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Estudillo Romero A, Migliaccio R, Batrancourt B, Jannin P, Baxter JSH. Analysis of convolutional neural networks for fronto-temporal dementia biomarker discovery. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03197-w. [PMID: 38874653 DOI: 10.1007/s11548-024-03197-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Frontotemporal lobe dementia (FTD) results from the degeneration of the frontal and temporal lobes. It can manifest in several different ways, leading to the definition of variants characterised by their distinctive symptomatologies. As these variants are detected based on their symptoms, it can be unclear if they represent different types of FTD or different symptomatological axes. The goal of this paper is to investigate this question with a constrained cohort of FTD patients in order to see if the heterogeneity within this cohort can be inferred from medical images rather than symptom severity measurements. METHODS An ensemble of convolutional neural networks (CNNs) is used to classify diffusion tensor images collected from two databases consisting of 72 patients with behavioural variant FTD and 120 healthy controls. FTD biomarkers were found using voxel-based analysis on the sensitivities of these CNNs. Sparse principal components analysis (sPCA) is then applied on the sensitivities arising from the patient cohort in order to identify the axes along which the patients express these biomarkers. Finally, this is correlated with their symptom severity measurements in order to interpret the clinical presentation of each axis. RESULTS The CNNs result in sensitivities and specificities between 83 and 92%. As expected, our analysis determines that all the robust biomarkers arise from the frontal and temporal lobes. sPCA identified four axes in terms of biomarker expression which are correlated with symptom severity measurements. CONCLUSION Our analysis confirms that behavioural variant FTD is not a singular type or spectrum of FTD, but rather that it has multiple symptomatological axes that relate to distinct regions of the frontal and temporal lobes. This analysis suggests that medical images can be used to understand the heterogeneity of FTD patients and the underlying anatomical changes that lead to their different clinical presentations.
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Affiliation(s)
- Alfonso Estudillo Romero
- Laboratoire Traitement du Signal et de l'Image (LTSI, INSERM UMR 1099), Université de Rennes, Rennes, France
| | - Raffaella Migliaccio
- Frontal Functions and Pathology Laboratory (FrontLab), Institut du Cerveau, Paris, France
| | - Bénédicte Batrancourt
- Frontal Functions and Pathology Laboratory (FrontLab), Institut du Cerveau, Paris, France
| | - Pierre Jannin
- Laboratoire Traitement du Signal et de l'Image (LTSI, INSERM UMR 1099), Université de Rennes, Rennes, France
| | - John S H Baxter
- Laboratoire Traitement du Signal et de l'Image (LTSI, INSERM UMR 1099), Université de Rennes, Rennes, France.
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Ai Y, Li F, Hou Y, Li X, Li W, Qin K, Suo X, Lei D, Shang H, Gong Q. Differential cortical gray matter changes in early- and late-onset patients with amyotrophic lateral sclerosis. Cereb Cortex 2024; 34:bhad426. [PMID: 38061694 DOI: 10.1093/cercor/bhad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 01/19/2024] Open
Abstract
Age at onset may be an important feature associated with distinct subtypes of amyotrophic lateral sclerosis (ALS). Little is known about the neuropathological mechanism of early-onset ALS (EO-ALS) and late-onset ALS (LO-ALS). Ninety ALS patients were divided into EO-ALS and LO-ALS group, and 128 healthy controls were matched into young controls(YCs) and old controls (OCs). A voxel-based morphometry approach was employed to investigate differences in gray matter volume (GMV). Significant age at onset-by-diagnosis interactions were found in the left parietal operculum, left precentral gyrus, bilateral postcentral gyrus, right occipital gyrus, and right orbitofrontal cortex. Post hoc analysis revealed a significant decrease in GMV in all affected regions of EO-ALS patients compared with YCs, with increased GMV in 5 of the 6 brain regions, except for the right orbitofrontal cortex, in LO-ALS patients compared with OCs. LO-ALS patients had a significantly increased GMV than EO-ALS patients after removing the aging effect. Correspondingly, GMV of the left postcentral gyrus correlated with disease severity in the 2 ALS groups. Our findings suggested that the pathological mechanisms in ALS patients with different ages at onset might differ. These findings provide unique insight into the clinical and biological heterogeneity of the 2 ALS subtypes.
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Affiliation(s)
- Yuan Ai
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Fei Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Xiuli Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Wenbin Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Kun Qin
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Xueling Suo
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Du Lei
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, 699 Jinyuan Xi Road, Jimei District, Xiamen, Fujian 361021, China
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Rajagopalan V, Pioro EP. Graph network measures reveal distinct white matter abnormalities in motor and extra-motor brain regions of two UMN-predominant ALS subtypes. J Neurol Sci 2023; 452:120765. [PMID: 37672915 DOI: 10.1016/j.jns.2023.120765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Routine clinical magnetic resonance imaging (MRI) shows bilateral corticospinal tract (CST) hyperintensity in some patients with upper motor neuron (UMN)-predominant ALS (ALS-CST+) but not in others (ALS-CST-). Although, similar in their UMN features, the ALS-CST+ patient group is significantly younger in age, has faster disease progression and shorter survival than the ALS-CST- patient group. Reasons for the differences are unclear. METHOD In order to evaluate more objective MRI measures of these ALS subgroups, we used diffusion tensor images (DTI) obtained using single shot echo planar imaging sequence from 1.5 T Siemens MRI Scanner. We performed an exploratory whole brain white matter (WM) network analysis using graph theory approach on 45 ALS patients (ALS-CST+) (n = 21), and (ALS-CST-) (n = 24) and neurological controls (n = 14). RESULTS Significant (p < 0.05) differences in nodal degree measure between ALS patients and controls were observed in motor and extra motor regions, supplementary motor area, subcortical WM regions, cerebellum and vermis. Importantly, WM network abnormalities were significantly (p < 0.05) different between ALS-CST+ and ALS-CST- subgroups. Compared to neurologic controls, both ALS subgroups showed hubs in the right superior occipital gyrus and cuneus as well as significantly (p < 0.05) reduced small worldness supportive of WM network damage. CONCLUSIONS Significant differences between ALS-CST+ and ALS-CST- subgroups of WM network abnormalities, age of onset, symptom duration prior to MRI, and progression rate suggest these patients represent distinct clinical phenotypes and possibly pathophysiologic mechanisms of ALS.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Wang Y, Shen D, Hou B, Sun X, Yang X, Gao J, Liu M, Feng F, Cui L. Brain structural and perfusion changes in amyotrophic lateral sclerosis-frontotemporal dementia patients with cognitive and motor onset: a preliminary study. Brain Imaging Behav 2022; 16:2164-2174. [PMID: 35838935 DOI: 10.1007/s11682-022-00686-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Abstract
