1
|
Keith CM, Haut MW, D'Haese PF, Mehta RI, Vieira Ligo Teixeira C, Coleman MM, Miller M, Ward M, Navia RO, Marano G, Wang X, McCuddy WT, Lindberg K, Wilhelmsen KC. More Similar than Different: Memory, Executive Functions, Cortical Thickness, and Glucose Metabolism in Biomarker-Positive Alzheimer's Disease and Behavioral Variant Frontotemporal Dementia. J Alzheimers Dis Rep 2024; 8:57-73. [PMID: 38312533 PMCID: PMC10836603 DOI: 10.3233/adr-230049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/13/2023] [Indexed: 02/06/2024] Open
Abstract
Background Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) are typically associated with very different clinical and neuroanatomical presentations; however, there is increasing recognition of similarities. Objective To examine memory and executive functions, as well as cortical thickness, and glucose metabolism in AD and bvFTD signature brain regions. Methods We compared differences in a group of biomarker-defined participants with Alzheimer's disease and a group of clinically diagnosed participants with bvFTD. These groups were also contrasted with healthy controls (HC). Results As expected, memory functions were generally more impaired in AD, followed by bvFTD, and both clinical groups performed more poorly than the HC group. Executive function measures were similar in AD compared to bvFTD for motor sequencing and go/no-go, but bvFTD had more difficulty with a set shifting task. Participants with AD showed thinner cortex and lower glucose metabolism in the angular gyrus compared to bvFTD. Participants with bvFTD had thinner cortex in the insula and temporal pole relative to AD and healthy controls, but otherwise the two clinical groups were similar for other frontal and temporal signature regions. Conclusions Overall, the results of this study highlight more similarities than differences between AD and bvFTD in terms of cognitive functions, cortical thickness, and glucose metabolism. Further research is needed to better understand the mechanisms mediating this overlap and how these relationships evolve longitudinally.
Collapse
Affiliation(s)
- Cierra M Keith
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Department of Neurology, West Virginia University, Morgantown, WV, USA
- Department of Radiology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Pierre-François D'Haese
- Department of Neuroradiology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Rashi I Mehta
- Department of Neuroradiology, West Virginia University, Morgantown, WV, USA
- Department of Radiology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | | | - Michelle M Coleman
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Mark Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Melanie Ward
- Department of Neurology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - R Osvaldo Navia
- Department of Medicine, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Gary Marano
- Department of Neuroradiology, West Virginia University, Morgantown, WV, USA
- Department of Radiology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Xiaofei Wang
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - William T McCuddy
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Katharine Lindberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Kirk C Wilhelmsen
- Department of Neurology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
2
|
Rezai AR, D'Haese PF, Finomore V, Carpenter J, Ranjan M, Wilhelmsen K, Mehta RI, Wang P, Najib U, Vieira Ligo Teixeira C, Arsiwala T, Tarabishy A, Tirumalai P, Claassen DO, Hodder S, Haut MW. Ultrasound Blood-Brain Barrier Opening and Aducanumab in Alzheimer's Disease. N Engl J Med 2024; 390:55-62. [PMID: 38169490 DOI: 10.1056/nejmoa2308719] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Antiamyloid antibodies have been used to reduce cerebral amyloid-beta (Aβ) load in patients with Alzheimer's disease. We applied focused ultrasound with each of six monthly aducanumab infusions to temporarily open the blood-brain barrier with the goal of enhancing amyloid removal in selected brain regions in three participants over a period of 6 months. The reduction in the level of Aβ was numerically greater in regions treated with focused ultrasound than in the homologous regions in the contralateral hemisphere that were not treated with focused ultrasound, as measured by fluorine-18 florbetaben positron-emission tomography. Cognitive tests and safety evaluations were conducted over a period of 30 to 180 days after treatment. (Funded by the Harry T. Mangurian, Jr. Foundation and the West Virginia University Rockefeller Neuroscience Institute.).
Collapse
Affiliation(s)
- Ali R Rezai
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Pierre-Francois D'Haese
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Victor Finomore
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Jeffrey Carpenter
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Manish Ranjan
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Kirk Wilhelmsen
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Rashi I Mehta
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Peng Wang
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Umer Najib
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Camila Vieira Ligo Teixeira
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Tasneem Arsiwala
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Abdul Tarabishy
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Padmashree Tirumalai
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Daniel O Claassen
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Sally Hodder
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| | - Marc W Haut
- From the Departments of Neurosurgery (A.R.R., P.-F.D., M.R.), Neuroradiology (P.-F.D., J.C., R.I.M., P.W., A.T.), Neuroscience (A.R.R., V.F., C.V.L.T., T.A., P.T., M.W.H., R.I.M.), Neurology (K.W., U.N., M.W.H.), and Behavioral Medicine and Psychiatry (M.W.H.), Rockefeller Neuroscience Institute, Department of Medicine (S.H.), and West Virginia Clinical and Translational Science Institute (S.H.), West Virginia University, Morgantown; and the Department of Neurology, Vanderbilt University, Nashville (D.O.C.)
| |
Collapse
|
3
|
Piamjariyakul U, McKenrick SR, Smothers A, Giolzetti A, Melnick H, Beaver M, Shafique S, Wang K, Carte KJ, Grimes B, Haut MW, Navia RO, Patrick JH, Wilhelmsen K. Developing, implementing, and evaluating the visiting Neighbors' program in rural Appalachia: A quality improvement protocol. PLoS One 2024; 19:e0296438. [PMID: 38166130 PMCID: PMC10760886 DOI: 10.1371/journal.pone.0296438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months. PURPOSE The purpose of this paper was to describe the 3M's Visiting Neighbors protocol steps guiding the quality improvement procedures relating to program development, implementation, and evaluation. METHODS AND MATERIALS This Visiting Neighbors study used a single-group exploratory quality improvement design. This program was tested using quality improvement standards, including collecting participant questionnaires and visit observations. RESULTS Older adults (> 65 years) living alone (N = 30) participants were female (79%) with a mean age of 82.96 (SD = 7.87) years. Volunteer visitor participants (N = 10) were older adult females. Two volunteer visitors implemented each visit, guided by the 3M's activities manual. All visits were verified as being consistently delivered (fidelity). Enrollment and retention data found the program was feasible to conduct. The older adult participants' total program helpfulness ratings (1 to 5) were high (M = 51.27, SD = 3.77). All volunteer visitor's program helpfulness ratings were also high (M = 51.78, SD = 3.73). DISCUSSION The Visiting Neighbors program consistently engaged older Appalachian adults living alone in the 3M's activities. The feasibility and fidelity of the 3M's home visits were verified. The quality improvement processes included engaging the expert advisory committee and rural county stakeholders to ensure the quality of the program development, implementation, and evaluation.
Collapse
Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Susan R. McKenrick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angel Smothers
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angelo Giolzetti
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Helen Melnick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Molly Beaver
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Saima Shafique
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kesheng Wang
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kerri J. Carte
- Family & Community Development, West Virginia University-Extension, Kanawha County, Charleston, WV, United States of America
| | - Brad Grimes
- Meredith Center for Career Services and Professional Development, West Virginia University College of Law, Morgantown, WV, United States of America
| | - Marc W. Haut
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Department of Behavioral Medicine/Psychiatry, Director, Memory Health Clinic, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
| | - R. Osvaldo Navia
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Division Chief of Geriatrics, Palliative Medicine & Hospice and Grace Kinney Mead Chair of Geriatrics, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Julie Hicks Patrick
- Life-Span Developmental Psychology, West Virginia University, Morgantown, WV, United States of America
| | - Kirk Wilhelmsen
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Chief Cognitive Neurology, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
| |
Collapse
|
4
|
Rezai AR, Mahoney JJ, Ranjan M, Haut MW, Zheng W, Lander LR, Berry JH, Farmer DL, Marton JL, Tirumalai P, Mears A, Thompson-Lake DGY, Finomore VS, D'Haese PF, Aklin WM, George DT, Corrigan JD, Hodder SL. Safety and feasibility clinical trial of nucleus accumbens deep brain stimulation for treatment-refractory opioid use disorder. J Neurosurg 2024; 140:231-239. [PMID: 37329519 DOI: 10.3171/2023.4.jns23114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE There were more than 107,000 drug overdose deaths in the US in 2021, the most ever recorded. Despite advances in behavioral and pharmacological treatments, over 50% of those receiving treatment for opioid use disorder (OUD) experience drug use recurrence (relapse). Given the prevalence of OUD and other substance use disorders (SUDs), the high rate of drug use recurrence, and the number of drug overdose deaths, novel treatment strategies are desperately needed. The objective of this study was to evaluate the safety and feasibility of deep brain stimulation (DBS) targeting the nucleus accumbens (NAc)/ventral capsule (VC) and potential impact on outcomes in individuals with treatment-refractory OUD. METHODS A prospective, open-label, single-arm study was conducted among participants with longstanding treatment-refractory OUD (along with other co-occurring SUDs) who underwent DBS in the NAc/VC. The primary study endpoint was safety; secondary/exploratory outcomes included opioid and other substance use, substance craving, and emotional symptoms throughout follow-up and 18FDG-PET neuroimaging. RESULTS Four male participants were enrolled and all tolerated DBS surgery well with no serious adverse events (AEs) and no device- or stimulation-related AEs. Two participants sustained complete substance abstinence for > 1150 and > 520 days, respectively, with significant post-DBS reductions in substance craving, anxiety, and depression. One participant experienced post-DBS drug use recurrences with reduced frequency and severity. The DBS system was explanted in one participant due to noncompliance with treatment requirements and the study protocol. 18FDG-PET neuroimaging revealed increased glucose metabolism in the frontal regions for the participants with sustained abstinence only. CONCLUSIONS DBS of the NAc/VC was safe, feasible, and can potentially reduce substance use, craving, and emotional symptoms in those with treatment-refractory OUD. A randomized, sham-controlled trial in a larger cohort of patients is being initiated.
