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Chun MY, Lee T, Kim SH, Lee HS, Kim YJ, Lee PH, Sohn YH, Jeong Y, Chung SJ. Hypoperfusion in Alzheimer's Disease-Prone Regions and Dementia Conversion in Parkinson's Disease. Clin Nucl Med 2024; 49:521-528. [PMID: 38584352 DOI: 10.1097/rlu.0000000000005211] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
PURPOSE OF THE REPORT Although early detection of individuals at risk of dementia conversion is important in patients with Parkinson's disease (PD), there is still no consensus on neuroimaging biomarkers for predicting future cognitive decline. We aimed to investigate whether cerebral perfusion patterns on early-phase 18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane ( 18 F-FP-CIT) PET have the potential to serve as a neuroimaging predictor for early dementia conversion in patients with PD. MATERIALS AND METHODS In this retrospective analysis, we enrolled 187 patients with newly diagnosed PD who underwent dual-phase 18 F-FP-CIT PET at initial assessment and serial cognitive assessments during the follow-up period (>5 years). Patients with PD were classified into 2 groups: the PD with dementia (PDD)-high-risk (PDD-H; n = 47) and the PDD-low-risk (PDD-L; n = 140) groups according to dementia conversion within 5 years of PD diagnosis. We explored between-group differences in the regional uptake in the early-phase 18 F-FP-CIT PET images. We additionally performed a linear discriminant analysis to develop a prediction model for early PDD conversion. RESULTS The PDD-H group exhibited hypoperfusion in Alzheimer's disease (AD)-prone regions (inferomedial temporal and posterior cingulate cortices, and insula) compared with the PDD-L group. A prediction model using regional uptake in the right entorhinal cortex, left amygdala, and left isthmus cingulate cortex could optimally distinguish the PDD-H group from the PDD-L group. CONCLUSIONS Regional hypoperfusion in the AD-prone regions on early-phase 18 F-FP-CIT PET can be a useful biomarker for predicting early dementia conversion in patients with PD.
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Affiliation(s)
| | | | | | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Phil Hyu Lee
- From the Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Chung SJ, Kim SH, Park CW, Lee HS, Yun M, Kim YJ, Sohn YH, Jeong Y, Lee PH. Patterns of regional cerebral hypoperfusion in early Parkinson's disease: Clinical implications. Parkinsonism Relat Disord 2024; 121:106024. [PMID: 38377658 DOI: 10.1016/j.parkreldis.2024.106024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/07/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This study aimed to investigate whether regional cerebral perfusion patterns on early-phase 18F-FP-CIT PET scans, which is typically coupled to cerebral metabolism, predict the long-term prognosis of Parkinson's disease (PD). METHODS We enrolled 397 drug-naïve patients with early-stage PD who underwent dual-phase 18F-FP-CIT PET scans. After quantifying the early-phase 18F-FP-CIT PET images, cluster analysis was performed to delineate the PD subtypes according to the patterns of regional cerebral perfusion. We compared the risk of developing levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and dementia between the PD subtypes. RESULTS Cluster analysis classified patients into three subtypes: cluster 1 (relatively preserved cortical uptake; n = 175), cluster 2 (decreased uptake in the frontal, parietal, and temporal regions; n = 151), and cluster 3 (decreased uptake in more extensive regions, additionally involving the lateral occipital regions; n = 71). Cluster 1 was characterized by a younger age-of-onset, less severe motor deficits, less severely decreased 18F-FP-CIT binding in the caudate, and better cognitive performance. Cluster 3 was characterized by an older age-of-onset, more severe motor deficits, and poorer cognitive performance. Cluster 2 was intermediate between clusters 1 and 3. Cox regression analyses demonstrated that clusters 2 and 3 had a higher risk for dementia conversion than cluster 1, whereas the risk for developing LID, wearing-off, and FOG did not differ among the clusters. CONCLUSION The patterns of regional cerebral perfusion can provide information on long-term prognosis with regards to cognitive, but not motor aspects of patients with early-stage PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; YONSEI BEYOND LAB, Yongin, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Radiology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; YONSEI BEYOND LAB, Yongin, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Radiology, Yeungnam University College of Medicine, Daegu, South Korea; Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Lee J, Sohn YH, Chung SJ, Kim E, Kim Y. Presentations of nonmotor symptoms by sex and onset age in people with Parkinson's disease. Int J Nurs Pract 2024; 30:e13177. [PMID: 37394896 DOI: 10.1111/ijn.13177] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND There is growing evidence that sex and onset age are important factors of clinical features in Parkinson's disease. AIM The study aimed to identify nonmotor symptoms based on sex and onset age in people with Parkinson's disease. DESIGN This is a cross-sectional descriptive study. METHODS A total of 210 participants were recruited from the university hospital and the Parkinson's disease association. This study measured the Korean version of the nonmotor symptoms questionnaire which includes gastrointestinal, urinary, apathy/attention/memory, hallucination/delusions, depression/anxiety, sexual function, cardiovascular, sleep disorder, and miscellaneous domains. RESULTS All participants reported at least one nonmotor symptom. The most commonly reported symptoms were nocturia (65.7%) and constipation (61.9%). The male participants reported more dribbling of saliva, constipation, and impaired sexual function, whereas the female reported more weight change. Young-onset people with Parkinson's disease reported more depression than late-onset people with Parkinson's disease. CONCLUSION This study contributes to the understanding of symptom experience beyond motor-related symptomatology for those with Parkinson's disease and adds to the current literature. Individualized symptom assessment and management should be provided by prioritizing prevalent sex or onset age-specific symptoms, rather than addressing with all nonmotor symptoms.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Centre of Korea: A Joanna Briggs Institute of Excellence, College of Nursing, Yonsei University, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Eunyoung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Yielin Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
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Yun SY, Suh CH, Byun JH, Jo SY, Chung SJ, Lim JS, Lee JH, Kim MJ, Kim HS, Kim SJ. Efficacy and safety of shunt surgery in patients with idiopathic normal-pressure hydrocephalus: can we predict shunt response by preoperative magnetic resonance imaging (MRI)? Clin Radiol 2024:S0009-9260(24)00142-9. [PMID: 38622045 DOI: 10.1016/j.crad.2024.03.004] [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: 02/07/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
AIM The aim of this study was to identify preoperative magnetic resonance imaging (MRI) findings that can predict the shunt responsiveness in idiopathic normal-pressure hydrocephalus (iNPH) patients and to investigate postoperative outcome and complications. MATERIALS AND METHODS A total of 192 patients with iNPH who underwent shunt at our hospital between 2000 and 2021 were included to investigate complications. Of these, after exclusion, 127 (1-month postoperative follow-up) and 77 (1-year postoperative follow-up) patients were evaluated. The preoperative MRI features (the presence of tightness of the high-convexity subarachnoid space, Sylvian fissure enlargement, Evans' index, and callosal angle) of the shunt-response and nonresponse groups were compared, and a systematic review was conducted to evaluate whether preoperative MRI findings could predict shunt response. RESULTS Postoperative complications within one month after surgery were observed in 6.8% (13/192), and the most common complication was hemorrhage. Changes in corpus callosum were observed in 4.2% (8/192). The shunt-response rates were 83.5% (106/127) in the 1-month follow-up group and 70.1% (54/77) in 1-year follow-up group. In the logistic regression analysis, only Evans' index measuring >0.4 had a significant negative relationship with shunt response at 1-month follow-up; however, no significant relationship was observed at 1-year follow-up. According to our systematic review, it is still controversial whether preoperative MRI findings could predict shunt response. CONCLUSION Evans' index measure of >0.4 had a significant relationship with the shunt response in the 1-month follow-up group. In systematic reviews, there is ongoing debate about whether preoperative MRI findings can accurately predict responses to shunt surgery. Postoperative corpus callosal change was observed in 4.2% of iNPH patients.
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Affiliation(s)
- S Y Yun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - J H Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Y Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-S Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Yoon S, Chung SJ, Kim YJ. Primary Familial Brain Calcification With XPR1 Mutation Presenting With Cognitive Dysfunction. J Clin Neurol 2024; 20:229-231. [PMID: 38433488 PMCID: PMC10921053 DOI: 10.3988/jcn.2023.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Sojung Yoon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea.
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Chun MY, Chung SJ, Kim SH, Park CW, Jeong SH, Lee HS, Lee PH, Sohn YH, Jeong Y, Kim YJ. Hippocampal Perfusion Affects Motor and Cognitive Functions in Parkinson Disease: An Early Phase 18 F-FP-CIT Positron Emission Tomography Study. Ann Neurol 2024; 95:388-399. [PMID: 37962393 DOI: 10.1002/ana.26827] [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: 04/22/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE We investigated whether hippocampal perfusion changes are associated with cognitive decline, motor deficits, and the risk of dementia conversion in patients with Parkinson disease (PD). METHODS We recruited patients with newly diagnosed and nonmedicated PD and healthy participants who underwent dual phase 18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane positron emission tomography scans. Patients were classified into 3 groups according to hippocampal perfusion measured by standard uptake value ratios (SUVRs): (1) PD hippocampal hypoperfusion group (1 standard deviation [SD] below the mean hippocampal SUVR of healthy controls; PD-hippo-hypo), (2) PD hippocampal hyperperfusion group (1 SD above the mean; PD-hippo-hyper), and (3) the remaining patients (PD-hippo-normal). We compared the baseline cognitive performance, severity of motor deficits, hippocampal volume, striatal dopamine transporter (DAT) availability, and risk of dementia conversion among the groups. RESULTS We included 235 patients (PD-hippo-hypo, n = 21; PD-hippo-normal, n = 157; PD-hippo-hyper, n = 57) and 48 healthy participants. Patients in the PD-hippo-hypo group were older and had smaller hippocampal volumes than those in the other PD groups. The PD-hippo-hypo group showed less severely decreased DAT availability in the putamen than the other groups despite similar severities of motor deficit. The PD-hippo-hypo group had a higher risk of dementia conversion compared to the PD-hippo-normal (hazard ratio = 2.59, p = 0.013) and PD-hippo-hyper (hazard ratio = 3.73, p = 0.006) groups, despite similar cognitive performance at initial assessment between groups. INTERPRETATION Hippocampal hypoperfusion may indicate a reduced capacity to cope with neurodegenerative processes in terms of the development of motor deficits and cognitive decline in patients with PD. ANN NEUROL 2024;95:388-399.