Amyotrophic lateral sclerosis-frontotemporal dementia (ALS-FTD) is rare but exhibits worse prognosis than either ALS or FTD alone. However, cognitive onset ALS-FTD (ALS-FTD-C) confers significantly better patient survival than does motor onset ALS-FTD (ALS-FTD-M), underscoring a meager understanding of pathological group differences. This study aimed to assess disparities in cortical atrophy and perfusion shown by patients with the above disease variants. A total of 38 participants (ALS-FTD-C, 8; ALS-FTD-M, 6; simultaneous-onset ALS-FTD [ALS-FTD-S], 4; healthy controls [HC], 20) qualified for the study and underwent magnetic resonance imaging scan. Three-dimensional T1-weighted structural brain imaging and 3D-pseudocontinuous arterial spin-labeled imaging were routinely collected. Gray matter volume (GMV) and cerebral blood flow (CBF) in ALS-FTD-C and ALS-FTD-M were compared through voxel-based analysis. Correlations between imaging parameters and clinical data were also assessed. Compared with HC, ALS-FTD had significant GMV reduction mainly in bilateral limbic system. GMV reduction in ALS-FTD-C was similar in pattern but less widespread, whereas ALS-FTD-M lacked any significant GMV reduction. In CBF analyses, ALS-FTD displayed hypoperfusion in bilateral motor cortex, frontotemporal lobe, and left basal ganglia. Hypoperfusion involved bilateral temporal lobe, prefrontal cortex, and putamen in ALS-FTD-C but was limited to left parahippocampal gyrus in ALS-FTD-M. Correlations between clinical data and GMV/CBF changes in specific regions were also identified in ALS-FTD. Group-specific patterns of cortical atrophy and perfusion were evident in ALS-FTD-C and ALS-FTD-M. ALS-FTD-C showed pronounced cortical atrophy and hypoperfusion, which were otherwise minimal in ALS-FTD-M. Above findings preliminarily revealed the pathological group differences that may help in classifying patients with ALS-FTD.
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Affiliation(s)
- Yanying Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaohan Sun
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Xunzhe Yang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.
- Neuroscience Centre, Chinese Academy of Medical Sciences, Beijing, China.
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Rajagopalan V, Pioro EP. Graph theory network analysis provides brain MRI evidence of a partial continuum of neurodegeneration in patients with UMN-predominant ALS and ALS-FTD. Neuroimage Clin 2022; 35:103037. [PMID: 35597032 PMCID: PMC9123271 DOI: 10.1016/j.nicl.2022.103037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 04/20/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our routine clinical neuroimaging showed hyperintense signal along the corticospinal tract only in some but not all patients with upper motor neuron (UMN)-predominant ALS. ALS patients with CST hyperintensity (ALS-CST+) and those without CST hyperintensity (ALS-CST-) present with nearly identical clinical UMN-predominant symptoms. Some previous studies have suggested that ALS patients with frontotemporal dementia (FTD) are on a continuum with ALS patients without FTD, while others have not. We aimed to determine whether: (a) ALS-CST+, ALS-CST-, and ALS-FTD patients show differential sites of predominant neurodegeneration occurring primarily cortically in the perikaryon or subcortically in the white matter (WM), or (b) UMN-predominant ALS is on a continuum with ALS-FTD. METHODS Exploratory whole brain grey matter (GM) voxel-based morphometry and WM network analysis using graph theory approach were performed. In this exploratory study, MRI data from 58 ALS patients (ALS-FTD, n = 15; ALS-CST+, n = 19; ALS-CST-, n = 24) and 14 neurological controls were obtained. RESULTS Significant differences in degree measures (evaluating WM networks) were observed between ALS patients and controls in frontal, motor, extra-motor, subcortical, and cerebellar regions. GM atrophy was observed only in the ALS-FTD subgroup and not in the other ALS subgroups. CONCLUSION Although WM network disruption by the ALS disease process showed different patterns between ALS-CST+, ALS-CST-, and ALS-FTD subgroups, there were some overlaps, particularly in prefrontal regions and between ALS-CST+ and ALS-FTD patients. Our preliminary findings suggest a partial continuum of, at least, WM degeneration between these subgroups with predominance of cortical pathology ("neuronopathy") in ALS-FTD patients and subcortical WM pathology ("axonopathy") in ALS-CST+ and ALS-CST- patients.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, United States; Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States; Neuromuscular Division, The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States.
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Steinbach R, Prell T, Gaur N, Roediger A, Gaser C, Mayer TE, Witte OW, Grosskreutz J. Patterns of grey and white matter changes differ between bulbar and limb onset amyotrophic lateral sclerosis. Neuroimage Clin 2021; 30:102674. [PMID: 33901988 PMCID: PMC8099783 DOI: 10.1016/j.nicl.2021.102674] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/18/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that is characterized by a high heterogeneity in patients' disease course. Patients with bulbar onset of symptoms (b-ALS) have a poorer prognosis than patients with limb onset (l-ALS). However, neuroimaging correlates of the assumed biological difference between b-ALS and l-ALS may have been obfuscated by patients' diversity in the disease course. We conducted Voxel-Based-Morphometry (VBM) and Tract-Based-Spatial-Statistics (TBSS) in a group of 76 ALS patients without clinically relevant cognitive deficits. The subgroups of 26 b-ALS and 52 l-ALS patients did not differ in terms of disease Phase or disease aggressiveness according to the D50 progression model. VBM analyses showed widespread ALS-related changes in grey and white matter, that were more pronounced for b-ALS. TBSS analyses revealed that b-ALS was predominantly characterized by frontal fractional anisotropy decreases. This demonstrates a higher degree of neurodegenerative burden for the group of b-ALS patients in comparison to l-ALS. Correspondingly, higher bulbar symptom burden was associated with right-temporal and inferior-frontal grey matter density decreases as well as fractional anisotropy decreases in inter-hemispheric and long association tracts. Contrasts between patients in Phase I and Phase II further revealed that b-ALS was characterized by an early cortical pathology and showed a spread only outside primary motor regions to frontal and temporal areas. In contrast, l-ALS showed ongoing structural integrity loss within primary motor-regions until Phase II. We therefore provide a strong rationale to treat both onset types of disease separately in ALS studies.
