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Roussakis AA, Gennaro M, Gordon MF, Reilmann R, Borowsky B, Rynkowski G, Lao-Kaim NP, Papoutsou Z, Savola JM, Hayden MR, Owen DR, Kalk N, Lingford-Hughes A, Gunn RN, Searle G, Tabrizi SJ, Piccini P. A PET-CT study on neuroinflammation in Huntington's disease patients participating in a randomized trial with laquinimod. Brain Commun 2023; 5:fcad084. [PMID: 37020532 PMCID: PMC10069663 DOI: 10.1093/braincomms/fcad084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
Microglia activation, an indicator of central nervous system inflammation, is believed to contribute to the pathology of Huntington's disease. Laquinimod is capable of regulating microglia. By targeting the translocator protein, 11C-PBR28 PET-CT imaging can be used to assess the state of regional gliosis in vivo and explore the effects of laquinimod treatment. This study relates to the LEGATO-HD, multi-centre, double-blinded, Phase 2 clinical trial with laquinimod (US National Registration: NCT02215616). Fifteen patients of the UK LEGATO-HD cohort (mean age: 45.2 ± 7.4 years; disease duration: 5.6 ± 3.0 years) were treated with laquinimod (0.5 mg, N = 4; 1.0 mg, N = 6) or placebo (N = 5) daily. All participants had one 11C-PBR28 PET-CT and one brain MRI scan before laquinimod (or placebo) and at the end of treatment (12 months apart). PET imaging data were quantified to produce 11C-PBR28 distribution volume ratios. These ratios were calculated for the caudate and putamen using the reference Logan plot with the corpus callosum as the reference region. Partial volume effect corrections (Müller-Gartner algorithm) were applied. Differences were sought in Unified Huntington's Disease Rating Scale scores and regional distribution volume ratios between baseline and follow-up and between the two treatment groups (laquinimod versus placebo). No significant change in 11C-PBR28 distribution volume ratios was found post treatment in the caudate and putamen for both those treated with laquinimod (N = 10) and those treated with placebo (N = 5). Over time, the patients treated with laquinimod did not show a significant clinical improvement. Data from the 11C-PBR28 PET-CT study indicate that laquinimod may not have affected regional translocator protein expression and clinical performance over the studied period.
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Affiliation(s)
| | - Marta Gennaro
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | | | | | | | | | - Nicholas P Lao-Kaim
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Zoe Papoutsou
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | | | - Michael R Hayden
- Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital and Research Institute, University of British Columbia, Vancouver V5Z 4H4, Canada
| | - David R Owen
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Nicola Kalk
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Anne Lingford-Hughes
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Roger N Gunn
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
- Invicro, Hammersmith Hospital,, London W12 0NN, UK
| | | | - Sarah J Tabrizi
- Huntington’s Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Paola Piccini
- Brain Sciences, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
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2
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Mohamed MA, Zeng Z, Gennaro M, Lao-Kaim NP, Myers JFM, Calsolaro V, Femminella GD, Tyacke RJ, Martin-Bastida A, Gunn RN, Nutt DJ, Edison P, Piccini P, Roussakis AA. Astrogliosis in aging and Parkinson’s disease dementia: a new clinical study with 11C-BU99008 PET. Brain Commun 2022; 4:fcac199. [PMID: 36072646 PMCID: PMC9445175 DOI: 10.1093/braincomms/fcac199] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
The role of astrogliosis in the pathology of brain aging and neurodegenerative diseases has recently drawn great attention. Imidazoline-2 binding sites represent a possible target to map the distribution of reactive astrocytes. In this study, we use 11C-BU99008, an imidazoline-2 binding sites-specific PET radioligand, to image reactive astrocytes in vivo in healthy controls and patients with established Parkinson’s disease dementia. Eighteen healthy controls (age: 45–78 years) and six patients with Parkinson’s disease dementia (age: 64–77 years) had one 11C-BU99008 PET-CT scan with arterial input function. All subjects underwent one 3 T MRI brain scan to facilitate the analysis of the PET data and to capture individual cerebral atrophy. Regional 11C-BU99008 volumes of distribution were calculated for each subject by the two-tissue compartmental modelling. Positive correlations between 11C-BU99008 volumes of distribution values and age were found for all tested regions across the brain within healthy controls (P < 0.05); furthermore, multiple regression indicated that aging affects 11C-BU99008 volumes of distribution values in a region-specific manner. Independent samples t-test indicated that there was no significant group difference in 11C-BU99008 volumes of distribution values between Parkinson’s disease dementia (n = 6; mean age = 71.97 ± 4.66 years) and older healthy controls (n = 9; mean age = 71.90 ± 5.51 years). Our data set shows that astrogliosis is common with aging in a region-specific manner. However, in this set-up, 11C-BU99008 PET cannot differentiate patients with Parkinson’s disease dementia from healthy controls of similar age.