Collapse
Affiliation(s)
| | | | | | - Marc W Haut
- 2Neuroscience
- 3Behavioral Medicine and Psychiatry
- 4Neurology
- 5Radiology, and
| | | | | | | | | | | | | | | | | | | | - Pierre-François D'Haese
- 10Neuroradiology, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, West Virginia
| | | | - David T George
- 7National Institute on Alcohol Abuse and Addiction, NIH, Bethesda, Maryland
| | - John D Corrigan
- 8Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio; and
| | - Sally L Hodder
- 9West Virginia Clinical & Translational Science Institute, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
5
|
Mahoney JJ, Haut MW, Carpenter J, Ranjan M, Thompson-Lake DGY, Marton JL, Zheng W, Berry JH, Tirumalai P, Mears A, D’Haese P, Finomore VS, Hodder SL, Rezai AR. Low-intensity focused ultrasound targeting the nucleus accumbens as a potential treatment for substance use disorder: safety and feasibility clinical trial. Front Psychiatry 2023; 14:1211566. [PMID: 37779628 PMCID: PMC10540197 DOI: 10.3389/fpsyt.2023.1211566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/18/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction While current treatments for substance use disorder (SUD) are beneficial, success rates remain low and treatment outcomes are complicated by co-occurring SUDs, many of which are without available medication treatments. Research involving neuromodulation for SUD has recently gained momentum. This study evaluated two doses (60 and 90 W) of Low Intensity Focused Ultrasound (LIFU), targeting the bilateral nucleus accumbens (NAc), in individuals with SUD. Methods Four participants (three male), who were receiving comprehensive outpatient treatment for opioid use disorder at the time of enrollment and who also had a history of excessive non-opioid substance use, completed this pilot study. After confirming eligibility, these participants received 10 min sham LIFU followed by 20 min active LIFU (10 min to left then right NAc). Outcomes were the safety, tolerability, and feasibility during the LIFU procedure and throughout the 90-day follow-up. Outcomes also included the impact of LIFU on cue-induced substance craving, assessed via Visual Analog Scale (VAS), both acutely (pre-, during and post-procedure) and during the 90-day follow-up. Daily craving ratings (without cues) were also obtained for one-week prior to and one-week following LIFU. Results Both LIFU doses were safe and well-tolerated based on reported adverse events and MRI scans revealed no structural changes (0 min, 24 h, and 1-week post-procedure). For the two participants receiving "enhanced" (90 W) LIFU, VAS craving ratings revealed active LIFU attenuated craving for participants' primary substances of choice relative to sham sonication. For these participants, reductions were also noted in daily VAS craving ratings (0 = no craving; 10 = most craving ever) across the week following LIFU relative to pre-LIFU; Participant #3 pre- vs. post-LIFU: opioids (3.6 ± 0.6 vs. 1.9 ± 0.4), heroin (4.2 ± 0.8 vs. 1.9 ± 0.4), methamphetamine (3.2 ± 0.4 vs. 0.0 ± 0.0), cocaine (2.4 ± 0.6 vs. 0.0 ± 0.0), benzodiazepines (2.8 ± 0.5 vs. 0.0 ± 0.0), alcohol (6.0 ± 0.7 vs. 2.7 ± 0.8), and nicotine (5.6 ± 1.5 vs. 3.1 ± 0.7); Participant #4: alcohol (3.5 ± 1.3 vs. 0.0 ± 0.0) and nicotine (5.0 ± 1.8 vs. 1.2 ± 0.8) (all p's < 0.05). Furthermore, relative to screening, longitudinal reductions in cue-induced craving for several substances persisted during the 90-day post-LIFU follow-up evaluation for all participants. Discussion In conclusion, LIFU targeting the NAc was safe and acutely reduced substance craving during the LIFU procedure, and potentially had longer-term impact on craving reductions. While early observations are promising, NAc LIFU requires further investigation in a controlled trial to assess the impact on substance craving and ultimately substance use and relapse.
Collapse
Affiliation(s)
- James J. Mahoney
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Marc W. Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neurology, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Jeffrey Carpenter
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neuroradiology, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Manish Ranjan
- Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Daisy G. Y. Thompson-Lake
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Jennifer L. Marton
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Padma Tirumalai
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Ashley Mears
- Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Pierre D’Haese
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Victor S. Finomore
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Ali R. Rezai
- Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
- Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| |
Collapse
|
6
|
Coleman MM, Keith CM, Wilhelmsen K, Mehta RI, Vieira Ligo Teixeira C, Miller M, Ward M, Navia RO, McCuddy WT, D'Haese PF, Haut MW. Surface-based correlates of cognition along the Alzheimer's continuum in a memory clinic population. Front Neurol 2023; 14:1214083. [PMID: 37731852 PMCID: PMC10508059 DOI: 10.3389/fneur.2023.1214083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 09/22/2023] Open
Abstract
Composite cognitive measures in large-scale studies with biomarker data for amyloid and tau have been widely used to characterize Alzheimer's disease (AD). However, little is known about how the findings from these studies translate to memory clinic populations without biomarker data, using single measures of cognition. Additionally, most studies have utilized voxel-based morphometry or limited surface-based morphometry such as cortical thickness, to measure the neurodegeneration associated with cognitive deficits. In this study, we aimed to replicate and extend the biomarker, composite study relationships using expanded surface-based morphometry and single measures of cognition in a memory clinic population. We examined 271 clinically diagnosed symptomatic individuals with mild cognitive impairment (N = 93) and Alzheimer's disease dementia (N = 178), as well as healthy controls (N = 29). Surface-based morphometry measures included cortical thickness, sulcal depth, and gyrification index within the "signature areas" of Alzheimer's disease. The cognitive variables pertained to hallmark features of Alzheimer's disease including verbal learning, verbal memory retention, and language, as well as executive function. The results demonstrated that verbal learning, language, and executive function correlated with the cortical thickness of the temporal, frontal, and parietal areas. Verbal memory retention was correlated to the thickness of temporal regions and gyrification of the inferior temporal gyrus. Language was related to the temporal regions and the supramarginal gyrus' sulcal depth and gyrification index. Executive function was correlated with the medial temporal gyrus and supramarginal gyrus sulcal depth, and the gyrification index of temporal regions and supramarginal gyrus, but not with the frontal areas. Predictions of each of these cognitive measures were dependent on a combination of structures and each of the morphometry measurements, and often included medial temporal gyrus thickness and sulcal depth. Overall, the results demonstrated that the relationships between cortical thinning and cognition are widespread and can be observed using single measures of cognition in a clinically diagnosed AD population. The utility of sulcal depth and gyrification index measures may be more focal to certain brain areas and cognitive measures. The relative importance of temporal, frontal, and parietal regions in verbal learning, language, and executive function, but not verbal memory retention, was replicated in this clinic cohort.
Collapse
Affiliation(s)
- Michelle M. Coleman
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Cierra M. Keith
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, United States
| | - Kirk Wilhelmsen
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neurology, West Virginia University, Morgantown, WV, United States
| | - Rashi I. Mehta
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neuroradiology, West Virginia University, Morgantown, WV, United States
| | | | - Mark Miller
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, United States
| | - Melanie Ward
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neurology, West Virginia University, Morgantown, WV, United States
| | - Ramiro Osvaldo Navia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Medicine, West Virginia University, Morgantown, WV, United States
| | - William T. McCuddy
- Department of Neuropsychology, St. Joseph Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neurology, West Virginia University, Morgantown, WV, United States
| | - Marc W. Haut
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, United States
- Department of Neurology, West Virginia University, Morgantown, WV, United States
| |
Collapse
|
7
|
Keith CM, McCuddy WT, Lindberg K, Miller LE, Bryant K, Mehta RI, Wilhelmsen K, Miller M, Navia RO, Ward M, Deib G, D'Haese PF, Haut MW. Procedural learning and retention relative to explicit learning and retention in mild cognitive impairment and Alzheimer's disease using a modification of the trail making test. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:669-686. [PMID: 35603568 DOI: 10.1080/13825585.2022.2077297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) dementia are characterized by pathological changes to the medial temporal lobes, resulting in explicit learning and retention reductions. Studies demonstrate that implicit/procedural memory processes are relatively intact in these populations, supporting different anatomical substrates for differing memory systems. This study examined differences between explicit and procedural learning and retention in individuals with aMCI and AD dementia relative to matched healthy controls. We also examined anatomical substrates using volumetric MRI. Results revealed expected difficulties with explicit learning and retention in individuals with aMCI and AD with relatively preserved procedural memory. Explicit verbal retention was associated with medial temporal cortex volumes. However, procedural retention was not related to medial temporal or basal ganglia volumes. Overall, this study confirms the dissociation between explicit relative to procedural learning and retention in aMCI and AD dementia and supports differing anatomical substrates.
Collapse
Affiliation(s)
- Cierra M Keith
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - William T McCuddy
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Katharine Lindberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Liv E Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Kirk Bryant
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Rashi I Mehta
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Neuroradiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Kirk Wilhelmsen
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Neurology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Mark Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - R Osvaldo Navia
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Melanie Ward
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Neurology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Gerard Deib
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Neuroradiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Pierre-François D'Haese
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Neuroradiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- The Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Neurology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| |
Collapse
|
8
|
Keith CM, Haut MW, Wilhelmsen K, Mehta RI, Miller M, Navia RO, Ward M, Lindberg K, Coleman M, McCuddy WT, Deib G, Giolzetti A, D'Haese PF. Frontal and temporal lobe correlates of verbal learning and memory in aMCI and suspected Alzheimer's disease dementia. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:923-939. [PMID: 36367308 DOI: 10.1080/13825585.2022.2144618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
Alzheimer's disease is primarily known for deficits in learning and retaining new information. This has long been associated with pathological changes in the mesial temporal lobes. The role of the frontal lobes in memory in Alzheimer's disease is less well understood. In this study, we examined the role of the frontal lobes in learning, recognition, and retention of new verbal information, as well as the presence of specific errors (i.e., intrusions and false-positive errors). Participants included one hundred sixty-seven patients clinically diagnosed with amnestic mild cognitive impairment or suspected Alzheimer's disease dementia who were administered the California Verbal Learning Test and completed high-resolution MRI. We confirmed the role of the mesial temporal lobes in learning and retention, including the volumes of the hippocampus, entorhinal cortex, and parahippocampal gyrus. In addition, false-positive errors were associated with all volumes of the mesial temporal lobes and widespread areas within the frontal lobes. Errors of intrusion were related to the supplementary motor cortex and hippocampus. Most importantly, the mesial temporal lobes interacted with the frontal lobes for learning, recognition, and memory errors. Lower volumes in both regions explained more performance variance than any single structure. This study supports the interaction of the frontal lobes with the temporal lobes in many aspects of memory in Alzheimer's disease.