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Affiliation(s)
- Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Christian Gaser
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Thomas E Mayer
- Department of Neuroradiology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena
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Corticospinal Tract and Related Grey Matter Morphometric Shape Analysis in ALS Phenotypes: A Fractal Dimension Study. Brain Sci 2021; 11:brainsci11030371. [PMID: 33799358 PMCID: PMC8001972 DOI: 10.3390/brainsci11030371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
A pathological hallmark of amyotrophic lateral sclerosis (ALS) is corticospinal tract (CST) degeneration resulting in upper motor neuron (UMN) dysfunction. No quantitative test is available to easily assess UMN pathways. Brain neuroimaging in ALS promises to potentially change this through identifying biomarkers of UMN dysfunction that may accelerate diagnosis and track disease progression. Fractal dimension (FD) has successfully been used to quantify brain grey matter (GM) and white matter (WM) shape complexity in various neurological disorders. Therefore, we investigated CST and whole brain GM and WM morphometric changes using FD analyses in ALS patients with different phenotypes. We hypothesized that FD would detect differences between ALS patients and neurologic controls and even between the ALS subgroups. Neuroimaging was performed in neurologic controls (n = 14), and ALS patients (n = 75). ALS patients were assigned into four groups based on their clinical or radiographic phenotypes. FD values were estimated for brain WM and GM structures. Patients with ALS and frontotemporal dementia (ALS-FTD) showed significantly higher CST FD values and lower primary motor and sensory cortex GM FD values compared to other ALS groups. No other group of ALS patients revealed significant FD value changes when compared to neurologic controls or with other ALS patient groups. These findings support a more severe disease process in ALS-FTD patients compared to other ALS patient groups. FD value measures may be a sensitive index to evaluate GM and WM (including CST) degeneration in ALS patients.
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Regional prefrontal cortical atrophy predicts specific cognitive-behavioral symptoms in ALS-FTD. Brain Imaging Behav 2021; 15:2540-2551. [PMID: 33587281 DOI: 10.1007/s11682-021-00456-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 01/01/2023]
Abstract
Amyotrophic Lateral Sclerosis-Frontotemporal Dementia (ALS-FTD) may present typical behavioral variant FTD symptoms. This study aims to determine whether profile and severity of cognitive-behavioral symptoms in ALS/ALS-FTD are predicted by regional cortical atrophy. The hypothesis is that executive dysfunction can be predicted by dorsolateral prefrontal cortical (dlPFC) atrophy, apathy by dorsomedial PFC (dmPFC) and anterior cingulate cortical (ACC) atrophy, disinhibition by orbitofrontal cortical (OFC) atrophy. 3.0 Tesla MRI scans were acquired from 22 people with ALS or ALS-FTD. Quantitative cortical thickness analysis was performed with FreeSurfer. A priori-defined regions of interest (ROI) were used to measure cortical thickness in each participant and calculate magnitude of atrophy in comparison to 115 healthy controls. Spearman correlations were used to evaluate associations between frontal ROI cortical thickness and cognitive-behavioral symptoms, measured by Neuropsychiatric Inventory Questionnaire (NPI-Q) and Clinical Dementia Rating (CDR) scale. ALS-FTD participants exhibited variable degrees of apathy (NPI-Q/apathy: 1.6 ± 1.2), disinhibition (NPI-Q/disinhibition: 1.2 ± 1.2), executive dysfunction (CDR/judgment-problem solving: 1.7 ± 0.8). Within the ALS-FTD group, executive dysfunction correlated with dlPFC atrophy (ρ:-0.65;p < 0.05); similar trends were seen for apathy with ACC (ρ:-0.53;p < 0.10) and dmPFC (ρ:-0.47;p < 0.10) atrophy, for disinhibition with OFC atrophy (ρ:-0.51;p < 0.10). Compared to people with ALS, those with ALS-FTD showed more diffuse atrophy involving precentral gyrus, prefrontal, temporal regions. Profile and severity of cognitive-behavioral symptoms in ALS-FTD are predicted by regional prefrontal atrophy. These findings are consistent with established brain-behavior models and support the role of quantitative MRI in diagnosis, management, counseling, monitoring and prognostication for a neurodegenerative disorder with diverse phenotypes.
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Zamudio F, Loon AR, Smeltzer S, Benyamine K, Navalpur Shanmugam NK, Stewart NJF, Lee DC, Nash K, Selenica MLB. TDP-43 mediated blood-brain barrier permeability and leukocyte infiltration promote neurodegeneration in a low-grade systemic inflammation mouse model. J Neuroinflammation 2020; 17:283. [PMID: 32979923 PMCID: PMC7519496 DOI: 10.1186/s12974-020-01952-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neuronal cytoplasmic inclusions containing TAR DNA-binding protein 43 (TDP-43) are a neuropathological feature of several neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), frontotemporal dementia (FTD), and Alzheimer's Disease (AD). Emerging evidence also indicates that systemic inflammation may be a contributor to the pathology progression of these neurodegenerative diseases. METHODS To investigate the role of systemic inflammation in the progression of neuronal TDP-43 pathology, AAV9 particles driven by the UCHL1 promoter were delivered to the frontal cortex of wild-type aged mice via intracranial injections to overexpress TDP-43 or green fluorescent protein (GFP) in corticospinal motor neurons. Animals were then subjected to a low-dose (500 μg/kg) intraperitoneal E. coli lipopolysaccharide (LPS) administration challenge for 2 weeks to mimic a chronically altered low-grade systemic inflammatory state. Mice were then subjected to neurobehavioral studies, followed by biochemical and immunohistochemical analyses of the brain tissue. RESULTS In the present study, we report that elevated neuronal TDP-43 levels induced microglial and astrocytic activation in the cortex of injected mice followed by increased RANTES signaling. Moreover, overexpression of TDP-43 exerted abundant mouse immunoglobulin G (IgG), CD3, and CD4+ T cell infiltration as well as endothelial and pericyte activation suggesting increased blood-brain barrier permeability. The BBB permeability in TDP-43 overexpressing brains yielded the frontal cortex vulnerable to the systemic inflammatory response following LPS treatment, leading to marked neutrophil infiltration, neuronal loss, reduced synaptosome-associated protein 25 (SNAP-25) levels, and behavioral impairments in the radial arm water maze (RAWM) task. CONCLUSIONS These results reveal a novel role for TDP-43 in BBB permeability and leukocyte recruitment, indicating complex intermolecular interactions between an altered systemic inflammatory state and pathologically prone TDP-43 protein to promote disease progression.
