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Carlier J, Le Goff F, Pouliquen D, Bliaux E, Bioux S, Gerardin E, Cruypeninck Y, Segobin S, Savouré A, Martinaud O. Evaluation of the cognitive outcome after out-of-hospital cardiac arrest: the role of thalamus. Eur J Neurosci 2023. [PMID: 37066486 DOI: 10.1111/ejn.15978] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
Cardiac arrest survivors develop a variety of neuropsychological impairments and neuroanatomical lesions. The goal of this study is to evaluate if brain Voxel-Based Morphometry and lesional Magnetic Resonance Imaging (MRI) analyses performed in the acute phase of an Out-of-Hospital Cardiac Arrest (OHCA) can be sensitive enough to predict the persistence of neuropsychological disorders beyond three months. Survivors underwent a prospective brain MRI during the first month after an OHCA, and performed neuropsychological assessments at one and three months. According to the second neuropsychological assessment, survivors were separated into two subgroups, a deficit subgroup with persistent memory, executive functions, attention and/or praxis disorders (n = 11) and a preserved subgroup, disorders free (n = 14). Brain vascular lesion images were investigated and volumetric changes were compared with healthy controls. Correlations were discussed between brain MRI results, OHCA data, and the second neuropsychological assessment. Analyses of acute ischemic lesions did not reveal significant differences between the two subgroups (p = 0.35) and correlations with cognitive impairments could not be assessed. Voxel-Based Morphometry analyses revealed a global cerebral volume reduction for the two subgroups, and a clear decrease of the right thalamic volume for the deficit subgroup. It was associated with a cognitive dysexecutive syndrome represented by four executive indexes according to the "Groupe de Réflexion pour l'Evaluation des Fonctions EXécutives" criteria. The right thalamus atrophy seems to be more predictive than the vascular lesions, and more specific than a global cerebral volume reduction of post-OHCA neuropsychological executive disorders.
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Affiliation(s)
- Jasmine Carlier
- Neurology Department, Rouen University Hospital, Rouen, France
- Neurology Department, Pierre Paul Riquet University Hospital, Toulouse, France
| | | | | | | | - Sandrine Bioux
- Neurology Department, Rouen University Hospital, Rouen, France
| | | | - Yohann Cruypeninck
- Radiology Department, Rouen University Hospital, Rouen, France
- Radiology Department, Fécamp Hospital, Fécamp, France
| | - Shailendra Segobin
- Normandie UNIV, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, Neuropsychologie et Imagerie de la mémoire humaine, Caen, France
| | - Arnaud Savouré
- Cardiology Department, Rouen University Hospital, Rouen, France
| | - Olivier Martinaud
- Neurology Department, Rouen University Hospital, Rouen, France
- Normandie UNIV, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, Neuropsychologie et Imagerie de la mémoire humaine, Caen, France
- Neurology Department, Caen University Hospital, Caen, France
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Dougherty RJ, Liu F, An Y, Wanigatunga AA, Tian Q, Davatzikos C, Simonsick EM, Ferrucci L, Resnick SM, Schrack JA. Energetic Cost of Walking and Brain Atrophy in Mid-to-Late Life. J Gerontol A Biol Sci Med Sci 2022; 77:2068-2076. [PMID: 34628503 PMCID: PMC9536456 DOI: 10.1093/gerona/glab309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Higher energetic costs for mobility are associated with declining gait speed, and slow gait is linked to cognitive decline and Alzheimer's disease. However, the physiological underpinnings of gait and brain health have not been well explored. We examined the associations of the energetic cost of walking with brain volume in cognitively unimpaired adults from the Baltimore Longitudinal Study of Aging. METHODS We used brain magnetic resonance imaging (MRI) data from 850 participants (mean baseline age 66.3 ± 14.5 years), of whom 451 had longitudinal MRI data (2.8 ± 1.0 MRI scans over 4.0 ± 2.0 years). The energetic cost of walking was assessed as the average energy expended (V̇O2) during 2.5 minutes of customary-paced overground walking. Multivariable linear mixed-effects models examined the associations between baseline energetic cost of walking and regional brain volumes adjusting for covariates. RESULTS At baseline, higher energetic cost of walking was cross-sectionally associated with lower gray and white matter volumes within the frontal, parietal, and temporal lobes, as well as hippocampal, total brain, and larger ventricular volumes (all false-discovery rate [FDR] p < .05). A baseline energetic cost of walking × time interaction demonstrated that participants with higher energetic cost of walking had faster annual decline in hippocampal volume (FDR p = .02) and accelerated annual increase in ventricular volumes (FDR p = .02). CONCLUSIONS The energetic cost of walking is associated with gray and white matter volumes and subsequent hippocampal atrophy and ventricular enlargement. Collectively, these data suggest the energetic cost of walking may be an early marker of neurodegeneration that contributes to the gait brain connection.
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Affiliation(s)
- Ryan J Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fangyu Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yang An
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Amal A Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qu Tian
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Susan M Resnick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
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Calvi A, Tur C, Chard D, Stutters J, Ciccarelli O, Cortese R, Battaglini M, Pietroboni A, De Riz M, Galimberti D, Scarpini E, De Stefano N, Prados F, Barkhof F. Slowly expanding lesions relate to persisting black-holes and clinical outcomes in relapse-onset multiple sclerosis. Neuroimage Clin 2022; 35:103048. [PMID: 35598462 PMCID: PMC9130104 DOI: 10.1016/j.nicl.2022.103048] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Slowly expanding lesions (SELs) are MRI markers of chronic active lesions in multiple sclerosis (MS). T1-hypointense black holes, and reductions in magnetization transfer ratio (MTR) are pathologically correlated with myelin and axonal loss. While all associated with progressive MS, the relationship between these lesion's metrics and clinical outcomes in relapse-onset MS has not been widely investigated. OBJECTIVES To explore the relationship of SELs with T1-hypointense black holes, and longitudinal T1 intensity contrast ratio and MTR, their correlation to brain volume, and their contribution to MS disability in relapse-onset patients. METHODS 135 patients with relapsing-remitting MS (RRMS) were studied with clinical assessments and brain MRI (T2/FLAIR and T1-weighted scans at 1.5/3 T) at baseline and two subsequent follow-ups; a subset of 83 patients also had MTR acquisitions. Early-onset patients were defined when the baseline disease duration was ≤ 5 years (n = 85). SELs were identified using deformation field maps from the manually segmented baseline T2 lesions and differentiated from the non-SELs. Persisting black holes (PBHs) were defined as a subset of T2 lesions with a signal below a patient-specific grey matter T1 intensity in a semi-quantitative manner. SELs, PBH counts, and brain volume were computed, and their associations were assessed through Spearman and Pearson correlation. Clusters of patients according to low (up to 2), intermediate (3 to 10), or high (more than 10) SEL counts were determined with a Gaussian generalised mixture model. Mixed-effects and logistic regression models assessed volumes, T1 and MTR within SELs, and their correlation with Expanded Disability Status Scale (EDSS) and confirmed disability progression (CDP). RESULTS Mean age at study onset was 35.5 years (73% female), disease duration 5.5 years and mean time to last follow-up 6.5 years (range 1 to 12.5); median baseline EDSS 1.5 (range 0 to 5.5) and a mean EDSS change of 0.31 units at final follow-up. Among 4007 T2 lesions, 27% were classified as SELs and 10% as PBHs. Most patients (n = 65) belonged to the cluster with an intermediate SEL count (3 to 10 SELs). The percentage of PBHs was higher in SELs than non-SELs (up to 61% vs 44%, p < 0.001) and within-patient SEL volumes positively correlated with PBH volumes (r = 0.53, p < 0.001). SELs showed a decrease in T1 intensity over time (beta = -0.004, 95%CI -0.005 to -0.003, p < 0.001), accompanied by lower cross-sectional baseline and follow-up MTR. In mixed-effects models, EDSS worsening was predicted by the SEL log-volumes increase over time (beta = 0.11, 95%CI 0.03 to 0.20, p = 0.01), which was confirmed in the sub-cohort of patients with early onset MS (beta = 0.14, 95%CI 0.04 to 0.25, p = 0.008). In logistic regressions, a higher risk for CDP was associated with SEL volumes (OR = 5.15, 95%CI 1.60 to 16.60, p = 0.006). CONCLUSIONS SELs are associated with accumulation of more destructive pathology as indicated by an association with PBH volume, longitudinal reduction in T1 intensity and MTR. Higher SEL volumes are associated with clinical progression, while lower ones are associated with stability in relapse-onset MS.