Collapse
Affiliation(s)
- Cierra M Keith
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Neurology, West Virginia University, Morgantown, West Virginia, United States
| | - Kirk Wilhelmsen
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Neurology, West Virginia University, Morgantown, West Virginia, United States
| | - Rashi I Mehta
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Neuroradiology, West Virginia University, Morgantown, West Virginia, United States
| | - Mark Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
| | - R Osvaldo Navia
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Medicine, West Virginia University, Morgantown, West Virginia, United States
| | - Melanie Ward
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Neurology, West Virginia University, Morgantown, West Virginia, United States
| | - Katharine Lindberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
| | - Michelle Coleman
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
| | - William T McCuddy
- Department of Neuropsychology, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Gerard Deib
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Neuroradiology, West Virginia University, Morgantown, West Virginia, United States
| | - Angelo Giolzetti
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States
- Department of Neurology, West Virginia University, Morgantown, West Virginia, United States
| |
Collapse
|
9
|
Butts AM, Haut MW. Introductory editorial to the special issue: Alzheimer's disease biomarkers and cognitive functioning along the Alzheimer's continuum. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:861-865. [PMID: 37632292 DOI: 10.1080/13825585.2023.2249190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Alissa M Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
- External Research Collaborator, Mayo Clinic, Rochester, MN, USA
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
10
|
Mehta RI, Carpenter JS, Mehta RI, Haut MW, Wang P, Ranjan M, Najib U, D'Haese PF, Rezai AR. Ultrasound-mediated blood-brain barrier opening uncovers an intracerebral perivenous fluid network in persons with Alzheimer's disease. Fluids Barriers CNS 2023; 20:46. [PMID: 37328855 DOI: 10.1186/s12987-023-00447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening is under investigation as a therapeutic modality for neurodegeneration, yet its effects in humans are incompletely understood. Here, we assessed physiologic responses to FUS administered in multifocal brain sites of persons with Alzheimer's disease (AD). METHODS At a tertiary neuroscience institute, eight participants with AD (mean age 65, 38% F) enrolled in a phase 2 clinical trial underwent three successive targeted BBB opening procedures at 2 week intervals using a 220 kHz FUS transducer in combination with systemically administered microbubbles. In all, 77 treatment sites were evaluated and encompassed hippocampal, frontal, and parietal brain regions. Post-FUS imaging changes, including susceptibility effects and spatiotemporal gadolinium-based contrast agent enhancement patterns, were analyzed using serial 3.0-Tesla MRI. RESULTS Post-FUS MRI revealed expected intraparenchymal contrast extravasation due to BBB opening at all targeted brain sites. Immediately upon BBB opening, hyperconcentration of intravenously-administered contrast tracer was consistently observed around intracerebral veins. Following BBB closure, within 24-48 h of FUS intervention, permeabilization of intraparenchymal veins was observed and persisted for up to one week. Notably, extraparenchymal meningeal venous permeabilization and associated CSF effusions were also elicited and persisted up to 11 days post FUS treatment, prior to complete spontaneous resolution in all participants. Mild susceptibility effects were detected, however no overt intracranial hemorrhage or other serious adverse effects occurred in any participant. CONCLUSIONS FUS-mediated BBB opening is safely and reproducibly achieved in multifocal brain regions of persons with AD. Post-FUS tracer enhancement phenomena suggest the existence of a brain-wide perivenous fluid efflux pathway in humans and demonstrate reactive physiological changes involving these conduit spaces in the delayed, subacute phase following BBB disruption. The delayed reactive venous and perivenous changes are consistent with a dynamic, zonal exudative response to upstream capillary manipulation. Further preclinical and clinical investigations of these FUS-related imaging phenomena and of intracerebral perivenous compartment changes are needed to elucidate physiology of this pathway as well as biological effects of FUS administered with and without adjuvant neurotherapeutics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03671889, registered 9/14/2018.
Collapse
Affiliation(s)
- Rashi I Mehta
- Department of Neuroradiology, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA.
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA.
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA.
| | - Jeffrey S Carpenter
- Department of Neuroradiology, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
| | - Rupal I Mehta
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Marc W Haut
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neurology, West Virginia University, Morgantown, WV, 26506, USA
| | - Peng Wang
- Department of Neuroradiology, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
| | - Manish Ranjan
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neurosurgery, West Virginia University, Morgantown, WV, 26506, USA
| | - Umer Najib
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neurology, West Virginia University, Morgantown, WV, 26506, USA
| | | | - Ali R Rezai
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neurosurgery, West Virginia University, Morgantown, WV, 26506, USA
| |
Collapse
|
11
|
Buetefisch CM, Haut MW, Revill KP, Shaeffer S, Edwards L, Barany DA, Belagaje SR, Nahab F, Shenvi N, Easley K. Stroke Lesion Volume and Injury to Motor Cortex Output Determines Extent of Contralesional Motor Cortex Reorganization. Neurorehabil Neural Repair 2023; 37:119-130. [PMID: 36786394 PMCID: PMC10079613 DOI: 10.1177/15459683231152816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND After stroke, increases in contralesional primary motor cortex (M1CL) activity and excitability have been reported. In pre-clinical studies, M1CL reorganization is related to the extent of ipsilesional M1 (M1IL) injury, but this has yet to be tested clinically. OBJECTIVES We tested the hypothesis that the extent of damage to the ipsilesional M1 and/or its corticospinal tract (CST) determines the magnitude of M1CL reorganization and its relationship to affected hand function in humans recovering from stroke. METHODS Thirty-five participants with a single subacute ischemic stroke affecting M1 or CST and hand paresis underwent MRI scans of the brain to measure lesion volume and CST lesion load. Transcranial magnetic stimulation (TMS) of M1IL was used to determine the presence of an electromyographic response (motor evoked potential (MEP+ and MEP-)). M1CL reorganization was determined by TMS applied to M1CL at increasing intensities. Hand function was quantified with the Jebsen Taylor Hand Function Test. RESULTS The extent of M1CL reorganization was related to greater lesion volume in the MEP- group, but not in the MEP+ group. Greater M1CL reorganization was associated with more impaired hand function in MEP- but not MEP+ participants. Absence of an MEP (MEP-), larger lesion volumes and higher lesion loads in CST, particularly in CST fibers originating in M1 were associated with greater impairment of hand function. CONCLUSIONS In the subacute post-stroke period, stroke volume and M1IL output determine the extent of M1CL reorganization and its relationship to affected hand function, consistent with pre-clinical evidence.ClinicalTrials.gov Identifier: NCT02544503.
Collapse
Affiliation(s)
- Cathrin M Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.,Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Kate P Revill
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott Shaeffer
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Lauren Edwards
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Samir R Belagaje
- Department of Neurology, Emory University, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Neeta Shenvi
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
12
|
Rezai AR, Ranjan M, Haut MW, Carpenter J, D’Haese PF, Mehta RI, Najib U, Wang P, Claassen DO, Chazen JL, Krishna V, Deib G, Zibly Z, Hodder SL, Wilhelmsen KC, Finomore V, Konrad PE, Kaplitt M, _ _. Focused ultrasound–mediated blood-brain barrier opening in Alzheimer’s disease: long-term safety, imaging, and cognitive outcomes. J Neurosurg 2022:1-9. [DOI: 10.3171/2022.9.jns221565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
MRI-guided low-intensity focused ultrasound (FUS) has been shown to reversibly open the blood-brain barrier (BBB), with the potential to deliver therapeutic agents noninvasively to target brain regions in patients with Alzheimer’s disease (AD) and other neurodegenerative conditions. Previously, the authors reported the short-term safety and feasibility of FUS BBB opening of the hippocampus and entorhinal cortex (EC) in patients with AD. Given the need to treat larger brain regions beyond the hippocampus and EC, brain volumes and locations treated with FUS have now expanded. To evaluate any potential adverse consequences of BBB opening on disease progression, the authors report safety, imaging, and clinical outcomes among participants with mild AD at 6–12 months after FUS treatment targeted to the hippocampus, frontal lobe, and parietal lobe.
METHODS
In this open-label trial, participants with mild AD underwent MRI-guided FUS sonication to open the BBB in β-amyloid positive regions of the hippocampus, EC, frontal lobe, and parietal lobe. Participants underwent 3 separate FUS treatment sessions performed 2 weeks apart. Outcome assessments included safety, imaging, neurological, cognitive, and florbetaben β-amyloid PET.
RESULTS
Ten participants (range 55–76 years old) completed 30 separate FUS treatments at 2 participating institutions, with 6–12 months of follow-up. All participants had immediate BBB opening after FUS and BBB closure within 24–48 hours. All FUS treatments were well tolerated, with no serious adverse events related to the procedure. All 10 participants had a minimum of 6 months of follow-up, and 7 participants had a follow-up out to 1 year. Changes in the Alzheimer’s Disease Assessment Scale–cognitive and Mini-Mental State Examination scores were comparable to those in controls from the Alzheimer’s Disease Neuroimaging Initiative. PET scans demonstrated an average β-amyloid plaque of 14% in the Centiloid scale in the FUS-treated regions.
CONCLUSIONS
This study is the largest cohort of participants with mild AD who received FUS treatment, and has the longest follow-up to date. Safety was demonstrated in conjunction with reversible and repeated BBB opening in multiple cortical and deep brain locations, with a concomitant reduction of β-amyloid. There was no apparent cognitive worsening beyond expectations up to 1 year after FUS treatment, suggesting that the BBB opening treatment in multiple brain regions did not adversely influence AD progression. Further studies are needed to determine the clinical significance of these findings. FUS offers a unique opportunity to decrease amyloid plaque burden as well as the potential to deliver targeted therapeutics to multiple brain regions in patients with neurodegenerative disorders.
Collapse
Affiliation(s)
| | | | - Marc W. Haut
- Behavioral Medicine and Psychiatry,
- Neurology, and
| | - Jeffrey Carpenter
- Neuroradiology, WVU Rockefeller Neuroscience Institute, Morgantown, West Virginia
| | | | - Rashi I. Mehta
- Neuroradiology, WVU Rockefeller Neuroscience Institute, Morgantown, West Virginia
| | | | - Peng Wang
- Neuroradiology, WVU Rockefeller Neuroscience Institute, Morgantown, West Virginia
| | | | | | - Vibhor Krishna
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - Gerard Deib
- Neuroradiology, WVU Rockefeller Neuroscience Institute, Morgantown, West Virginia
| | - Zion Zibly
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel; and
| | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, West Virginia
| | | | | | | | - Michael Kaplitt
- Neurological Surgery, Weill Cornell Medical College, New York, New York
| | | |
Collapse
|
13
|
Bossarte RM, Kessler RC, Nierenberg AA, Chattopadhyay A, Cuijpers P, Enrique A, Foxworth PM, Gildea SM, Belnap BH, Haut MW, Law KB, Lewis WD, Liu H, Luedtke AR, Pigeon WR, Rhodes LA, Richards D, Rollman BL, Sampson NA, Stokes CM, Torous J, Webb TD, Zubizarreta JR. The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients. Trials 2022; 23:520. [PMID: 35725644 PMCID: PMC9207842 DOI: 10.1186/s13063-022-06438-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems. METHODS Enrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE. DISCUSSION The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT. TRIAL REGISTRATION ClinicalTrials.gov NCT04120285 . Registered on October 19, 2019.