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Affiliation(s)
- Min Young Chun
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Radiology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
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Baik K, Kim YJ, Park M, Chung SJ, Sohn YH, Jeong Y, Lee PH. Functional Brain Networks of Minor and Well-Structured Major Hallucinations in Parkinson's Disease. Mov Disord 2024; 39:318-327. [PMID: 38140793 DOI: 10.1002/mds.29681] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/08/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Minor hallucinations (mHs) and well-structured major hallucinations (MHs) are common symptoms of Parkinson's disease (PD) psychosis. OBJECTIVES To investigate the resting-state networks (RSNs) in patients with PD without hallucinations (PD-nH), with mH (PD-mH), and with MH (PD-MH). METHODS A total of 73 patients with PD were enrolled (27 PD-nH, 23 PD-mH, and 23 PD-MH). Using seed-based functional connectivity analyses, we investigated the RSNs supposedly related to hallucinations in PD: the default mode network (DMN), executive control network (ECN), dorsal attention network (DAN), ventral attention network (VAN), and visual network (VN). We compared the cognitive function and RSN connectivity among the three groups. In addition, we performed a seed-to-seed analysis to examine the inter-network connectivity within each group using the corresponding RSN seeds. RESULTS PD-MH group had lower test scores for attention and visuospatial functions compared with those in the other groups. The connectivity of the right intracalcarine cortex within the DAN was lower in the PD-MH group than in the others. The PD-mH and PD-MH groups showed higher connectivity in the left orbitofrontal cortex within DMN compared with the PD-nH group, whereas the connectivity was lower in the right middle frontal gyrus (MFG) within ECN, precuneus cortex within VAN, right middle temporal gyrus and precuneus cortex within DAN, and left MFG within VN. The PD-mH and PD-MH groups showed different inter-network connectivity between the five RSNs, especially regarding DAN connectivity. CONCLUSIONS DAN dysfunction may be a key factor in the progression from mH to MH in patients with PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kyoungwon Baik
- Department of Neurology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yae Ji Kim
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Mincheol Park
- Department of Neurology, Chung-Ang University College of Medicine and Graduate School of Medicine, Gwangmyeong Hospital, Gwangmyeong, South Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Jeong SH, Chung SJ, Yoo HS, Jung JH, Baik JS, Sohn YH, Lee PH. Differential effects of cholesterol levels on cognition according to body mass index in Parkinson's disease. Alzheimers Res Ther 2024; 16:24. [PMID: 38297344 PMCID: PMC10829366 DOI: 10.1186/s13195-023-01326-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Cholesterol is an essential component of the neuronal cell membrane and is crucial for neuronal function; however, the role of cholesterol levels in Parkinson's disease (PD) is debatable. This study investigated the complex relationship between total cholesterol (TC) levels, body mass index (BMI), and cognition in patients with PD. METHODS This study included 321 drug-naïve patients with PD who underwent dopamine transporter (DAT) imaging and baseline neuropsychological tests. Multivariate linear regression and Cox regression models were used to investigate the effect of TC levels on the composite score of each cognitive domain and dementia conversion after adjusting for covariates, respectively. Interaction analyses were performed to examine the interaction effect between TC levels and BMI on baseline cognition and dementia conversion. RESULTS TC levels and cognition showed no significant relationship after adjusting for potential confounders. A significant interaction effect between TC levels and BMI was observed in frontal/executive function and dementia conversion. Further analyses showed that TC levels were positively associated with frontal/executive function in the under-/normal weight group (β = 0.205, p = 0.013), whereas a negative relationship existed between TC levels and frontal/executive function in the obese group (β = - 0.213, p = 0.017). Cox regression analyses also showed the differential effects of TC levels on dementia conversion according to BMI (under-/normal weight group: hazard ratio [HR] = 0.550, p = 0.013; obese group: HR = 2.085, p = 0.014). CONCLUSIONS This study suggests a cross-over interaction between TC levels and BMI on cognitive symptoms in PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Inje Universitiy Busan Paik Hospital, Seoul, South Korea
| | - Jong Sam Baik
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Jeong SH, Park CJ, Cha J, Kim SY, Lee SK, Kim YJ, Sohn YH, Chung SJ, Lee PH. Choroid Plexus Volume, Amyloid Burden, and Cognition in the Alzheimer's Disease Continuum. Aging Dis 2024:AD.2024.0118. [PMID: 38300638 DOI: 10.14336/ad.2024.0118] [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: 10/29/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
As a part of the glymphatic system, the choroid plexus (CP) is involved in the clearance of harmful metabolites from the brain. We investigated the association between CP volume (CPV), amyloid-β (Aβ) burden, and cognition in patients on the Alzheimer's disease (AD) continuum. We retrospectively reviewed the records of 203 patients on the AD continuum and 82 healthy controls who underwent brain magnetic resonance imaging and 18F-florbetaben positron emission tomography. Automatic segmentation was performed, and the CPV was calculated. Cognitive function was assessed using detailed neuropsychological tests, and patients on the AD continuum were categorized into the non-dementia and dementia groups. The relationships between CPV, Aβ burden, and cognitive function were assessed using multivariate linear regression and linear mixed model. CPV was greater in the AD group than in the healthy control group (1.50 vs. 1.30, P < 0.001), but was comparable between the AD non-dementia and dementia groups (1.50 vs. 1.48, P = 0.585). After adjusting for age and sex, a larger CPV was significantly associated with greater global Aβ deposition (β = 0.20, P = 0.002). Larger CPV was also associated with worse general cognitive function assessed using the sum of boxes of the clinical dementia rating scale (β = 0.85, P = 0.034) and lower composite scores for memory (β = -0.68, P = 0.002) and frontal/executive function domains (β = -0.65, P < 0.001). In addition, a larger CPV was associated with a more rapid decline in Mini-Mental State Examination scores in the AD dementia group (β = -0.58, P = 0.004). The present study demonstrated that CP enlargement was associated with increased Aβ deposition and impaired memory and frontal/executive function in patients on the AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Chae Jung Park
- Department of Radiology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sang-Young Kim
- MR Clinical Science, Health Systems, Philips Korea, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Centre for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Jeong SH, Cha J, Yoo HS, Chung SJ, Jung JH, Sohn YH, Lee PH. Different effect of hypo- and hypermetabolism on cognition in dementia with Lewy bodies: are they coupled or independent? NPJ Parkinsons Dis 2024; 10:4. [PMID: 38172188 PMCID: PMC10764327 DOI: 10.1038/s41531-023-00622-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
Patients with dementia with Lewy bodies (DLB) show widespread brain metabolic changes. This study investigated whether brain hypo- and hypermetabolism in DLB have differential effects on cognition. We enrolled 55 patients with DLB (15 prodromal DLB [MCI-LB] and 40 probable DLB) and 13 healthy controls who underwent 18F-fluorodeoxyglucose positron emission tomography and detailed neuropsychological tests. Metabolic indices reflecting associated changes in regional cerebral glucose metabolism were calculated as follows: index(-) for hypometabolism [DLB-hypo] and index(+) for hypermetabolism [DLB-hyper]. The effects of DLB-hypo or DLB-hyper on cognitive function were assessed using a multivariate linear regression model. Additionally, a linear mixed model was used to investigate the association between each index and the longitudinal cognitive decline. There was no correlation between DLB-hypo and DLB-hyper in the disease group. The multivariate linear regression model showed that DLB-hypo was associated with language, visuospatial, visual memory, and frontal/executive functions; whereas DLB-hyper was responsible for attention and verbal memory. There was significant interaction between DLB-hypo and DLB-hyper for verbal and visual memory, which was substantially affected by DLB-hyper in relatively preserved DLB-hypo status. A linear mixed model showed that DLB-hypo was associated with longitudinal cognitive outcomes, regardless of cognitive status, and DLB-hyper contributed to cognitive decline only in the MCI-LB group. The present study suggests that DLB-hypo and DLB-hyper may be independent of each other and differentially affect the baseline and longitudinal cognitive function in patients with DLB.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Han Soo Yoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Lee DH, Heo H, Suh CH, Shim WH, Kim E, Jo S, Chung SJ, Lee CS, Kim HS, Kim SJ. Improved diagnostic performance of susceptibility-weighted imaging with compressed sensing-sensitivity encoding and neuromelanin-sensitive MRI for Parkinson's disease and atypical Parkinsonism. Clin Radiol 2024; 79:e102-e111. [PMID: 37863747 DOI: 10.1016/j.crad.2023.09.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Abstract
AIM To verify the diagnostic performance of the loss of nigrosome-1 on susceptibility-weighted imaging (SWI) with compressed sensing-sensitivity encoding (CS-SENSE) and neuromelanin on neuromelanin-sensitive (NM) magnetic resonance imaging (MRI) for the diagnosis of Parkinson's disease (PD) and atypical Parkinsonism. MATERIALS AND METHODS A total of 195 patients who underwent MRI between October 2019 and February 2020, including SWI, with or without CS-SENSE, and NM-MRI, were reviewed retrospectively. Two neuroradiologists assessed the loss of nigrosome-1 on SWI and neuromelanin on the NM-MRI. The result of N-3-fluoropropyl-2-beta-carbomethoxy-3-beta-(4-iodophenyl) nortropane positron-emission tomography (PET) was set as the reference standard. RESULTS When CS-SENSE was applied for nigrosome-1 imaging on SWI, the non-diagnostic scan rate was lowered significantly from 19.3% (17/88) to 5.6% (6/107; p=0.004). Diagnosis of PD and atypical Parkinsonism based on the loss of nigrosome-1 on SWI and based on NM-MRI showed good diagnostic value (area under the curve [AUC] 0.821, 95% confidence interval [CI] = 0.755-0.875: AUC 0.832, 95% CI = 0.771-0.882, respectively) with a substantial inter-reader agreement (κ = 0.791 and 0.681, respectively). Combined SWI and neuromelanin had a similar discriminatory ability (AUC 0.830, 95% CI = 0.770-0.880). Similarly, the diagnosis of PD was excellent. CONCLUSIONS CS-SENSE may add value to the diagnostic capability of nigrosome-1 on SWI to reduce the nondiagnostic scan rates. Furthermore, loss of nigrosome-1 on SWI or volume loss of neuromelanin on NM-MRI may be helpful for diagnosing PD.
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Affiliation(s)
- D H Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - H Heo
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - W H Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - E Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - S Jo
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C S Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Chung SJ, Kim SH, Park CW, Lee HS, Kim YJ, Lee PH, Jeong Y, Sohn YH. Is the cingulate island sign a marker for early dementia conversion in Parkinson's disease? Eur J Neurol 2023; 30:3732-3740. [PMID: 37505994 DOI: 10.1111/ene.16007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND To investigate whether the cingulate island sign (CIS) ratio (i.e., the ratio of regional uptake in the posterior cingulate cortex relative to the precuneus and cuneus on cerebral perfusion scans) is associated with early dementia conversion in Parkinson's disease (PD). METHODS We enrolled 226 patients with newly diagnosed PD and 48 healthy controls who underwent dual-phase 18 F-FP-CIT PET scans. Patients with PD were classified into three groups according to the CIS ratio on early-phase 18 F-FP-CIT PET images: a PD group with CIS or high CIS ratios (PD-CIS; n = 96), a PD group with inverse CIS or low CIS ratios (PD-iCIS; n = 40), and a PD group consisting of the remaining patients with normal CIS ratios (PD-nCIS; n = 90). We compared the risk of dementia conversion within a 5-year time point between the groups. RESULTS There were no significant differences in age, sex, education, or baseline cognitive function between the PD groups. The PD-CIS group had higher Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and more severely decreased dopamine transporter availability in the putamen. The PD-iCIS group had a smaller hippocampal volume compared with the other groups. The risk of dementia conversion in the PD-CIS group did not differ from that in the PD-iCIS and PD-nCIS groups. Meanwhile, the PD-iCIS group had a higher risk of dementia conversion than the PD-nCIS group. CONCLUSION The results of this study suggest that inverse CIS, rather than CIS, is relevant to early dementia conversion in patients with PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Radiology, Yeungnam University College of Medicine, Daegu, Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Jeong SH, Park CJ, Jeong HJ, Sunwoo MK, Ahn SS, Lee SK, Lee PH, Kim YJ, Sohn YH, Chung SJ. Association of choroid plexus volume with motor symptoms and dopaminergic degeneration in Parkinson's disease. J Neurol Neurosurg Psychiatry 2023; 94:1047-1055. [PMID: 37399288 DOI: 10.1136/jnnp-2023-331170] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The choroid plexus (CP) is involved in the clearance of harmful metabolites from the brain, as a part of the glymphatic system. This study aimed to investigate the association between CP volume (CPV), nigrostriatal dopaminergic degeneration and motor outcomes in Parkinson's disease (PD). METHODS We retrospectively searched drug-naïve patients with early-stage PD who underwent dopamine transporter (DAT) scanning and MRI. Automatic CP segmentation was performed, and the CPV was calculated. The relationship between CPV, DAT availability and Unified PD Rating Scale Part III (UPDRS-III) scores was assessed using multivariate linear regression. We performed longitudinal analyses to assess motor outcomes according to CPV. RESULTS CPV was negatively associated with DAT availability in each striatal subregion (anterior caudate, β=-0.134, p=0.012; posterior caudate, β=-0.162, p=0.002; anterior putamen, β=-0.133, p=0.024; posterior putamen, β=-0.125, p=0.039; ventral putamen, β=-0.125, p=0.035), except for the ventral striatum. CPV was positively associated with the UPDRS-III score even after adjusting for DAT availability in the posterior putamen (β=0.121; p=0.035). A larger CPV was associated with the future development of freezing of gait in the Cox regression model (HR 1.539, p=0.027) and a more rapid increase in dopaminergic medication in the linear mixed model (CPV×time, p=0.037), but was not associated with the risk of developing levodopa-induced dyskinesia or wearing off. CONCLUSION These findings suggest that CPV has the potential to serve as a biomarker for baseline and longitudinal motor disabilities in PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Korea (the Republic of)
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Chae Jung Park
- Department of Radiology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Geyonggi-do, Korea (the Republic of)
| | - Hyun-Jae Jeong
- Research Institute of Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Mun Kyung Sunwoo
- Department of Neurology, Daejin Medical Foundation Bundang Jesaeng Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Sung Soo Ahn
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Centre for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Koo Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Centre for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Gyeonggi-do, Korea (the Republic of)
- YONSEI BEYOND LAB, Yongin, Gyeonggi-do, South Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Gyeonggi-do, Korea (the Republic of)
- YONSEI BEYOND LAB, Yongin, Gyeonggi-do, South Korea
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14
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Lee J, Sohn YH, Chung SJ, Kim SH, Suh Y, Park J, Kim Y. Validity and Reliability of the Korean Version of the Parkinson's Disease Questionnaire-Carer. J Clin Neurol 2023; 19:547-557. [PMID: 37488956 PMCID: PMC10622727 DOI: 10.3988/jcn.2022.0390] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/12/2023] [Accepted: 04/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The importance of the quality of life (QOL) of carers has been increasingly recognized as it has a wide range of effects on the psychological, emotional, and social outcomes of patients with Parkinson's disease (PD). Understanding their QOL is important as it reflects their unique characteristics; however, there have been few studies on this in Korea. This study aimed to translate and validate the Korean version of the Parkinson's Disease Questionnaire-Carer (PDQ-Carer). METHODS This was a methodological study that included a translation process and a cross-sectional investigation. The Korean version of the scale was developed using back translation, semantic adjustment, and pretests. The final version was self-administered by 125 Korean family carers. Cronbach's alpha values were used to assess the internal consistency of the PDQ-Carer. Exploratory and confirmatory factor analyses were used to validate the translated scale. RESULTS Exploratory factor analysis identified four factors that accounted for 64.51% of the variance. A modified model using modification indices was found to fit the data well in the confirmatory factor analysis. That factor analysis supported the structure of the original four factors with relocation of several items that reflected Korean culture. Cronbach's alpha values were 0.96 for the total scale, 0.93 for personal and social activities, 0.89 for strain, 0.85 for anxiety and depression, and 0.85 for self-care. CONCLUSIONS This study verified that the Korean version of the PDQ-Carer can be used to acquire important information about the multidimensional aspects of the QOL of Korean carers for patients with PD.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Centre of Korea: a Joanna Briggs Institute of Excellence, College of Nursing, Yonsei University, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Sung Hae Kim
- Department of Nursing, Tongmyong University, Busan, Korea
| | - Yujin Suh
- College of Nursing, Health Science & Human Ecology, Dong-Eui University, Busan, Korea
| | - Jungah Park
- College of Nursing, CHA University, Pocheon, Korea
| | - Yielin Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Korea.
