1
|
Lista S, Vergallo A, Teipel SJ, Lemercier P, Giorgi FS, Gabelle A, Garaci F, Mercuri NB, Babiloni C, Gaire BP, Koronyo Y, Koronyo-Hamaoui M, Hampel H, Nisticò R. Determinants of approved acetylcholinesterase inhibitor response outcomes in Alzheimer's disease: relevance for precision medicine in neurodegenerative diseases. Ageing Res Rev 2023; 84:101819. [PMID: 36526257 DOI: 10.1016/j.arr.2022.101819] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Acetylcholinesterase inhibitors (ChEI) are the global standard of care for the symptomatic treatment of Alzheimer's disease (AD) and show significant positive effects in neurodegenerative diseases with cognitive and behavioral symptoms. Although experimental and large-scale clinical evidence indicates the potential long-term efficacy of ChEI, primary outcomes are generally heterogeneous across outpatient clinics and regional healthcare systems. Sub-optimal dosing or slow tapering, heterogeneous guidelines about the timing for therapy initiation (prodromal versus dementia stages), healthcare providers' ambivalence to treatment, lack of disease awareness, delayed medical consultation, prescription of ChEI in non-AD cognitive disorders, contribute to the negative outcomes. We present an evidence-based overview of determinants, spanning genetic, molecular, and large-scale networks, involved in the response to ChEI in patients with AD and other neurodegenerative diseases. A comprehensive understanding of cerebral and retinal cholinergic system dysfunctions along with ChEI response predictors in AD is crucial since disease-modifying therapies will frequently be prescribed in combination with ChEI. Therapeutic algorithms tailored to genetic, biological, clinical (endo)phenotypes, and disease stages will help leverage inter-drug synergy and attain optimal combined response outcomes, in line with the precision medicine model.
Collapse
Affiliation(s)
- Simone Lista
- Memory Resources and Research Center (CMRR), Neurology Department, Gui de Chauliac University Hospital, Montpellier, France; School of Pharmacy, University of Rome "Tor Vergata", Rome, Italy.
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Pablo Lemercier
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Sean Giorgi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Audrey Gabelle
- Memory Resources and Research Center (CMRR), Neurology Department, Gui de Chauliac University Hospital, Montpellier, France
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Casa di Cura "San Raffaele Cassino", Cassino, Italy
| | - Nicola B Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele Cassino, Cassino, Italy
| | - Bhakta Prasad Gaire
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Robert Nisticò
- School of Pharmacy, University of Rome "Tor Vergata", Rome, Italy; Laboratory of Pharmacology of Synaptic Plasticity, EBRI Rita Levi-Montalcini Foundation, Rome, Italy.
| |
Collapse
|
2
|
Cholinergic relevant functional reactivity is associated with dopamine responsiveness of tremor in Parkinson's disease. Brain Imaging Behav 2022; 16:1234-1245. [PMID: 34973120 PMCID: PMC9107430 DOI: 10.1007/s11682-021-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Tremor in Parkinson’s disease (PD) has distinct responsiveness to dopamine, which is supposed not be exclusively related to dopamine deficiency but has a close relationship with cholinergic system. This phenomenon indicates that cholinergic system may be an important regulatory for distinct dopamine responsiveness of parkinsonian tremor. Through investigating the alterations of cholinergic and dopaminergic network during levodopa administration, we aimed at exploring the mechanisms of differed dopamine responsiveness of parkinsonian tremor. Fifty-two PD patients with tremor were enrolled. MRI scanning, UPDRS III and its sub-symptom scores were collected in OFF and ON status (dopaminergic challenge test). Then, patients were divided into two groups (dopamine-resistant tremor and dopamine-responsive tremor) according to the tremor change rate median score. Dopaminergic and cholinergic network were obtained. LASSO regression was conducted to identify functional connectivity with distinct reactivity during levodopa administration between groups. Afterwards, detailed group comparisons, interaction and correlation analyses were performed. The reactivity of cholinergic connectivity showed the highest possibility to distinguish two groups, especially connectivity of right basal forebrain 123 to right parietal operculum cortex (R.BF123-R.PO). After levodopa administration, connectivity of R.BF123-R.PO was decreased for dopamine-responsive tremor while which remained unchanged for dopamine-resistant tremor. The reactivity of R.BF123-R.PO was negatively correlated with tremor change rate. Reduced cholinergic connectivity to parietal operculum may be an underlying mechanism for the responsive tremor in PD and the distinct cholinergic reactivity of parietal operculum to levodopa may be a core pathophysiology for the differed DA responsiveness of tremor in PD.