Collapse
Affiliation(s)
- Robert M Bossarte
- Department of Psychiatry and Behavioral Neuroscience, University of South Florida, 3515 E. Fletcher Ave, FL, 33613, Tampa, USA.
| | - Ronald C Kessler
- Department of Healthcare Policy, Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- The Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, Amsterdam, 1081 BT, The Netherlands
| | - Angel Enrique
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College Dublin and Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | | | - Sarah M Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Bea Herbeck Belnap
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA.,Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA.,Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Kari B Law
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA
| | - William D Lewis
- Department of Family Medicine, West Virginia University School of Medicine and West Virginia University Clinical and Translational Science Institute, Morgantown, WV, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.,Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Alexander R Luedtke
- Department of Statistics, University of Washington and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Larry A Rhodes
- Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Institute for Community and Rural Health, Morgantown, WV, USA
| | - Derek Richards
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College Dublin and Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Bruce L Rollman
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Cara M Stokes
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA.,West Virginia University Injury Control Research Center, Morgantown, WV, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tyler D Webb
- Department of Psychiatry and Behavioral Neuroscience, University of South Florida, 3515 E. Fletcher Ave, FL, 33613, Tampa, USA
| | - Jose R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.,Department of Statistics, Harvard University, Cambridge, MA, USA.,Department of Biostatistics, Harvard University, Cambridge, MA, USA
| |
Collapse
|
14
|
Revill KP, Barany DA, Vernon I, Rellick S, Caliban A, Tran J, Belagaje SR, Nahab F, Haut MW, Buetefisch CM. Evaluating the Abnormality of Bilateral Motor Cortex Activity in Subacute Stroke Patients Executing a Unimanual Motor Task With Increasing Demand on Precision. Front Neurol 2022; 13:836716. [PMID: 35693005 PMCID: PMC9174784 DOI: 10.3389/fneur.2022.836716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Abnormal contralesional M1 activity is consistently reported in patients with compromised upper limb and hand function after stroke. The underlying mechanisms and functional implications of this activity are not clear, which hampers the development of treatment strategies targeting this brain area. The goal of the present study was to determine the extent to which contralesional M1 activity can be explained by the demand of a motor task, given recent evidence for increasing ipsilateral M1 activity with increasing demand in healthy age-matched controls. We hypothesized that higher activity in contralesional M1 is related to greater demand on precision in a hand motor task. fMRI data were collected from 19 patients with ischemic stroke affecting hand function in the subacute recovery phase and 31 healthy, right-handed, age-matched controls. The hand motor task was designed to parametrically modulate the demand on movement precision. Electromyography data confirmed strictly unilateral task performance by all participants. Patients showed significant impairment relative to controls in their ability to perform the task in the fMRI scanner. However, patients and controls responded similarly to an increase in demand for precision, with better performance for larger targets and poorer performance for smaller targets. Patients did not show evidence of elevated ipsilesional or contralesional M1 blood oxygenation level-dependent (BOLD) activation relative to healthy controls and mean BOLD activation levels were not elevated for patients with poorer performance relative to patients with better task performance. While both patients and healthy controls showed demand-dependent increases in BOLD activation in both ipsilesional/contralateral and contralesional/ipsilateral hemispheres, patients with stroke were less likely to show evidence of a linear relationship between the demand on precision and BOLD activation in contralesional M1 than healthy controls. Taken together, the findings suggest that task demand affects the BOLD response in contralesional M1 in patients with stroke, though perhaps less strongly than in healthy controls. This has implications for the interpretation of reported abnormal bilateral M1 activation in patients with stroke because in addition to contralesional M1 reorganization processes it could be partially related to a response to the relatively higher demand of a motor task when completed by patients rather than by healthy controls.
Collapse
Affiliation(s)
- Kate Pirog Revill
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Deborah A. Barany
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Isabelle Vernon
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stephanie Rellick
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Alexandra Caliban
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Julie Tran
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Samir R. Belagaje
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Marc W. Haut
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- Department of Radiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Cathrin M. Buetefisch
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
- Department of Radiology, Emory University, Atlanta, GA, United States
- *Correspondence: Cathrin M. Buetefisch
| |
Collapse
|
15
|
Mahoney JJ, Haut MW, Hodder SL, Zheng W, Lander LR, Berry JH, Farmer DL, Marton JL, Ranjan M, Brandmeir NJ, Finomore VS, Hensley JL, Aklin WM, Wang GJ, Tomasi D, Shokri-Kojori E, Rezai AR. Deep brain stimulation of the nucleus accumbens/ventral capsule for severe and intractable opioid and benzodiazepine use disorder. Exp Clin Psychopharmacol 2021; 29:210-215. [PMID: 34043402 PMCID: PMC8422285 DOI: 10.1037/pha0000453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Given high relapse rates and the prevalence of overdose deaths, novel treatments for substance use disorder (SUD) are desperately needed for those who are treatment refractory. The objective of this study was to evaluate the safety of deep brain stimulation (DBS) for SUD and the effects of DBS on substance use, substance craving, emotional symptoms, and frontal/executive functions. DBS electrodes were implanted bilaterally within the Nucleus Accumbens/Ventral anterior internal capsule (NAc/VC) of a man in his early 30s with >10-year history of severe treatment refractory opioid and benzodiazepine use disorders. DBS of the NAc/VC was found to be safe with no serious adverse events noted and the participant remained abstinent and engaged in comprehensive treatment at the 12-week endpoint (and 12-month extended follow-up). Using a 0-100 visual analog scale, substance cravings decreased post-DBS implantation; most substantially in benzodiazepine craving following the final DBS titration (1.0 ± 2.2) compared to baseline (53.4 ± 29.5; p < .001). A trend toward improvement in frontal/executive function was observed on the balloon analog risk task performance following the final titration (217.7 ± 76.2) compared to baseline (131.3 ± 28.1, p = .066). FDG PET demonstrated an increase in glucose metabolism in the dorsolateral prefrontal and medial premotor cortices at the 12-week endpoint compared to post-surgery/pre-DBS titration. Heart Rate Variability (HRV) improved following the final titration (rMSSD = 56.0 ± 11.7) compared to baseline (19.2 ± 8.2; p < .001). In a participant with severe, treatment refractory opioid and benzodiazepine use disorder, DBS of the NAc/VC was safe, reduced substance use and craving, and improved frontal and executive functions. Confirmation of these findings with future studies is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- James J. Mahoney
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Marc W. Haut
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM),Department of Neurology, Department of Radiology, RNI, WVUSOM
| | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, WVUSOM
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Daniel L. Farmer
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Jennifer L. Marton
- Department of Behavioral Medicine and Psychiatry, Department of Neuroscience, Rockefeller Neuroscience Institute (RNI), West Virginia University School of Medicine (WVUSOM)
| | - Manish Ranjan
- Department of Neurosurgery, Department of Neuroscience, RNI, WVUSOM
| | | | | | | | - Will M. Aklin
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, Maryland, United States
| | - Gene-Jack Wang
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Dardo Tomasi
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Ehsan Shokri-Kojori
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Ali R. Rezai
- Department of Neurosurgery, Department of Neuroscience, RNI, WVUSOM
| |
Collapse
|
16
|
Mahoney JJ, Winstanley EL, Lander LR, Berry JH, Marshalek PJ, Haut MW, Marton JL, Kimble WD, Armistead M, Wen S, Cai Y, Hodder SL. High prevalence of co-occurring substance use in individuals with opioid use disorder. Addict Behav 2021; 114:106752. [PMID: 33348147 DOI: 10.1016/j.addbeh.2020.106752] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/14/2020] [Accepted: 11/22/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Funding to address the current opioid epidemic has focused on treatment of opioid use disorder (OUD); however, rates of other substance use disorders (SUDs) remain high and non-opioid related overdoses account for nearly 30% of overdoses. This study assesses the prevalence of co-occurring substance use in West Virginia (WV) to inform treatment strategies. The objective of this study was to assess the prevalence of, and demographic and clinical characteristics (including age, gender, hepatitis C virus (HCV) status) associated with, co-occurring substance use among patients with OUD in WV. METHODS This retrospective study utilized the West Virginia Clinical and Translation Science Institute Integrated Data Repository, comprised of Electronic Medical Record (EMR) data from West Virginia University Medicine. Deidentified data were extracted from inpatient psychiatric admissions and emergency department (ED) healthcare encounters between 2009 and 2018. Eligible patients were those with OUD who had a positive urine toxicology screen for opioids at the time of their initial encounter with the healthcare system. Extracted data included results of comprehensive urine toxicology testing during the study timeframe. RESULTS 3,127 patients met the inclusion criteria of whom 72.8% had co-occurring substance use. Of those who were positive for opioids and at least one additional substance, benzodiazepines were the most common co-occurring substances (57.4% of patients yielded a positive urine toxicology screen for both substances), followed by cannabis (53.1%), cocaine (24.5%) and amphetamine (21.6%). Individuals who used co-occurring substances were younger than those who were positive for opioids alone (P < 0.001). There was a higher prevalence of individuals who used co-occurring substances that were HCV positive in comparison to those who used opioids alone (P < 0.001). There were limited gender differences noted between individuals who used co-occurring substances and those who used opioids alone. Among ED admissions who were positive for opioids, 264 were diagnosed with substance toxicity/overdose, 78.4% of whom had co-occurring substance use (benzodiazepines: 65.2%; cannabis: 44.4%; cocaine: 28.5%; amphetamine: 15.5%). Across the 10-year timespan, the greatest increase for the entire sample was in the rate of co-occurring amphetamine and opioid use (from 12.6% in 2014 to 47.8% in 2018). CONCLUSIONS These data demonstrate that the current substance use epidemic extends well beyond opioids, suggesting that comprehensive SUD prevention and treatment strategies are needed, especially for those substances which do not yet have any evidence-based and/or medication treatments available.