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Affiliation(s)
- Mohamed A Mohamed
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Zhou Zeng
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Xiangya Hospital of Central South University , Changsha, Hunan , P.R. China
| | - Marta Gennaro
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Nicholas P Lao-Kaim
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Jim F M Myers
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Valeria Calsolaro
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Grazia Daniela Femminella
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Department of Translational Medical Sciences, University of Naples Federico II , Naples , Italy
| | - Robin J Tyacke
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Antonio Martin-Bastida
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra , Pamplona-Madrid , Spain
| | - Roger N Gunn
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - David J Nutt
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Paul Edison
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
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Parkin BL, Daws RE, Das-Neves I, Violante IR, Soreq E, Faisal AA, Sandrone S, Lao-Kaim NP, Martin-Bastida A, Roussakis AA, Piccini P, Hampshire A. Dissociable effects of age and Parkinson's disease on instruction-based learning. Brain Commun 2021; 3:fcab175. [PMID: 34485905 PMCID: PMC8410985 DOI: 10.1093/braincomms/fcab175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
The cognitive deficits associated with Parkinson's disease vary across individuals and change across time, with implications for prognosis and treatment. Key outstanding challenges are to define the distinct behavioural characteristics of this disorder and develop diagnostic paradigms that can assess these sensitively in individuals. In a previous study, we measured different aspects of attentional control in Parkinson's disease using an established fMRI switching paradigm. We observed no deficits for the aspects of attention the task was designed to examine; instead those with Parkinson's disease learnt the operational requirements of the task more slowly. We hypothesized that a subset of people with early-to-mid stage Parkinson's might be impaired when encoding rules for performing new tasks. Here, we directly test this hypothesis and investigate whether deficits in instruction-based learning represent a characteristic of Parkinson's Disease. Seventeen participants with Parkinson's disease (8 male; mean age: 61.2 years), 18 older adults (8 male; mean age: 61.3 years) and 20 younger adults (10 males; mean age: 26.7 years) undertook a simple instruction-based learning paradigm in the MRI scanner. They sorted sequences of coloured shapes according to binary discrimination rules that were updated at two-minute intervals. Unlike common reinforcement learning tasks, the rules were unambiguous, being explicitly presented; consequently, there was no requirement to monitor feedback or estimate contingencies. Despite its simplicity, a third of the Parkinson's group, but only one older adult, showed marked increases in errors, 4 SD greater than the worst performing young adult. The pattern of errors was consistent, reflecting a tendency to misbind discrimination rules. The misbinding behaviour was coupled with reduced frontal, parietal and anterior caudate activity when rules were being encoded, but not when attention was initially oriented to the instruction slides or when discrimination trials were performed. Concomitantly, Magnetic Resonance Spectroscopy showed reduced gamma-Aminobutyric acid levels within the mid-dorsolateral prefrontal cortices of individuals who made misbinding errors. These results demonstrate, for the first time, that a subset of early-to-mid stage people with Parkinson's show substantial deficits when binding new task rules in working memory. Given the ubiquity of instruction-based learning, these deficits are likely to impede daily living. They will also confound clinical assessment of other cognitive processes. Future work should determine the value of instruction-based learning as a sensitive early marker of cognitive decline and as a measure of responsiveness to therapy in Parkinson's disease.