Collapse
|
3
|
Khomenko I, Pronina M, Kataeva G, Kropotov J, Irishina Y, Susin D. Combined 18F-fluorodeoxyglucose positron emission tomography and event-related potentials study of the cognitive impairment mechanisms in Parkinson’s disease. J Clin Neurosci 2020; 72:335-341. [DOI: 10.1016/j.jocn.2019.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
|
4
|
Abstract
Once a diagnosis of Parkinson's disease (PD) has been made, even in its earliest prodromal form of subjective memory impairment, cognitive impairment has begun and involves anterior cingulate cortex (ACC). While the Braak staging scheme showed mid- to later-stage PD progression from cingulate allocortex adjacent to the corpus callosum and progressing into its neocortical moieties, the last decade has produced substantial information on the role of cingulate cortex in multiple symptoms, not just global measures of cognition. Voxel-based morphometry has been used in many studies of mild cognitive impairment (MCI) in PD to show reduced thickness in ACC and posterior cingulate cortex (PCC). Regional cerebral blood flow is altered in association with verbal IQ in all the PCC and anterior midcingulate cortex and executive impairments in ACC. Diffusion tensor imaging shows reduced fractional anisotropy throughout the entire cingulum bundle. Amnestic MCI is associated with reduced dopamine-2 receptor binding in ACC and, even in cognitively normal PD cases, dopaminergic pathways in ACC are impaired early in association with executive and language functions. The cholinergic system also has substantial changes in nicotinic and muscarinic receptor binding, and therapy with donepezil improves Mini-Mental State Exam scores and metabolism in pACC and dPCC. Cingulate cortex is also engaged in two critical symptoms: apathy and visual hallucinations. Finally, one can be optimistic that cingulate cortex will play an important role in developing new biomarkers of early PD. These methods have already been shown to be useful in cingulate cortex and include magnetic resonance spectroscopy, next-generation gene expression, and the new α-synuclein proximity ligation assay that specifically recognizes α-synuclein oligomers. Thus the future is bright for developing multivariate, multimodal biomarkers that include cingulate cortex.
Collapse
Affiliation(s)
- Brent A Vogt
- Cingulum Neurosciences Institute, Manlius, NY, United States; Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States.