Collapse
|
17
|
Mehta RI, Carpenter JS, Mehta RI, Haut MW, Ranjan M, Najib U, Lockman P, Wang P, D'haese PF, Rezai AR. Blood-Brain Barrier Opening with MRI-guided Focused Ultrasound Elicits Meningeal Venous Permeability in Humans with Early Alzheimer Disease. Radiology 2021; 298:654-662. [PMID: 33399511 DOI: 10.1148/radiol.2021200643] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Opening of the blood-brain barrier (BBB) induced with MRI-guided focused ultrasound has been shown in experimental animal models to reduce amyloid-β plaque burden, improve memory performance, and facilitate delivery of therapeutic agents to the brain. However, physiologic effects of this procedure in humans with Alzheimer disease (AD) require further investigation. Purpose To assess imaging effects of focused ultrasound-induced BBB opening in the hippocampus of human participants with early AD and to evaluate fluid flow patterns after BBB opening by using serial contrast-enhanced MRI. Materials and Methods Study participants with early AD recruited to a Health Insurance Portability and Accountability Act-compliant, prospective, ongoing phase II clinical trial (ClinicalTrials.gov identifier, NCT03671889) underwent three separate focused ultrasound-induced BBB opening procedures that used a 220-kHz transducer with a concomitant intravenous microbubble contrast agent administered at 2-week intervals targeting the hippocampus and entorhinal cortex between October 2018 and May 2019. Posttreatment effects and gadolinium-based contrast agent enhancement patterns were evaluated by using 3.0-T MRI. Results Three women (aged 61, 72, and 73 years) consecutively enrolled in the trial successfully completed repeated focused ultrasound-induced BBB opening of the hippocampus and entorhinal cortex. Postprocedure contrast enhancement was clearly identified within the targeted brain volumes, indicating immediate spatially precise BBB opening. Parenchymal enhancement resolved within 24 hours after all treatments, confirming BBB closure. Transient perivenous enhancement was consistently observed during the acute phase after BBB opening. Notably, contrast enhancement reappeared in the perivenular regions after BBB closure. This imaging marker is consistent with blood-meningeal barrier permeability and persisted for 24-48 hours before spontaneous resolution. No evidence of intracranial hemorrhage or other adverse effect was identified. Conclusion MRI-guided focused ultrasound-induced blood-brain barrier opening was safely performed in the hippocampi of three participants with Alzheimer disease without any adverse effects. Posttreatment MRI reveals a unique spatiotemporal contrast enhancement pattern that suggests a perivenular immunologic healing response downstream from targeted sites. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Klibanov in this issue.
Collapse
Affiliation(s)
- Rashi I Mehta
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Jeffrey S Carpenter
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Rupal I Mehta
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Marc W Haut
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Manish Ranjan
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Umer Najib
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Paul Lockman
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Peng Wang
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Pierre-François D'haese
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| | - Ali R Rezai
- From the Departments of Neuroradiology (Rashi I. Mehta, J.S.C., P.W., P.F.D.), Radiology (Rashi I. Mehta, J.S.C.), and Neuroscience (Rashi I. Mehta, J.S.C., M.W.H., P.L., A.R.R.); Rockefeller Neuroscience Institute (Rashi I. Mehta, J.S.C., M.W.H., M.R., U.N., P.L., P.W., P.F.D., A.R.R.); and Departments of Behavioral Medicine and Psychiatry (M.W.H.), Neurosurgery (M.W.H., M.R., A.R.R.), Neurology (M.W.H., U.N.), and Pharmaceutical Sciences (P.L.), West Virginia University, 1 Medical Center Dr, Morgantown, WV 26505; Center for Translational Neuromedicine, University of Rochester, Rochester, NY (Rupal I. Mehta); and Alzheimer's Disease Center and Department of Pathology, Rush University Medical Center, Chicago, Ill (Rupal I. Mehta)
| |
Collapse
|
18
|
D'Haese PF, Ranjan M, Song A, Haut MW, Carpenter J, Dieb G, Najib U, Wang P, Mehta RI, Chazen JL, Hodder S, Claassen D, Kaplitt M, Rezai AR. β-Amyloid Plaque Reduction in the Hippocampus After Focused Ultrasound-Induced Blood-Brain Barrier Opening in Alzheimer's Disease. Front Hum Neurosci 2020; 14:593672. [PMID: 33132889 PMCID: PMC7575813 DOI: 10.3389/fnhum.2020.593672] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
The blood–brain barrier (BBB) limits therapeutic delivery in Alzheimer’s disease (AD) and other neurological disorders. Animal models have demonstrated safe BBB opening and reduction in β-amyloid plaque with focused ultrasound (FUS). We recently demonstrated the feasibility, safety, and reversibility of FUS-induced BBB opening in the hippocampus and entorhinal cortex in six participants with early AD. We now report the effect of BBB opening with FUS treatment on β-amyloid plaque. Six participants underwent 18F-Florbetaben PET scan at baseline and 1 week after the completion of the third FUS treatment (60 days interval). PET analysis comparing the hippocampus and entorhinal cortex in the treated and untreated hemispheres revealed a decrease in the ratio of 18F-Florbetaben ligand binding. The standard uptake value ratios (SUVr) reduction ranged from 2.7% to 10% with an average of 5.05% (±2.76) suggesting a decrease in β-amyloid plaque.
Collapse
Affiliation(s)
- Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Neurological Surgery, Vanderbilt University, Nashville, TN, United States.,Department of Neuroradiology, West Virginia University, Nashville, TN, United States
| | - Manish Ranjan
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neurosurgery, West Virginia University, Nashville, TN, United States
| | - Alexander Song
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - Marc W Haut
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, United States
| | - Jeffrey Carpenter
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neuroradiology, West Virginia University, Nashville, TN, United States
| | - Gerard Dieb
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neuroradiology, West Virginia University, Nashville, TN, United States
| | - Umer Najib
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neurology, West Virginia University, Morgantown, WV, United States
| | - Peng Wang
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neuroradiology, West Virginia University, Nashville, TN, United States
| | - Rashi I Mehta
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neuroradiology, West Virginia University, Nashville, TN, United States
| | - J Levi Chazen
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, United States
| | - Daniel Claassen
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - Michael Kaplitt
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Ali R Rezai
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.,Department of Neurosurgery, West Virginia University, Nashville, TN, United States
| |
Collapse
|
19
|
Winstanley EL, Mahoney JJ, Lander LR, Berry JH, Marshalek P, Zheng W, Haut MW. Something to despair: Gender differences in adverse childhood experiences among rural patients. J Subst Abuse Treat 2020; 116:108056. [PMID: 32741501 DOI: 10.1016/j.jsat.2020.108056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 01/27/2023]
Abstract
Existing research has demonstrated that patients in treatment for an opioid use disorder (OUD) have high rates of adverse childhood experiences (ACE) compared to community-based samples. While research has documented important gender differences in ACEs in patients with OUD receiving treatment in urban areas, research has not shown whether these findings would generalize to rural and Appalachian areas, which are known to have lower ACE scores. We conducted a secondary analysis of existing clinical data, utilizing intake assessment data from a rural Appalachian outpatient buprenorphine program. We restricted the sample to patients with an OUD who presented for treatment between June 2018 and June 2019 (n = 173). The clinical intake assessment included a modified 17-item ACE instrument that patients self-administered. More than half (54.3%) of patients reported having experienced 4+ categories of adverse childhood experiences. On average, females endorsed 4.5 categories of adverse experiences, whereas males endorsed 3.3 (p < 0.00); female patients were significantly more likely to have experienced sexual abuse (42.4% versus 10.6%, p < 0.00). Alarmingly, 25.9% of females and 8.2% of males reported being forced to have sex before age 18. Disproportionately high rates of childhood adversities, particularly among females, may partially explain despair in rural Appalachian areas. OUD treatment programs should conduct clinical assessments of trauma and integrate trauma-informed care into drug treatment, especially for female patients residing in rural Appalachia.
Collapse
Affiliation(s)
- Erin L Winstanley
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States.
| | - James J Mahoney
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Laura R Lander
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James H Berry
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Patrick Marshalek
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Wanhong Zheng
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Marc W Haut
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States; West Virginia University, School of Medicine, Department of Neurology, United States; West Virginia University, School of Medicine, Department of Radiology, United States
| |
Collapse
|
20
|
Mahoney JJ, Marshalek PJ, Rezai AR, Lander LR, Berry JH, Haut MW. A case report illustrating the effects of repetitive transcranial magnetic stimulation on cue-induced craving in an individual with opioid and cocaine use disorder. Exp Clin Psychopharmacol 2020; 28:1-5. [PMID: 31647279 PMCID: PMC7037539 DOI: 10.1037/pha0000289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nationally, it was estimated that 11.4 million people misused opioids in 2017 with more than 47,000 opioid-related deaths. Although medication-assisted treatment (MAT) has been effective in enhancing treatment retention and decreasing frequency of opioid use, relapse rates for opioids and other substances remain high, emphasizing the importance of investigating novel interventions to augment MAT. One potential treatment approach is repetitive transcranial magnetic stimulation (rTMS)-a noninvasive, electrophysiological method of neuromodulation. Recently published studies of rTMS in individuals with alcohol, nicotine, and cocaine use disorder have suggested that this treatment shows promise in reducing cravings and substance use. The literature specific to rTMS and opioid use disorder (OUD) is limited to a single published study in heroin users, which showed that a single session of rTMS to the left dorsolateral prefrontal cortex (DLPFC) reduced cue-induced craving, with a further reduction following 5 consecutive days of rTMS. The following case report involved a 25-year-old Caucasian male diagnosed with OUD and cocaine use disorder. This subject continued to demonstrate ongoing substance use despite participating in comprehensive MAT with buprenorphine/naloxone in combination with psychosocial interventions. He was administered 7 separate sessions of rTMS targeting the left DLPFC. Substance-related cues were presented prior to, during, and following these rTMS administration sessions and the subject rated his substance cravings via a 100-point Visual Analog Scale. When compared with his cue-induced craving ratings, there was a mean reduction in craving for heroin and cocaine by ∼60% to 82% following the 7 administration sessions. Although this is a single case, further investigation of rTMS as an augmentation strategy for OUD and polysubstance use is warranted. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- James J Mahoney
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine
| | - Patrick J Marshalek
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine
| | - Ali R Rezai
- Department of Behavioral Medicine, Rockefeller Neuroscience Institute, West Virginia University School of Medicine
| | - Laura R Lander
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine
| | - James H Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine
| | - Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine
| |
Collapse
|
21
|
Revill KP, Haut MW, Belagaje SR, Nahab F, Drake D, Buetefisch CM. Hebbian-Type Primary Motor Cortex Stimulation: A Potential Treatment of Impaired Hand Function in Chronic Stroke Patients. Neurorehabil Neural Repair 2020; 34:159-171. [PMID: 31976804 DOI: 10.1177/1545968319899911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background. Stroke often involves primary motor cortex (M1) and its corticospinal (CST) projections. As hand function is critically dependent on these structures, its recovery is often incomplete. Objective. To determine whether impaired hand function in patients with chronic ischemic stroke involving M1 or CST benefits from the enhancing effect of Hebbian-type stimulation (pairing M1 afferent stimulation and M1 activity in a specific temporal relationship) on M1 plasticity and hand function. Methods. In a double-blind, randomized, sham-controlled design, 20 patients with chronic ischemic stroke affecting M1 or CST were randomly assigned to 5 days of hand motor training that was combined with either Hebbian-type (trainingHebb) or sham stimulation (trainingsham) of the lesioned M1. Measures of hand function and task-based M1 functional magnetic resonance imaging (fMRI) activity were collected prior to, immediately following, and 4 weeks after the intervention. Results. Both interventions were effective in improving affected hand function at the completion of training, but only participants in the trainingHebb group maintained functional gains. Changes in hand function and fMRI activity were positively correlated in both ipsilesional and contralesional M1. Compared with trainingsham, participants in the trainingHebb group showed a stronger relationship between improved hand function and changes in M1 functional activity. Conclusions. Only when motor training was combined with Hebbian-type stimulation were functional gains maintained over time and correlated with measures of M1 functional plasticity. As hand dexterity is critically dependent on M1 function, these results suggest that functional reorganization in M1 is facilitated by Hebbian-type stimulation. ClinicalTrials.gov Identifier: NCT01569607.