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Affiliation(s)
- Alberto Calvi
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Corresponding author.
| | - Carmen Tur
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Declan Chard
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom
| | - Jonathan Stutters
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom
| | - Rosa Cortese
- Dep. of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Marco Battaglini
- Dep. of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Anna Pietroboni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Milena De Riz
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Elio Scarpini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Nicola De Stefano
- Dep. of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Ferran Prados
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom,e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Frederik Barkhof
- Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), United Kingdom,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom,Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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Bonacchi R, Meani A, Pagani E, Marchesi O, Filippi M, Rocca MA. The role of cerebellar damage in explaining disability and cognition in multiple sclerosis phenotypes: a multiparametric MRI study. J Neurol 2022; 269:3841-3857. [PMID: 35230471 DOI: 10.1007/s00415-022-11021-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebellar involvement is not comprehensively studied from an MRI point of view in multiple sclerosis (MS). We aimed to quantify cerebellar damage and identify predictors of physical disability and cognitive dysfunction in MS patients, and to characterize patients with cerebellar disability. METHODS In this prospective study, 164 (89 relapsing-remitting and 75 progressive) MS patients and 53 healthy controls were enrolled. Subjects underwent 3T MRI with sequences for assessing lesions and atrophy in cerebellum, supratentorial brain, brainstem and cervical cord. Cerebellar peduncle diffusion-tensor metrics were also derived. Random forest models identified MRI predictors of Expanded Disability Status Scale (EDSS) score and cognition z-score. Hierarchical clustering was applied on MRI metrics in patients with cerebellar disability. RESULTS In MS patients, predictors of higher EDSS score (out-of-bag-R2 = 0.83) were: lower cord grey matter (GM) and global areas, brain volume, GM volume (GMV), cortical GMV, cerebellum lobules I-IV and vermis GMV; and higher cord GM and brainstem lesion volume (LV). Predictors of lower cognition z-score (out-of-bag-R2 = 0.25) were: higher supratentorial and superior cerebellar peduncle LV; and lower brain, thalamus and basal ganglia volumes, GMV, cerebellum lobule VIIIb and Crus II GMV. In patients with cerebellar disability, we found three clusters with homogenous MRI metrics: patients with high brain lesion volumes (including cerebellar peduncles), those with marked cerebellum GM atrophy and patients with severe cord damage. CONCLUSIONS Damage to cerebellum GM and connecting structures has a relevant role in explaining cognitive dysfunction and physical disability in MS. Data-driven MRI clustering might improve our knowledge of MRI-clinical correlations.
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Affiliation(s)
- Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Olga Marchesi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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Nillo RM, Broce IJ, Uzgil B, Singhal NS, Glastonbury CM, Hess CP, Barkovich JA, Desikan RS, Sugrue LP. Longitudinal analysis of regional brain changes in anti-NMDAR encephalitis: a case report. BMC Neurol 2021; 21:412. [PMID: 34706674 DOI: 10.1186/s12883-021-02446-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-NMDA receptor encephalitis is an immune-mediated disorder characterized by antibodies against the GluN1 subunit of the NMDA receptor that is increasingly recognized as a treatable cause of childhood epileptic encephalopathy. In adults, the disorder has been associated with reversible changes in brain volume over the course of treatment and recovery, but in children, little is known about its time course and associated imaging manifestations. CASE PRESENTATION A previously healthy 20-month-old boy presented with first-time unprovoked seizures, dysautonomia, and dyskinesia. Paraneoplastic workup was negative, but CSF was positive for anti-NMDAR antibodies. The patient's clinical condition waxed and waned over a 14-month course of treatment with first- and second-line immunotherapies (including steroids, IVIG, rituximab, and cyclophosphamide). Serial brain MRIs scans obtained at 5 time points spanning this same period showed no abnormal signal or enhancement but were remarkable for cycles of reversible regional cortical volume loss. All scans included identical 1-mm resolution 3D T1-weighted sequences obtained on the same 3 T scanner. Using a novel longitudinal processing stream in FreeSurfer6 (Reuter M, et. al, Neuroimage 61:1402-18, 2012) we quantified the rate of change in cortical volume at each vertex (% volume change per month) between consecutive scans and correlated these changes with the time course of the patient's treatment and clinical response. We found regionally specific changes in cortical volume (up to 7% per month) that preferentially affected the frontal and occipital lobes and paralleled the patient's clinical course, with clinical decline associated with volume loss and clinical improvement associated with volume gain. CONCLUSIONS Our results suggest that reversible cortical volume loss in anti-NMDA encephalitis has a regional specificity that mirrors many of the clinical symptoms associated with the disorder and tracks the dynamics of disease severity over time. This case illustrates how quantitative morphometric techniques can be applied to clinical imaging data to reveal patterns of brain change that may provide insight into disease pathophysiology. More widespread application of this approach might reveal regional and temporal patterns specific to different types of autoimmune encephalitis, providing a tool for diagnosis and a surrogate marker for monitoring treatment response.
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Dougherty RJ, Hoang TD, Launer LJ, Jacobs DR, Sidney S, Yaffe K. Long-term television viewing patterns and gray matter brain volume in midlife. Brain Imaging Behav 2021; 16:637-644. [PMID: 34487279 DOI: 10.1007/s11682-021-00534-4] [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] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate whether long-term television viewing patterns, a common sedentary behavior, in early to mid-adulthood is associated with gray matter brain volume in midlife and if this is independent of physical activity. We evaluated 599 participants (51% female, 44% black, mean age 30.3 ± 3.5 at baseline and 50.2 ± 3.5 years at follow-up and MRI) from the prospective Coronary Artery Risk Development in Young Adults (CARDIA) study. We assessed television patterns with repeated interviewer-administered questionnaire spanning 20 years. Structural MRI (3T) measures of frontal cortex, entorhinal cortex, hippocampal, and total gray matter volumes were assessed at midlife. Over the 20 years, participants reported viewing an average of 2.5 ± 1.7 h of television per day (range: 0-10 h). After multivariable adjustment, greater television viewing was negatively associated with gray matter volume in the frontal (β = - 0.77; p = 0.01) and entorhinal cortex (β = - 23.83; p = 0.05) as well as total gray matter (β = - 2.09; p = 0.003) but not hippocampus. These results remained unchanged after additional adjustment for physical activity. For each one standard deviation increase in television viewing, the difference in gray matter volume z-score was approximately 0.06 less for each of the three regions (p < 0.05). Among middle-aged adults, greater television viewing in early to mid-adulthood was associated with lower gray matter volume. Sedentariness or other facets of television viewing may be important for brain aging even in middle age.
