Wilson's disease with extensive degeneration of cerebral white matter and cortex

Basal ganglia-orbitofrontal circuits are associated with prospective memory deficits in Wilson's disease

Degenerative changes in the basal ganglia (BG) are thought to contribute to neurological symptoms in Wilson's disease (WD). However, very little is known about whether and how the BG have an influence on prospective memory (PM) by interacting with the cerebral cortex. Here, we employed structural magnetic resonance imaging to systematically examine the effect of volume atrophy of BG on cortical thickness and to evaluate the relationships between cortical thickness of regions associated with BG atrophy and PM performance in WD. Cortical thickness atrophy in the left temporal pole and medial frontal gyrus are not related to degenerative changes in BG. Cortical thickness in the left superior frontal gyrus and right orbitofrontal gyrus (ORB) have stronger correlations with volume atrophy of the left accumbens, pallidum, and putamen in WD when compared with healthy controls. Furthermore, the cortical thickness of the right ORB is not only significantly correlated with PM performance but can also distinguish the severity of PM impairment in WD. Additionally, the middle cingulate cortex was related to volume atrophy of the accumbens, and its cortical thickness has a significant positive correlation with event-based PM. Together, these findings highlight that BG-orbitofrontal circuits may serve as neural biomarkers of PM and provide implications for the neural mechanisms underlying cognitive impairment in WD.

Autonomic involvement in Wilson's disease: a study of sympathetic skin response and RR interval variation

Autonomic nervous system involvement in Wilson's disease (WD) was studied in 25 patients by sympathetic skin response (SSR) and RR interval variation (RRIV). The control group consisted of age-matched healthy subjects. Palmar SSRs were obtained by central activation from median nerve stimulation and by activation of sympathetic trunk from magnetic stimulation of the neck. Electric SSRs were prolonged in 11 patients and absent in 2; magnetic SSRs were delayed in 4 and absent in 1; and the sympathetic central conduction time was prolonged in 3. The mean latencies and mean central conduction of the SSRs were all significantly prolonged in WD when compared to the control group. On the other hand, parasympathetic function was abnormal in 3 patients only during forced deep breathing, and as a group only mean D% was significantly reduced. The present findings suggest that autonomic dysfunction may occur in WD, and that sympathetic function is predominantly affected, mainly due to central involvement.