Collapse
Affiliation(s)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, WV, USA
| | | | | | | | | |
Collapse
|
22
|
Kaski SW, Brooks S, Wen S, Haut MW, Siderovski DP, Berry JH, Lander LR, Setola V. Four single nucleotide polymorphisms in genes involved in neuronal signaling are associated with Opioid Use Disorder in West Virginia. J Opioid Manag 2019; 15:103-109. [PMID: 31057342 DOI: 10.5055/jom.2019.0491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Pilot study to assess utility in opioid use disorder (OUD) of a panel of single nucleotide polymorphisms in genes previously related to substance use disorder (SUD) and/or phenotypes that predispose individuals to OUD/SUD. Design Genetic association study. Setting West Virginia University's Chestnut Ridge Center Comprehensive Opioid Abuse Treatment (COAT) clinic for individuals diagnosed with OUD. Patients Sixty patients 18 years of age or older with OUD undergoing medication (buprenorphine/naloxone)-assisted treatment (MAT); all sixty patients recruited contributed samples for genetic analysis. Outcome Measures Minor allele frequencies for single nucleotide polymorphisms. Results Four of the fourteen single nucleotide polymorphisms examined were present at frequencies that are statistically significantly different than in a demographically-matched general population. Conclusions For the purposes of testing WV individuals via genetic means for predisposition to OUD, at least four single nucleotide polymorphisms in three genes are likely to have utility in predicting susceptibility. Additional studies with larger populations will need to be conducted to confirm these results before use in a clinical setting.
Collapse
Affiliation(s)
- Shane W Kaski
- Department of Physiology & Pharmacology, West Virginia University School of Medicine, Morgantown, WV
| | | | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV
| | - Marc W Haut
- Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - David P Siderovski
- Department of Physiology & Pharmacology, West Virginia University School of Medicine, Morgantown, WV
| | - James H Berry
- Chestnut Ridge Center and Inpatient Acute Dual Diagnosis Program, West Virginia University School of Medicine, Morgantown, WV
| | - Laura R Lander
- West Virginia University School of Medicine, Morgantown, WV
| | - Vincent Setola
- Departments of Behavioral Medicine & Psychiatry, Neuroscience, and Physiology & Pharmacology, West Virginia University School of Medicine, Morgantown, WV
| |
Collapse
|
23
|
Winstanley EL, Lander LR, Berry JH, Mahoney JJ, Zheng W, Herschler J, Marshalek P, Sayres S, Mason J, Haut MW. West Virginia's model of buprenorphine expansion: Preliminary results. J Subst Abuse Treat 2019; 108:40-47. [PMID: 31221524 DOI: 10.1016/j.jsat.2019.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/18/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
West Virginia (WV) is situated at the epicenter of the opioid epidemic with the highest rates of overdose deaths and some of the lowest rates of access to life saving evidence-based medication assisted treatment (MAT) for patients with opioid use disorder (OUD). WV used a modified hub-and-spoke model to build organizational capacity for facilities to use buprenorphine to treat patients with OUD and to provide ongoing case consultation. The purpose of this study is to 1) describe the group-base model of buprenorphine treatment and the model used to build organizational capacity, 2) to describe the preliminary results of buprenorphine expansion in WV and 3) to report preliminary data describing and comparing the characteristics of the patients served across five hubs. A single Coordinating Center uses video conferencing to train hubs and provide ongoing case consultation, as well as clinical support. Hubs were trained to deliver a buprenorphine treatment model that is multi-disciplinary and includes group-based medication management and psychosocial therapy. Five regional hubs independently treat patients and are leading MAT expansion in their local areas by training and mentoring spokes (n = 13). As a result of the WV STR funding, 14 health care facilities have started to use buprenorphine, 56 health professionals were trained and 196 patients with OUD have been treated. There were few sociodemographic characteristic differences across patients treated at the five hubs, while there were differences in self-reported alcohol and drug use in the 30 days prior to intake. Additional research is needed to determine whether the WV modified hub-and-spoke model resulted in statistically significant improvements in buprenorphine treatment capacity; there is a need to address MAT stigma and regulatory barriers in order to ensure the long-term sustainability of the buprenorphine expansion.
Collapse
Affiliation(s)
- Erin L Winstanley
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States.
| | - Laura R Lander
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James H Berry
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James J Mahoney
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Wanhong Zheng
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Jeremy Herschler
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States
| | - Patrick Marshalek
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Sheena Sayres
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, West Virginial Clinical and Translational Science Institute, United States
| | - Jay Mason
- West Virginia University, West Virginial Clinical and Translational Science Institute, United States
| | - Marc W Haut
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States; West Virginia University, School of Medicine, Department of Neurology, United States; West Virginia University, School of Medicine, Department of Radiology, United States
| |
Collapse
|
24
|
Duru UB, Pawar G, Barash JA, Miller LE, Thiruselvam IK, Haut MW. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 169:662-663. [PMID: 30398631 PMCID: PMC6464382 DOI: 10.7326/l18-0411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Uzoma B Duru
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Gauri Pawar
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | | | - Liv E Miller
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Indrani K Thiruselvam
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| |
Collapse
|
25
|
Buetefisch CM, Revill KP, Haut MW, Kowalski GM, Wischnewski M, Pifer M, Belagaje SR, Nahab F, Cobia DJ, Hu X, Drake D, Hobbs G. Abnormally reduced primary motor cortex output is related to impaired hand function in chronic stroke. J Neurophysiol 2018; 120:1680-1694. [PMID: 29924707 DOI: 10.1152/jn.00715.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Stroke often involves primary motor cortex (M1) and its corticospinal projections (CST). As hand function is critically dependent on these structures, its recovery is often incomplete. The neuronal substrate supporting affected hand function is not well understood but likely involves reorganized M1 and CST of the lesioned hemisphere (M1IL and CSTIL). We hypothesized that affected hand function in chronic stroke is related to structural and functional reorganization of M1IL and CSTIL. We tested 18 patients with chronic ischemic stroke involving M1 or CST. Their hand function was compared with 18 age-matched healthy subjects. M1IL thickness and CSTIL fractional anisotropy (FA) were determined with MRI and compared with measures of the other hemisphere. Transcranial magnetic stimulation (TMS) was applied to M1IL to determine its input-output function [stimulus response curve (SRC)]. The plateau of the SRC (MEPmax), inflection point, and slope parameters of the curve were extracted. Results were compared with measures in 12 age-matched healthy controls. MEPmax of M1IL was significantly smaller ( P = 0.02) in the patients, indicating reduced CSTIL motor output, and was correlated with impaired hand function ( P = 0.02). M1IL thickness ( P < 0.01) and CSTIL-FA ( P < 0.01) were reduced but did not correlate with hand function. The results indicate that employed M1IL or CSTIL structural measures do not explain the extent of impairment in hand function once M1 and CST are sufficiently functional for TMS to evoke a motor potential. Instead, impairment of hand function is best explained by the abnormally low output from M1IL. NEW & NOTEWORTHY Hand function often remains impaired after stroke. While the critical role of the primary motor cortex (M1) and its corticospinal output (CST) for hand function has been described in the nonhuman primate stroke model, their structure and function have not been systematically evaluated for patients after stroke. We report that in chronic stroke patients with injury to M1 and/or CST an abnormally reduced M1 output is related to impaired hand function.
Collapse
Affiliation(s)
- C M Buetefisch
- Department of Neurology, Emory University , Atlanta, Georgia.,Department of Rehabilitation Medicine, Emory University , Atlanta, Georgia
| | - K P Revill
- Department of Psychology, Emory University , Atlanta, Georgia
| | - M W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, West Virginia.,Department of Neurology, West Virginia University School of Medicine , Morgantown, West Virginia.,Department of Radiology, West Virginia University School of Medicine , Morgantown, West Virginia
| | - G M Kowalski
- Department of Neurology, Emory University , Atlanta, Georgia
| | - M Wischnewski
- Department of Neurology, Emory University , Atlanta, Georgia
| | - M Pifer
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, West Virginia
| | - S R Belagaje
- Department of Neurology, Emory University , Atlanta, Georgia.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital , Atlanta, Georgia
| | - F Nahab
- Department of Neurology, Emory University , Atlanta, Georgia
| | - D J Cobia
- Department of Psychology and Neuroscience Center, Brigham Young University , Provo, Utah
| | - X Hu
- Department of Bioengineering, University of California Riverside , Riverside, California
| | - D Drake
- Department of Biostatistics, The Mailman School of Public Health, Columbia University , New York, New York
| | - G Hobbs
- Department of Statistics, West Virginia University , Morgantown, West Virginia
| |
Collapse
|
26
|
Duru UB, Pawar G, Barash JA, Miller LE, Thiruselvam IK, Haut MW. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 168:747-748. [PMID: 29379942 DOI: 10.7326/l17-0575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Uzoma B Duru
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Gauri Pawar
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | | | - Liv E Miller
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Indrani K Thiruselvam
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| |
Collapse
|
27
|
Abstract
We report a case of a 57-year-old male with clinically diagnosed and autopsy-confirmed early onset Alzheimer's disease who completed suicide by gunshot wound to the chest. This case has several unique aspects that have not been discussed in previous case reports of completed suicide in Alzheimer's disease. In particular, our patient's death was highly planned with successful compensation for his cognitive deficits. After all firearms had been removed from the home as a safety precaution, he obtained a new weapon, hid it and left himself cues to find and use it. The case is discussed in the context of literature differentiating the neural circuitry propagating impulsive versus planned suicidal acts.
