White matter tract microstructure, macrostructure, and associated cortical gray matter morphology across the lifespan

The effect of common parameters of bipolar stimulation on brain evoked potentials

OBJECTIVE

To identify optimal bipolar stimulation parameters for robust generation of brain evoked potentials (BEPs), namely the interelectrode distance (IED) and the intensity of stimulation (IS), in cortical and axonal stimulation.

METHODS

In 15 patients who underwent awake surgery for brain tumor removal, BEPs were elicited at different values of IED and IS, respectively: 5 mm-5 mA, 5 mm-10 mA, and 10 mm-10 mA. The number of BEPs elicited by stimulation, as well as the delays and amplitudes of the N1 waves were compared between the different groups of stimulation parameters and according to the stimulated brain structure (cortical vs. axonal).

RESULTS

The amplitudes of N1 increased with the intensity of bipolar stimulation, either in cortical or axonal stimulation, while N1 peak delays were not affected by the stimulation parameters. Furthermore, axonal stimulation produced more N1s than cortical stimulation, with lower latencies.

CONCLUSIONS

Understanding the relationship between stimulation parameters and BEP is of utmost importance to determine whether the generated N1 waves accurately reflect the underlying structural anatomy. Other factors, such as stimulation frequency or pulse width and shape, may also play a role and warrant further investigation.

SIGNIFICANCE

This study represents the first step in describing the influence of common bipolar stimulation parameters on robustness of BEPs by examining the impact of IED and IS on the N1 wave.

Greater white matter degeneration and lower structural connectivity in non-amnestic vs. amnestic Alzheimer's disease

Introduction

Multimodal evidence indicates Alzheimer's disease (AD) is characterized by early white matter (WM) changes that precede overt cognitive impairment. WM changes have overwhelmingly been investigated in typical, amnestic mild cognitive impairment and AD; fewer studies have addressed WM change in atypical, non-amnestic syndromes. We hypothesized each non-amnestic AD syndrome would exhibit WM differences from amnestic and other non-amnestic syndromes.

Materials and methods

Participants included 45 cognitively normal (CN) individuals; 41 amnestic AD patients; and 67 patients with non-amnestic AD syndromes including logopenic-variant primary progressive aphasia (lvPPA, n = 32), posterior cortical atrophy (PCA, n = 17), behavioral variant AD (bvAD, n = 10), and corticobasal syndrome (CBS, n = 8). All had T1-weighted MRI and 30-direction diffusion-weighted imaging (DWI). We performed whole-brain deterministic tractography between 148 cortical and subcortical regions; connection strength was quantified by tractwise mean generalized fractional anisotropy. Regression models assessed effects of group and phenotype as well as associations with grey matter volume. Topological analyses assessed differences in persistent homology (numbers of graph components and cycles). Additionally, we tested associations of topological metrics with global cognition, disease duration, and DWI microstructural metrics.

Results

Both amnestic and non-amnestic patients exhibited lower WM connection strength than CN participants in corpus callosum, cingulum, and inferior and superior longitudinal fasciculi. Overall, non-amnestic patients had more WM disease than amnestic patients. LvPPA patients had left-lateralized WM degeneration; PCA patients had reductions in connections to bilateral posterior parietal, occipital, and temporal areas. Topological analysis showed the non-amnestic but not the amnestic group had more connected components than controls, indicating persistently lower connectivity. Longer disease duration and cognitive impairment were associated with more connected components and fewer cycles in individuals' brain graphs.

Discussion

We have previously reported syndromic differences in GM degeneration and tau accumulation between AD syndromes; here we find corresponding differences in WM tracts connecting syndrome-specific epicenters. Determining the reasons for selective WM degeneration in non-amnestic AD is a research priority that will require integration of knowledge from neuroimaging, biomarker, autopsy, and functional genetic studies. Furthermore, longitudinal studies to determine the chronology of WM vs. GM degeneration will be key to assessing evidence for WM-mediated tau spread.