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Affiliation(s)
- Ryan J Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2024 E. Monument St., Suite 2-700, Baltimore, MD, 21205, USA.
| | - Tina D Hoang
- San Francisco VA Health Care System, San Francisco, CA, USA
| | | | | | - Stephen Sidney
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Kristine Yaffe
- San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, San Francisco, CA, USA
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Barrett MJ, Murphy JM, Zhang J, Blair JC, Flanigan JL, Nawaz H, Dalrymple WA, Sperling SA, Patrie J, Druzgal TJ. Olfaction, cholinergic basal forebrain degeneration, and cognition in early Parkinson disease. Parkinsonism Relat Disord 2021; 90:27-32. [PMID: 34348192 DOI: 10.1016/j.parkreldis.2021.07.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Impaired olfaction and reduced cholinergic nucleus 4 (Ch4) volume both predict greater cognitive decline in Parkinson's disease (PD). We examined the relationship between olfaction, longitudinal change in cholinergic basal forebrain nuclei and their target regions, and cognition in early PD. METHODS We analyzed a cohort of 97 PD participants from the Parkinson's Progression Markers Initiative with brain MRIs at baseline, 1 year, 2 years, and 4 years. Using probabilistic maps, regional grey matter density (GMD) was calculated for Ch4, cholinergic nuclei 1, 2, and 3 (Ch123), and their target regions. RESULTS Baseline University of Pennsylvania Smell Identification Test score correlated with change in GMD of all regions of interest (all p < 0.05). Rate of change of Ch4 GMD was correlated with rate of change of Ch123 (p = 0.034), cortex (p = 0.001), and amygdala GMD (p < 0.001), but not hippocampus GMD (p = 0.38). Rate of change of Ch123 GMD was correlated with rate of change of cortex (p = 0.001) and hippocampus (p < 0.001), but not amygdala GMD (p = 0.133). In a linear regression model including change in GMD of all regions of interest and age as predictors, change in cortex GMD (βˆslope= 38.2; 95 % CI: [0.47, 75.9]) and change in hippocampus GMD (βˆslope= 24.8; 95 % CI: [0.80, 48.8]) were significant predictors of Montreal Cognitive Assessment score change over time. CONCLUSION Impaired olfaction is associated with degeneration of the cholinergic basal forebrain and bilateral cortex, amygdala, and hippocampus in PD. The relationship between impaired olfaction and cognitive decline may be mediated by greater atrophy of the cortex and hippocampus.
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Affiliation(s)
- Matthew J Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Justin M Murphy
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jeffrey Zhang
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jamie C Blair
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Huma Nawaz
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - W Alex Dalrymple
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - T Jason Druzgal
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, USA
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Voormolen EHJ, Champagne PO, Roca E, Giammattei L, Passeri T, di Russo P, Sanchez MM, Bernat AL, Yoldjian I, Fontanel S, Weill A, Mandonnet E, Froelich S. Intracranial Meningiomas Decrease in Volume on Magnetic Resonance Imaging After Discontinuing Progestin. Neurosurgery 2021; 89:308-314. [PMID: 34166514 DOI: 10.1093/neuros/nyab175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/14/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The behavior of meningiomas under influence of progestin therapy remains unclear. OBJECTIVE To investigate the relationship between growth kinetics of intracranial meningiomas and usage of the progestin cyproterone acetate (PCA). METHODS This study prospectively followed 108 women with 262 intracranial meningiomas and documented PCA use. A per-meningioma analysis was conducted. Changes in meningioma volumes over time, and meningioma growth velocities, were measured on magnetic resonance imaging (MRI) after stopping PCA treatment. RESULTS Mean follow-up time was 30 (standard deviation [SD] 29) mo. Ten (4%) meningiomas were treated surgically at presentation. The other 252 meningiomas were followed after stopping PCA treatment. Overall, followed meningiomas decreased their volumes by 33% on average (SD 28%). A total of 188 (72%) meningiomas decreased, 51 (20%) meningiomas remained stable, and 13 (4%) increased in volume of which 3 (1%) were surgically treated because of radiological progression during follow-up after PCA withdrawal. In total, 239 of 262 (91%) meningiomas regressed or stabilized during follow-up. Subgroup analysis in 7 women with 19 meningiomas with follow-up before and after PCA withdrawal demonstrated that meningioma growth velocity changed statistically significantly (P = .02). Meningiomas grew (average velocity of 0.25 mm3/day) while patients were using PCA and shrank (average velocity of -0.54 mm3/day) after discontinuation of PCA. CONCLUSION Ninety-one percent of intracranial meningiomas in female patients with long-term PCA use decrease or stabilize on MRI after stopping PCA treatment. Meningioma growth kinetics change significantly from growth during PCA usage to shrinkage after PCA withdrawal.
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Affiliation(s)
- Eduard H J Voormolen
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | | | - Elena Roca
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Lorenzo Giammattei
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Paolo di Russo
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Miguel Marigil Sanchez
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Anne Laure Bernat
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Isabelle Yoldjian
- National Agency for the Safety of Medicines and Health Products (ANSM), Paris, France
| | | | - Alain Weill
- Scientific Interest Group-Health Product Epidemiology (ANSM-CNAM EPI-PHARE SIG), National Health Insurance, Department of Public Health Studies, Saint-Denis, France
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris Diderot, Paris, France
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Bassal FC, Harwood M, Oh A, Lundberg JN, Hoffman J, Cornejo P, Chapple KM, Hughes JN, Narayan R. Anti-NMDA receptor encephalitis and brain atrophy in children and adults: A quantitative study. Clin Imaging 2021; 78:296-300. [PMID: 34186471 DOI: 10.1016/j.clinimag.2021.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/06/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether brain atrophy was present in patients with anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE) using qualitative and quantitative analyses of brain magnetic resonance imaging (MRI) and to explore clinical differences in patients with anti-NMDARE with or without brain atrophy. METHODS A retrospective observational study encompassing the serologic, cerebrospinal fluid, and brain MRI data of 23 patients with anti-NMDARE was conducted. Median patient age was 14 years (interquartile range [IQR], 12 years). The cohort included 15 children (<18 years old) and 8 adults (≥18 years old). There were 6 male and 17 female patients. Imaging analysis involved 2 expert readers' observations of MRIs and automated volumetric quantification using NeuroQuant (CorTechs Labs, Inc.) software. RESULTS Of 23 pediatric and adult patients, 11 patients had 14 brain MRIs that were quantitatively analyzed. Quantitative NeuroQuant volumetric analysis showed atrophy in 9 of 14 MRIs for 7 of 11 patients compared to age-controlled normative data. In these 9 MRIs, atrophy was present in the temporal lobes (n = 9), cerebral cortex (n = 3), and cerebellum (n = 3). Qualitative analysis of 59 MRIs (23 patients) revealed volume loss in 6 patients: 5 with global cerebral and temporal lobe volume loss and 1 with temporal lobe volume loss. No patient showed cerebellar volume loss on qualitative analysis. Mean length of stay in the intensive care unit was not significantly different for patients with or without quantitative volume loss (3.5 [5.2] vs 27.4 [23.4] days; p = 0.08). CONCLUSIONS In this cohort of patients with anti-NMDARE, quantitative volumetric analysis showed brain atrophy, particularly affecting the temporal lobes, in 64% (7/11) of the patients. Qualitative analysis showed brain atrophy in 26% (6/23). These findings highlight the increased sensitivity of quantitative methods for volume loss detection. Larger studies are needed.
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Affiliation(s)
- Frederick C Bassal
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Matthew Harwood
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Ann Oh
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Jaclyn N Lundberg
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Justin Hoffman
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Patricia Cornejo
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Kristina M Chapple
- Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Jeremy N Hughes
- Department of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Ram Narayan
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States of America; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America.
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10
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Ezzati A, Zammit AR, Habeck C, Hall CB, Lipton RB. Detecting biological heterogeneity patterns in ADNI amnestic mild cognitive impairment based on volumetric MRI. Brain Imaging Behav 2021; 14:1792-1804. [PMID: 31104279 DOI: 10.1007/s11682-019-00115-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is substantial biological heterogeneity among older adults with amnestic mild cognitive impairment (aMCI). We hypothesized that this heterogeneity can be detected solely based on volumetric MRI measures, which potentially have clinical implications and can improve our ability to predict clinical outcomes. We used latent class analysis (LCA) to identify subgroups among persons with aMCI (n = 696) enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI), based on baseline volumetric MRI measures. We used volumetric measures of 10 different brain regions. The subgroups were validated with respect to demographics, cognitive performance, and other AD biomarkers. The subgroups were compared with each other and with normal and Alzheimer's disease (AD) groups with respect to baseline cognitive function and longitudinal rate of conversion. Four aMCI subgroups emerged with distinct MRI patterns: The first subgroup (n = 404), most similar to normal controls in volumetric characteristics and cognitive function, had the lowest incidence of AD. The second subgroup (n = 230) had the most similar MRI profile to early AD, along with poor performance in memory and executive function domains. The third subgroup (n = 36) had the highest global atrophy, very small hippocampus and worst overall cognitive performance. The fourth subgroup (n = 26) had the least amount of atrophy, however still had poor cognitive function specifically in in the executive function domain. Individuals with aMCI who were clinically categorized within one group other showed substantial heterogeneity based on MRI volumetric measures.