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Jeong SH, Jeong HJ, Sunwoo MK, Ahn SS, Lee SK, Lee PH, Kim YJ, Sohn YH, Park CJ, Chung SJ. Association between choroid plexus volume and cognition in Parkinson disease. Eur J Neurol 2023; 30:3114-3123. [PMID: 37498202 DOI: 10.1111/ene.15999] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/05/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND AND PURPOSE The choroid plexus (CP) clears harmful metabolites from the central nervous system as part of the glymphatic system. We investigated the association of CP volume (CPV) with baseline and longitudinal cognitive decline in patients with Parkinson disease (PD). METHODS We retrospectively reviewed the medical records of 240 patients with newly diagnosed PD who had undergone detailed neuropsychological tests and high-resolution T1-weighted structural magnetic resonance imaging during the initial assessment. The CPV of each patient was automatically segmented, and the intracranial volume ratio was used in subsequent analyses. The relationship between CPV and baseline composite scores of each cognitive domain was assessed using multivariate linear regression analyses. A Cox proportional hazards model was used to compare the risk of dementia conversion with CPV. RESULTS CPV negatively correlated with composite scores of the frontal/executive function domain (β = -0.375, p = 0.002) after adjusting for age, sex, years of education, and parkinsonian symptom duration. The Cox regression model revealed that a larger CPV was associated with a higher risk of dementia conversion (hazard ratio [HR] = 1.509, p = 0.038), which was no longer significant after adjusting for the composite scores of the frontal/executive function domain. A mediation analysis demonstrated that the effect of CPV on the risk of dementia conversion was completely mediated by frontal/executive function (direct effect: HR = 1.203, p = 0.396; indirect effect: HR = 1.400, p = 0.015). CONCLUSIONS Baseline CPV is associated with baseline frontal/executive function, which subsequently influences dementia conversion risk in patients with PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Jae Jeong
- Research Institute of Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mun Kyung Sunwoo
- Department of Neurology, Bundang Jesaeng General Hospital, Seongnam-si, Korea
| | - Sung Soo Ahn
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Centre for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Centre for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Chae Jung Park
- Department of Radiology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
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16
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Jeong SH, Kim SH, Park CW, Lee HS, Lee PH, Kim YJ, Sohn YH, Jeong Y, Chung SJ. Differential Implications of Cerebral Hypoperfusion and Hyperperfusion in Parkinson's Disease. Mov Disord 2023; 38:1881-1890. [PMID: 37489576 DOI: 10.1002/mds.29565] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) exhibit widespread brain perfusion changes. OBJECTIVE This study investigated whether cerebral regions with hypoperfusion and hyperperfusion have differential effects on motor and cognitive symptoms in PD using early-phase 18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (18 F-FP-CIT) positron emission tomography (PET) scans. METHODS We enrolled 394 patients with newly diagnosed PD who underwent dual-phase 18 F-FP-CIT PET scans. Indices reflecting associated changes in regional cerebral hypoperfusion and hyperperfusion on early-phase 18 F-FP-CIT PET scans were calculated as PD[hypo] and PD[hyper] , respectively. The associations of PD[hypo] and PD[hyper] on motor and cognitive symptoms at baseline were assessed using multivariate linear regression. Also, Cox regression and linear mixed models were performed to investigate the effects of baseline PD[hypo] and PD[hyper] on longitudinal outcomes. RESULTS There was a weak correlation between PD[hypo] and PD[hyper] (γ = -0.19, P < 0.001). PD[hypo] was associated with baseline Unified Parkinson's Disease Rating Scale Part III scores (β = -1.02, P = 0.045), rapid increases in dopaminergic medications (β = -18.02, P < 0.001), and a higher risk for developing freezing of gait (hazard ratio [HR] = 0.67, P = 0.019), whereas PD[hyper] was not associated. Regarding cognitive function, PD[hypo] was more relevant to the baseline cognitive performance levels of visuospatial, memory, and frontal/executive function than PD[hyper] . However, greater PD[hyper] was associated with future dementia conversion (HR = 1.43, P = 0.004), whereas PD[hypo] was not associated. CONCLUSIONS These findings suggest that PD[hypo] and PD[hyper] may differentially affect motor and cognitive functions in patients with PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
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Kim DY, Shin JY, Lee JE, Kim HN, Chung SJ, Yoo HS, Kim SJ, Cho HJ, Lee EJ, Nam SJ, Kim SH, Jang J, Lee SE, Lee PH. A selective ER-phagy exerts neuroprotective effects via modulation of α-synuclein clearance in parkinsonian models. Proc Natl Acad Sci U S A 2023; 120:e2221929120. [PMID: 37669380 PMCID: PMC10500278 DOI: 10.1073/pnas.2221929120] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
The endoplasmic reticulum (ER) is selectively degraded by ER-phagy to maintain cell homeostasis. α-synuclein accumulates in the ER, causing ER stress that contributes to neurodegeneration in Parkinson's disease (PD), but the role of ER-phagy in α-synuclein modulation is largely unknown. Here, we investigated the mechanisms by which ER-phagy selectively recognizes α-synuclein for degradation in the ER. We found that ER-phagy played an important role in the degradation of α-synuclein and recovery of ER function through interaction with FAM134B, where calnexin is required for the selective FAM134B-mediated α-synuclein clearance via ER-phagy. Overexpression of α-synuclein in the ER of the substantia nigra (SN) resulted in marked loss of dopaminergic neurons and motor deficits, mimicking PD characteristics. However, enhancement of ER-phagy using FAM134B overexpression in the SN exerted neuroprotective effects on dopaminergic neurons and recovered motor performance. These data suggest that ER-phagy represents a specific ER clearance mechanism for the degradation of α-synuclein.
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Affiliation(s)
- Dong Yeol Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Jin Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
- Department of Biomedical Science, Yonsei University College of Medicine, Seoul03722, South Korea
| | - Ji Eun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Ha Na Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin16995, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Sang Jin Kim
- Department of Neurology, Inje University Busan Paik Hospital, Busan47392, South Korea
| | - Hwa Jin Cho
- Department of Pathology, Inje University Busan Paik Hospital, Busan47392, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul05505, South Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul05505, South Korea
| | - Seong Heon Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon24289, South Korea
| | - Jaewon Jang
- Department of Neurology, Kangwon National University Hospital, Chuncheon24289, South Korea
| | - Seung Eun Lee
- Virus Facility, Research Animal Resource Center, Korea Institute of Science and Technology, Seoul02792, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, South Korea
- Department of Biomedical Science, Yonsei University College of Medicine, Seoul03722, South Korea
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18
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Park CJ, Eom J, Park KS, Park YW, Chung SJ, Kim YJ, Ahn SS, Kim J, Lee PH, Sohn YH, Lee SK. An interpretable multiparametric radiomics model of basal ganglia to predict dementia conversion in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:127. [PMID: 37648733 PMCID: PMC10468504 DOI: 10.1038/s41531-023-00566-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
Cognitive impairment in Parkinson's disease (PD) severely affects patients' prognosis, and early detection of patients at high risk of dementia conversion is important for establishing treatment strategies. We aimed to investigate whether multiparametric MRI radiomics from basal ganglia can improve the prediction of dementia development in PD when integrated with clinical profiles. In this retrospective study, 262 patients with newly diagnosed PD (June 2008-July 2017, follow-up >5 years) were included. MRI radiomic features (n = 1284) were extracted from bilateral caudate and putamen. Two models were developed to predict dementia development: (1) a clinical model-age, disease duration, and cognitive composite scores, and (2) a combined clinical and radiomics model. The area under the receiver operating characteristic curve (AUC) were calculated for each model. The models' interpretabilities were studied. Among total 262 PD patients (mean age, 68 years ± 8 [standard deviation]; 134 men), 51 (30.4%), and 24 (25.5%) patients developed dementia within 5 years of PD diagnosis in the training (n = 168) and test sets (n = 94), respectively. The combined model achieved superior predictive performance compared to the clinical model in training (AUCs 0.928 vs. 0.894, P = 0.284) and test set (AUCs 0.889 vs. 0.722, P = 0.016). The cognitive composite scores of the frontal/executive function domain contributed most to predicting dementia. Radiomics derived from the caudate were also highly associated with cognitive decline. Multiparametric MRI radiomics may have an incremental prognostic value when integrated with clinical profiles to predict future cognitive decline in PD.
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Affiliation(s)
- Chae Jung Park
- Department of Radiology, Yongin Severance Hospital, Yonsei University Health System, Yongin-si, Gyeonggi-do, South Korea
| | - Jihwan Eom
- Department of Computer Science, Yonsei University, Seoul, South Korea
| | - Ki Sung Park
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea.
| | - Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin-si, Gyeonggi-do, South Korea.