| |
Collapse
|
5
|
Homenko JG, Susin DS, Kataeva GV, Irishina JA, Zavolokov IG. [Characteristics of cerebral glucose metabolism in patients with cognitive impairment in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018. [PMID: 28638030 DOI: 10.17116/jnevro20171175146-51] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To study the relationship between early cognitive impairment symptoms and cerebral glucose metabolism in different brain regions (according to the positron emission tomography (PET) data) in Parkinson's disease (PD) in order to increase the diagnostic and treatment efficacy. MATERIAL AND METHODS Two groups of patients with PD (stage I-III), including 11 patients without cognitive disorders and 13 with mild cognitive impairment (MCI), were examined. The control group included 10 age-matched people with normal cognition. To evaluate cognitive state, the Mini mental state examination (MMSE), the Frontal assessment battery (FAB) and the 'clock drawing test' were used. The regional cerebral glucose metabolism rate (CMRglu) was assessed using PET with 18F-fluorodeoxyglucose (FDG). RESULTS AND CONCLUSION In PD patients, CMRglu were decreased in the frontal (Brodmann areas (BA) 9, 10, 11, 46, 47), occipital (BA 19) and parietal (BA 39), temporal (BA 20, 37), and cingulate cortex (BA 32) compared to the control group. Cerebral glucose metabolism was decreased in the frontal (BA 8, 9, 10, 45, 46, 47), parietal (BA 7, 39, 40) and cingulate cortex (BA 23, 24, 31, 32) in the group of PD patients with MCI compared to PD patients with normal cognition. Hypometabolism in BA 7, 8, 23, 24, 31, 40 was revealed only in comparison of PD and PD-MCI groups, and did not appear in case of comparison of cognitively normal PD patients with the control group. It is possible to suggest that the mentioned above brain areas were associated with cognitive impairment. The revealed glucose hypometabolism pattern possibly has the diagnostic value for the early and preclinical diagnosis of MCI in PD and control of treatment efficacy.
Collapse
Affiliation(s)
- Ju G Homenko
- N. Bekhtereva Institute of the Human Brain of the Russian Academy of Science, St. Petersburg, Russia
| | - D S Susin
- N. Bekhtereva Institute of the Human Brain of the Russian Academy of Science, St. Petersburg, Russia
| | - G V Kataeva
- N. Bekhtereva Institute of the Human Brain of the Russian Academy of Science, St. Petersburg, Russia
| | - Ju A Irishina
- N. Bekhtereva Institute of the Human Brain of the Russian Academy of Science, St. Petersburg, Russia
| | - I G Zavolokov
- N. Bekhtereva Institute of the Human Brain of the Russian Academy of Science, St. Petersburg, Russia
| |
Collapse
|
6
|
Abstract
PET studies play an important role in the early detection of Alzheimer's and Parkinson's diseases (AD and PD). Fluorine-18 fluorodeoxyglucose (F-FDG) PET imaging of regional cerebral glucose metabolism and PET amyloid imaging are the two major PET studies for AD. F-FDG PET is highly sensitive for the early diagnosis of AD, in predicting conversion from mild cognitive impairment to AD, and in differentiating AD from other dementias. PET amyloid imaging is positive in the majority of patients with AD. Negative amyloid PET reduces the likelihood of AD. The main limitations of PET amyloid imaging is its high positivity in the normal elderly population and in other medical conditions with amyloid pathologies. Various PET tracers are available to assess motor and cognitive dysfunctions in PD. PET tracers targeting presynaptic dopaminergic function (F-DOPA, radiolabeled PET tracers assessing the availability of dopamine transporters and vesicular monoamine transporters) and postsynaptic dopamine receptors are used to assess motor dysfunction in PD. PET tracers, particularly dopamine transporters, are highly sensitive in the early diagnosis of PD. Uptake of PET tracers in the striatum is inversely correlated with disease severity. PET is valuable in differentiating PD from other movement disorders. PET studies, particularly F-FDG PET, help to evaluate cortical metabolism in PD patients with cognitive dysfunction and dementia.