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Affiliation(s)
- Ali Ezzati
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA. .,Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.
| | - Andrea R Zammit
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Christian Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.,Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Coarelli G, Darios F, Petit E, Dorgham K, Adanyeguh I, Petit E, Brice A, Mochel F, Durr A. Plasma neurofilament light chain predicts cerebellar atrophy and clinical progression in spinocerebellar ataxia. Neurobiol Dis 2021; 153:105311. [PMID: 33636389 DOI: 10.1016/j.nbd.2021.105311] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 11/13/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Neurofilament light chain (NfL) is a marker of brain atrophy and predictor of disease progression in rare diseases such as Huntington Disease, but also in more common neurological disorders such as Alzheimer's disease. The aim of this study was to measure NfL longitudinally in autosomal dominant spinocerebellar ataxias (SCAs) and establish correlation with clinical and imaging parameters. We enrolled 62 pathological expansions carriers (17 SCA1, 13 SCA2, 19 SCA3, and 13 SCA7) and 19 age-matched controls in a prospective biomarker study between 2011 and 2015 and followed for 24 months at the Paris Brain Institute. We performed neurological examination, brain 3 T MRI and plasma NfL measurements using an ultrasensitive single-molecule array at baseline and at the two-year follow-up visit. We evaluated NfL correlations with ages, CAG repeat sizes, clinical scores and volumetric brain MRIs. NfL levels were significantly higher in SCAs than controls at both time points (p < 0.001). Age-adjusted NfL levels were significantly correlated at baseline with clinical scores (p < 0.01). We identified optimal NfL cut-off concentrations to differentiate controls from carriers for each genotype (SCA1 16.87 pg/mL, SCA2, 19.1 pg/mL, SCA3 16.04 pg/mL, SCA7 16.67 pg/mL). For all SCAs, NfL concentration was stable over two years (p = 0.95) despite a clinical progression (p < 0.0001). Clinical progression between baseline and follow-up was associated with higher NfL concentrations at baseline (p = 0.04). Of note, all premanifest carriers with NfL levels close to cut off concentrations had signs of the disease at follow-up. For all SCAs, the higher the observed NfL, the lower the pons volume at baseline (p < 0.01) and follow-up (p = 0.02). Higher NfL levels at baseline in all SCAs predicted a decrease in cerebellar volume (p = 0.03). This result remained significant for SCA2 only among all genotypes (p = 0.02). Overall, plasma NfL levels at baseline in SCA expansion carriers predict cerebellar volume change and clinical score progression. NfL levels might help refine inclusion criteria for clinical trials in carriers with very subtle signs.
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Affiliation(s)
- Giulia Coarelli
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Frederic Darios
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Emilien Petit
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Karim Dorgham
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), F-75013 Paris, France
| | - Isaac Adanyeguh
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Elodie Petit
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexis Brice
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Fanny Mochel
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexandra Durr
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.
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12
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Tinaz S, Arora J, Nalamada K, Vives-Rodriguez A, Sezgin M, Robakis D, Patel A, Constable RT, Schilsky ML. Structural and functional brain changes in hepatic and neurological Wilson disease. Brain Imaging Behav 2020; 15:2269-2282. [PMID: 33244627 DOI: 10.1007/s11682-020-00420-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/14/2022]
Abstract
Wilson disease (WD) can manifest with hepatic or neuropsychiatric symptoms. Our understanding of the in vivo brain changes in WD, particularly in the hepatic phenotype, is limited. Thirty subjects with WD and 30 age- and gender-matched controls participated. WD group underwent neuropsychiatric assessment. Unified WD Rating Scale neurological exam scores were used to determine neurological (WDN, score > 0) and hepatic-only (WDH, score 0) subgroups. All subjects underwent 3 Tesla anatomical and resting-state functional MRI. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) were performed only in the WD group. Volumetric, DTI, and functional connectivity analyses were performed to determine between-group differences. WDN and WDH groups were matched in demographic and psychiatric profiles. The entire WD group compared to controls showed significant thinning in the bilateral superior frontal cortex. The WDN group compared to control and WDH groups showed prominent structural brain changes including significant striatal and thalamic atrophy, more subcortical hypointense lesions on SWI, and diminished white matter integrity in the bilateral anterior corona radiata and corpus callosum. However, the WDH group also showed significant white matter volume loss compared to controls. The functional connectivity between the frontostriatal nodes was significantly reduced in the WDN group, whereas that of the hippocampus was significantly increased in the WDH group compared to controls. In summary, structural and functional brain changes were present even in neurologically non-manifesting WD patients in this cross-sectional study. Longitudinal brain MRI scans may be useful as biomarkers for prognostication and optimization of treatment strategies in WD.
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Affiliation(s)
- Sule Tinaz
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA. .,Clinical Neurosciences Imaging Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Jagriti Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Keerthana Nalamada
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA
| | - Ana Vives-Rodriguez
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA
| | - Mine Sezgin
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA.,Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Daphne Robakis
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA.,Department of Neurology, State University of New York Downstate College of Medicine, Brooklyn, NY, USA
| | - Amar Patel
- Department of Neurology, Yale University School of Medicine, 15 York St, LCI Suite 710, New Haven, CT, 06510, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Michael L Schilsky
- Departments of Medicine and Surgery, Sections of Digestive Diseases and Transplant and Immunology, Yale University School of Medicine, New Haven, CT, USA
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13
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Lin CY, Chen CH, Tom SE, Kuo SH; Alzheimer’s Disease Neuroimaging Initiative. Cerebellar Volume Is Associated with Cognitive Decline in Mild Cognitive Impairment: Results from ADNI. Cerebellum 2020; 19:217-25. [PMID: 31900856 DOI: 10.1007/s12311-019-01099-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a disease with dysfunctional brain network. Previous studies found the cerebellar volume changes over the course of AD disease progression; however, whether cerebellar volume change contributes to the cognitive decline in AD, or its earlier disease stage (i.e., mild cognitive impairment [MCI]) remains unclear. In ADNI, cognitive function was assessed using Alzheimer's Disease Assessment Scale-Cognitive Behavior section (ADAS-Cog). We used linear regression and linear mixed effects models to examine whether cerebellar volume is associated with either baseline cognition or with cognitive changes over time in MCI or in AD. We used logistic regression to assess the relationship between cerebellar volume and disease progression to MCI and AD. We found that cerebellar volume is associated with cognition in patients with MCI, after adjusting for age, gender, education, hippocampal volume, and APOE4 status. Consistently, cerebellar volume is associated with increased odds of the disease stages of MCI and AD when compared to controls. However, cerebellar volume is not associated with cognitive changes over time in either MCI or AD. In summary, cerebellar volume may contribute to cognition level in MCI, but not in AD, indicating that the cerebellar network might modulate the cognitive function in the early stage of the disease. The cerebellum may be a potential target for neuromodulation in treating MCI.