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Affiliation(s)
- Frank Zamudio
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
- Department of Neurology, Massachusetts General Hospital Research Institute, Charlestown, MA 02129 USA
| | - Anjanet R. Loon
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
| | - Shayna Smeltzer
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
| | - Khawla Benyamine
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
| | | | - Nicholas J. F. Stewart
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
| | - Daniel C. Lee
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
- Sanders-Brown Center on Aging, Department of Molecular and Cellular Biochemistry, College of Medicine, University of Kentucky, Lexington, KY USA
| | - Kevin Nash
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612 USA
| | - Maj-Linda B. Selenica
- Byrd Alzheimer’s Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL 33613 USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33613 USA
- Sanders-Brown Center on Aging, Department of Molecular and Cellular Biochemistry, College of Medicine, University of Kentucky, Lexington, KY USA
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van der Burgh HK, Westeneng HJ, Walhout R, van Veenhuijzen K, Tan HHG, Meier JM, Bakker LA, Hendrikse J, van Es MA, Veldink JH, van den Heuvel MP, van den Berg LH. Multimodal longitudinal study of structural brain involvement in amyotrophic lateral sclerosis. Neurology 2020; 94:e2592-e2604. [PMID: 32414878 PMCID: PMC7455328 DOI: 10.1212/wnl.0000000000009498] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To understand the progressive nature of amyotrophic lateral sclerosis (ALS) by investigating differential brain patterns of gray and white matter involvement in clinically or genetically defined subgroups of patients using cross-sectional, longitudinal, and multimodal MRI. METHODS We assessed cortical thickness, subcortical volumes, and white matter connectivity from T1-weighted and diffusion-weighted MRI in 292 patients with ALS (follow-up: n = 150) and 156 controls (follow-up: n = 72). Linear mixed-effects models were used to assess changes in structural brain measurements over time in patients compared to controls. RESULTS Patients with a C9orf72 mutation (n = 24) showed widespread gray and white matter involvement at baseline, and extensive loss of white matter integrity in the connectome over time. In C9orf72-negative patients, we detected cortical thinning of motor and frontotemporal regions, and loss of white matter integrity of connections linked to the motor cortex. Patients with spinal onset displayed widespread white matter involvement at baseline and gray matter atrophy over time, whereas patients with bulbar onset started out with prominent gray matter involvement. Patients with unaffected cognition or behavior displayed predominantly motor system involvement, while widespread cerebral changes, including frontotemporal regions with progressive white matter involvement over time, were associated with impaired behavior or cognition. Progressive loss of gray and white matter integrity typically occurred in patients with shorter disease durations (<13 months), independent of progression rate. CONCLUSIONS Heterogeneity of phenotype and C9orf72 genotype relates to distinct patterns of cerebral degeneration. We demonstrate that imaging studies have the potential to monitor disease progression and early intervention may be required to limit cerebral degeneration.
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Affiliation(s)
- Hannelore K van der Burgh
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Henk-Jan Westeneng
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Renée Walhout
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Kevin van Veenhuijzen
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Harold H G Tan
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Jil M Meier
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Leonhard A Bakker
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Michael A van Es
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Jan H Veldink
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Martijn P van den Heuvel
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology (H.K.v.d.B., H.-J.W., R.W., K.v.V., H.H.G.T., J.M.M., L.A.B., M.A.v.E., J.H.V., L.H.v.d.B.), Center of Excellence for Rehabilitation Medicine (L.A.B.), and Department of Radiology (J.H.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (L.A.B.), Utrecht; and Department of Complex Trait Genetics (M.P.v.d.H.), Center for Neurogenomics and Cognitive Research, VU University Amsterdam, the Netherlands.
