Repetitive transcranial magnetic stimulation for hypokinetic dysarthria in Parkinson's disease enhances white matter integrity of the auditory-motor loop

Microstructural white matter changes underlying speech deficits in Parkinson's disease

Speech impairments are one of the common symptoms of individuals with Parkinson's disease (PD). However, little is known about the underlying neuroanatomical structural deficits specifically in the basal ganglia-thalamocortical (BGTC) loop in the speech deficits of PD. Here we investigated white matter differences in PD using probabilistic tractography. Diffusion tensor imaging data were downloaded from the Parkinson's Progression Markers Initiative database. We included three groups of participants: 20 PD individuals with speech deficits, 20 PD individuals without speech deficits, and 20 age- and gender-matched control participants. Overall, PD individuals with speech deficits had higher mean diffusivity in the BGTC pathway in the left hemisphere compared with PD individuals without speech deficits. The present study exhibits that there may be a distinct pathophysiological profile of white matter for speech deficits in PD.

rTMS concurrent with cognitive training rewires AD brain by enhancing GM-WM functional connectivity: a preliminary study

Repetitive transcranial magnetic stimulation (rTMS) and cognitive training for patients with Alzheimer's disease (AD) can change functional connectivity (FC) within gray matter (GM). However, the role of white matter (WM) and changes of GM-WM FC under these therapies are still unclear. To clarify this problem, we applied 40 Hz rTMS over angular gyrus (AG) concurrent with cognitive training to 15 mild-moderate AD patients and analyzed the resting-state functional magnetic resonance imaging before and after treatment. Through AG-based FC analysis, corona radiata and superior longitudinal fasciculus (SLF) were identified as activated WM tracts. Compared with the GM results with AG as seed, more GM regions were found with activated WM tracts as seeds. The averaged FC, fractional amplitude of low-frequency fluctuation (fALFF), and regional homogeneity (ReHo) of the above GM regions had stronger clinical correlations (r/P = 0.363/0.048 vs 0.299/0.108, 0.351/0.057 vs 0.267/0.153, 0.420/0.021 vs 0.408/0.025, for FC/fALFF/ReHo, respectively) and better classification performance to distinguish pre-/post-treatment groups (AUC = 0.91 vs 0.88, 0.65 vs 0.63, 0.87 vs 0.82, for FC/fALFF/ReHo, respectively). Our results indicated that rTMS concurrent with cognitive training could rewire brain network by enhancing GM-WM FC in AD, and corona radiata and SLF played an important role in this process.