Collapse
Affiliation(s)
- Jennifer Wiener Hartzell
- Department of Supportive Oncology, Levine Cancer Institute, Carolinas HealthCare System, NC 28202, USA.,Department of Neuropsychology & Psychology, Carolinas Rehabilitation, Carolinas HealthCare System, NC 28203, USA
| | - Richard Geary
- Department of Psychiatry, Overlake Medical Center, WA 98004, USA
| | - Kymberly Gyure
- Department of Pathology, West Virginia University School of Medicine, WV 26506, USA.,Department of Neurology, West Virginia University School of Medicine, WV 26506, USA.,Department of Neurosurgery, West Virginia University School of Medicine, WV 26506, USA
| | - Venkata Ravi Chivukula
- Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, WV 26505, USA
| | - Marc W Haut
- Department of Neurology, West Virginia University School of Medicine, WV 26506, USA.,Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, WV 26505, USA.,Department of Radiology, West Virginia University School of Medicine, WV 26506, USA
| |
Collapse
|
28
|
Abstract
Primary motor cortex (M1) plasticity is involved in motor learning and stroke motor recovery, and enhanced by increasing monoaminergic transmission. Age impacts these processes but there is a paucity of systematic studies on the effects of monoaminergic drugs in older adults. Here, in ten older adults (age 61+4years, 4 males), we determine the effects of a single oral dose of carbidopa/levodopa (DOPA), d-amphetamine (AMPH), methylphenidate (MEPH) and placebo (PLAC) on M1 excitability and motor training-induced M1 plasticity. M1 plasticity is defined as training related long lasting changes in M1 excitability and kinematics of the trained movement. At peak plasma level of the drugs, subjects trained wrist extension movements for 30min. Outcome measures were motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation at increasing intensity (stimulus response curve, SRC) and peak acceleration of the trained wrist extension movements. Measures were obtained before and after completion of training. The curve parameters plateau (MEPmax), inflection point, and slope were extracted from SRC. At baseline drugs had a differential effect on curve parameters, while kinematics remained unchanged. Training alone (PLAC) increased MEPmax but did not improve kinematics. Drugs affected training-related changes of the curve parameters differently, but did not enhance them or kinematics when compared to PLAC. The results demonstrate that in the older adults, MEPH, DOPA, or AMPH have differential effects on baseline M1 excitability and training-related M1 plasticity but fail to enhance them above the naïve level.
Collapse
Affiliation(s)
- Trisha M Kesar
- Dept. of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | | | - Paola Pergami
- Dept. of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Marc W Haut
- Dept. of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA; Dept. of Radiology, West Virginia University, Morgantown, WV, USA
| | - Gerald Hobbs
- Dept. of Statistics, West Virginia University, Morgantown, WV, USA
| | - Cathrin M Buetefisch
- Dept. of Rehabilitation Medicine, Emory University, Atlanta, GA, USA; Dept. of Neurology, Emory University, Atlanta, GA, USA.
| |
Collapse
|
29
|
Haut MW, Hogg JP, Marshalek PJ, Suter BC, Miller LE. Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use. Front Neurol 2017; 8:27. [PMID: 28228745 PMCID: PMC5296355 DOI: 10.3389/fneur.2017.00027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 01/20/2017] [Indexed: 12/27/2022] Open
Abstract
We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia.
Collapse
Affiliation(s)
- Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA; Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA; Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jeffery P Hogg
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA; Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Patrick J Marshalek
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, WV , USA
| | - Blair C Suter
- West Virginia University School of Medicine , Morgantown, WV , USA
| | - Liv E Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, WV , USA
| |
Collapse
|
30
|
Wischnewski M, Kowalski GM, Rink F, Belagaje SR, Haut MW, Hobbs G, Buetefisch CM. Demand on skillfulness modulates interhemispheric inhibition of motor cortices. J Neurophysiol 2016; 115:2803-13. [PMID: 26961108 DOI: 10.1152/jn.01076.2015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/08/2016] [Indexed: 11/22/2022] Open
Abstract
The role of primary motor cortex (M1) in the control of hand movements is still unclear. Functional magnetic resonance imaging (fMRI) studies of unimanual performance reported a relationship between level of precision of a motor task and additional ipsilateral M1 (iM1) activation. In the present study, we determined whether the demand on accuracy of a movement influences the magnitude of the inhibitory effect between primary motor cortices (IHI). We used transcranial magnetic stimulation (TMS) to measure active IHI (aIHI) of the iM1 on the contralateral M1 (cM1) in the premovement period of a left-hand motor task. Ten healthy participants manipulated a joystick to point to targets of two different sizes. For aIHI, the conditioning stimulus (CS) was applied to iM1, and the test stimulus (TS) to cM1, with an interstimulus interval of 10 ms. The amount of the inhibitory effect of the CS on the motor-evoked potential (MEP) of the subsequent TS was expressed as percentage of the mean MEP amplitude evoked by the single TS. Across different time points of aIHI measurements in the premovement period, there was a significant effect for target size on aIHI. Preparing to point to small targets was associated with weaker aIHI compared with pointing to large targets. The present findings suggest that, during the premovement period, aIHI from iM1 on cM1 is modulated by the demand on accuracy of the motor task. This is consistent with task fMRI findings showing bilateral M1 activation during high-precision movements but only unilateral M1 activity during low-precision movements.
Collapse
Affiliation(s)
| | | | | | - Samir R Belagaje
- Department of Neurology and Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia
| | | | - Gerald Hobbs
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia
| | - Cathrin M Buetefisch
- Department of Neurology and Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia;
| |
Collapse
|
31
|
Abstract
We present the clinical history and the cognitive and behavioral presentations of a male patient with suspected progressive supranuclear palsy (PSP) who fatally shot himself in the head. We believe his act of suicide was the consequence of impulsivity, rather than primary depression or mood disturbance. In cases of suspected PSP and other atypical parkinsonisms, health professionals must be aware of neurobehavioral risk factors for suicide attempts and completions to promote patient safety; however, the literature on this topic is sparse. Our case highlights the potentially lethal consequences of impulsivity and other neuropsychiatric symptoms in PSP and related syndromes.
Collapse
Affiliation(s)
- Jennifer Wiener
- Department of Neurology & Rehabilitation, NYU Lutheran, NYU Langone Health System, 150 55th Street, Brooklyn, NY 11220, USA
| | - Maria T Moran
- Department of Behavioral Medicine & Psychiatry, West Virginia University, WV 26505-2854, USA
| | - Marc W Haut
- Department of Behavioral Medicine & Psychiatry, West Virginia University, WV 26505-2854, USA
| |
Collapse
|
32
|
Buetefisch CM, Howard C, Korb C, Haut MW, Shuster L, Pergami P, Smith C, Hobbs G. Conditions for enhancing the encoding of an elementary motor memory by rTMS. Clin Neurophysiol 2014; 126:581-93. [PMID: 25113275 DOI: 10.1016/j.clinph.2014.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 06/12/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Motor learning results in changes of movement representation in primary motor cortex (M1) a process involving long-term potentiation (LTP). Pairing motor training with repetitive transcranial magnetic stimulation (rTMS) of M1 enhances the formation of a motor memory. Here we determined the effect of pairing M1 stimulation and the execution of training movements at different times and frequencies on the formation of a motor memory. METHODS Formation of a motor memory was defined as increases in motor evoked potentials (MEP) of the training agonist (extensor carpi ulnaris muscle, ECU) and increases in peak acceleration of the trained movements that last more than 60min. Training consisted of auditory-paced ballistic wrist extension movements (30min, 0.5Hz) paired with 0.1, 0.25 or 0.5Hz subthreshold rTMS. The rTMS pulse was applied at either the onset, 100ms prior to or 300ms after the onset of training movement related increases in electromyographic (EMG) activity of ECU. This was compared to a Sham condition. RESULTS Only 0.1Hz rTMS applied at the onset of the training related increase in ECU-EMG activity resulted in increases in MEP amplitudes and peak acceleration when compared to the Sham. CONCLUSIONS The formation of motor memory is enhanced above the naïve level by co-administration of low frequency rTMS at the time of execution of training movements. SIGNIFICANCE These results indicate the importance of time and frequency of rTMS in these settings and should be considered in the design of rehabilitation treatment strategies using rTMS.
Collapse
Affiliation(s)
- C M Buetefisch
- Department of Neurology, West Virginia University, Morgantown, WV, USA; Department of Neurology, Emory University, Atlanta, GA, USA; Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA; Department of Radiology, Emory University, Atlanta, GA, USA.
| | - C Howard
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - C Korb
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - M W Haut
- Department of Behavioral Medicine, West Virginia University, Morgantown, WV, USA
| | - L Shuster
- Department of Language Speech Pathology, West Virginia University, Morgantown, WV, USA
| | - P Pergami
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - C Smith
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - G Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
33
|
Haut MW, Roberts VJ, Goldstein FC, Martin RC, Keefover RW, Rankin ED. Working Memory Demands and Semantic Sensitivity for Prose in Mild Alzheimer's Disease. Aging, Neuropsychology, and Cognition 2010. [DOI: 10.1076/anec.5.1.63.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
34
|
|
35
|
Haut MW, Kuwabara H, Leach S, Callahan T. Age-Related Changes in Neural Activation During Working Memory Performance. Aging, Neuropsychology, and Cognition 2010. [DOI: 10.1076/1382-5585(200006)7:2;1-u;ft119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Buckalew N, Haut MW, Aizenstein H, Morrow L, Perera S, Kuwabara H, Weiner DK. Differences in brain structure and function in older adults with self-reported disabling and nondisabling chronic low back pain. Pain Med 2010; 11:1183-97. [PMID: 20609128 DOI: 10.1111/j.1526-4637.2010.00899.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The primary aim of this pilot study was to identify structural and functional brain differences in older adults with self-reported disabling chronic low back pain (CLBP) compared with those who reported nondisabling CLBP. DESIGN Cross-sectional. PARTICIPANTS Sixteen cognitively intact older adults, eight with disabling CLBP and eight with nondisabling CLBP. Exclusions were psychiatric or neurological disorders, substance abuse, opioid use, or diabetes mellitus. METHODS Participants underwent: structural and functional brain MRI; neuropsychological assessment using the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Tests A and B; and physical performance assessment using the Short Physical Performance Battery. RESULTS In the disabled group, there was significantly lower white matter (WM) integrity (P < 0.05) of the splenium of the corpus callosum. This group also demonstrated activation of the right medial prefrontal cortex at rest whereas the nondisabled demonstrated activation of the left lateral prefrontal cortex. Combined groups analysis revealed a strong positive correlation (r(s) = 0.80, P < 0.0002) between WM integrity of the left centrum semiovale with gait-speed. Secondary analysis revealed a strong negative correlation between total months of CLBP and WM integrity of the SCC (r(s) = -0.59, P < 0.02). CONCLUSIONS Brain structure and function is different in older adults with disabling CLBP compared with those with nondisabling CLBP. Deficits in brain morphology combining groups are associated with pain duration and poor physical function. Our findings suggest brain structure and function may play a key role in chronic pain related disability and may be important treatment targets.