Collapse
|
7
|
Madhyastha TM, Askren MK, Boord P, Zhang J, Leverenz JB, Grabowski TJ. Cerebral perfusion and cortical thickness indicate cortical involvement in mild Parkinson's disease. Mov Disord 2015; 30:1893-900. [PMID: 25759166 PMCID: PMC4567553 DOI: 10.1002/mds.26128] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/28/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022] Open
Abstract
Cortical dysfunction in Parkinson's disease (PD) may be caused by disruption to ascending systems or by intrinsic cortical neuropathology. We introduce and conduct a joint analysis of metabolism and atrophy capable of identifying whether metabolic disruption occurs in mild PD without cortical atrophy, to determine the extent and spatial pattern of cortical involvement in mild PD. The design was observational, studying 23 cognitively normal participants with mild PD (mean Hoehn & Yahr stage 2) and 21 healthy controls. Cortical thickness (obtained from analysis of structural magnetic resonance imaging [MRI] with FreeSurfer) and cerebral perfusion measures (obtained from arterial spin labeling [ASL]) analyzed independently and then together in a joint multiple factorial analysis to identify spatial patterns of perfusion and cortical thickness. We identify a pattern of changes in perfusion and cortical thickness characterized by symmetric parietal cortical thinning and reduced precuneus perfusion, with relative preservation of thickness and perfusion in the anterior cingulate cortex (ACC), right prefrontal gyrus, and medial frontal gyrus. The expression of this pattern is correlated with motor system symptoms and speed of processing. A spatial pattern of joint parietal cortical thinning and disproportionate reduction in perfusion occurs in our nondemented PD sample. We found no PD-related components of reduced perfusion without cortical thinning. This suggests that PD affects the cortex itself, even when symptoms are relatively mild.
Collapse
Affiliation(s)
| | - Mary K Askren
- Department of Radiology, University of Washington, Seattle, USA
| | - Peter Boord
- Department of Radiology, University of Washington, Seattle, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, USA
| | - James B Leverenz
- Cleveland Lou Ruvo Center for Brain Health at Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas J Grabowski
- Department of Radiology, University of Washington, Seattle, USA
- Department of Neurology, University of Washington, Seattle, USA
| |
Collapse
|
8
|
Xu Y, Wei X, Liu X, Liao J, Lin J, Zhu C, Meng X, Xie D, Chao D, Fenoy AJ, Cheng M, Tang B, Zhang Z, Xia Y, Wang Q. Low Cerebral Glucose Metabolism: A Potential Predictor for the Severity of Vascular Parkinsonism and Parkinson's Disease. Aging Dis 2015; 6:426-36. [PMID: 26618044 DOI: 10.14336/ad.2015.0204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/04/2015] [Indexed: 01/18/2023] Open
Abstract
This study explored the association between cerebral metabolic rates of glucose (CMRGlc) and the severity of Vascular Parkinsonism (VP) and Parkinson's disease (PD). A cross-sectional study was performed to compare CMRGlc in normal subjects vs. VP and PD patients. Twelve normal subjects, 22 VP, and 11 PD patients were evaluated with the H&Y and MMSE, and underwent 18F-FDG measurements. Pearson's correlations were used to identify potential associations between the severity of VP/PD and CMRGlc. A pronounced reduction of CMRGlc in the frontal lobe and caudate putamen was detected in patients with VP and PD when compared with normal subjects. The VP patients displayed a slight CMRGlc decrease in the caudate putamen and frontal lobe in comparison with PD patients. These decreases in CMRGlc in the frontal lobe and caudate putamen were significantly correlated with the VP patients' H&Y, UPDRS II, UPDRS III, MMSE, cardiovascular, and attention/memory scores. Similarly, significant correlations were observed in patients with PD. This is the first clinical study finding strong evidence for an association between low cerebral glucose metabolism and the severity of VP and PD. Our findings suggest that these changes in glucose metabolism in the frontal lobe and caudate putamen may underlie the pathophysiological mechanisms of VP and PD. As the scramble to find imaging biomarkers or predictors of the disease intensifies, a better understanding of the roles of cerebral glucose metabolism may give us insight into the pathogenesis of VP and PD.