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14
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Bennett KH, Pujar SS, Martinos MM, Clark CA, Yoong M, Scott RC, Chin RFM. Subcortical nuclei volumes are associated with cognition in children post-convulsive status epilepticus: Results at nine years follow-up. Epilepsy Behav 2020; 110:107119. [PMID: 32526686 DOI: 10.1016/j.yebeh.2020.107119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of the present study was to investigate the relationship between subcortical nuclei volume and cognition in children with post-convulsive status epilepticus (CSE). METHODS Structural T1-weighted magnetic resonance imaging (MRI) scans (Siemens Avanto, 1.5 T) and neuropsychological assessments (full-scale intelligence quotient (FSIQ) and Global Memory Scores (GMS)) were collected from subjects at a mean 8.5 years post-CSE (prolonged febrile seizures (PFS), n = 30; symptomatic/known, n = 28; and other, n = 12) and from age- and sex-matched healthy controls (HC). Subjects with CSE were stratified into those with lower cognitive ability (LCA) (CSE+, n = 22) and those without (CSE-, n = 48). Quantitative volumetric analysis using Functional MRI of the Brain Software Library (FSL) (Analysis Group, FMRIB, Oxford) provided segmented MRI brain volumes. Univariate analysis of covariance (ANCOVA) was performed to compare subcortical nuclei volumes across subgroups. Multivariable linear regression was performed for each subcortical structure and for total subcortical volume (SCV) to identify significant predictors of LCA (FSIQ <85) while adjusting for etiology, age, socioeconomic status, sex, CSE duration, and intracranial volume (ICV); Bonferroni correction was applied for the analysis of individual subcortical nuclei. RESULTS Seventy subjects (11.8 ± 3.4 standard deviation (SD) years; 34 males) and 72 controls (12.1 ± 3.0SD years; 29 males) underwent analysis. Significantly smaller volumes of the left thalamus, left caudate, right caudate, and SCV were found in subjects with CSE+ compared with HC, after adjustment for intracranial, gray matter (GM), or cortical/cerebellar volume. When compared with subjects with CSE-, subjects with CSE+ also had smaller volumes of the left thalamus, left pallidum, right pallidum, and SCV. Individual subcortical nuclei were not associated, but SCV was associated with FSIQ (p = 0.005) and GMS (p = 0.014). Intracranial volume and etiology were similarly predictive. CONCLUSIONS Nine years post-CSE, SCV is significantly lower in children who have LCA compared with those that do not. However, in this cohort, we are unable to determine whether the relationship is independent of ICV or etiology. Future, larger scale studies may help tease this out.
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15
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Azzarito M, Seif M, Kyathanahally S, Curt A, Freund P. Tracking the neurodegenerative gradient after spinal cord injury. Neuroimage Clin 2020; 26:102221. [PMID: 32145681 PMCID: PMC7058923 DOI: 10.1016/j.nicl.2020.102221] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/21/2020] [Accepted: 02/17/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify neurodegenerative changes along the cervical spinal cord rostral to a spinal cord injury (SCI) by means of quantitative MRI (qMRI) and to determine its relationship with clinical impairment. METHODS Thirty chronic SCI patients (15 tetraplegics and 15 paraplegics) and 23 healthy controls underwent a high-resolution T1-weighted and myelin-sensitive magnetization transfer (MT) MRI. We assessed macro- and microstructural changes along the cervical cord from levels C1 to C4, calculating cross-sectional spinal cord area, its anterior-posterior and left-right width and myelin content (i.e. MT). Regression analysis determined associations between qMRI parameters and clinical impairment. RESULTS In SCI patients, cord area decreased by 2.67 mm2 (p = 0.004) and left-right width decreased by 0.35 mm (p = 0.002) per cervical cord level in the caudal direction when compared to the healthy controls. This gradient of neurodegeneration was greater in tetraplegic than paraplegics in the cross-sectional cervical cord area (by 3.28 mm2, p = 0.011), left-right width (by 0.36 mm, p = 0.03), and mean cord MT (by 0.13%, p = 0.04), but independant of lesion severity (p > 0.05). Higher lesion level was associated with greater magnitudes of neurodegeneration. Greater loss in myelin content in the dorsal columns and spinothalamic tract was associated with worse light touch (p = 0.016) and pin prick score (p = 0.024), respectively. CONCLUSIONS A gradient of neurodegeneration is evident in the cervical cord remote from a SCI. Tract-specific associations with appropriate clinical outcomes highlight that remote neurodegenerative changes are clinically eloquent. Monitoring the neurodegenerative gradient could be used to track treatment effects of regenerative and neuroprotective agents, both in trials targeting cervical and thoracic SCI patients.
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Affiliation(s)
- Michela Azzarito
- Spinal Cord Injury Center Balgrist, University Hospital, Zurich, Switzerland.
| | - Maryam Seif
- Spinal Cord Injury Center Balgrist, University Hospital, Zurich, Switzerland.
| | | | - Armin Curt
- Spinal Cord Injury Center Balgrist, University Hospital, Zurich, Switzerland.
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital, Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom; Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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16
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Magon S, Tsagkas C, Gaetano L, Patel R, Naegelin Y, Amann M, Parmar K, Papadopoulou A, Wuerfel J, Stippich C, Kappos L, Chakravarty MM, Sprenger T. Volume loss in the deep gray matter and thalamic subnuclei: a longitudinal study on disability progression in multiple sclerosis. J Neurol 2020; 267:1536-1546. [PMID: 32040710 DOI: 10.1007/s00415-020-09740-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Volume loss in the deep gray matter (DGM) has been reported in patients with multiple sclerosis (MS) already at early stages of the disease and is thought to progress throughout the disease course. OBJECTIVE To investigate the impact and predictive value of volume loss in DGM and thalamic subnuclei on disability worsening in patients MS over a 6-year follow-up period. METHODS Hundred and seventy-nine patients with RRMS (132 women; median Expanded Disability Status Scale, EDSS: 2.5) and 50 with SPMS (27 women; median EDSS: 4.5) were included in the study. Patients underwent annual EDSS assessments and annual MRI at 1.5 T. DGM/thalamic subnuclei volumes were identified on high-resolution T1-weighted. A hierarchical linear mixed model for each anatomical DGM area and each thalamic subnucleus was performed to investigate the associations with disability scores. Cox regression was used to estimate the predictive properties of volume loss in DGM and thalamic subnuclei on disease worsening. RESULTS In the whole sample and in RRMS, volumes of the thalamus and the striatum were associated with the EDSS; however, only thalamic volume loss was associated with EDSS change at follow-up. Regarding thalamic subnuclei, volume loss in the anterior nucleus, the pulvinar and the ventral anterior nucleus was associated with EDSS change in the whole cohort. A trend was observed for the ventral lateral nucleus. Volume loss in the anterior and ventral anterior nuclei was associated with EDSS change over time in patients with RRMS. Moreover, MS phenotype and annual rates of volume loss in the thalamus and ventral lateral nucleus were predictive of disability worsening. CONCLUSION These results highlight the relevance of volume loss in the thalamus as a key metric for predicting disability worsening as assessed by EDSS (in RRMS). Moreover, the volume loss in specific nuclei such as the ventral lateral nucleus seems to play a role in disability worsening.
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Affiliation(s)
- Stefano Magon
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Medical Image Analysis Center AG, Basel, Switzerland.