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Rajagopalan V, Pioro EP. Unbiased MRI Analyses Identify Micropathologic Differences Between Upper Motor Neuron-Predominant ALS Phenotypes. Front Neurosci 2019; 13:704. [PMID: 31354413 PMCID: PMC6639827 DOI: 10.3389/fnins.2019.00704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/21/2019] [Indexed: 11/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is an incurable and progressively fatal neurodegenerative disease that manifests with distinct clinical phenotypes, which are seen in neuroimaging, and clinical studies. T2- and proton density (PD)-weighted magnetic resonance imaging (MRI) displays hyperintense signal along the corticospinal tract (CST) in some ALS patients with upper motor neuron (UMN)-predominant signs. These patients tend to be younger and have significantly faster disease progression. We hypothesize that such ALS patients with CST hyperintensity (ALS-CST+) comprise a clinical subtype distinct from other ALS subtypes, namely patients with UMN-predominant ALS without CST hyperintensity, classic ALS, and ALS with frontotemporal dementia (FTD). Novel approaches such as fractal dimension analysis on conventional MRI (cMRI) and advanced MR techniques such as diffusion tensor imaging (DTI) reveal significant differences between ALS-CST+ and the aforementioned ALS subtypes. Our unbiased neuroimaging studies demonstrate that the ALS-CST+ group, which can be initially identified by T2-, PD-, and FLAIR-weighted cMRI, is distinctive and distinguishable from other ALS subtypes with possible differences in disease pathogenesis.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science, Pilani, Hyderabad, India.,Department of Biomedical Engineering, ND2, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Erik P Pioro
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.,Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
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12
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Trojsi F, Caiazzo G, Siciliano M, Femiano C, Passaniti C, Russo A, Bisecco A, Monsurrò MR, Cirillo M, Esposito F, Tedeschi G, Santangelo G. Microstructural correlates of Edinburgh Cognitive and Behavioural ALS Screen (ECAS) changes in amyotrophic lateral sclerosis. Psychiatry Res Neuroimaging 2019; 288:67-75. [PMID: 30987770 DOI: 10.1016/j.pscychresns.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed for testing patients with amyotrophic lateral sclerosis (ALS), a multi-system neurodegenerative disease characterized by progressive physical disability. In this study, we aim to explore the potential brain microstructural substrates associated with performance on ECAS in the early stages of ALS, using a whole-brain tract-based spatial statistics diffusion tensor imaging approach. Thirty-six non-demented ALS patients, assessed using ECAS, and 35 age-, sex- and education-matched healthy controls underwent magnetic resonance imaging at 3 Tesla. The ALS patients showed decreased fractional anisotropy (FA) in the cortico-spinal tracts and corpus callosum (CC) and significant association between verbal fluency score, among ALS-specific ECAS scores, and FA measures in several long association fiber tracts in the frontal, temporal and parietal lobes. Furthermore, the ALS non-specific total score was inversely related to axial diffusivity (AD) in the mediodorsal nucleus of the thalamus, with more extended areas of correlation in the CC, when considering only the memory subscore. Our results point towards microstructural degeneration across motor and extra-motor areas in ALS, underlining that alterations in verbal fluency performances may be related to impairment of frontotemporal connectivity, while alterations of memory may be associated with damage of thalamocortical circuits.
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Affiliation(s)
- Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy.
| | - Giuseppina Caiazzo
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Cinzia Femiano
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Carla Passaniti
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Maria Rosaria Monsurrò
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana" University of Salerno, Baronissi, Salerno, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research Centre "SUN-FISM", University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples 80138, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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Abstract
The past decade has seen tremendous efforts in biomarker discovery and validation for neurodegenerative diseases. The source and type of biomarkers has continued to grow for central nervous system diseases, from biofluid-based biomarkers (blood or cerebrospinal fluid (CSF)), to nucleic acids, tissue, and imaging. While DNA remains a predominant biomarker used to identify familial forms of neurodegenerative diseases, various types of RNA have more recently been linked to familial and sporadic forms of neurodegenerative diseases during the past few years. Imaging approaches continue to evolve and are making major contributions to target engagement and early diagnostic biomarkers. Incorporation of biomarkers into drug development and clinical trials for neurodegenerative diseases promises to aid in the development and demonstration of target engagement and drug efficacy for neurologic disorders. This review will focus on recent advancements in developing biomarkers for clinical utility in Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS).
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Affiliation(s)
| | - Robert Bowser
- Iron Horse Diagnostics, Inc., Scottsdale, AZ, 85255, USA.
- Divisions of Neurology and Neurobiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
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Driven to decay: Excitability and synaptic abnormalities in amyotrophic lateral sclerosis. Brain Res Bull 2018; 140:318-333. [PMID: 29870780 DOI: 10.1016/j.brainresbull.2018.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron (MN) disease and is clinically characterised by the death of corticospinal motor neurons (CSMNs), spinal and brainstem MNs and the degeneration of the corticospinal tract. Degeneration of CSMNs and MNs leads inexorably to muscle wastage and weakness, progressing to eventual death within 3-5 years of diagnosis. The CSMNs, located within layer V of the primary motor cortex, project axons constituting the corticospinal tract, forming synaptic connections with brainstem and spinal cord interneurons and MNs. Clinical ALS may be divided into familial (∼10% of cases) or sporadic (∼90% of cases), based on apparent random incidence. The emergence of transgenic murine models, expressing different ALS-associated mutations has accelerated our understanding of ALS pathogenesis, although precise mechanisms remain elusive. Multiple avenues of investigation suggest that cortical electrical abnormalities have pre-eminence in the pathophysiology of ALS. In addition, glutamate-mediated functional and structural alterations in both CSMNs and MNs are present in both sporadic and familial forms of ALS. This review aims to promulgate debate in the field with regard to the common aetiology of sporadic and familial ALS. A specific focus on a nexus point in ALS pathogenesis, namely, the synaptic and intrinsic hyperexcitability of CSMNs and MNs and alterations to their structure are comprehensively detailed. The association of extramotor dysfunction with neuronal structural/functional alterations will be discussed. Finally, the implications of the latest research on the dying-forward and dying-back controversy are considered.
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Dharmadasa T, Huynh W, Tsugawa J, Shimatani Y, Ma Y, Kiernan MC. Implications of structural and functional brain changes in amyotrophic lateral sclerosis. Expert Rev Neurother 2018; 18:407-419. [PMID: 29667443 DOI: 10.1080/14737175.2018.1464912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes progressive muscle weakness and disability, eventually leading to death. Heterogeneity of disease has become a major barrier to understanding key clinical questions such as prognosis and disease spread, and has disadvantaged clinical trials in search of therapeutic intervention. Patterns of disease have been explored through recent advances in neuroimaging, elucidating structural, molecular and functional changes. Unique brain signatures have emerged that have lent a greater understanding of critical disease mechanisms, offering opportunities to improve diagnosis, guide prognosis, and establish candidate biomarkers to direct future therapeutic strategies. Areas covered: This review explores patterns of cortical and subcortical change in ALS through advanced neuroimaging techniques and discusses the implications of these findings. Expert commentary: Cortical and subcortical signatures and patterns of atrophy are now consistently recognised, providing important pathophysiological insight into this heterogenous disease. The spread of cortical change, particularly involving frontotemporal networks, correlates with cognitive impairment and poorer prognosis. Cortical differences are also evident between ALS phenotypes and genotypes, which may partly explain the heterogeneity of prognosis. Ultimately, multimodal approaches with larger cohorts will be needed to provide sensitive biomarkers of disease spread at the level of the individual patient.