Collapse
Affiliation(s)
- Yunqi Xu
- 1 Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
| | - Xiaobo Wei
- 1 Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
| | - Xu Liu
- 1 Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
| | - Jinchi Liao
- 1 Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
| | - Jiaping Lin
- 2 Department of Neurosurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangdong 510080, China
| | - Cansheng Zhu
- 1 Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
| | - Xiaochun Meng
- 4 Department of Radiology and Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Dongsi Xie
- 4 Department of Radiology and Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Dongman Chao
- 3 Department of Neurosurgery, the University of Texas Medical School at Houston, Houston, TX 77030, USA
| | - Albert J Fenoy
- 3 Department of Neurosurgery, the University of Texas Medical School at Houston, Houston, TX 77030, USA
| | - Muhua Cheng
- 4 Department of Radiology and Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Beisha Tang
- 5 The State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410078, China
| | - Zhuohua Zhang
- 5 The State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410078, China
| | - Ying Xia
- 3 Department of Neurosurgery, the University of Texas Medical School at Houston, Houston, TX 77030, USA
| | - Qing Wang
- 1 Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
| |
Collapse
|
9
|
Kim E, Howes OD, Kapur S. Molecular imaging as a guide for the treatment of central nervous system disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24174903 PMCID: PMC3811103 DOI: 10.31887/dcns.2013.15.3/ekim] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Molecular imaging techniques have a number of advantages for research into the pathophysiology and treatment of central nervous system (CNS) disorders. Firstly, they provide a noninvasive means of characterizing physiological processes in the living brain, enabling molecular alterations to be linked to clinical changes. Secondly, the pathophysiological target in a given CNS disorder can be measured in animal models and in experimental human models in the same way, which enables translational research. Moreover, as molecular imaging facilitates the detection of functional change which precedes gross pathology, it is particularly useful for the early diagnosis and treatment of CNS disorders. This review considers the application of molecular imaging to CNS disorders focusing on its potential to inform the development and evaluation of treatments. We focus on schizophrenia, Parkinson's disease, depression, and dementia as major CNS disorders. We also review the potential of molecular imaging to guide new drug development for CNS disorders.
Collapse
Affiliation(s)
- Euitae Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, Korea
| | | | | |
Collapse
|
10
|
Thobois S, Ballanger B, Poisson A, Broussolle E. [Imaging non motor signs in Parkinson's disease]. Rev Neurol (Paris) 2012; 168:576-84. [PMID: 22921250 DOI: 10.1016/j.neurol.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022]
Abstract
Parkinson's disease is mainly considered as a motor disorder defined by a motor triad. However, various non-motor manifestations may be encountered in Parkinson's disease, including hyposmia, pain, fatigue, sleep disorders, cognitive and behavioral disorders. The pathophysiology of these signs is complex, not univocal and remains poorly understood. Functional imaging techniques either by positron emission tomography, single photon emission tomography or functional magnetic resonance imaging provide an invaluable opportunity to better understand the pathophysiology of these signs. In this paper, we present a review of the recent advances provided by functional imaging in this area.
Collapse
Affiliation(s)
- S Thobois
- CNRS, UMR 5229, centre de neurosciences cognitives, Bron cedex, France.
| | | | | | | |
Collapse
|
11
|
Garcia-Garcia D, Clavero P, Gasca Salas C, Lamet I, Arbizu J, Gonzalez-Redondo R, Obeso JA, Rodriguez-Oroz MC. Posterior parietooccipital hypometabolism may differentiate mild cognitive impairment from dementia in Parkinson's disease. Eur J Nucl Med Mol Imaging 2012; 39:1767-77. [PMID: 22872307 DOI: 10.1007/s00259-012-2198-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Patients with Parkinson's disease (PD) may have normal cognition, mild cognitive impairment (MCI) or dementia. We investigated differences in cerebral metabolism associated with these three cognitive states and the relationship between metabolism and cognitive dysfunction. METHODS FDG PET and a battery of neuropsychological tests were used to study PD patients with dementia (n = 19), MCI (n = 28) and normal cognition (n = 21), and control subjects (n = 20). Regional glucose metabolism in patients and controls was analysed using statistical parametric mapping (SPM8) corrected for age, motor severity and depression. Correlations between the mini-mental state examination score and Z-score values of the different cognitive domains with respect to cerebral FDG uptake were assessed using SPM8. RESULTS PD patients with MCI (PD-MCI patients) exhibited decreased FDG uptake in the frontal lobe, and to a lesser extent in parietal areas compared with cognitively normal patients. Patients with dementia showed reduced metabolism in the parietal, occipital and temporal areas and a less extensive reduction in the frontal lobe compared with PD-MCI patients, while widespread hypometabolism was seen in comparison with patients with normal cognition. PD-MCI patients exhibited reduced FDG uptake in the parietal and occipital lobes and in localized areas of the frontal and temporal lobes compared with controls, whereas patients with dementia showed a widespread reduction of cortical metabolism. Mini-mental state examination score correlated positively with metabolism in several lobes, executive function with metabolism in the parietooccipitotemporal junction and frontal lobe, memory with temporoparietal metabolism, visuospatial function with occipitoparietal and temporal metabolism, and language with frontal metabolism. CONCLUSION PD patients with MCI exhibited hypometabolism in several cortical regions compared with controls, and in the frontal and parietal regions compared with cognitively normal patients. Hypometabolism was higher in patients with dementia than in those with MCI, mainly in the posterior cortical areas where it was correlated with visuospatial, memory and executive functions.