Collapse
Affiliation(s)
- Neilly Buckalew
- Clinical Scientist Training Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Affiliation(s)
- B L Adamovich
- Robert C. Byrd Health Sciences Center, PO Box 9180, WV University, Morgantown, WV 26506-9180, USA.
| | | | | | | | | |
Collapse
|
38
|
Abraham J, Haut MW, Moran MT, Filburn S, Lemiuex S, Kuwabara H. Adjuvant chemotherapy for breast cancer: effects on cerebral white matter seen in diffusion tensor imaging. Clin Breast Cancer 2008; 8:88-91. [PMID: 18501063 DOI: 10.3816/cbc.2008.n.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to examine the effect of adjuvant chemotherapy on normal-appearing white matter in women with breast cancer. PATIENTS AND METHODS Ten patients with early-stage breast cancer who were treated with adjuvant chemotherapy and 9 age-, education-, and IQ-matched healthy controls were studied with magnetic resonance imaging. Diffusion tensor imaging was used to calculate fractional anisotropy (FA), a measure of white matter integrity. Measurements were made in the genu and splenium of the corpus callosum. Participants also completed measures of processing speed, depression, and anxiety. RESULTS Relative to controls, patients had slower processing speed and lower FA in the genu. Processing speed was positively correlated with FA in the genu. CONCLUSION The results of this pilot study suggest that adjuvant chemotherapy affects normal-appearing white matter in the genu of the corpus callosum and that this is related to the cognitive deficits experienced by patients.
Collapse
Affiliation(s)
- Jame Abraham
- Department of Medicine, Section of Hematology and Oncology, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Carey ME, Haut MW, Reminger SL, Hutter JJ, Theilmann R, Kaemingk KL. Reduced frontal white matter volume in long-term childhood leukemia survivors: a voxel-based morphometry study. AJNR Am J Neuroradiol 2008; 29:792-7. [PMID: 18184841 DOI: 10.3174/ajnr.a0904] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE To our knowledge, no published studies have examined whole-brain regional differences to identify more discrete volumetric changes in the brains of childhood leukemia survivors. We used voxel-based morphometry (VBM) to examine regional gray and white matter differences in a group of long-term survivors of acute lymphoblastic leukemia (ALL) compared with a group of healthy controls. Differences in regional white matter volume were expected, given previous reports of white matter changes during treatment for ALL and reduced brain white matter volumes in long-term survivors. Follow-up analyses examined the relationship of regional brain volumes to cognitive function. MATERIALS AND METHODS We compared 9 long-term survivors of ALL with 14 healthy controls. Survivors of ALL were treated with systemic and intrathecal chemotherapy only. T1-weighted axial 3D spoiled gradient high-resolution images collected on a 1.5T MR imaging scanner were used for the VBM analysis. Neuropsychological evaluations were conducted within 2 months of the MR imaging to assess cognitive function. RESULTS VBM analysis revealed 2 specific regions of reduced white matter in the right frontal lobes of survivors of ALL compared with healthy controls. Survivors of ALL had lower performances on tests of attention, visual-constructional skills, mental flexibility, and math achievement compared with healthy individuals. Decreased performance on neuropsychological measures was associated with decreased regional white matter volumes. No differences were found between the groups with respect to gray matter regions. CONCLUSION These findings are consistent with previous literature describing the long-term cognitive, academic, and imaging findings of survivors of ALL and suggest that right frontal white matter is particularly vulnerable to disruption following intensive chemotherapy for ALL. Future studies should focus on further clarifying the white matter changes observed.
Collapse
Affiliation(s)
- M E Carey
- Departments of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV 26505, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Buckalew N, Haut MW, Morrow L, Weiner D. Chronic Pain Is Associated with Brain Volume Loss in Older Adults: Preliminary Evidence. Pain Med 2008; 9:240-8. [DOI: 10.1111/j.1526-4637.2008.00412.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
41
|
Swayampakula AK, Alkhouri N, Haut MW, Abraham J. Cognitive impairment with significant brain parenchymal volume loss following standard adjuvant chemotherapy in a patient with breast cancer. Clin Adv Hematol Oncol 2007; 5:985-988. [PMID: 18277960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Anil Kumar Swayampakula
- Department of Community Medicine, Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | | | | | | |
Collapse
|
42
|
Haut MW, Moran MT, Lancaster MA, Kuwabara H, Parsons MW, Puce A. White Matter Correlates of Cognitive Capacity Studied With Diffusion Tensor Imaging: Implications for Cognitive Reserve. Brain Imaging Behav 2007. [DOI: 10.1007/s11682-007-9008-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
43
|
Haut MW, Kuwabara H, Ducatman AM, Hatfield G, Parsons MW, Scott A, Parsons E, Morrow LA. Corpus Callosum Volume in Railroad Workers With Chronic Exposure to Solvents. J Occup Environ Med 2006; 48:615-24. [PMID: 16766926 DOI: 10.1097/01.jom.0000205211.67120.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Changes to cognition and behavior have been reported after long-term exposure to solvents. Solvents are hypothesized to affect brain white matter. To test this, we examined the volume of the corpus callosum in workers with a history of exposure to solvents. METHODS We manually traced (blind to group membership) the volume of the corpus callosum in 31 railroad workers and 31 matched controls. RESULTS There was a decrease in the genu of the corpus callosum in the solvent-exposed workers compared with controls. A smaller volume of the genu of the corpus callosum was associated with greater exposure and worse performance on cognitive tasks. CONCLUSIONS This study supports the hypothesis that occupational exposure to solvents affects the anterior white matter of the brain and is related to extent of exposure and degree of cognitive change.
Collapse
Affiliation(s)
- Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Parsons MW, Haut MW, Lemieux SK, Moran MT, Leach SG. Anterior medial temporal lobe activation during encoding of words: FMRI methods to optimize sensitivity. Brain Cogn 2006; 60:253-61. [PMID: 16472901 DOI: 10.1016/j.bandc.2005.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2005] [Indexed: 12/01/2022]
Abstract
The existence of a rostrocaudal gradient of medial temporal lobe (MTL) activation during memory encoding has historically received support from positron emission tomography studies, but less so from functional MRI (FMRI) studies. More recently, FMRI studies have demonstrated that characteristics of the stimuli can affect the location of activation seen in the MTL when those stimuli are encoded. The current study tested the hypothesis that MTL activation during memory encoding is related to the modality of stimulus presentation. Subjects encoded auditorily or visually presented words in an FMRI novelty paradigm. Imaging and analysis parameters were optimized to minimize susceptibility artifact in the anterior MTL. Greater activation was observed in the anterior than posterior MTL for both modalities of stimulus presentation. The results indicate that anterior MTL activation occurred during encoding, independent of stimulus modality and provide support for the hypothesis that verbal-semantic memory processing occurs in anterior MTL. The authors suggest that technical factors are critical for observing the rostrocaudal gradient in MTL memory activation.
Collapse
Affiliation(s)
- Michael W Parsons
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, 26506, USA.
| | | | | | | | | |
Collapse
|
45
|
Haut MW, Kuwabara H, Moran MT, Leach S, Arias R, Knight D. The Effect of Education on Age-Related Functional Activation During Working Memory. Aging, Neuropsychology, and Cognition 2005. [DOI: 10.1080/13825580590969325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
46
|
Abstract
Lesion studies have demonstrated that frequency memory, or memory for the frequency of occurrence, is associated with prefrontal and not temporal lobe lesions. This study examined neural activation during performance on a frequency-memory-judgment task and a recognition-memory task, both using words. Relative to a control task, the authors observed peaks of activation during frequency-memory performance in the left ventrolateral prefrontal cortex (BA 45) and other areas typically associated with working memory (dorsolateral prefrontal cortex, posterior parietal cortex). Recognition performance was associated with activation in the same left ventrolateral prefrontal location as was observed with frequency memory. When comparing activation during frequency memory with activation during recognition memory, the authors found a suppression of activation in the hippocampus bilaterally during frequency memory. This study supports a neuroanatomical distinction between frequency and recognition memory.
Collapse
Affiliation(s)
- M W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown 26506, USA.
| | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Abstract
Lesion studies have demonstrated that frequency memory, or memory for the frequency of occurrence, is associated with prefrontal and not temporal lobe lesions. This study examined neural activation during performance on a frequency-memory-judgment task and a recognition-memory task, both using words. Relative to a control task, the authors observed peaks of activation during frequency-memory performance in the left ventrolateral prefrontal cortex (BA 45) and other areas typically associated with working memory (dorsolateral prefrontal cortex, posterior parietal cortex). Recognition performance was associated with activation in the same left ventrolateral prefrontal location as was observed with frequency memory. When comparing activation during frequency memory with activation during recognition memory, the authors found a suppression of activation in the hippocampus bilaterally during frequency memory. This study supports a neuroanatomical distinction between frequency and recognition memory.
Collapse
Affiliation(s)
- M W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown 26506, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
Recent advances in neuroimaging have enabled researchers to establish relatively specific areas of the brain that are involved in working memory. In this positron emission tomography study we examined the pattern of neural activation associated with performance on number-letter sequencing, a purported measure of working memory included in the new Wechsler scales for memory and intelligence. After controlling for basic audition, verbalization, and attention, areas of activation were observed in the orbital frontal lobe, dorsolateral prefrontal cortex, and posterior parietal cortex. This is highly consistent with reports from the literature on activation patterns associated with working memory. More activation peaks were observed in the right hemisphere, suggesting the participants utilized visualization of the verbal information. Consistent with task conceptualization, this study provides support for number-letter sequencing as a task involving working memory.
Collapse
Affiliation(s)
- M W Haut
- Departments of Behavioral Medicine and Psychiatry, Neurology, and Radiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
| | | | | | | |
Collapse
|
50
|
Haut MW, Leach S, Kuwabara H, Whyte S, Callahan T, Ducatman A, Lombardo LJ, Gupta N. Verbal working memory and solvent exposure: a positron emission tomography study. Neuropsychology 2001. [PMID: 11055257 DOI: 10.1037//0894-4105.14.4.551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Neuropsychological studies have documented frontal dysfunction in patients with a history of exposure to organic solvents. The deficits typically observed in these patients appear to be related to working memory (WM). This study used [15O] water positron emission tomography (PET) to examine the pattern of neural activation during verbal working memory in patients with a history of exposure to solvents. Six individuals with solvent exposure were compared with 6 age- and education-matched controls. On the 2 WM tasks examined with PET, with equivalent task performance, participants with solvent exposure demonstrated frontal peaks that were atypical for the tasks, whereas the posterior peaks were typical for the tasks. The results support frontal dysfunction and compensatory use within anterior regions of the WM system in patients with solvent exposure.
Collapse
Affiliation(s)
- M W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown 26506, USA.
| | | | | | | | | | | | | | | |
Collapse
|