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Affiliation(s)
| | - William Huynh
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia
| | - Jun Tsugawa
- c Department of Neurology , Fukuoka University Hospital , Fukuoka city , Japan
| | - Yoshimitsu Shimatani
- d Department of Neurology , Tokushima Prefectural Hospital , Tokushima city , Japan
| | - Yan Ma
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia
| | - Matthew C Kiernan
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,b Department of Neurology , Royal Prince Alfred Hospital , Sydney , Australia
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Chen J, Kostenko V, Pioro EP, Trapp BD. MR Imaging-based Estimation of Upper Motor Neuron Density in Patients with Amyotrophic Lateral Sclerosis: A Feasibility Study. Radiology 2018; 287:955-964. [PMID: 29361242 DOI: 10.1148/radiol.2018162967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if magnetic resonance (MR) imaging metrics can estimate primary motor cortex (PMC) motor neuron (MN) density in patients with amyotrophic lateral sclerosis (ALS). Materials and Methods Between 2012 and 2014, in situ brain MR imaging was performed in 11 patients with ALS (age range, 35-81 years; seven women and four men) soon after death (mean, 5.5 hours after death; range, 3.2-9.6 hours). The brain was removed, right PMC (RPMC) was excised, and MN density was quantified. RPMC metrics (thickness, volume, and magnetization transfer ratio) were calculated from MR images. Regression modeling was used to estimate MN density by using RPMC and global MR imaging metrics (brain and tissue volumes); clinical variables were subsequently evaluated as additional estimators. Models were tested at in vivo MR imaging by using the same imaging protocol (six patients with ALS; age range, 54-66 years; three women and three men). Results RPMC mean MN density varied over a greater than threefold range across patients and was estimated by a linear function of normalized gray matter volume (adjusted R2 = 0.51; P = .008; <10% error in most patients). When considering only sporadic ALS, a linear function of normalized RPMC and white matter volumes estimated MN density (adjusted R2 = 0.98; P = .01; <10% error in all patients). In vivo data analyses detected decreases in MN density over time. Conclusion PMC mean MN density varies widely in end-stage ALS possibly because of disease heterogeneity. MN density can potentially be estimated by MR imaging metrics. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Jacqueline Chen
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
| | - Volodymyr Kostenko
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
| | - Erik P Pioro
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
| | - Bruce D Trapp
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
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Xu J, Li H, Li C, Yao JC, Hu J, Wang J, Hu Q, Zhang Y, Zhang J. Abnormal cortical-basal ganglia network in amyotrophic lateral sclerosis: A voxel-wise network efficiency analysis. Behav Brain Res 2017; 333:123-128. [DOI: 10.1016/j.bbr.2017.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/28/2022]
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Westeneng HJ, Walhout R, Straathof M, Schmidt R, Hendrikse J, Veldink JH, van den Heuvel MP, van den Berg LH. Widespread structural brain involvement in ALS is not limited to the C9orf72 repeat expansion. J Neurol Neurosurg Psychiatry 2016; 87:1354-1360. [PMID: 27756805 PMCID: PMC5136726 DOI: 10.1136/jnnp-2016-313959] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with a C9orf72 repeat expansion (C9+), a neuroimaging phenotype with widespread structural cerebral changes has been found. We aimed to investigate the specificity of this neuroimaging phenotype in patients with amyotrophic lateral sclerosis (ALS). METHODS 156 C9- and 14 C9+ patients with ALS underwent high-resolution T1-weighted MRI; a subset (n=126) underwent diffusion-weighted imaging. Cortical thickness, subcortical volumes and white matter integrity were compared between C9+ and C9- patients. Using elastic net logistic regression, a model defining the neuroimaging phenotype of C9+ was determined and applied to C9- patients with ALS. RESULTS C9+ patients showed cortical thinning outside the precentral gyrus, extending to the bilateral pars opercularis, fusiform, lingual, isthmus-cingulate and superior parietal cortex, and smaller volumes of the right hippocampus and bilateral thalamus, and reduced white matter integrity of the inferior and superior longitudinal fasciculus compared with C9- patients (p<0.05). Among 128 C9- patients, we detected a subgroup of 27 (21%) with a neuroimaging phenotype congruent to C9+ patients, while 101 (79%) C9- patients showed cortical thinning restricted to the primary motor cortex. C9- patients with a 'C9+' neuroimaging phenotype had lower performance on the frontal assessment battery, compared with other C9- patients with ALS (p=0.004). CONCLUSIONS This study shows that widespread structural brain involvement is not limited to C9+ patients, but also presents in a subgroup of C9- patients with ALS and relates to cognitive deficits. Our neuroimaging findings reveal an intermediate phenotype that may provide insight into the complex relationship between genetic factors and clinical characteristics.
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Affiliation(s)
- Henk-Jan Westeneng
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renée Walhout
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Milou Straathof
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben Schmidt
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn P van den Heuvel
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Traub R, Mitsumoto H. Recent advances and opportunities for improving diagnosis of amyotrophic lateral sclerosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1213164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rebecca Traub
- Department of Neurology, Columbia University, New York, NY, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, The Eleanor and Lou Gehrig MDA/ALS, Research Center, Columbia University, New York, NY, USA
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Blasco H, Vourc'h P, Pradat PF, Gordon PH, Andres CR, Corcia P. Further development of biomarkers in amyotrophic lateral sclerosis. Expert Rev Mol Diagn 2016; 16:853-68. [PMID: 27275785 DOI: 10.1080/14737159.2016.1199277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is an idiopathic neurodegenerative disease usually fatal in less than three years. Even if standard guidelines are available to diagnose ALS, the mean diagnosis delay is more than one year. In this context, biomarker discovery is a priority. Research has to focus on new diagnostic tools, based on combined explorations. AREAS COVERED In this review, we specifically focus on biology and imaging markers. We detail the innovative field of 'omics' approach and imaging and explain their limits to be useful in routine practice. We describe the most relevant biomarkers and suggest some perspectives for biomarker research. Expert commentary: The successive failures of clinical trials in ALS underline the need for new strategy based on innovative tools to stratify patients and to evaluate their responses to treatment. Biomarker data may be useful to improve the designs of clinical trials. Biomarkers are also needed to better investigate disease pathophysiology, to identify new therapeutic targets, and to improve the performance of clinical assessments for diagnosis and prognosis in the clinical setting. A consensus on the best management of neuroimaging and 'omics' methods is necessary and a systematic independent validation of findings may add robustness to future studies.