| | - Charidimos Tsagkas
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Medical Image Analysis Center AG, Basel, Switzerland
| | - Laura Gaetano
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Medical Image Analysis Center AG, Basel, Switzerland
| | - Raihaan Patel
- Cerebral Imaging Centre-Douglas Mental Health University Institute, Verdun, QC, Canada.,Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Yvonne Naegelin
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Amann
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Medical Image Analysis Center AG, Basel, Switzerland.,Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Katrin Parmar
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Medical Image Analysis Center AG, Basel, Switzerland
| | - Athina Papadopoulou
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jens Wuerfel
- Medical Image Analysis Center AG, Basel, Switzerland.,Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Christoph Stippich
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - M Mallar Chakravarty
- Cerebral Imaging Centre-Douglas Mental Health University Institute, Verdun, QC, Canada.,Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Till Sprenger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
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17
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Cocozza S, Costabile T, Pontillo G, Lieto M, Russo C, Radice L, Pane C, Filla A, Brunetti A, Saccà F. Cerebellum and cognition in Friedreich ataxia: a voxel-based morphometry and volumetric MRI study. J Neurol 2020; 267:350-8. [PMID: 31641877 DOI: 10.1007/s00415-019-09582-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent studies have suggested the presence of a significant atrophy affecting the cerebellar cortex in Friedreich ataxia (FRDA) patients, an area of the brain long considered to be relatively spared by neurodegenerative phenomena. Cognitive deficits, which occur in FRDA patients, have been associated with cerebellar volume loss in other conditions. The aim of this study was to investigate the correlation between cerebellar volume and cognition in FRDA. METHODS Nineteen FRDA patients and 20 healthy controls (HC) were included in this study and evaluated via a neuropsychological examination. Cerebellar global and lobular volumes were computed using the Spatially Unbiased Infratentorial Toolbox (SUIT). Furthermore, a cerebellar voxel-based morphometry (VBM) analysis was also carried out. Correlations between MRI metrics and clinical data were tested via partial correlation analysis. RESULTS FRDA patients showed a significant reduction of the total cerebellar volume (p = 0.004), significantly affecting the Lobule IX (p = 0.001). At the VBM analysis, we found a cluster of significant reduced GM density encompassing the entire lobule IX (p = 0.003). When correlations were probed, we found a direct correlation between Lobule IX volume and impaired visuo-spatial functions (r = 0.58, p = 0.02), with a similar correlation that was found between the same altered function and results obtained at the VBM (r = 0.52; p = 0.03). CONCLUSIONS With two different image analysis techniques, we confirmed the presence of cerebellar volume loss in FRDA, mainly affecting the posterior lobe. In particular, Lobule IX atrophy correlated with worse visuo-spatial abilities, further expanding our knowledge about the physiopathology of cognitive impairment in FRDA.
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Lepage C, Muehlmann M, Tripodis Y, Hufschmidt J, Stamm J, Green K, Wrobel P, Schultz V, Weir I, Alosco ML, Baugh CM, Fritts NG, Martin BM, Chaisson C, Coleman MJ, Lin AP, Pasternak O, Makris N, Stern RA, Shenton ME, Koerte IK. Limbic system structure volumes and associated neurocognitive functioning in former NFL players. Brain Imaging Behav 2019; 13:725-734. [PMID: 29779184 PMCID: PMC6854905 DOI: 10.1007/s11682-018-9895-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts. CTE has been linked to disruptions in cognition, mood, and behavior. Unfortunately, the diagnosis of CTE can only be made post-mortem. Neuropathological evidence suggests limbic structures may provide an opportunity to characterize CTE in the living. Using 3 T magnetic resonance imaging, we compared select limbic brain regional volumes - the amygdala, hippocampus, and cingulate gyrus - between symptomatic former National Football League (NFL) players (n = 86) and controls (n = 22). Moreover, within the group of former NFL players, we examined the relationship between those limbic structures and neurobehavioral functioning (n = 75). The former NFL group comprised eighty-six men (mean age = 55.2 ± 8.0 years) with at least 12 years of organized football experience, at least 2 years of active participation in the NFL, and self-reported declines in cognition, mood, and behavior within the last 6 months. The control group consisted of men (mean age = 57.0 ± 6.6 years) with no history of contact-sport involvement or traumatic brain injury. All control participants provided neurobehavioral data. Compared to controls, former NFL players exhibited reduced volumes of the amygdala, hippocampus, and cingulate gyrus. Within the NFL group, reduced bilateral cingulate gyrus volume was associated with worse attention and psychomotor speed (r = 0.4 (right), r = 0.42 (left); both p < 0.001), while decreased right hippocampal volume was associated with worse visual memory (r = 0.25, p = 0.027). Reduced volumes of limbic system structures in former NFL players are associated with neurocognitive features of CTE. Volume reductions in the amygdala, hippocampus, and cingulate gyrus may be potential biomarkers of neurodegeneration in those at risk for CTE.
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Affiliation(s)
- Christian Lepage
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Marc Muehlmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Yorghos Tripodis
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jakob Hufschmidt
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Julie Stamm
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA
| | - Katie Green
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pawel Wrobel
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Isabelle Weir
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Alosco
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Baugh
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA
| | - Nathan G Fritts
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
| | - Brett M Martin
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Christine Chaisson
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikos Makris
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neural Systems Investigations, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A Stern
- BU Alzheimer's Disease and CTE Center, Boston University, Boston, MA, USA
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA
- Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
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Smolinski L, Litwin T, Redzia-Ogrodnik B, Dziezyc K, Kurkowska-Jastrzebska I, Czlonkowska A. Brain volume is related to neurological impairment and to copper overload in Wilson's disease. Neurol Sci 2019; 40:2089-95. [PMID: 31147855 DOI: 10.1007/s10072-019-03942-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
Abstract
Introduction To determine whether brain volume was associated with functional and neurological impairments and with copper overload markers in patients with Wilson’s disease. Methods In 48 treatment-naïve patients, we assessed functional and neurological impairments with the Unified Wilson’s Disease Rating Scale, measured normalized brain volumes based on magnetic resonance images, and assessed concentration of non-ceruloplasmin-bound copper. We correlated brain volume measures with functional and neurological impairment scores and copper overload indices. Results Functional and neurological impairments correlated with all brain volume measures, including the total brain volume and the volumes of white matter and gray matter (both peripheral gray matter and deep brain nuclei). Higher non-ceruloplasmin-bound copper concentrations were associated with greater functional and neurological impairments and lower brain volumes. Conclusions Our findings provided the first in vivo evidence that the severity of brain atrophy is a correlate of functional and neurological impairments in patients with Wilson’s disease and that brain volume could serve as a marker of neurodegeneration induced by copper. Electronic supplementary material The online version of this article (10.1007/s10072-019-03942-z) contains supplementary material, which is available to authorized users.
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Rogalski EJ, Sridhar J, Martersteck A, Rader B, Cobia D, Arora AK, Fought AJ, Bigio EH, Weintraub S, Mesulam MM, Rademaker A. Clinical and cortical decline in the aphasic variant of Alzheimer's disease. Alzheimers Dement 2019; 15:543-552. [PMID: 30765195 DOI: 10.1016/j.jalz.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/18/2018] [Accepted: 12/02/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) displays variable progression trajectories that require further elucidation. METHODS Longitudinal quantitation of atrophy and language over 12 months was completed for PPA patients with and without positive amyloid PET (PPAAβ+ and PPAAβ-), an imaging biomarker of underlying Alzheimer's disease. RESULTS Over 12 months, both PPA groups showed significantly greater cortical atrophy rates in the left versus right hemisphere, with a more widespread pattern in PPAAβ+. The PPAAβ+ group also showed greater decline in performance on most language tasks. There was no obligatory relationship between the logopenic PPA variant and amyloid status. Effect sizes from quantitative MRI data were more robust than neuropsychological metrics. DISCUSSION Preferential language network neurodegeneration is present in PPA irrespective of amyloid status. Clinical and anatomical progression appears to differ for PPA due to Alzheimer's disease versus non-Alzheimer's disease neuropathology, a distinction that may help to inform prognosis and the design of intervention trials.
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Affiliation(s)
- Emily Joy Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA; NU Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA.