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
- YONSEI BEYOND LAB, Yongin-si, Gyeonggi-do, South Korea.
| | - Yun Joong Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin-si, Gyeonggi-do, South Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- YONSEI BEYOND LAB, Yongin-si, Gyeonggi-do, South Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinna Kim
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
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19
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Baik K, Cha J, Park M, Lee Y, Chung SJ, Yoo HS, Sohn YH, Lee PH. Distinct amyloid-dependent patterns of nigra dopamine depletion in Lewy body diseases. Front Aging Neurosci 2023; 15:1196602. [PMID: 37614472 PMCID: PMC10442581 DOI: 10.3389/fnagi.2023.1196602] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Concomitant amyloid pathology is not uncommon and contributes to the clinical characteristics of Lewy body disease (LBD). We investigated the effect of amyloid on striatal18F-FP-CIT uptake patterns in LBD, including Parkinson's disease (PD) and dementia with Lewy bodies. Methods We enrolled 125 patients with LBD who underwent18F-florbetaben positron emission tomography (PET) and18F-FP-CIT PET. Patients were divided into amyloid-positive and amyloid-negative groups. We investigated the effect of amyloid on striatal dopamine transporter (DAT) availability, depending on the type of LBD, using general linear models with interaction analysis after controlling for age, sex, education, deep white matter hyperintensity (WMH), periventricular WMH, and cognitive status. Results There was a significant interaction effect between the disease group and the presence of amyloid on DAT availability in the anterior putamen, posterior putamen, caudate, and ventral striatum. In the presence of amyloid, only the PD group exhibited decreased DAT availability in the anterior and posterior putamen. In both groups, the presence of amyloid was not associated with DAT availability in the caudate and ventral striatum. The presence of amyloid was not directly related to the worse parkinsonian motor symptoms in both groups. However, there was a significant indirect effect of amyloid on parkinsonian motor symptoms, which was mediated by anterior and posterior putaminal DAT availability in the PD group alone. Discussion This study demonstrates different amyloid-dependent or amyloid-independent18F-FP-CIT PET patterns in patients with LBD, suggesting distinctive interactions between α-synuclein and amyloid pathology based on the type of LBD.
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Affiliation(s)
- Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mincheol Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Chung-Ang University College of Medicine and Graduate School of Medicine, Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Younggun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young H. Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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20
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Jeong SH, Cha J, Jung JH, Yun M, Sohn YH, Chung SJ, Lee PH. Occipital Amyloid Deposition Is Associated with Rapid Cognitive Decline in the Alzheimer's Disease Continuum. J Alzheimers Dis 2023:JAD230187. [PMID: 37355901 DOI: 10.3233/jad-230187] [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: 06/26/2023]
Abstract
BACKGROUND Clinical significance of additional occipital amyloid-β (Aβ) plaques in Alzheimer's disease (AD) remains unclear. OBJECTIVE In this study, we investigated the effect of regional Aβ deposition on cognition in patients on the AD continuum, especially in the occipital region. METHODS We retrospectively reviewed the medical record of 208 patients with AD across the cognitive continuum (non-dementia and dementia). Multivariable linear regression analyses were performed to determine the effect of regional Aβ deposition on cognitive function. A linear mixed model was used to assess the effect of regional deposition on longitudinal changes in Mini-Mental State Examination (MMSE) scores. Additionally, the patients were dichotomized according to the occipital-to-global Aβ deposition ratio (ratio ≤1, Aβ-OCC- group; ratio >1, Aβ-OCC+ group), and the same statistical analyses were applied for between-group comparisons. RESULTS Regional Aβ burden itself was not associated with baseline cognitive function. In terms of Aβ-OCC group effect, the Aβ-OCC+ group exhibited a poorer cognitive performance on language function compared to the Aβ-OCC- group. High Aβ retention in each region was associated with a rapid decline in MMSE scores, only in the dementia subgroup. Additionally, Aβ-OCC+ individuals exhibited a faster annual decline in MMSE scores than Aβ-OCC- individuals in the non-dementia subgroup (β= -0.77, standard error [SE] = 0.31, p = 0.013). CONCLUSION The present study demonstrated that additional occipital Aβ deposition was associated with poor baseline language function and rapid cognitive deterioration in patients on the AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- YONSEI BEYOND LAB, Yongin, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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21
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Baik K, Jeon S, Yang SJ, Na Y, Chung SJ, Yoo HS, Yun M, Lee PH, Sohn YH, Ye BS. Cortical Thickness and Brain Glucose Metabolism in Healthy Aging. J Clin Neurol 2023; 19:138-146. [PMID: 36647225 PMCID: PMC9982173 DOI: 10.3988/jcn.2022.0021] [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: 01/10/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to determine the effect of demographic factors on cortical thickness and brain glucose metabolism in healthy aging subjects. METHODS The following tests were performed on 71 subjects with normal cognition: neurological examination, 3-tesla magnetic resonance imaging, 18F-fluorodeoxyglucose positron-emission tomography, and neuropsychological tests. Cortical thickness and brain metabolism were measured using vertex- and voxelwise analyses, respectively. General linear models (GLMs) were used to determine the effects of age, sex, and education on cortical thickness and brain glucose metabolism. The effects of mean lobar cortical thickness and mean lobar metabolism on neuropsychological test scores were evaluated using GLMs after controlling for age, sex, and education. The intracranial volume (ICV) was further included as a predictor or covariate for the cortical thickness analyses. RESULTS Age was negatively correlated with the mean cortical thickness in all lobes (frontal and parietal lobes, p=0.001; temporal and occipital lobes, p<0.001) and with the mean temporal metabolism (p=0.005). Education was not associated with cortical thickness or brain metabolism in any lobe. Male subjects had a lower mean parietal metabolism than did female subjects (p<0.001), while their mean cortical thicknesses were comparable. ICV was positively correlated with mean cortical thickness in the frontal (p=0.016), temporal (p=0.009), and occipital (p=0.007) lobes. The mean lobar cortical thickness was not associated with cognition scores, while the mean temporal metabolism was positively correlated with verbal memory test scores. CONCLUSIONS Age and sex affect cortical thickness and brain glucose metabolism in different ways. Demographic factors must therefore be considered in analyses of cortical thickness and brain metabolism.
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Affiliation(s)
- Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Jeon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Soh-Jeong Yang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yeona Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young H. Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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22
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Jung JH, Na HK, Jeong SH, Chung SJ, Yoo HS, Lee YH, Baik K, Kim SJ, Sohn YH, Lee PH. Effects of Dihydropyridines on the Motor and Cognitive Outcomes of Patients with Parkinson's Disease. Mov Disord 2023. [PMID: 36825772 DOI: 10.1002/mds.29367] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Dihydropyridines (DHPs) may have neuroprotective effects against Parkinson's disease (PD). OBJECTIVE This study investigated the effects of DHPs on nigrostriatal dopaminergic denervation and longitudinal motor and cognitive outcomes in PD. METHODS We classified 476 patients with drug-naive PD who had undergone dopamine transporter imaging into three groups. They were selected according to a prior diagnosis of hypertension and use of DHPs and were matched using propensity scores: patients without hypertension (HTN-; n = 50) and patients with hypertension treated without DHP (HTN+/DHP-; n = 50) or with DHP (HTN+/DHP+; n = 50). Multiple linear regression and linear mixed model analyses were performed to determine intergroup differences in baseline dopamine transporter availability and longitudinal changes in the levodopa-equivalent dose, respectively. Using Kaplan-Meier analyses, we compared the risks of levodopa-induced dyskinesia, wearing off, and dementia-free survival during the 5.06 years of the mean follow-up period. The Cox regression model determined the independent effects of DHPs on dementia conversion. RESULTS Dopamine transporter availability in all striatal subregions was comparable between the HTN-, HTN+/DHP-, and HTN+/DHP+ groups. The risks of levodopa-induced dyskinesia and wearing off, as well as longitudinal changes in the levodopa-equivalent dose, did not differ between the groups. The HTN+/DHP+ group had a lower risk of developing dementia than the HTN+/DHP- (Bonferroni-corrected Plog-rank = 0.036) group. The use of DHP was independently associated with a lower risk of dementia conversion after controlling for other antihypertensive drugs and confounding factors (hazard ratio, 0.242; 95% confidence interval, 0.087-0.668; P = 0.006). CONCLUSIONS DHPs may be associated with better long-term cognitive outcomes in hypertensive patients with PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.,Dementia and Neurodegenerative Disease Research Center, Inje University, Busan, South Korea
| | - Han Kyu Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Ho Jeong
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Jin Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.,Dementia and Neurodegenerative Disease Research Center, Inje University, Busan, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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23
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Jeong SH, Lee HS, Chung SJ, Yoo HS, Jung JH, Baik K, Baik JS, Sohn YH, Lee PH. Association of cholesterol level with dopamine loss and motor deficits in Parkinson disease: A cross-sectional study. Eur J Neurol 2023; 30:107-115. [PMID: 36209467 DOI: 10.1111/ene.15592] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/06/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Cholesterol is vital in neuronal function; however, the influence of cholesterol levels on parkinsonism is unclear. This study investigated the relationship between baseline total cholesterol (TC) levels, dopamine loss, and motor symptoms in drug-naïve Parkinson disease (PD). METHODS This cross-sectional study enrolled 447 drug-naïve patients with PD who underwent dopamine transporter (DAT) imaging. Multivariate linear regression was used to investigate the effect of cholesterol levels on Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) total score and each subscore after adjusting for the covariates. An interaction analysis was performed to examine the interaction between TC levels and statin use on the UPDRS-III scores. RESULTS No significant correlation was found between TC levels and DAT availability after adjusting for potential confounders. Multivariate linear regression showed that TC levels were significantly and negatively associated with the UPDRS-III total score (β = -0.116, p = 0.013) and bradykinesia subscore (β = -0.145, p = 0.011). Dichotomized analysis according to TC levels showed that TC levels were significantly associated with UPDRS-III total score, and rigidity, bradykinesia, and axial subscores only in the low TC group. There was an interaction effect between TC levels and statin use for the axial subscores (β = -0.523, p = 0.025). Subgroup analysis showed that TC levels were significantly and negatively associated with the axial subscore in statin users; however, no association was found in statin nonusers. CONCLUSIONS This study suggests that TC levels affect parkinsonian motor symptoms, especially in subjects with low cholesterol status, whereas the severity of axial motor symptoms is negatively associated with TC levels only in statin users.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Inje Universitiy Busan Paik Hospital, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Sam Baik
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Jeong SH, Park CW, Lee HS, Kim YJ, Yun M, Lee PH, Sohn YH, Chung SJ. Patterns of striatal dopamine depletion and motor deficits in de novo Parkinson's disease. J Neural Transm (Vienna) 2023; 130:19-28. [PMID: 36462096 DOI: 10.1007/s00702-022-02571-9] [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: 10/10/2022] [Accepted: 11/24/2022] [Indexed: 12/07/2022]
Abstract
The background of this study is to investigate whether striatal dopamine depletion patterns (selective involvement in the sensorimotor striatum or asymmetry) are associated with motor deficits in Parkinson's disease (PD). We enrolled 404 drug-naïve patients with early stage PD who underwent dopamine transporter (DAT) imaging. After quantifying DAT availability in each striatal sub-region, principal component (PC) analysis was conducted to yield PCs representing the spatial patterns of striatal dopamine depletion. Subsequently, multivariate linear regression analysis was conducted to investigate the relationship between striatal dopamine depletion patterns and motor deficits assessed using the Unified PD Rating Scale Part III (UPDRS-III). Mediation analyses were used to evaluate whether dopamine deficiency in the posterior putamen mediated the association between striatal dopamine depletion patterns and parkinsonian motor deficits. Three PCs indicated patterns of striatal dopamine depletion: PC1 (overall striatal dopamine deficiency), PC2 (selective dopamine loss in the sensorimotor striatum), and PC3 (symmetric dopamine loss in the striatum). Multivariate linear regression analysis revealed that PC1 (β = - 1.605, p < 0.001) and PC2 (β = 3.201, p < 0.001) were associated with motor deficits (i.e., higher UPDRS-III scores in subjects with severe dopamine depletion throughout the whole striatum or more selective dopamine loss in the sensorimotor striatum), whereas PC3 was not (β = - 0.016, p = 0.992). Mediation analyses demonstrated that the effects of PC1 and PC2 on UPDRS-III scores were indirectly mediated by DAT availability in the posterior putamen, with a non-significant direct effect. Dopamine deficiency in the posterior putamen was most relevant to the severity of motor deficits in patients with PD, while the spatial patterns of striatal dopamine depletion were not a key determinant.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, 363 Dongbaekjukjeon-daero Giheung-gu, Yongin-si, Gyeonggi-do, 16995, South Korea.,YONSEI BEYOND LAB, Yongin, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea. .,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, 363 Dongbaekjukjeon-daero Giheung-gu, Yongin-si, Gyeonggi-do, 16995, South Korea. .,YONSEI BEYOND LAB, Yongin, South Korea.