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Affiliation(s)
- Beth L Parkin
- Department of Psychology, School of Social Science, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - Richard E Daws
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - Ines Das-Neves
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - Ines R Violante
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eyal Soreq
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - A Aldo Faisal
- Brain and Behaviour Laboratory, Department of Bioengineering, Imperial College London, London W12 0NN, UK
- Brain and Behaviour Laboratory, Department of Computing, Imperial College London, London W12 0NN, UK
- Behaviour Analytics Lab, Data Science Institute, Imperial College London, London W12 0NN, UK
- MRC London Institute of Medical Sciences, London W12 0NN, UK
| | - Stefano Sandrone
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Division of Neurology, Imperial College London, London W12 0NN, UK
| | - Antonio Martin-Bastida
- Neurology Imaging Unit, Division of Neurology, Imperial College London, London W12 0NN, UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra, Pamplona-Madrid 28027, Spain
| | | | - Paola Piccini
- Neurology Imaging Unit, Division of Neurology, Imperial College London, London W12 0NN, UK
| | - Adam Hampshire
- The Cognitive, Computational and Clinical Neuroscience Laboratory, Department of Medicine, Imperial College London, London W120NN, UK
- UK DRI Care Research & Technology Centre, Imperial College London, London W12 0NN, UK
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Hannaway N, Lao-Kaim NP, Martín-Bastida A, Roussakis AA, Howard J, Wall MB, Loane C, Barker RA, Piccini P. Longitudinal changes in movement-related functional MRI activity in Parkinson's disease patients. Parkinsonism Relat Disord 2021; 87:61-69. [PMID: 33975081 DOI: 10.1016/j.parkreldis.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 06/30/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Functional brain imaging has shown alterations in the basal ganglia, cortex and cerebellum in Parkinson's disease patients. However, few functional imaging studies have tested how these changes evolve over time. Our study aimed to test the longitudinal progression of movement-related functional activity in Parkinson's disease patients. METHODS At baseline, 48 Parkinson's disease patients and 16 healthy controls underwent structural and functional magnetic resonance imaging during a joystick motor task. Patients had repeated imaging after 18-months (n = 42) and 36-months (n = 32). T-tests compared functional responses between Parkinson's disease patients and controls, and linear mixed effects models examined longitudinal differences within Parkinson's disease. Correlations of motor-activity with bradykinesia, rigidity and tremor were undertaken. All contrasts used whole-brain analyses, thresholded at Z > 3.1 with a cluster-wise P < 0.05. RESULTS Baseline activation was significantly greater in patients than controls across contralateral parietal and occipital regions, ipsilateral precentral gyrus and thalamus. Longitudinally, patients showed significant increases in cerebellar activity at successive visits following baseline. Task-related activity also increased in the contralateral motor, parietal and temporal areas at 36 months compared to baseline, however this was reduced when controlling for motor task performance. CONCLUSION We have shown that there are changes over time in the blood-activation level dependent response of patients with Parkinson's disease undertaking a simple motor task. These changes are observed primarily in the ipsilateral cerebellum and may be compensatory in nature.
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Affiliation(s)
- Naomi Hannaway
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | - Antonio Martín-Bastida
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom; Neurology Department, Clinica Universidad de Navarra, Pamplona, Navarra, 31008, Spain.
| | - Andreas-Antonios Roussakis
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | | | | | - Clare Loane
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, SE5 9RT, United Kingdom.
