 PD patients and 56 age- and gender-matched healthy controls (HC). SCNs were constructed by thresholding SD correlation matrices of 68 regions and analyzed using graph theoretical approaches. Compared with HC, PD patients showed increased normalized clustering coefficient and normalized path length, as well as a reorganization of degree-based and betweenness-based hubs (i.e., less frontal hubs). Moreover, the degree distribution analysis showed more high-degree nodes in PD patients. In addition, we also found the increased assortativity and reduced robustness under a random attack in PD patients compared to HC. Taken together, these findings indicated an abnormal topological organization of SD-based SCNs in PD patients, which may contribute in understanding the pathophysiology of PD at the network level.