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25
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Chung SJ, Kim YJ, Kim YJ, Lee HS, Jeong SH, Hong JM, Sohn YH, Yun M, Jeong Y, Lee PH. Association Between White Matter Networks and the Pattern of Striatal Dopamine Depletion in Patients With Parkinson Disease. Neurology 2022; 99:e2672-e2682. [PMID: 36195451 DOI: 10.1212/wnl.0000000000201269] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Individual variability in nigrostriatal dopaminergic denervation is an important factor underlying clinical heterogeneity in Parkinson disease (PD). This study aimed to explore whether the pattern of striatal dopamine depletion was associated with white matter (WM) networks in PD. METHODS A total of 240 newly diagnosed patients with PD who underwent 18F-FP-CIT PET scans and brain diffusion tensor imaging at initial assessment were enrolled in this study. We measured 18F-FP-CIT tracer uptake as an indirect marker for striatal dopamine depletion. Factor analysis-derived striatal dopamine loss patterns were estimated in each patient to calculate the composite scores of 4 striatal subregion factors (caudate, more-affected and less-affected sensorimotor striata, and anterior putamen) based on the availability of striatal dopamine transporter. The WM structural networks that were correlated with the composite scores of each striatal subregion factor were identified using a network-based statistical analysis. RESULTS A higher composite score of caudate (i.e., relatively preserved dopaminergic innervation in the caudate) was associated with a strong structural connectivity in a single subnetwork comprising the left caudate and left frontal gyri. Selective dopamine loss in the caudate was associated with strong connectivity in the structural subnetwork whose hub nodes were bilateral thalami and left insula, which were connected to the anterior cingulum. However, no subnetworks were correlated with the composite scores of other striatal subregion factors. The connectivity strength of the network with a positive correlation with the composite score of caudate affected the frontal/executive function either directly or indirectly through the mediation of dopamine depletion in the caudate. CONCLUSIONS Our findings indicate that different patterns of striatal dopamine depletion are closely associated with WM structural alterations, which may contribute to heterogeneous cognitive profiles in individuals with PD.
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Affiliation(s)
- Seok Jong Chung
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Yae Ji Kim
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
| | - Seong Ho Jeong
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Man Hong
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
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Jeong SH, Lee EC, Chung SJ, Lee HS, Jung JH, Sohn YH, Seong JK, Lee PH. Local striatal volume and motor reserve in drug-naïve Parkinson's disease. NPJ Parkinsons Dis 2022; 8:168. [PMID: 36470876 PMCID: PMC9722895 DOI: 10.1038/s41531-022-00429-1] [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: 12/27/2021] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Motor reserve (MR) may explain why individuals with similar pathological changes show marked differences in motor deficits in Parkinson's disease (PD). In this study, we investigated whether estimated individual MR was linked to local striatal volume (LSV) in PD. We analyzed data obtained from 333 patients with drug naïve PD who underwent dopamine transporter scans and high-resolution 3-tesla T1-weighted structural magnetic resonance images. Using a residual model, we estimated individual MRs on the basis of initial UPDRS-III score and striatal dopamine depletion. We performed a correlation analysis between MR estimates and LSV. Furthermore, we assessed the effect of LSV, which is correlated with MR estimates, on the longitudinal increase in the levodopa-equivalent dose (LED) during the 4-year follow-up period using a linear mixed model. After controlling for intracranial volume, there was a significant positive correlation between LSV and MR estimates in the bilateral caudate, anterior putamen, and ventro-posterior putamen. The linear mixed model showed that the large local volume of anterior and ventro-posterior putamen was associated with the low requirement of LED initially and accelerated LED increment thereafter. The present study demonstrated that LSV is crucial to MR in early-stage PD, suggesting LSV as a neural correlate of MR in PD.
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Affiliation(s)
- Seong Ho Jeong
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea ,grid.411627.70000 0004 0647 4151Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Eun-Chong Lee
- grid.222754.40000 0001 0840 2678School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Seok Jong Chung
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea ,grid.413046.40000 0004 0439 4086Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Hye Sun Lee
- grid.15444.300000 0004 0470 5454Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- grid.411625.50000 0004 0647 1102Department of Neurology, Inje University Busan Paik Hospital, Seoul, South Korea
| | - Young H. Sohn
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- grid.222754.40000 0001 0840 2678School of Biomedical Engineering, Korea University, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Phil Hyu Lee
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea ,grid.15444.300000 0004 0470 5454Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Chung SJ, Kim Y, Jung JH, Lee HS, Ye BS, Sohn YH, Jeong Y, Lee PH. White matter connectivity networks predict early dementia conversion in Parkinson’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.062016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Seok Jong Chung
- Yonsei University College of Medicine Seoul Republic of South Korea
- Yongin Severance Hospital Yongin Republic of South Korea
| | - Yaeji Kim
- Korea Advanced Institute of Science and Technology Daejeon Republic of South Korea
| | - Jin Ho Jung
- Inje University Busan Paik Hospital Busan Republic of South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Yonsei University College of Medicine Seoul Republic of South Korea
| | - Byoung Seok Ye
- Yonsei University College of Medicine Seoul Republic of South Korea
| | - Young H Sohn
- Yonsei University College of Medicine Seoul Republic of South Korea
| | - Yong Jeong
- Department of Bio and Engineering, KAIST Daejeon Republic of South Korea
| | - Phil Hyu Lee
- Yonsei University College of Medicine Seoul Republic of South Korea
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Lee SJ, Kim D, Suh CH, Shim WH, Heo H, Jo S, Chung SJ, Kim HS, Kim SJ. Detection rate of MR myelography without intrathecal gadolinium in patients with newly diagnosed spontaneous intracranial hypotension. Clin Radiol 2022; 77:848-854. [PMID: 35985843 DOI: 10.1016/j.crad.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the detection rate of magnetic resonance (MR) myelography without intrathecal gadolinium for cerebrospinal fluid (CSF) leakage in patients with newly diagnosed spontaneous intracranial hypotension (SIH) and to validate a published scoring system for predicting CSF leakage. MATERIALS AND METHODS This retrospective, observational, single-institution study included patients with newly diagnosed SIH between March 2015 and April 2021. Patients were included if they (a) had newly diagnosed SIH and (b) underwent initial brain MR imaging and preprocedural MR myelography with two- and three-dimensional turbo spin-echo sequences. Patients who underwent spine surgery or procedures including epidural injection and acupuncture were excluded. The detection rate was defined as the proportion of patients with a true-positive MR myelography result among all patients with confirmed CSF leakage. The interobserver agreement for the MR myelography results between two radiologists was analysed using weighted kappa statistics. RESULTS A total of 136 patients (mean age, 48 years; 70 women) with suspected SIH were included. Of these patients, 120 (88%, 120/136) were confirmed to have CSF leakage. Of the patients with confirmed CSF leakage, 90 (75%, 90/120) had epidural fluid collection. The detection rate of MR myelography for CSF leakage was 88% (105/120). The interobserver agreement between the two readers for detecting CSF leakage (κ = 0.76) or epidural fluid collection (κ = 0.76) on MR myelography was high. Among 24 patients with normal brain MR imaging results, 16 had CSF leakage (67%, 16/24). CONCLUSIONS Non-invasive MR myelography without intrathecal gadolinium should be considered to detect CSF leakage in patients with suspected SIH.
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Affiliation(s)
- S J Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - W H Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H Heo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Jeong SH, Cha J, Park M, Jung JH, Ye BS, Sohn YH, Chung SJ, Lee PH. Association of Enlarged Perivascular Spaces With Amyloid Burden and Cognitive Decline in Alzheimer Disease Continuum. Neurology 2022; 99:e1791-e1802. [PMID: 35985826 DOI: 10.1212/wnl.0000000000200989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the effects of enlarged perivascular space (EPVS) on amyloid burden and cognitive function in Alzheimer disease (AD) continuum. METHODS We retrospectively reviewed 208 patients with AD across the cognitive continuum (preclinical, prodromal, and AD dementia) who showed amyloid deposition on 18F-florbetaben PET scans and 82 healthy controls. EPVSs were counted for each patient in the basal ganglia (BG), centrum semiovale (CSO), and hippocampus (HP) on axial T2-weighted images. Patients were then classified according to the number of EPVSs into the EPVS+ (>10 EPVSs) and EPVS- (0-10 EPVSs) groups for the BG and CSO, respectively. In terms of HP-EPVS, equal or more than 7 EPVSs on bilateral hemisphere were regarded as the presence of HP-EPVS. After adjusting for markers of small vessel disease (SVD), multiple linear regression analyses were performed to determine the intergroup differences in global and regional amyloid deposition and cognitive function at the time of diagnosis of AD continuum. A linear mixed model was used to assess the effects of EPVSs on the longitudinal changes in the Mini-Mental State Examination (MMSE) scores. RESULTS Amyloid burden at the time of diagnosis of AD continuum was not associated with the degree of BG-, CSO-, or HP-EPVS. BG-EPVS affected language and frontal/executive function via SVD markers, and HP-EPVS was associated with general cognition via SVD markers. However, CSO-EPVS was not associated with baseline cognition. A higher number of CSO-EPVS was significantly associated with a more rapid decline in MMSE scores (β = -0.58, standard error = 0.23, p = 0.011) independent of the amyloid burden. In terms of BG and HP, there was no difference between the EPVS+ and EPVS- groups in the rate of longitudinal decreases in MMSE scores. DISCUSSION Our findings suggest that BG-, CSO-, and HP-EPVS are not associated with baseline β-amyloid burden or cognitive function independently of SVD at the diagnosis of AD continuum. However, CSO-EPVS appears to be associated with the progression of cognitive decline in an amyloid-independent manner. Further studies are needed to investigate whether CSO-EPVS is a potential therapeutic target in patients with AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Mincheol Park
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.H.J., M.P., B.S.Y., Y.H.S., S.J.C., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Inje University Sanggye Paik Hospital, Seoul, South Korea; Nash Family Center for Advanced Circuit Therapeutics (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (J.H.J.), Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Yonsei Beyond Lab (S.J.C.), Yongin, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
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Chung SJ, Kim YJ, Kim YJ, Lee HS, Yun M, Lee PH, Jeong Y, Sohn YH. Potential Link Between Cognition and Motor Reserve in Patients With Parkinson's Disease. J Mov Disord 2022; 15:249-257. [PMID: 36065615 DOI: 10.14802/jmd.22063] [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: 04/18/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate whether there is a link between cognitive function and motor reserve (i.e., individual capacity to cope with nigrostriatal dopamine depletion) in patients with newly diagnosed Parkinson's disease (PD). Methods A total of 163 patients with drug-naïve PD who underwent 18F-FP-CIT PET, brain MRI, and a detailed neuropsychological test were enrolled. We estimated individual motor reserve based on initial motor deficits and striatal dopamine depletion using a residual model. We performed correlation analyses between motor reserve estimates and cognitive composite scores. Diffusion connectometry analysis was performed to map the white matter fiber tracts, of which fractional anisotropy (FA) values were well correlated with motor reserve estimates. Additionally, Cox regression analysis was used to assess the effect of initial motor reserve on the risk of dementia conversion. Results The motor reserve estimate was positively correlated with the composite score of the verbal memory function domain (γ = 0.246) and with the years of education (γ = 0.251). Connectometry analysis showed that FA values in the left fornix were positively correlated with the motor reserve estimate, while no fiber tracts were negatively correlated with the motor reserve estimate. Cox regression analysis demonstrated that higher motor reserve estimates tended to be associated with a lower risk of dementia conversion (hazard ratio, 0.781; 95% confidence interval, 0.576-1.058). Conclusion The present study demonstrated that the motor reserve estimate was well correlated with verbal memory function and with white matter integrity in the left fornix, suggesting a possible link between cognition and motor reserve in patients with PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea.,YONSEI BEYOND LAB, Yongin, Korea
| | - Yae Ji Kim
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.,KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea.,YONSEI BEYOND LAB, Yongin, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Jeong
- YONSEI BEYOND LAB, Yongin, Korea.,Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.,Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Kim YJ, Park CW, Shin HW, Lee HS, Kim YJ, Yun M, Lee PH, Sohn YH, Jeong Y, Chung SJ. Identifying the white matter structural network of motor reserve in early Parkinson's disease. Parkinsonism Relat Disord 2022; 102:108-114. [PMID: 35987039 DOI: 10.1016/j.parkreldis.2022.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/26/2022] [Revised: 07/18/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Motor reserve refers to the individual capacity to cope with nigrostriatal dopamine depletion in Parkinson's disease (PD). This study aimed to explore the white matter structural network associated with motor reserve in patients with newly diagnosed PD. METHODS A total of 238 patients with early-stage drug-naïve PD who underwent 18F-FP-CIT PET and brain MRI scans at initial assessment were enrolled. We estimated individual motor reserve based on the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) scores and dopamine transporter availability in the posterior putamen using a residual model. Then, we performed threshold-free network-based statistics (TFNBS) analysis to identify the structural brain network associated with the estimated motor reserve. We also assessed the effect of the network connectivity strength on the longitudinal increase in levodopa-equivalent dose (LED). RESULTS The mean age at PD symptom onset was 69.10 ± 9.03 years and the mean UPDRS-III score at the time of PD diagnosis was 22.44 ± 9.72. TFNBS analysis identified a motor reserve-associated structural network whose nodes were mainly in the frontal region and cerebellum. Higher network strength (i.e., greater motor reserve) was associated with a slower longitudinal increase in LED during a 3-year follow-up period. CONCLUSION The structural brain network is associated with motor reserve in patients with PD. Connectivity strength within the identified network indicates the individual's capacity to tolerate PD-related pathologies, which is maintained with disease progression and affects the long-term motor prognosis of PD.