Collapse
Affiliation(s)
- David Garcia-Garcia
- Neurosciences Area, CIMA, Department of Neurology and Neurosurgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Nobili F, Morbelli S, Arnaldi D, Ferrara M, Campus C, Brugnolo A, Mazzei D, Mehrdad N, Sambuceti G, Rodriguez G. Radionuclide brain imaging correlates of cognitive impairment in Parkinson's disease (PD). J Neurol Sci 2011; 310:31-5. [PMID: 21762928 DOI: 10.1016/j.jns.2011.06.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 06/19/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
Abstract
A subtle cognitive impairment can be detected early in the course of Parkinson's disease (PD). Executive, memory and visuospatial functions are specifically affected, but the underlying pathophysiological basis is not well elucidated yet and may be heterogeneous. The recent identification of a PD-related cognitive metabolic pattern (PDCP), including hypometabolism in associative frontal, parietal and posterior limbic structures, has integrated the classical notion of a striato-frontal syndrome at the basis of cognitive dys-function. Recent evidence suggests that whilst executive dys-function is seen in virtually all PD patients, visuospatial and memory impairment may share a higher risk for the subsequent development of dementia. By means of perfusion SPECT and [18F]FDG-PET, cortical dys-function may be highlighted since the early stages, it is more evident in PD patients with Mild Cognitive Impairment (MCI), and reaches the maximum in PD dementia (PDD). Posterior temporo-parieto-occipital dys-function in associative and limbic cortex, closely resembling that found in Alzheimer's disease patients, is found in PDD, with a more severe occipital hypometabolism and a relatively milder hypometabolism in medial temporal lobe structures. Furthermore, deficit of acetylcholinesterase (AchE) can be found by means of [11C]MP4A-PET already in early stage of PD, especially in posterior regions, then becoming more severe in PDD and in dementia with Lewy bodies (DLB). Administration of AchE inhibitors to PDD patients increased brain metabolism in bilateral frontal and left parietal regions, and left posterior cingulate. Finally, the recent availability of radiopharmaceuticals able to disclose amyloid brain deposition has allowed to demonstrate amyloid load in a part of patients with PDD, possibly due to diffuse rather than neuritic plaques. Brain PET and SPECT have strongly contributed to the understanding of the pathophysiology of cognitive impairment in PD and may serve as probes to monitor the effects of therapeutic interventions.