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, United Kingdom and WT-MRC Cambridge Stem Cell, Cambridge, United Kingdom.
| | - Paola Piccini
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
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Roussakis AA, Zeng Z, Lao-Kaim NP, Martin-Bastida A, Piccini P. Parkinson's disease laterality: a 11C-PE2I PET imaging study. J Neurol 2021; 268:582-589. [PMID: 32880071 PMCID: PMC7880931 DOI: 10.1007/s00415-020-10204-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Abstract
Asymmetry of striatal dopaminergic deficits and motor symptoms is a typical characteristic of idiopathic Parkinson's disease (PD). This study aims to characterise the trend of asymmetry in moderate-stage PD. We performed a 19-month longitudinal study in 27 patients with PET-CT imaging and appropriate clinical assessments. 11C-PE2I non-displaceable binding potential (BPND) was calculated bilaterally for the striatum at baseline and follow-up to estimate the in vivo density of striatal dopamine transporters (DAT). Changes in striatal 11C-PE2I BPND over time were more prominent in the ipsilateral as compared to contralateral side. Changes in MDS-UPDRS-III (motor component of the Movement Disorders Society Unified PD Rating Scale) were not different between the clinically most and least affected body sides. Our data support that the asymmetry in striatal dopaminergic degeneration becomes less prominent in moderate-stage PD. In contrast, during the above period, the asymmetry of motor symptoms was maintained between the clinically most and least affected body sides.
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Affiliation(s)
- Andreas-Antonios Roussakis
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Zhou Zeng
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
- Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Nicholas P Lao-Kaim
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Antonio Martin-Bastida
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra, Pamplona, Madrid, Spain
| | - Paola Piccini
- Division of Neurology, Neurology Imaging Unit, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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6
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Porter E, Roussakis AA, Lao-Kaim NP, Piccini P. Multimodal dopamine transporter (DAT) imaging and magnetic resonance imaging (MRI) to characterise early Parkinson's disease. Parkinsonism Relat Disord 2020; 79:26-33. [PMID: 32861103 DOI: 10.1016/j.parkreldis.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 01/12/2023]
Abstract
Idiopathic Parkinson's disease (PD), the second most common neurodegenerative disorder, is characterised by the progressive loss of dopaminergic nigrostriatal terminals. Currently, in early idiopathic PD, dopamine transporter (DAT)-specific imaging assesses the extent of striatal dopaminergic deficits, and conventional magnetic resonance imaging (MRI) of the brain excludes the presence of significant ischaemic load in the basal ganglia as well as signs indicative of other forms of Parkinsonism. In this article, we discuss the use of multimodal DAT-specific and MRI protocols for insight into the early pathological features of idiopathic PD, including: structural MRI, diffusion tensor imaging, nigrosomal iron imaging and neuromelanin-sensitive MRI sequences. These measures may be acquired serially or simultaneously in a hybrid scanner. From current evidence, it appears that both nigrosomal iron imaging and neuromelanin-sensitive MRI combined with DAT-specific imaging are useful to assist clinicians in diagnosing PD, while conventional structural MRI and diffusion tensor imaging protocols are better suited to a research context focused on characterising early PD pathology. We believe that in the future multimodal imaging will be able to characterise prodromal PD and stratify the clinical stages of PD progression.
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Affiliation(s)
- Eleanor Porter
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK
| | | | - Nicholas P Lao-Kaim
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK
| | - Paola Piccini
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK.
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7
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Zeng Z, Roussakis AA, Lao-Kaim NP, Piccini P. Astrocytes in Parkinson's disease: from preclinical assays to in vivo imaging and therapeutic probes. Neurobiol Aging 2020; 95:264-270. [PMID: 32905922 DOI: 10.1016/j.neurobiolaging.2020.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/04/2019] [Revised: 04/30/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) is increasingly thought to be associated with glial pathology. Recently, research in neurodegenerative disorders has applied a greater focus to better understanding the role of astrocytes in the disease pathophysiology. In this article, we review results from the latest preclinical and clinical work, including functional imaging studies on astrocytes in PD and highlight key molecules that may prove valuable as biomarkers. We discuss how astrocytes may contribute to the initiation and progression of PD. We additionally present trials of investigational medicinal products and the current background for the design of future clinical trials.