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Affiliation(s)
- Yae Ji Kim
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Shin
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; YONSEI BEYOND LAB, Yongin, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; YONSEI BEYOND LAB, Yongin, South Korea.
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Yoo HS, Lee EC, Chung SJ, Ye BS, Sohn YH, Seong JK, Lee PH. Contracted thalamic shape is associated with early development of levodopa-induced dyskinesia in Parkinson's disease. Sci Rep 2022; 12:12631. [PMID: 35879381 PMCID: PMC9314442 DOI: 10.1038/s41598-022-16747-6] [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: 02/25/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023] Open
Abstract
Levodopa-induced dyskinesia (LID), a long-term motor complication in Parkinson’s disease (PD), is attributable to both presynaptic and postsynaptic mechanisms. However, no studies have evaluated the baseline structural changes associated with LID at a subcortical level in PD. A total of 116 right-handed PD patients were recruited and based on the LID latency of 5 years, we classified patients into those vulnerable to LID (PD-vLID, n = 49) and those resistant to LID (PD-rLID, n = 67). After adjusting for covariates including dopamine transporter (DAT) availability of the posterior putamen, we compared the subcortical shape between the groups and investigated its association with the onset of LID. The PD-vLID group had lower DAT availability in the posterior putamen, higher parkinsonian motor deficits, and faster increment in levodopa equivalent dose than the PD-rLID group. The PD-vLID group had significant inward deformation in the right thalamus compared to the PD-rLID group. Inward deformation in the thalamus was associated with an earlier onset of LID at baseline. This study suggests that independent of presynaptic dopamine depletion, the thalamus is a major neural substrate for LID and that a contracted thalamic shape at baseline is closely associated with an early development of LID.
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Affiliation(s)
- Han Soo Yoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Chong Lee
- School of Biomedical Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea. .,Department of Artificial Intelligence, Korea University, Seoul, South Korea. .,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. .,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Jeong SH, Lee HS, Lee PH, Sohn YH, Chung SJ. Does dopamine deficiency affect sex-dependent prognosis in Parkinson's disease? Parkinsonism Relat Disord 2022; 102:57-63. [DOI: 10.1016/j.parkreldis.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
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Lee JE, Shin YJ, Kim YS, Kim HN, Kim DY, Chung SJ, Yoo HS, Shin JY, Lee PH. Uric Acid Enhances Neurogenesis in a Parkinsonian Model by Remodeling Mitochondria. Front Aging Neurosci 2022; 14:851711. [PMID: 35721028 PMCID: PMC9201452 DOI: 10.3389/fnagi.2022.851711] [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: 01/10/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Adult neurogenesis is the process of generating new neurons to enter neural circuits and differentiate into functional neurons. However, it is significantly reduced in Parkinson’s disease (PD). Uric acid (UA), a natural antioxidant, has neuroprotective properties in patients with PD. This study aimed to investigate whether UA would enhance neurogenesis in PD. Methods We evaluated whether elevating serum UA levels in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonian mouse model would restore neurogenesis in the subventricular zone (SVZ). For a cellular model, we primary cultured neural precursor cells (NPCs) from post-natal day 1 rat and evaluated whether UA treatment promoted cell proliferation against 1-methyl-4-phenylpyridinium (MPP+). Results Uric acid enhanced neurogenesis in both in vivo and in vitro parkinsonian model. UA-elevating therapy significantly increased the number of bromodeoxyuridine (BrdU)-positive cells in the SVZ of PD animals as compared to PD mice with normal UA levels. In a cellular model, UA treatment increased the expression of Ki-67. In the process of modulating neurogenesis, UA elevation up-regulated the expression of mitochondrial fusion markers. Conclusion In MPTP-induced parkinsonian model, UA probably enhanced neurogenesis via regulating mitochondrial dynamics, promoting fusion machinery, and inhibiting fission process.
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Affiliation(s)
- Ji Eun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yu Jin Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yi Seul Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Na Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Yeol Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University, Seoul, South Korea
- *Correspondence: Phil Hyu Lee,
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Jeon J, Kim K, Baek K, Chung SJ, Yoon J, Kim YJ. Accuracy of Machine Learning Using the Montreal Cognitive Assessment for the Diagnosis of Cognitive Impairment in Parkinson’s Disease. J Mov Disord 2022; 15:132-139. [PMID: 35670022 PMCID: PMC9171310 DOI: 10.14802/jmd.22012] [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: 01/22/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The Montreal Cognitive Assessment (MoCA) is recommended for assessing general cognition in Parkinson’s disease (PD). Several cutoffs of MoCA scores for diagnosing PD with cognitive impairment (PD-CI) have been proposed, with varying sensitivity and specificity. This study investigated the utility of machine learning algorithms using MoCA cognitive domain scores for improving diagnostic performance for PD-CI. Methods In total, 2,069 MoCA results were obtained from 397 patients with PD enrolled in the Parkinson’s Progression Markers Initiative database with a diagnosis of cognitive status based on comprehensive neuropsychological assessments. Using the same number of MoCA results randomly sampled from patients with PD with normal cognition or PD-CI, discriminant validity was compared between machine learning (logistic regression, support vector machine, or random forest) with domain scores and a cutoff method. Results Based on cognitive status classification using a dataset that permitted sampling of MoCA results from the same individual (n = 221 per group), no difference was observed in accuracy between the cutoff value method (0.74 ± 0.03) and machine learning (0.78 ± 0.03). Using a more stringent dataset that excluded MoCA results (n = 101 per group) from the same patients, the accuracy of the cutoff method (0.66 ± 0.05), but not that of machine learning (0.74 ± 0.07), was significantly reduced. Inclusion of cognitive complaints as an additional variable improved the accuracy of classification using the machine learning method (0.87–0.89). Conclusion Machine learning analysis using MoCA domain scores is a valid method for screening cognitive impairment in PD.
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Affiliation(s)
- Junbeom Jeon
- Department of Computer Engineering, Hallym University, Chuncheon, Korea
| | - Kiyong Kim
- Department of Electronic Engineering, Kyonggi University, Suwon, Korea
| | - Kyeongmin Baek
- Department of Computer Engineering, Hallym University, Chuncheon, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jeehee Yoon
- Department of Computer Engineering, Hallym University, Chuncheon, Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- Corresponding author: Yun Joong Kim, MD, PhD Department of Neurology, Yongin Severance Hospital, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin 16995, Korea / Tel: +82-31-5189-8140 / Fax: +82-31-5189-8565 / E-mail:
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Jeong SH, Lee HS, Jung JH, Baik K, Sohn YH, Chung SJ, Lee PH. Associations between white matter hyperintensities, striatal dopamine loss, and cognition in drug-naïve Parkinson's disease. Parkinsonism Relat Disord 2022; 97:1-7. [PMID: 35276583 DOI: 10.1016/j.parkreldis.2022.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 12/13/2021] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study investigated the relationship between white matter hyperintensities (WMHs), nigrostriatal dopamine deficits, and cognitive decline in patients with drug-naïve early-stage Parkinson's disease (PD). METHOD This cross-sectional study enrolled 309 non-demented patients with de novo PD who underwent [18F] N-(3-fluoropropyl)-2β-carbonethoxy-3β-(4-iodophenyl) nortropane positron emission tomography, brain magnetic resonance imaging, and a detailed neuropsychological test at baseline. We quantified dopamine transporter (DAT) availability in each striatal sub-region and applied the Scheltens scale to assess the severity of periventricular and deep WMHs. The relationships between WMHs, DAT availability, and cognition in PD were assessed using multivariate linear regression and mediation analyses while adjusting for age at parkinsonian symptom onset, sex, disease duration, and vascular risk factors. RESULTS The severities of periventricular and frontal WMHs were associated with striatal DAT availability. Periventricular WMHs affected the level of cognitive performance in all cognitive domains, while frontal WMHs affected the attention/working memory and frontal/executive function domains. The effects of WMHs on attention/working memory and frontal/executive dysfunction were mostly direct with minimal mediating effects through striatal DAT availability. Meanwhile, striatal DAT availability fully mediated the association between WMHs and cognitive impairment in the visuospatial and memory function domains. CONCLUSION This study demonstrated the different effects of WMHs on cognitive impairment depending on the cognitive domains in PD. These findings suggest a close link between comorbid WMHs, striatal dopamine depletion, and cognition in patients with PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea; Dementia and Neurodegenerative Disease Research Center, Inje University, Busan, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Chung SJ, Chang Y, Jeon J, Shin JI, Song TJ, Kim J. Association of Alzheimer's Disease with COVID-19 Susceptibility and Severe Complications: A Nationwide Cohort Study. J Alzheimers Dis 2022; 87:701-710. [PMID: 35275548 DOI: 10.3233/jad-220031] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Identification of patients at high susceptibility and high risk of developing serious complications related to coronavirus disease 2019 (COVID-19) infection is clinically important in the face of the COVID-19 pandemic. OBJECTIVE To investigate whether patients with Alzheimer's disease (AD) are more susceptible to COVID-19 infection and whether they have a higher risk of developing serious complications. METHODS We retrospectively reviewed the Korean nationwide population-based COVID-19 dataset for participants who underwent real-time reverse transcription polymerase chain reaction assays for COVID-19 between January 1 and June 4, 2020. A 1 : 3 ratio propensity score matching and binary logistic regression analysis were performed to investigate the association between AD and the susceptibility or severe complications (i.e., mechanical ventilation, intensive care unit admission, or death) of COVID-19. RESULTS Among 195,643 study participants, 5,725 participants had AD and 7,334 participants were diagnosed with COVID-19. The prevalence of participants testing positive for COVID-19 did not differ according to the presence of AD (p = 0.234). Meanwhile, AD was associated with an increased risk of severe COVID-19 complications (OR 2.25 [95% CI 1.54-3.28]). Secondary outcome analyses showed that AD patients had an increased risk for mortality (OR 3.09 [95% CI 2.00-4.78]) but were less likely to receive mechanical ventilation (OR 0.42 [95% CI 0.20-0.87]). CONCLUSION AD was not associated with increased susceptibility to COVID-19 infection, but was associated with severe COVID-19 complications, especially with mortality. Early diagnosis and active intervention are necessary for patients with AD suspected COVID-19 infection.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jimin Jeon
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chung SJ, Kim YJ, Jung JH, Lee HS, Ye BS, Sohn YH, Jeong Y, Lee PH. Association Between White Matter Connectivity and Early Dementia in Patients With Parkinson Disease. Neurology 2022; 98:e1846-e1856. [PMID: 35190467 DOI: 10.1212/wnl.0000000000200152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Several clinical and neuroimaging biomarkers have been proposed to identify individuals with Parkinson's disease (PD) who are at risk for ongoing cognitive decline. This study aimed to explore whether white matter (WM) connectivity disruption is associated with dementia conversion in patients with newly diagnosed PD with mild cognitive impairment (PD-MCI). METHODS Seventy-five patients with drug-naïve PD-MCI who underwent serial cognitive assessments during the follow-up period (>5 years) were enrolled for the neuroimaging analyses. The patients were classified into either the PD with dementia (PDD) high-risk group (PDD-H, n = 38) or low-risk group (PDD-L, n = 37), depending on whether they converted to dementia within 5 years of PD diagnosis. We conducted degree-based statistic analyses based on a graph-theoretical concept to identify the subnetworks whose WM connectivity was disrupted in the PDD-H group compared with the PDD-L group. RESULTS The PDD-H group showed poorer cognitive performance on frontal/executive, visual memory/visuospatial, and attention/working memory/language function than the PDD-L group at baseline assessment. The PDD-H group exhibited more severely disrupted WM connectivity in both frontal and posterior cortical regions with eight hub nodes in the degree-based statistic analysis. The strength of structural connectivity within the identified subnetworks was correlated with the composite scores of frontal/executive function domain (γ = 0.393) and the risk score of PDD conversion within 5 years (γ = -0.480). CONCLUSIONS This study demonstrated that disrupted WM connectivity in frontal and posterior cortical regions, which correlated with frontal/executive dysfunction, is associated with early dementia conversion in PD-MCI.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Yae Ji Kim