| | - Jaiashre Sridhar
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA
| | - Adam Martersteck
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin Rader
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA
| | - Derin Cobia
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Anupa K Arora
- Avid Radiopharmaceuticals Inc, Philadelphia, PA, USA
| | - Angela J Fought
- NU Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, USA
| | - Eileen H Bigio
- NU Feinberg School of Medicine, Department of Pathology, Chicago, IL, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA; NU Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Marek-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA; NU Feinberg School of Medicine, Department of Neurology, Chicago, IL, USA
| | - Alfred Rademaker
- NU Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, USA
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Meijer KA, van Geest Q, Eijlers AJC, Geurts JJG, Schoonheim MM, Hulst HE. Is impaired information processing speed a matter of structural or functional damage in MS? Neuroimage Clin 2018; 20:844-850. [PMID: 30278371 PMCID: PMC6169100 DOI: 10.1016/j.nicl.2018.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/20/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022]
Abstract
Objective Cognitive deficits, especially those of information processing speed (IPS), are common in multiple sclerosis (MS), however, the underlying neurobiological mechanisms remain poorly understood. In this study, we examined structural and functional brain changes separately, but also in an integrative manner, in relation to IPS performance. Methods IPS was measured using the symbol digit modalities test (SDMT) in 330 MS patients and 96 controls. Patients with IPS impairment (IPS-I, z-score < −1.5) were compared to patients with preserved IPS performance (IPS-P) on volumetric measures, white matter integrity loss (using diffusion tensor imaging) and the severity of functional connectivity changes (using resting-state fMRI). Significant predictors of IPS performance were used to create groups of mild or severe structural and/or functional damage to determine the relative effect of structural and/or functional changes on IPS. Results IPS-I patients, compared to IPS-P patients, showed lower deep gray matter volume and less WM integrity, but stronger increases in functional connectivity. Patients with predominantly structural damage had worse IPS (z-score = −1.49) than patients with predominantly functional changes (z-score = −0.84), although both structural and functional measures remained significant in a regression model. Patients with severe structural and functional changes had worst IPS (z-score = −1.95). Conclusion The level of structural damage explains IPS performance better than functional changes. After integrating functional and structural changes, however, we were able to detect more subtle and stepwise decline in IPS. In subgroups with a similar degree of structural damage, more severe functional changes resulted in worse IPS scores than those with only mild functional changes. Impaired information processing in MS relates to structural and functional changes. There is no one-to-one relation between structural and functional damage. MS patients with severe structural and functional changes have the lowest IPS. Structural changes affect information processing more than functional changes. Functional changes seem to mediate the effect of structural damage on IPS.
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Affiliation(s)
- K A Meijer
- Department of Anatomy and Neurosciences, MS Centres Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands.
| | - Q van Geest
- Department of Anatomy and Neurosciences, MS Centres Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - A J C Eijlers
- Department of Anatomy and Neurosciences, MS Centres Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - J J G Geurts
- Department of Anatomy and Neurosciences, MS Centres Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - M M Schoonheim
- Department of Anatomy and Neurosciences, MS Centres Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - H E Hulst
- Department of Anatomy and Neurosciences, MS Centres Amsterdam, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
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Aladro Y, López-Alvarez L, Sánchez-Reyes JM, Hernández-Tamames JA, Melero H, Rubio-Fernández S, Thuissard I, Cerezo-García M. Relationship between episodic memory and volume of the brain regions of two functional cortical memory systems in multiple sclerosis. J Neurol 2018; 265:2182-2189. [PMID: 29995292 DOI: 10.1007/s00415-018-8965-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/19/2018] [Revised: 06/23/2018] [Accepted: 06/28/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVE Two functional networks are proposed as neuronal support for the complex processes of memory: the anterior temporal and the medial posterior systems. We examined the atrophy of hippocampus (HC) and of those areas constituting the two functional memory systems in multiple sclerosis (MS) patients with low disability. METHODS Episodic memory (EM) was assessed in 88 relapsing MS patients and in 40 healthy controls using Wechsler Memory Scale III (Spanish adaptation). FreeSurfer software was used to calculate normalized volume of total cortex, grey matter, white matter, subcortical grey matter (thalamus and striatum), HC and both the anterior temporal (entorhinal, ventral temporopolar, lateral orbitofrontal, amygdala) and posterior medial systems (thalamus, parahippocampal, posterior cingulate, precuneus, lateral parietal and medial prefrontal). Linear regression analysis was used to identify predictors of memory performance. RESULTS Total grey matter and cortex volumes correlated with all subtypes of EM, and the precuneus volume correlated with overall, immediate and delayed memories. Univariant regression analysis identified an association between the volumes of the posterior medial memory network regions and EM scores. The volume of the left precuneus area was the unique and independent predictor for all EM subtypes except for visual memory, for which left HC volume was also an independent predictor. CONCLUSION Left precuneus volume was the best predictor of memory in relapsing MS patients with low disability and mild deficits in EM.
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Affiliation(s)
- Yolanda Aladro
- Multiple Sclerosis Unit, Department of Neurology, Getafe University Hospital, European University of Madrid, Carretera de Toledo km 12,5, 28905, Madrid, Spain.
| | | | | | | | - Helena Melero
- Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Rey Juan Carlos University, Móstoles, Madrid, Spain
| | | | - Israel Thuissard
- Department of Statistic, European University of Madrid, Madrid, Spain
| | - Marta Cerezo-García
- Multiple Sclerosis Unit, Department of Neurology, Getafe University Hospital, European University of Madrid, Carretera de Toledo km 12,5, 28905, Madrid, Spain
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Semler E, Anderl-Straub S, Uttner I, Diehl-Schmid J, Danek A, Einsiedler B, Fassbender K, Fliessbach K, Huppertz HJ, Jahn H, Kornhuber J, Landwehrmeyer B, Lauer M, Muche R, Prudlo J, Schneider A, Schroeter ML, Ludolph AC, Otto M. A language-based sum score for the course and therapeutic intervention in primary progressive aphasia. Alzheimers Res Ther 2018; 10:41. [PMID: 29695300 PMCID: PMC5922300 DOI: 10.1186/s13195-018-0345-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022]
Abstract
Background With upcoming therapeutic interventions for patients with primary progressive aphasia (PPA), instruments for the follow-up of patients are needed to describe disease progression and to evaluate potential therapeutic effects. So far, volumetric brain changes have been proposed as clinical endpoints in the literature, but cognitive scores are still lacking. This study followed disease progression predominantly in language-based performance within 1 year and defined a PPA sum score which can be used in therapeutic interventions. Methods We assessed 28 patients with nonfluent variant PPA, 17 with semantic variant PPA, 13 with logopenic variant PPA, and 28 healthy controls in detail for 1 year. The most informative neuropsychological assessments were combined to a sum score, and associations between brain atrophy were investigated followed by a sample size calculation for clinical trials. Results Significant absolute changes up to 20% in cognitive tests were found after 1 year. Semantic and phonemic word fluency, Boston Naming Test, Digit Span, Token Test, AAT Written language, and Cookie Test were identified as the best markers for disease progression. These tasks provide the basis of a new PPA sum score. Assuming a therapeutic effect of 50% reduction in cognitive decline for sample size calculations, a number of 56 cases is needed to find a significant treatment effect. Correlations between cognitive decline and atrophy showed a correlation up to r = 0.7 between the sum score and frontal structures, namely the superior and inferior frontal gyrus, as well as with left-sided subcortical structures. Conclusion Our findings support the high performance of the proposed sum score in the follow-up of PPA and recommend it as an outcome measure in intervention studies. Electronic supplementary material The online version of this article (10.1186/s13195-018-0345-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisa Semler
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sarah Anderl-Straub
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technische Universität (TU) München, München, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität (LMU) München, München, Germany
| | - Beate Einsiedler
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Klaus Fliessbach
- Department of Psychiatry and Psychotherapy, University of Bonn and DZNE Bonn, Bonn, Germany
| | | | - Holger Jahn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | | | - Martin Lauer
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Johannes Prudlo
- Department of Neurology, Rostock University Medical Center and German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Anja Schneider
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Yoong M, Hunter M, Stephen J, Quigley A, Jones J, Shetty J, McLellan A, Bastin ME, Chin RFM. Cognitive impairment in early onset epilepsy is associated with reduced left thalamic volume. Epilepsy Behav 2018; 80:266-271. [PMID: 29422396 DOI: 10.1016/j.yebeh.2018.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/13/2017] [Revised: 01/13/2018] [Accepted: 01/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether reduction of thalamic volumes in children with early onset epilepsy (CWEOE) is associated with cognitive impairment. METHODS This is a nested case-control study including a prospectively recruited cohort of 76 children with newly-diagnosed early onset epilepsy (onset <5years age) and 14 healthy controls presenting to hospitals within NHS Lothian and Fife. Quantitative volumetric analysis of subcortical structures was performed using volumetric T1-weighted magnetic resonance imaging (MRI) and correlated with the results of formal neurocognitive and clinical assessment. False discovery rate was used to correct for multiple comparisons as appropriate with q<0.05 used to define statistical significance. RESULTS Age, gender, and intracranial volume (ICV)-adjusted left thalamic volumes were significantly reduced in CWEOE with cognitive impairment compared to CWEOE without impairment (5295mm3 vs 6418mm3, q=0.008) or healthy controls (5295mm3 vs 6410mm3, q<0.001). The differences in left thalamic volume remained if gray matter or cortical/cerebellar volumes were used as covariates rather than ICV (q<0.05). The degree of volume reduction correlated with the severity of cognitive impairment (q=0.048). SIGNIFICANCE Reduced left thalamic volume may be a biomarker for cognitive impairment in CWEOE and could help inform the need for further formal cognitive evaluations and interventions.