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Affiliation(s)
- Zhou Zeng
- Department of Brain Sciences, Imperial College London, Neurology Imaging Unit, London, UK; Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | | | - Nicholas P Lao-Kaim
- Department of Brain Sciences, Imperial College London, Neurology Imaging Unit, London, UK
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, Neurology Imaging Unit, London, UK.
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8
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Lao-Kaim NP, Giampietro VP, Williams SCR, Simmons A, Tchanturia K. Functional MRI investigation of verbal working memory in adults with anorexia nervosa. Eur Psychiatry 2020; 29:211-8. [PMID: 23849992 DOI: 10.1016/j.eurpsy.2013.05.003] [Citation(s) in RCA: 24] [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] [Received: 04/11/2013] [Revised: 05/10/2013] [Accepted: 05/22/2013] [Indexed: 11/28/2022] Open
Abstract
AbstractLiterature regarding verbal working memory (vWM) in anorexia nervosa (AN) has been inconsistent due to a misunderstanding of the key components of vWM and introduction of confounding stimuli. Furthermore, there are no studies looking at how brain function in people with AN relates to vWM performance. The present study used functional magnetic resonance imaging (fMRI) with a letter n-back paradigm to study the effect of increasing vWM task difficulty on cortical functioning in the largest AN sample to date (n = 31). Although the AN group had low BMI and higher anxious and depressive symptomology compared to age-matched controls (HC), there were no between-group differences in accuracy and speed at any task difficulty. fMRI data revealed no regions exhibiting significant differences in activation when groups were compared at each difficulty separately and no regions showing group x condition interaction. Although there was a trend towards lower accuracy as duration of illness increased, this was not correlated with activity in regions associated with vWM. These findings indicate that vWM in AN is as efficient and performed using the same cognitive strategy as HC, and that there may not be a need for therapies to pursue remediation of this particular neurocognitive faculty.
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Affiliation(s)
- N P Lao-Kaim
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - V P Giampietro
- King's College London, Institute of Psychiatry, Department of Neuroimaging, SE5 8AF London, United Kingdom
| | - S C R Williams
- King's College London, Institute of Psychiatry, Department of Neuroimaging, SE5 8AF London, United Kingdom; NIHR Biomedical Research Centre for Mental Health at South London, Maudsley NHS Foundation Trust, Institute of Psychiatry, King's College London, London, United Kingdom
| | - A Simmons
- King's College London, Institute of Psychiatry, Department of Neuroimaging, SE5 8AF London, United Kingdom; NIHR Biomedical Research Centre for Mental Health at South London, Maudsley NHS Foundation Trust, Institute of Psychiatry, King's College London, London, United Kingdom
| | - K Tchanturia
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom.
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Abstract
Purpose of Review Parkinson’s disease (PD) has a wide spectrum of symptoms including the presence of psychiatric disease. At present, most treatment plans, comprised of dopaminergic drugs, are chronic and complex. Though dopaminergic agents are quite efficient in managing the motor aspects of the disease, chronic pharmacotherapy specifically with dopamine receptor agonists has been highly linked to the occurrence of Impulse Compulsive disorder (ICD), which can be problematic for individual patients. Recent Findings Much of what is known today about PD-related ICD stems from brain imaging studies, however, evidence is not quite conclusive. Research in the field has been focused on identifying the underlying mechanisms of PD-related ICD and understanding the functions of the structures involved in the reward network. Summary This article presents an update of recent findings from key neuroimaging studies in PD-related ICD, discusses results from controversial studies, and identifies areas for future research in the field.