Collapse
Affiliation(s)
- Flavio Nobili
- Clinical Neurophysiology, Dept. of Neurosciences, Ophthalmology and Genetics, University of Genoa, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Cognitive impairment and dementia associated with Parkinson's disease (PD) are common and often have devastating effects upon the patient and their family. Early cognitive impairment in PD is frequent, and the functional impact may be underestimated. Optimal management will rely upon better identification of the predominant symptoms and greater knowledge of their pathophysiological basis. The management of dementia in PD (PD-D) also has to consider the significant neuropsychiatric burden that frequently accompanies the cognitive decline, as well as fluctuations in attention. Atypical anti-psychotics have a limited role at present in treating PD-D, although new drugs are under development. The mainstay of drug management for people with PD-D is cholinesterase inhibitors, although recent trials have suggested that the N-methyl-D aspartate antagonist memantine may also have some benefit. Disease modification remains the ultimate goal for preventing the inexorable decline in PD-D, although effective interventions are still some way off. Limited benefit may, however, be possible through exercise programmes and so-called "medical foods", although randomised trials are required to confirm largely anecdotal observations.
Collapse
Affiliation(s)
- David J Burn
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
| |
Collapse
|
15
|
Fitzpatrick T, Mattis P, Eidelberg D. Functional imaging of cognitive impairment in Parkinson's disease. Clin EEG Neurosci 2010; 41:119-26. [PMID: 20722344 DOI: 10.1177/155005941004100303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parkinson's disease (PD) is known by most persons to be a neurodegenerative disorder that affects one's motor skills. However, the disease is also characterized by the less recognized cognitive symptoms, including deficits in executive functioning, as well as mood and behavioral problems, which are just as disabling and distressing as the motor symptoms. Imaging methods such as positron emission tomography (PET) have recently enhanced our understanding of cognitive disturbances in PD, and are reviewed in the current article. Furthermore, insights gained from the use of specific radiotracers in the dopaminergic and cholinergic neurotransmitter systems are discussed, as well as findings from in vivo detection of amyloid-beta. We will also discuss the potential use of a metabolic covariance network as a biomarker in clinical trials for the objective assessment of cognitive dysfunction in PD.
Collapse
Affiliation(s)
- T Fitzpatrick
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York 11030, USA
| | | | | |
Collapse
|
16
|
|
17
|
Sioka C, Fotopoulos A, Kyritsis AP. Recent advances in PET imaging for evaluation of Parkinson’s disease. Eur J Nucl Med Mol Imaging 2010; 37:1594-603. [DOI: 10.1007/s00259-009-1357-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/07/2009] [Indexed: 12/20/2022]
|
18
|
Brooks DJ, Pavese N. Recent imaging advances in the diagnosis and management of Parkinson's disease. F1000 MEDICINE REPORTS 2009; 1. [PMID: 20948696 PMCID: PMC2948338 DOI: 10.3410/m1-82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this review we report novel sensitive imaging biomarkers for Parkinson’s disease (PD) and its atypical variants. Diffusion tensor imaging and transcranial brain sonography are potentially promising techniques that can differentiate typical PD from atypical variants (multiple system atrophy and progressive supranuclear palsy) and from benign tremor disorders. Non-motor symptoms, such as dementia, depression, and sleep disruption, are often more distressing to PD patients than their slowness and stiffness. Dopamine replacement treatment can also lead to complications such as dyskinesias, impulse control disorders, and psychosis. Recent positron emission tomography studies have helped to clarify the physiopathological mechanisms underlying dementia and compulsive gambling in PD and provide a rationale for therapeutic strategies.
Collapse
Affiliation(s)
- David J Brooks
- MRC Clinical Sciences Centre and Division of Neurosciences & Mental Health, Imperial College London Cyclotron Building, Hammersmith Hospital, Du Cane Road, London W12 0NN UK
| | | |
Collapse
|
19
|
Liepelt I, Reimold M, Maetzler W, Godau J, Reischl G, Gaenslen A, Herbst H, Berg D. Cortical hypometabolism assessed by a metabolic ratio in Parkinson's disease primarily reflects cognitive deterioration-[18
F]FDG-PET. Mov Disord 2009; 24:1504-11. [DOI: 10.1002/mds.22662] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|