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Affiliation(s)
- H Blasco
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P Vourc'h
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P F Pradat
- c Département des Maladies du Système Nerveux, Assistance Publique-Hôpitaux de Paris , Hôpital de la Salpêtrière , Paris , France.,d Sorbonne Universités, UPMC Université Paris 06, CNRS, INSERM , Laboratoire d'Imagerie Biomédicale , Paris , France
| | - P H Gordon
- e Neurology Unit, Northern Navajo Medical Center , Shiprock , NM , USA
| | - C R Andres
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France
| | - P Corcia
- a UMR INSERM U930 , Université François-Rabelais de Tours , Tours , France.,b Laboratoire de Biochimie et de Biologie Moléculaire , Hôpital Bretonneau, CHRU de Tours , Tours , France.,f Centre SLA , Service de Neurologie et Neurophysiologie Clinique, CHRU de Tours , Tours , France
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Benatar M, Boylan K, Jeromin A, Rutkove SB, Berry J, Atassi N, Bruijn L. ALS biomarkers for therapy development: State of the field and future directions. Muscle Nerve 2015; 53:169-82. [PMID: 26574709 DOI: 10.1002/mus.24979] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
Biomarkers have become the focus of intense research in the field of amyotrophic lateral sclerosis (ALS), with the hope that they might aid therapy development efforts. Notwithstanding the discovery of many candidate biomarkers, none have yet emerged as validated tools for drug development. In this review we present a nuanced view of biomarkers based on the perspective of the Food and Drug Administration; highlight the distinction between discovery and validation; describe existing and emerging resources; review leading biological fluid-based, electrophysiological, and neuroimaging candidates relevant to therapy development efforts; discuss lessons learned from biomarker initiatives in related neurodegenerative diseases; and outline specific steps that we, as a field, might take to hasten the development and validation of biomarkers that will prove useful in enhancing efforts to develop effective treatments for ALS patients. Most important among these is the proposal to establish a federated ALS Biomarker Consortium in which all interested and willing stakeholders may participate with equal opportunity to contribute to the broader mission of biomarker development and validation.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami, Miami, Florida, USA, 33136
| | - Kevin Boylan
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | | | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - James Berry
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nazem Atassi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Brain Parenchymal Fraction: A Relatively Simple MRI Measure to Clinically Distinguish ALS Phenotypes. BIOMED RESEARCH INTERNATIONAL 2015; 2015:693206. [PMID: 26783524 PMCID: PMC4691452 DOI: 10.1155/2015/693206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022]
Abstract
Even though neuroimaging and clinical studies indicate that amyotrophic lateral sclerosis (ALS) manifests with distinct clinical phenotypes, no objective test exists to assess upper motor degeneration in ALS. There is great interest in identifying biomarkers of ALS to allow earlier diagnosis and to recognize disease subtypes. Current quantitative neuroimaging techniques such as T2 relaxometry and diffusion tensor imaging are time-consuming to use in clinical settings due to extensive postprocessing requirements. Therefore, we aimed to study the potential role of brain parenchymal fraction (BPF) as a relatively simple quantitative measure for distinguishing ALS phenotypes. T1-weighted MR images of brain were obtained in 15 neurological controls and 88 ALS patients categorized into 4 distinct clinical phenotypes, upper motor neuron- (UMN-) predominant ALS patients with/without corticospinal tract (CST) hyperintensity on T2/PD-weighted images, classic ALS, and ALS with frontotemporal dementia (ALS-FTD). BPF was calculated using intracranial grey matter, white matter, and cerebrospinal fluid volumes obtained in control and ALS subgroups using SPM8 software. Only ALS-FTD patients had significant reduction in BPF when compared to controls and nondemented ALS patients. Correlation of clinical measures such as disease duration with BPF further supports the view that the BPF could be a potential biomarker for clinical diagnosis of ALS-FTD patients.
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Rajagopalan V, Pioro EP. Comparing brain structural MRI and metabolic FDG-PET changes in patients with ALS-FTD: 'the chicken or the egg?' question. J Neurol Neurosurg Psychiatry 2015; 86:952-8. [PMID: 25520437 DOI: 10.1136/jnnp-2014-308239] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/09/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Our previous voxel based morphometry (VBM) studies in patients with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (ALS-FTD) showed reduced motor and extramotor grey matter (GM) volume when compared to neurological controls. However, erroneously high GM values can result because VBM analysis includes both cortical gyri and sulci as a single GM region. In addition, the relationship between structural and functional changes is unknown. Therefore, we determined whether GM volumetric changes seen in patients with ALS-FTD were due to changes in cortical thickness, area or both, and compared these structural changes with metabolic changes as revealed by positron emission tomography (PET). METHODS T1-weighted MRIs were obtained in unaffected neurological controls and in patients with ALS-FTD; the latter also underwent PET imaging. We assessed brain GM structural changes using VBM and cortical thickness, and metabolic changes using PET images. Significant (p<0.05) reductions in GM volume and cortical thickness were observed in motor and extramotor regions in patients with ALS-FTD compared to controls. No significant difference in cortical surface area was observed in any of the brain regions. Results Significant (p<0.05) reductions in cerebral glucose metabolism rate were observed in brain regions where structural changes were also observed. Significant reductions primarily in cortical thickness were the likely reason for decreased GM volume in ALS-FTD. CONCLUSIONS Metabolic changes corresponded well with structural changes in motor and extramotor areas, and sometimes occurred even in the absence of GM volume reduction. Coincident structural and functional GM changes suggest that neurodegeneration may occur as "neuronopathy" in patients with ALS-FTD.