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Affiliation(s)
- Andreas-Antonios Roussakis
- Neurology Imaging Unit, Imperial College London - Hammersmith Hospital, 1st Floor, B-Block, Du Cane Road, London, W12 0NN, UK
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Imperial College London - Hammersmith Hospital, 1st Floor, B-Block, Du Cane Road, London, W12 0NN, UK
| | - Paola Piccini
- Neurology Imaging Unit, Imperial College London - Hammersmith Hospital, 1st Floor, B-Block, Du Cane Road, London, W12 0NN, UK.
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10
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Martín-Bastida A, Lao-Kaim NP, Roussakis AA, Searle GE, Xing Y, Gunn RN, Schwarz ST, Barker RA, Auer DP, Piccini P. Relationship between neuromelanin and dopamine terminals within the Parkinson's nigrostriatal system. Brain 2019; 142:2023-2036. [PMID: 31056699 PMCID: PMC6664390 DOI: 10.1093/brain/awz120] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/13/2019] [Accepted: 03/05/2019] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease is characterized by the progressive loss of pigmented dopaminergic neurons in the substantia nigra and associated striatal deafferentation. Neuromelanin content is thought to reflect the loss of pigmented neurons, but available data characterizing its relationship with striatal dopaminergic integrity are not comprehensive or consistent, and predominantly involve heterogeneous samples. In this cross-sectional study, we used neuromelanin-sensitive MRI and the highly specific dopamine transporter PET radioligand, 11C-PE2I, to assess the association between neuromelanin-containing cell levels in the substantia nigra pars compacta and nigrostriatal terminal density in vivo, in 30 patients with bilateral Parkinson's disease. Fifteen healthy control subjects also underwent neuromelanin-sensitive imaging. We used a novel approach taking into account the anatomical and functional subdivision of substantia nigra into dorsal and ventral tiers and striatal nuclei into pre- and post-commissural subregions, in accordance with previous animal and post-mortem studies, and consider the clinically asymmetric disease presentation. In vivo, Parkinson's disease subjects displayed reduced neuromelanin levels in the ventral (-30 ± 28%) and dorsal tiers (-21 ± 24%) as compared to the control group [F(1,43) = 11.95, P = 0.001]. Within the Parkinson's disease group, nigral pigmentation was lower in the ventral tier as compared to the dorsal tier [F(1,29) = 36.19, P < 0.001] and lower in the clinically-defined most affected side [F(1,29) = 4.85, P = 0.036]. Similarly, lower dopamine transporter density was observed in the ventral tier [F(1,29) = 76.39, P < 0.001] and clinically-defined most affected side [F(1,29) = 4.21, P = 0.049]. Despite similar patterns, regression analysis showed no significant association between nigral pigmentation and nigral dopamine transporter density. However, for the clinically-defined most affected side, significant relationships were observed between pigmentation of the ventral nigral tier with striatal dopamine transporter binding in pre-commissural and post-commissural striatal subregions known to receive nigrostriatal projections from this tier, while the dorsal tier correlated with striatal projection sites in the pre-commissural striatum (P < 0.05, Benjamini-Hochberg corrected). In contrast, there were no statistically significant relationships between these two measures in the clinically-defined least affected side. These findings provide important insights into the topography of nigrostriatal neurodegeneration in Parkinson's disease, indicating that the characteristics of disease progression may fundamentally differ across hemispheres and support post-mortem data showing asynchrony in the loss of neuromelanin-containing versus tyrosine hydroxylase positive nigral cells.