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.,KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea.,Dementia and Neurodegenerative Disease Research Center, Inje University, Busan, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.,KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.,Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; .,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Vignando M, Ffytche D, Lewis SJG, Lee PH, Chung SJ, Weil RS, Hu MT, Mackay CE, Griffanti L, Pins D, Dujardin K, Jardri R, Taylor JP, Firbank M, McAlonan G, Mak HKF, Ho SL, Mehta MA. Author Correction: Mapping brain structural differences and neuroreceptor correlates in Parkinson's disease visual hallucinations. Nat Commun 2022; 13:971. [PMID: 35169136 PMCID: PMC8847348 DOI: 10.1038/s41467-022-28491-6] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Miriam Vignando
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Dominic Ffytche
- Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Phil Hyu Lee
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1M 3BG, UK
- Wellcome Centre for Neuroimaging, University College London, London, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clare E Mackay
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Delphine Pins
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Renaud Jardri
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - John-Paul Taylor
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Grainne McAlonan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Henry K F Mak
- Division of Neurology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Shu Leong Ho
- Division of Neurology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mitul A Mehta
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Vignando M, Ffytche D, Lewis SJG, Lee PH, Chung SJ, Weil RS, Hu MT, Mackay CE, Griffanti L, Pins D, Dujardin K, Jardri R, Taylor JP, Firbank M, McAlonan G, Mak HKF, Ho SL, Mehta MA. Mapping brain structural differences and neuroreceptor correlates in Parkinson's disease visual hallucinations. Nat Commun 2022; 13:519. [PMID: 35082285 PMCID: PMC8791961 DOI: 10.1038/s41467-022-28087-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 02/23/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022] Open
Abstract
Parkinson's psychosis (PDP) describes a spectrum of symptoms that may arise in Parkinson's disease (PD) including visual hallucinations (VH). Imaging studies investigating the neural correlates of PDP have been inconsistent in their findings, due to differences in study design and limitations of scale. Here we use empirical Bayes harmonisation to pool together structural imaging data from multiple research groups into a large-scale mega-analysis, allowing us to identify cortical regions and networks involved in VH and their relation to receptor binding. Differences of morphometrics analysed show a wider cortical involvement underlying VH than previously recognised, including primary visual cortex and surrounding regions, and the hippocampus, independent of its role in cognitive decline. Structural covariance analyses point to the involvement of the attentional control networks in PD-VH, while associations with receptor density maps suggest neurotransmitter loss may be linked to the cortical changes.
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Affiliation(s)
- Miriam Vignando
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Dominic Ffytche
- Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Phil Hyu Lee
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1M 3BG, UK
- Wellcome Centre for Neuroimaging, University College London, London, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clare E Mackay
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Delphine Pins
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Renaud Jardri
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - John-Paul Taylor
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Grainne McAlonan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Henry K F Mak
- Division of Neurology, Dept of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Shu Leong Ho
- Division of Neurology, Dept of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mitul A Mehta
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Jeong SH, Chung SJ, Yoo HS, Jung JH, Baik K, Lee YH, Lee PH, Sohn YH. Premorbid Educational Attainment and Long-Term Motor Prognosis in Parkinson's Disease. J Parkinsons Dis 2022; 12:129-136. [PMID: 34542032 DOI: 10.3233/jpd-212791] [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] [Indexed: 06/13/2023]
Abstract
BACKGROUND Premorbid educational attainment is a well-known proxy of reserve, not only with regard to cognition, but also to motor symptoms. OBJECTIVE In the present study, we investigated the relationship between educational attainment and long-term motor prognosis in patients with Parkinson's disease (PD). METHODS We analyzed 466 patients with de novo PD without dementia who underwent dopamine transporter (DAT) scans and were followed up more than 2 years. Patients were divided into three groups: low education (years-of-education ≤6, n = 125), intermediate education (6 <years-of-education < 12, n = 108), and high education (years-of-education ≥12, n = 233). The effects of educational attainment on the development of levodopa-induced dyskinesia (LID), wearing-off, and freezing-of-gait, and longitudinal increase in levodopa-equivalent doses (LEDs) were assessed. RESULTS Multiple regression analysis showed that higher education was associated with milder parkinsonian symptoms after adjusting for DAT availability in the posterior putamen. Survival analysis showed that the rate of LID was significantly lower in the high education group than in the low education group (HR = 0.565, p = 0.010). A linear mixed model showed that the high education group had lower LED than the low education group until a period of 30 months; however, this difference in LED was not observed thereafter. CONCLUSION The present study demonstrated that premorbid educational attainment has protective effects on the development of LID in patients with PD and has sparing effects on LED during the early treatment period. These results suggest that high educational attainment has a beneficial effect on motor outcomes in patients with PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
BACKGROUND The concept of motor reserve explains the individual differences in motor deficits despite similar degrees of nigrostriatal dopamine depletion in Parkinson's disease (PD). OBJECTIVE To investigate glucocerebrosidase (GBA) variants as potential determinants of motor reserve for exploratory purposes. METHODS A total of 408 patients with drug-naïve PD were enrolled from the Parkinson's Progression Markers Initiative cohort database. All patients underwent SPECT dopamine transporter (DAT) scans and had results for Sanger sequencing of GBA. Parkinsonian motor deficits were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III). We compared MDS-UPDRS-III scores while adjusting for DAT availability in the putamen (i.e., motor reserve) between the PD groups according to the presence of GBA mutations. RESULTS Fifty-four (13.2%) patients carried GBA mutations. PD patients with GBA mutations were younger than those without mutations. There were no significant differences in sex, disease duration, years of education, and striatal DAT availability between the PD groups. PD patients with GBA mutations had higher MDS-UPDRS-III scores for the less affected side than those without mutations, despite similar levels of DAT availability in the contralateral putamen. The MDS-UPDRS-III sub-scores of the more affected side did not differ between the two PD groups. CONCLUSION The results of this study demonstrated the detrimental effect of GBA variants on individual capacity to cope with PD-related pathologies, with different impacts depending on the motor laterality.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
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Chung SJ, Kim YJ, Yoo HS, Jung JH, Baik K, Lee HS, Lee YH, Hong JM, Sohn YH, Lee PH. Temporalis Muscle Thickness as an Indicator of Sarcopenia Is Associated With Long-term Motor Outcomes in Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:2242-2248. [PMID: 33754634 DOI: 10.1093/gerona/glab082] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To investigate the relationship between temporalis muscle thickness (TMT) at baseline as a surrogate marker for sarcopenia and long-term motor outcomes in patients with Parkinson's disease (PD). METHODS We enrolled 249 patients with drug-naïve early-stage PD (119 males and 130 females, follow-up > 3 years). Baseline TMT of each patient was measured on the axial plane of T1-weighted images. The association between baseline TMT and long-term motor outcomes in PD was assessed using Cox regression models for levodopa-induced dyskinesia, wearing-off, and freezing of gait and a linear mixed model for the longitudinal increases in levodopa-equivalent dose per body weight over time. Statistical analyses were performed separately for sex if an interaction effect between TMT and sex was assumed. RESULTS TMT differed substantially between the sexes, and male PD patients had higher TMT (6.69 ± 1.39 mm) than female PD patients (5.64 ± 1.34 mm, p < .001). Cox regression models demonstrated that baseline TMT was not associated with the risk of developing levodopa-induced dyskinesia, wearing-off, or freezing of gait during the follow-up period. The linear mixed model was applied separately for sex and demonstrated that higher TMT at baseline was associated with slower increases in levodopa-equivalent dose per body weight in male PD patients, but not in female PD patients. CONCLUSIONS This study demonstrated that baseline TMT could be an indicator of the longitudinal requirement for dopaminergic medications in male patients with PD, suggesting that sarcopenia may have a detrimental effect on disease progression in PD in a sex-specific manner.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Ji-Man Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Jung JH, Kim YJ, Chung SJ, Yoo HS, Lee YH, Baik K, Jeong SH, Lee YG, Lee HS, Ye BS, Sohn YH, Jeong Y, Lee PH. White matter connectivity networks predict levodopa-induced dyskinesia in Parkinson's disease. J Neurol 2021; 269:2948-2960. [PMID: 34762146 DOI: 10.1007/s00415-021-10883-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although levodopa-induced dyskinesia-relevant white matter change has been evaluated, it is uncertain whether these changes may reflect the underlying predisposing conditions leading to the development of levodopa-induced dyskinesia. OBJECTIVE To elucidate the role of white matter connectivity networks in the development of levodopa-induced dyskinesia in drug-naïve Parkinson's disease. METHODS We recruited 30 patients who developed levodopa-induced dyskinesia within 5 years from MRI acquisition (vulnerable-group), 47 patients who had not developed levodopa-induced dyskinesia within 5 years (resistant-group), and 28 controls. We performed comparative analyses of whole-brain white matter integrity and connectivity using tract-based spatial and network- and degree-based statistics. We evaluated the predictability of levodopa-induced dyskinesia development and relationship with its latency, using the average connectivity strength as a predictor in Cox- and linear-regression, respectively. RESULTS Mean-diffusivity was lower mainly at the left frontal region in the vulnerable-group compared to the resistant-group. Network-based statistics identified a subnetwork consisting of the bilateral fronto-striato-pallido-thalamic and lateral parietal regions (subnetwork A) and degree-based statistics identified four subnetworks (hub-subnetwork) consisting of edges centered on the left superior frontal gyrus, left putamen, left insular, or left precentral gyrus, where the vulnerable-group had stronger connectivity compared to the resistant-group. Stronger connectivity within the subnetwork A and hub-subnetwork centered on the left superior frontal gyrus was a predictor of levodopa-induced dyskinesia development independent of known risk factors and had an inverse relationship with its latency. CONCLUSIONS Our data suggest that white matter connectivity subnetworks within corticostriatal regions play a pivotal role in the development of levodopa-induced dyskinesia.