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Affiliation(s)
- Venkateswaran Rajagopalan
- Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Hyderabad, India Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erik P Pioro
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland, Ohio, USA Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Motor and extra-motor gray matter atrophy in amyotrophic lateral sclerosis: quantitative meta-analyses of voxel-based morphometry studies. Neurobiol Aging 2015; 36:3288-3299. [PMID: 26362941 DOI: 10.1016/j.neurobiolaging.2015.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 02/05/2023]
Abstract
Considerable evidence from previous voxel-based morphometry studies indicates widespread but heterogeneous gray matter (GM) deficits in amyotrophic lateral sclerosis (ALS). Here, we aimed to investigate the concurrence across voxel-based morphometry studies to help clarify the spatial pattern of GM abnormalities that underlie this condition. Comprehensive meta-analyses to assess regional GM anomalies in ALS were conducted with the Anisotropic Effect Size version of Signed Differential Mapping software package. Twenty studies, which reported 22 comparisons and were composed of 454 ALS patients and 426 healthy controls, were included in the meta-analyses. Regional GM atrophy in ALS was consistently found in the frontal, temporal, and somatosensory areas. Meta-regression demonstrated that the disease duration, disease severity, and age were significantly related to GM deficits in ALS patients. The present meta-analysis provides convergent evidence that ALS is a multisystem degenerative disorder that is accompanied by a unique and widespread pattern of robust cortical GM atrophy. Future studies should investigate whether this atrophy pattern is a diagnostic and prognostic marker.
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Abstract
Amyotrophic lateral sclerosis (ALS) is now recognised to be a heterogeneous neurodegenerative syndrome of the motor system and its frontotemporal cortical connections. The development and application of structural and functional imaging over the last three decades, in particular magnetic resonance imaging (MRI), has allowed traditional post mortem histopathological and emerging molecular findings in ALS to be placed in a clinical context. Cerebral grey and white matter structural MRI changes are increasingly being understood in terms of brain connectivity, providing insights into the advancing degenerative process and producing candidate biomarkers. Such markers may refine the prognostic stratification of patients and the diagnostic pathway, as well as providing an objective assessment of changes in disease activity in response to future therapeutic agents. Studies are being extended to the spinal cord, and the application of neuroimaging to unaffected carriers of highly penetrant genetic mutations linked to the development of ALS offers a unique window to the pre-symptomatic landscape.
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Affiliation(s)
- Martin R. Turner
- />Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- />John Radcliffe Hospital, West Wing Level 3, Oxford, OX3 9DU UK
| | - Esther Verstraete
- />University of Utrecht, Utrecht, Netherlands
- />University Medical Center, Heidelberglaan 100, Utrecht, Netherlands
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ALFF Value in Right Parahippocampal Gyrus Acts as a Potential Marker Monitoring Amyotrophic Lateral Sclerosis Progression: a Neuropsychological, Voxel-Based Morphometry, and Resting-State Functional MRI Study. J Mol Neurosci 2015; 57:106-13. [DOI: 10.1007/s12031-015-0583-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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Palmieri A, Mento G, Calvo V, Querin G, D'Ascenzo C, Volpato C, Kleinbub JR, Bisiacchi PS, Sorarù G. Female gender doubles executive dysfunction risk in ALS: a case-control study in 165 patients. J Neurol Neurosurg Psychiatry 2015; 86:574-9. [PMID: 25063584 DOI: 10.1136/jnnp-2014-307654] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/10/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cognitive impairment, mainly characterised by executive dysfunction, occurs in about half of cases in amyotrophic lateral sclerosis (ALS). There is evidence that gender influences some clinical features of the disease, but its influence on the cognitive spectrum is unknown. Our objective was to investigate the impact of gender on cognitive profiles of patients with ALS. METHODS A retrospective study based on an exhaustive neuropsychological battery was performed in a group of 165 (70 females, 95 males) sporadic, non-demented patients with ALS compared with 134 healthy control participants. This assessment primarily focused on executive, memory and language functions. RESULTS 47 (29%) patients revealed impairment in executive function and 30 (18%) patients revealed cognitive non-executive impairment. Independent from mood tone and clinical variables, a significantly greater executive impairment was determined in female patients than in male patients and control participants. The relative risk for ALS females having impairment in executive function compared with male patients was 2.6 (95% CI 1.6 to 4.4; p=0.0003). ALS females scored lower in Phonemic Fluency, Trial Making, and Wisconsin Card Sorting test. CONCLUSIONS Results highlight a significant vulnerability of ALS female patients to develop cognitive dysfunctions peculiar to the disease, independently of bulbar onset. The explicative hypotheses of the data are focused on two interpretative lines not mutually exclusive: the role of gonadal hormones and gender-related brain asymmetry pre-existing to the disease. These findings, never reported before in the literature, can have important implications for models of ALS pathogenesis and for future clinical trial designs.
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Affiliation(s)
- Arianna Palmieri
- Department of Neurosciences, University of Padova, Padova, Italy Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Giovanni Mento
- Department of General Psychology, University of Padova, Padova, Italy
| | - Vincenzo Calvo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Giorgia Querin
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Carla D'Ascenzo
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Johann Roland Kleinbub
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
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Verstraete E, Foerster BR. Neuroimaging as a New Diagnostic Modality in Amyotrophic Lateral Sclerosis. Neurotherapeutics 2015; 12:403-16. [PMID: 25791072 PMCID: PMC4404464 DOI: 10.1007/s13311-015-0347-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is characterized by progressive degeneration of upper and lower motor neurons, with variable involvement of extramotor brain regions. Currently, there are no established objective markers of upper motor neuron and extramotor involvement in ALS. Here, we review the potential diagnostic value of advanced neuroimaging techniques that are increasingly being used to study the brain in ALS. First, we discuss the role of different imaging modalities in our increasing understanding of ALS pathogenesis, and their potential to contribute to objective upper motor neuron biomarkers for the disease. Second, we discuss the challenges to be overcome and the required phases of diagnostic test development to translate imaging technology to clinical care. We also present examples of multidimensional imaging approaches to achieve high levels of diagnostic accuracy. Last, we address the role of neuroimaging in clinical therapeutic trials. Advanced neuroimaging techniques will continue to develop and offer significant opportunities to facilitate the development of new effective treatments for ALS.
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Affiliation(s)
- Esther Verstraete
- />Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bradley R. Foerster
- />Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
- />Ann Arbor VA Healthcare System, Ann Arbor, MI USA
- />Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD USA
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ALS-Plus — Where does it begin, where does it end? J Neurol Sci 2014; 345:1-2. [DOI: 10.1016/j.jns.2014.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022]
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