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Affiliation(s)
- Antonio Martín-Bastida
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
- Neurology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nicholas P Lao-Kaim
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - Andreas Antonios Roussakis
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Yue Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Roger N Gunn
- Invicro LLC, London, UK
- Centre for Restorative Neuroscience, Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - Stefan T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Paola Piccini
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
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Roussakis AA, Gennaro M, Lao-Kaim NP, Towey D, Piccini P. Dopamine Transporter Density in de novo Parkinson's Disease Does Not Relate to the Development of Levodopa-Induced Dyskinesias. J Neuroinflamm Neurodegener Dis 2019; 3:10000. [PMID: 31819926 PMCID: PMC6901354] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), the onset of levodopa-induced dyskinesias (LIDs) is difficult to predict. This study examines whether dopamine transporter (DAT)-specific SPECT imaging in de novo PD relates to later development of LIDs. METHODS 42 de novo unilateral PD participants received DAT-specific SPECT imaging with 123I-FP-CIT at time of diagnosis. At five years post-diagnosis, all PD patients were clinically evaluated and divided into two groups based on whether they had or had not developed LIDs. Fourteen gender- and age-matched healthy volunteers undertook 123I-FP-CIT SPECT imaging and were included as controls. A semi-quantification approach was used for the 123I-FP-CIT data using the occipital cortex as the reference region. We calculated specific binding ratios (SBR) for the caudate and putamen (posterior and anterior putaminal subregions). In parallel, we analysed our 123I-FP-CIT dataset with a voxel-based analysis approach. RESULTS PD patients had significantly lower striatal 123I-FP-CIT SBR values in comparison to controls (p<0.001). After five years, dyskinetic patients (N=10) were taking higher daily doses of dopaminergic medication (p<0.001) and had more severe disease (difference in Hoehn & Yahr staging scores p<0.05) as compared to the non-dyskinetic group (N=32). At the time of diagnosis, 123I-FP-CIT SBR values were not statistically different between the two groups for all striatal regions (p>0.05). SPM voxel-based analysis did not show a statistically significant difference between the two groups (p>0.05). CONCLUSION 123I-FP-CIT SPECT imaging, performed at diagnosis in de novo early-stage PD could not differentiate patients who will develop LIDs within five years from those who will not.
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Affiliation(s)
| | | | | | - David Towey
- Radiological Sciences Unit, Imperial Healthcare NHS Trust, UK
| | - Paola Piccini
- Neurology Imaging Unit, Imperial College London, UK,Corresponding author: Professor Paola Piccini, Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, Du Cane Road, London, W12 0NN, United Kingdom, Tel.: +442033133172, Fax: +442033131783;
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12
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Lee JY, Lao-Kaim NP, Pasquini J, Deuschl G, Pavese N, Piccini P. Pallidal dopaminergic denervation and rest tremor in early Parkinson's disease: PPMI cohort analysis. Parkinsonism Relat Disord 2018; 51:101-104. [PMID: 29503156 DOI: 10.1016/j.parkreldis.2018.02.039] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/30/2018] [Accepted: 02/20/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND s: Over recent years there have been some conflicting reports upon the role of pallidal dopaminergic denervation in rest tremor in Parkinson's disease. OBJECTIVES To clarify this issue we analyzed the clinical and 123I-FP-CIT SPECT data of a large cohort of early Parkinson's disease patients enrolled in the PPMI study. METHODS Pallidal and striatal dopamine transporter uptake ratios were calculated in 382 patients (120 no-tremor, 60 tremor-dominant, and 202 indeterminate) and 150 controls. A region of interest (ROI) approach was used to estimate DAT uptake ratios from 123I-FP-CIT SPECT scans in the caudate nucleus, putamen, and globus pallidus after normalization to a DAT template. DAT uptake ratios for each region were compared between subgroups using ANCOVA and linear regression analyses were performed to evaluate the relationship between severity of rest tremor and regional DAT uptake ratios. RESULTS PD patients had significantly lower DAT uptake ratios in the pallidum, putamen and caudate as compared to healthy controls (p < 0.001). ANCOVA showed inter-PD subgroup differences in DAT uptake ratios in the putamen and pallidum (p < 0.05) after adjustment for age and disease duration, with post-hoc comparisons revealing significantly higher DAT uptake ratios for the tremor-dominant subgroup as compared to non-tremor and indeterminate subgroups (p < 0.016). There was no significant relationship between rest tremor severity and pallidal DAT either in the tremor-dominant subgroup or in the total PD population. CONCLUSIONS Pallidal dopaminergic denervation appears unrelated to rest tremor severity in early Parkinson's disease.