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Affiliation(s)
- Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yae Ji Kim
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Ho Jeong
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Young Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
- KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Chung SJ, Lee TY, Lee YH, Baik K, Jung JH, Yoo HS, Shim CJ, Eom H, Hong JY, Kim DJ, Sohn YH, Lee PH. Phase I Trial of Intra-arterial Administration of Autologous Bone Marrow-Derived Mesenchymal Stem Cells in Patients with Multiple System Atrophy. Stem Cells Int 2021; 2021:9886877. [PMID: 34712335 PMCID: PMC8548132 DOI: 10.1155/2021/9886877] [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: 07/18/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study is aimed at investigating the safety and tolerability of the intra-arterial administration of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) in patients with multiple system atrophy- (MSA-) cerebellar type (MSA-C). METHODS This was a single-center, open-label phase I clinical trial in patients with MSA-C. A three-stage dose escalation scheme (low-dose, 3.0 × 105 cells/kg; medium-dose, 6.0 × 105 cells/kg; high-dose, 9.0 × 105 cells/kg) was applied to determine the maximum tolerated dose of intra-arterial administration of BM-MSCs based on the no-observed-adverse-effect level derived from the toxicity study. The occurrence of adverse events was evaluated 1 day before and 1, 14, and 28 days after BM-MSC therapy. Additionally, we assessed changes in the Unified MSA Rating Scale (UMSARS) score 3 months after BM-MSC treatment. RESULTS One serious adverse drug reaction (ADR) of leptomeningeal enhancement following the intra-arterial BM-MSC administration occurred in one patient in the low-dose group. The safety review of the Internal Monitoring Committee interpreted this as radiological evidence of the blood-brain barrier permeability for MSCs. No other ADRs were observed in the medium- or high-dose groups. In particular, no ischemic lesions on diffusion-weighted images were observed in any of the study participants. Additionally, the medium- and high-dose groups tended to show a slower increase in UMSARS scores than the low-dose group during the 3-month follow-up. CONCLUSION The present study confirmed that a single intra-arterial administration of autologous BM-MSCs is a safe and promising neuroprotective strategy in patients with MSA-C.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin 16995, Republic of Korea
| | - Tae Yong Lee
- Bioengineering Institute, CORESTEM Inc., Seoul 04763, Republic of Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chang Jae Shim
- Bioengineering Institute, CORESTEM Inc., Seoul 04763, Republic of Korea
| | - Hyojin Eom
- Bioengineering Institute, CORESTEM Inc., Seoul 04763, Republic of Korea
| | - Ji-Yeon Hong
- Bioengineering Institute, CORESTEM Inc., Seoul 04763, Republic of Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young H. Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Choi H, Ko Y, Lee CY, Chung SJ, Kim HI, Kim JH, Park S, Hwang YI, Jang SH, Jung KS, Kim YK, Park JY. Impact of COVID-19 on TB epidemiology in South Korea. Int J Tuberc Lung Dis 2021; 25:854-860. [PMID: 34615583 DOI: 10.5588/ijtld.21.0255] [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] [Indexed: 11/10/2022] Open
Abstract
SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.
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Affiliation(s)
- H Choi
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
| | - Y Ko
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - C Y Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - S J Chung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Dongtan, Korea
| | - H I Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J-H Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y I Hwang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S H Jang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - K-S Jung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y K Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - J Y Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea, Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Lee YH, Jeon S, Yoo HS, Chung SJ, Jung JH, Baik K, Sohn YH, Lee PH, Yun M, Evans AC, Ye BS. Effect of Alzheimer's Disease and Lewy Body Disease on Metabolic Changes. J Alzheimers Dis 2021; 79:1471-1487. [PMID: 33459638 DOI: 10.3233/jad-201094] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The relationship among amyloid-β (Aβ) deposition on amyloid positron emission tomography (PET), cortical metabolism on 18F-fluoro-2-deoxy-D-glucose (FDG)-PET, and clinical diagnosis has not been elucidated for both Alzheimer's disease (AD) and Lewy body disease (LBD). OBJECTIVE We investigated the patterns of cerebral metabolism according to the presence of AD and LBD. METHODS A total of 178 subjects were enrolled including 42 pure AD, 32 pure LBD, 34 Lewy body variant AD (LBVAD), 15 LBD with amyloid, 26 AD with dementia with Lewy bodies (DLB), and 29 control subjects. Pure AD, LBVAD, and AD with DLB groups had biomarker-supported diagnoses of typical AD, while pure LBD, LBD with amyloid, and AD with DLB groups had biomarker-supported diagnoses of typical LBD. Typical AD and LBD with amyloid showed amyloid-positivity on 18F-florbetaben (FBB) PET, while typical LBD and LBVAD had abnormalities on dopamine transporter PET. We measured regional patterns of glucose metabolism using FDG-PET and evaluated their relationship with AD and LBD. RESULTS Compared with control group, typical AD and typical LBD commonly exhibited hypometabolism in the bilateral temporo-parietal junction, precuneus, and posterior cingulate cortex. Typical AD showed an additional hypometabolism in the entorhinal cortex, while patients with dopamine transporter abnormality-supported diagnosis of LBD showed diffuse hypometabolism that spared the sensory-motor cortex. Although the diffuse hypometabolism in LBD also involved the occipital cortex, prominent occipital hypometabolism was only seen in LBD with amyloid group. CONCLUSION Combining clinical and metabolic evaluations may enhance the diagnostic accuracy of AD, LBD, and mixed disease cases.
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Affiliation(s)
- Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seun Jeon
- McGill Center for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Alan C Evans
- McGill Center for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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48
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Chung SJ, Cho KH, Lee YH, Yoo HS, Baik K, Jung JH, Ye BS, Sohn YH, Cha J, Lee PH. Diffusion tensor imaging-based pontine damage as a degeneration marker in synucleinopathy. J Neurosci Res 2021; 99:2922-2931. [PMID: 34521154 DOI: 10.1002/jnr.24926] [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: 11/07/2020] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 11/08/2022]
Abstract
The pons is one of the earliest affected regions in patients with synucleinopathies. We aimed to investigate the diagnostic value of measuring pontine damage using diffusion tensor imaging (DTI) in these patients. We enrolled 49 patients with Parkinson's disease (PD), 16 patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), 23 patients with multiple system atrophy (MSA), and 39 healthy controls in this study. All the participants underwent high-resolution T1-weighted imaging and DTI. Mean diffusivity (MD) and fraction anisotropy (FA) values in the pons were calculated to characterize structural damage. The discriminatory power of pontine MD and FA values to differentiate patients with synucleinopathies from healthy controls was examined using receiver operating characteristics (ROC) analyses. Compared to healthy controls, patients with PD, iRBD, and MSA had increased MD values and decreased FA values in the pons, although no correlation was observed between these DTI measures and disease severity. The ROC analyses showed that MD values in the pons had a fair discriminatory power to differentiate healthy controls from patients with PD (area under the curve [AUC], 0.813), iRBD (AUC, 0.779), and MSA (AUC, 0.951). The AUC for pontine FA values was smaller than that for pontine MD values when differentiating healthy controls from patients with PD (AUC, 0.713; p = 0.054) and iRBD (AUC, 0.686; p = 0.045). Our results suggest that MD values in the pons may be a useful marker of brain stem neurodegeneration in patients with synucleinopathies.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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49
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Yoo HS, Kwon H, Chung SJ, Sohn YH, Lee JM, Lee PH. Neural correlates of self-awareness of cognitive deficits in non-demented patients with Parkinson's disease. Eur J Neurol 2021; 28:4022-4030. [PMID: 34478599 DOI: 10.1111/ene.15095] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate the neural correlates of impaired self-awareness of cognitive deficits (IACd) in non-demented patients with Parkinson's disease (PD). METHODS This cross-sectional study enrolled 153 drug-naïve and non-demented PD patients who underwent brain magnetic resonance imaging, dopamine transporter (DAT) positron emission tomography, detailed neuropsychological testing, and the Cognitive Complaints Interview at baseline. Based on the presence of mild cognitive impairment and subjective cognitive complaints, patients were grouped into those with IACd (PD-IACd+, n = 33) and those with normal recognition of cognitive function (n = 82) or underestimation of cognitive function (n = 38). Cortical thickness, white matter (WM) integrity, DAT availability and cognitive function were compared between the groups. RESULTS The prevalence of IACd was 21.6% in drug-naïve patients with PD. The PD-IACd+ group had a lower z-score in the Stroop color reading test than the other groups. Patients in the PD-IACd+ group had WM disintegrity, especially in the genu of the corpus callosum and anterior limb of the internal capsule, compared to those without IACd, whilst cortical thickness or striatal DAT availability was comparable regardless of the presence of IACd. Amongst patients with mild cognitive impairment, those with IACd had more severe WM disintegrity than those without IACd. CONCLUSION Structural connectivity between and from the frontal lobes is closely associated with self-awareness of cognitive deficits in PD. Evaluating frontal structural connectivity from the early stages of PD will be important in assessing the actual cognitive and daily life performance of patients with PD.
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Affiliation(s)
- Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeokjin Kwon
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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50
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Jeong SH, Lee HS, Chung SJ, Yoo HS, Jung JH, Baik K, Lee YH, Sohn YH, Lee PH. Effects of statins on dopamine loss and prognosis in Parkinson's disease. Brain 2021; 144:3191-3200. [PMID: 34347020 DOI: 10.1093/brain/awab292] [Citation(s) in RCA: 4] [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] [Received: 03/24/2021] [Revised: 06/13/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Statins are more widely used not only for the primary and secondary prevention of cardiovascular disease by blocking cholesterol biosynthesis but also for the potential neuroprotective agents during neurological disorders due to their pleiotropic effects. In this study, we investigate whether the prior use of statins affect baseline nigrostriatal dopamine loss at the time of diagnosis and longitudinal motor and cognitive outcomes in patients with Parkinson's disease. Five hundred drug-naïve patients with Parkinson's disease who underwent dopamine transporter imaging were classified into two groups according to the prior use of statins: patients with and without statin use. Multivariate linear regression was used to determine inter-group differences in dopamine transporter availability. We evaluated the longitudinal changes in levodopa-equivalent dose and dementia conversion between the groups using a linear mixed model and survival analysis, respectively. In addition, mediation analysis was applied to examine the effect of total cholesterol. Patients with Parkinson's disease treated with statin had a lower baseline dopamine transporter availability in the anterior (2.13 ± 0.55 vs. 2.37 ± 0.67; p = 0.002), posterior (1.31 ± 0.43 vs. 1.49 ± 0.54; p = 0.003), and ventral putamina (1.40 ± 0.39 vs. 1.56 ± 0.47; p = 0.002) than that in matched patients with Parkinson's disease without statin. After adjusting for age at symptom onset, sex, disease duration and vascular risk factors, linear regression models showed that a prior treatment of statin remained significantly and independently associated with more severely decreased dopamine transporter availability in the anterior putamen (Beta = -0.140, p = 0.004), posterior putamen (Beta = -0.162, p = 0.001), and ventral putamen (Beta = -0.140, p = 0.004). A linear mixed model revealed that patients with Parkinson's disease being treated with statin had a faster longitudinal increase in levodopa-equivalent dose than those without statin. A survival analysis showed that the rate of dementia conversion was significantly higher in patients with Parkinson's disease with statin (hazard ratio, 2.019; 95% CI, 1.108 - 3.678; P = 0.022) than those without statin. Mediation analyses revealed that the effect of statin treatment on baseline dopamine transporter availability and longitudinal outcome was not mediated by total cholesterol levels. This study suggests that statin use may have a detrimental effect on baseline nigrostriatal dopamine degeneration and long-term outcomes in patients with Parkinson's disease.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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