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Affiliation(s)
- Jee-Young Lee
- Division of Brain Sciences, Neurology Imaging Unit, Imperial College London, Hammersmith Campus, UK; Department of Neurology, Seoul National University Boramae Hospital, South Korea.
| | - Nicholas P Lao-Kaim
- Division of Brain Sciences, Neurology Imaging Unit, Imperial College London, Hammersmith Campus, UK
| | - Jacopo Pasquini
- Dipartimento di medicina clinica e sperimentale, Pisa University, Italy
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Germany
| | - Nicola Pavese
- Institute of Neuroscience, Newcastle University, UK; Department of Nuclear Medicine & PET Centre, Aarhus University, Denmark
| | - Paola Piccini
- Division of Brain Sciences, Neurology Imaging Unit, Imperial College London, Hammersmith Campus, UK
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13
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Martin-Bastida A, Lao-Kaim NP, Loane C, Politis M, Roussakis AA, Valle-Guzman N, Kefalopoulou Z, Paul-Visse G, Widner H, Xing Y, Schwarz ST, Auer DP, Foltynie T, Barker RA, Piccini P. Motor associations of iron accumulation in deep grey matter nuclei in Parkinson's disease: a cross-sectional study of iron-related magnetic resonance imaging susceptibility. Eur J Neurol 2016; 24:357-365. [PMID: 27982501 DOI: 10.1111/ene.13208] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 05/13/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE To determine whether iron deposition in deep brain nuclei assessed using high-pass filtered phase imaging plays a role in motor disease severity in Parkinson's disease (PD). METHODS Seventy patients with mild to moderate PD and 20 age- and gender-matched healthy volunteers (HVs) underwent susceptibility-weighted imaging on a 3 T magnetic resonance imaging scanner. Phase shifts (radians) in deep brain nuclei were derived from high-pass filtered phase images and compared between groups. Analysis of clinical laterality and correlations with motor severity (Unified Parkinson's Disease Rating Scale, Part III, UPDRS-III) were performed. Phase shifts (in radians) were compared between HVs and three PD subgroups divided according to UPDRS-III scores using analysis of covariance, adjusting for age and regional area. RESULTS Parkinson's disease patients had significantly (P < 0.001) higher radians than HVs bilaterally in the putamen, globus pallidus and substantia nigra (SN). The SN contralateral to the most affected side showed higher radians (P < 0.001) compared to the less affected side. SN radians positively correlated with UPDRS-III and bradykinesia-rigidity subscores, but not with tremor subscores. ancova followed by post hoc Bonferroni-adjusted pairwise comparisons revealed that SN radians were significantly greater in the PD subgroup with higher UPDRS-III scores compared to both lowest UPDRS-III PD and HV groups (P < 0.001). CONCLUSIONS Increased nigral iron accumulation in PD appears to be stratified according to disease motor severity and correlates with symptoms related to dopaminergic neurodegeneration. This semi-quantitative in vivo iron assessment could prove useful for objectively monitoring PD progression, especially in clinical trials concerning iron chelation therapies.
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Affiliation(s)
- A Martin-Bastida
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - N P Lao-Kaim
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - C Loane
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK.,Memory Research Group, Nuffield Department of Clinical Neurosciences, Medical Science Division, University of Oxford, Oxford, UK
| | - M Politis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK.,Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A A Roussakis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - N Valle-Guzman
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Z Kefalopoulou
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - G Paul-Visse
- Translational Neurology Group, Department of Clinical Sciences, Wallenberg Neuroscience Centre, Lund University, Lund, Sweden
| | - H Widner
- Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Y Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - S T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - D P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - T Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - R A Barker
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - P Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
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