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Affiliation(s)
- Michael Yoong
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK; Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK.
| | - Matthew Hunter
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Alan Quigley
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jeremy Jones
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jay Shetty
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ailsa McLellan
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Mark E Bastin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK; Brain Research Imaging Centre, University of Edinburgh, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, UK; Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
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Wojtowicz M, Gardner AJ, Stanwell P, Zafonte R, Dickerson BC, Iverson GL. Cortical thickness and subcortical brain volumes in professional rugby league players. Neuroimage Clin 2018; 18:377-381. [PMID: 29487794 PMCID: PMC5814377 DOI: 10.1016/j.nicl.2018.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 01/22/2023]
Abstract
Purpose The purpose of this study was to examine cortical thickness and subcortical volumes in professional rugby players with an extensive history of concussions compared to control subjects. Method Participants included 24 active and former professional rugby league players [Age M(SD) = 33.3(6.3); Range = 21–44] with an extensive history of concussion and 18 age- and education-matched controls with no history of neurotrauma or participation in contact sports. Participants underwent T1-weighted imaging and completed a neuropsychological battery, including two tests of memory. Whole brain cortical thickness analysis and structural volume analysis was performed using FreeSurfer version 6.0. Results Professional rugby league players reported greater alcohol consumption (p < .001) and had significantly worse delayed recall of a visually complex design (p = .04). They did not differ from controls on other clinical outcome measures. There were no differences in cortical thickness between the groups. Professional players had smaller whole brain (p = .003), bilateral hippocampi (ps = .03), and left amygdala volumes (p = .01) compared to healthy controls. Within the players group, there were significant associations between greater alcohol use and smaller bilateral hippocampi and left amygdala volumes. There were no associations between structural volumes and history of concussions or memory performance. Conclusions The literature examining cortical thickness in athletes with a history of multiple concussions is mixed. We did not observe differences in cortical thickness in professional rugby league players compared to controls. However, smaller subcortical volumes were found in players that were, in part, associated with greater alcohol consumption. No differences in cortical thickness were observed in rugby players compared to controls. Smaller hippocampal and amygdala volumes were observed in rugby players. Greater alcohol use was associated with smaller bilateral hippocampi and left amygdala volumes in rugby players.
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Affiliation(s)
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA.
| | | | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA; MassGeneral Hospital for Children™ Sport Concussion Program, Boston, MA 02114, USA.
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26
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Kirov II, Kuzniecky R, Hetherington HP, Soher BJ, Davitz MS, Babb JS, Pardoe HR, Pan JW, Gonen O. Whole brain neuronal abnormalities in focal epilepsy quantified with proton MR spectroscopy. Epilepsy Res 2018; 139:85-91. [PMID: 29212047 PMCID: PMC6411059 DOI: 10.1016/j.eplepsyres.2017.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To test the hypothesis that localization-related epilepsy is associated with widespread neuronal dysfunction beyond the ictal focus, reflected by a decrease in patients' global concentration of their proton MR spectroscopy (1H-MRS) observed marker, N-acetyl-aspartate (NAA). METHODS Thirteen patients with localization-related epilepsy (7 men, 6 women) 40±13 (mean±standard-deviation)years old, 8.3±13.4years of disease duration; and 14 matched controls, were scanned at 3 T with MRI and whole-brain (WB) 1H MRS. Intracranial fractions of brain volume, gray and white matter (fBV, fGM, fWM) were segmented from the MRI, and global absolute NAA creatine (Cr) and choline (Cho) concentrations were estimated from their WB 1H MRS. These metrics were compared between patients and controls using an unequal variance t test. RESULTS Patients' fBV, fGM and fWM: 0.81±0.07, 0.47±0.04, 0.31±0.04 were not different from controls' 0.79±0.05, 0.48±0.04, 0.32±0.02; nor were their Cr and Cho concentrations: 7.1±1.1 and 1.3±0.2 millimolar (mM) versus 7.7±0.7 and 1.4±0.1mM (p>0.05 all). Patients' global NAA concentration: 11.5±1.5 mM, however, was 12% lower than controls' 13.0±0.8mM (p=0.004). CONCLUSIONS These findings indicate that neuronal dysfunction in localization-related epilepsy extends globally, beyond the ictal zone, but without atrophy or spectroscopic evidence of other pathology. This suggests a diffuse decline in the neurons' health, rather than their number, early in the disease course. WB 1H-MRS assessment, therefore, may be a useful tool for quantification of global neuronal dysfunction load in epilepsy.
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Affiliation(s)
- Ivan I Kirov
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, USA.
| | - Ruben Kuzniecky
- Comprehensive Epilepsy Center, New York University School of Medicine,New York City, NY, USA.
| | - Hoby P Hetherington
- Department of Radiology and Neurology, University of Pittsburgh School of Medicine,Pittsburgh, PA, USA.
| | - Brian J Soher
- Department of Radiology, Duke University Medical Center, Durham NC, USA.
| | - Matthew S Davitz
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, USA.
| | - James S Babb
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, USA.
| | - Heath R Pardoe
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, USA.
| | - Jullie W Pan
- Department of Radiology and Neurology, University of Pittsburgh School of Medicine,Pittsburgh, PA, USA.
| | - Oded Gonen
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, USA.
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27
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Rashid A, Ram AN, Kates WR, Redmond KJ, Wharam M, Mark Mahone E, Horska A, Terezakis S. A prospective study of corpus callosum regional volumes and neurocognitive outcomes following cranial radiation for pediatric brain tumors. Childs Nerv Syst 2017; 33:965-972. [PMID: 28455540 DOI: 10.1007/s00381-017-3412-3] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/07/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE/OBJECTIVE(S) Cranial radiation therapy (CRT) may disrupt the corpus callosum (CC), which plays an important role in basic motor and cognitive functions. The aim of this prospective longitudinal study was to assess changes in CC mid-sagittal areas, CC volumes, and performance on neuropsychological (NP) tests related to the CC in children following CRT. MATERIALS/METHODS Twelve pediatric patients were treated with CRT for primary brain malignancies. Thirteen age-matched healthy volunteers served as controls. Brain MRIs and NP assessment emphasizing motor dexterity, processing speed, visuomotor integration, and working memory (visual and verbal) were performed at baseline and at 6, 15, and 27 months following completion of CRT. Linear mixed effects (LME) analyses were used to evaluate patient NP performance and changes in regional CC volumes (genu, anterior body, mid-body, posterior body, and splenium) and mid-sagittal areas over time and with radiation doses, correcting for age at CRT start. RESULTS The mean age at CRT was 9.41 (range 1.2-15.7) years. The median prescription dose was 54 (range 18-59.4) Gy. LME analysis revealed a significant decrease in overall CC volumes over time (p < 0.00001), with no overall effect of radiation dose. Analysis of individual CC regions demonstrated a significant decrease in all regional volumes over time (p < 0.00001) in patients, with no effect of radiation dose. Only in the splenium was there a trend toward a dose-dependent effect (p = 0.093). Patients had significantly reduced NP performance across visits-most notably in motor dexterity and visual working memory (both p < 0.0001). CONCLUSIONS These prospective data demonstrate a significant decrease in CC regional volumes after CRT, with associated decline in neurocognitive function, most notably in manual dexterity, attention, and working memory. Further prospective study of larger cohorts of patients is needed to establish the relationship between CRT dose, neuroanatomical, and functional changes in the CC.
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Affiliation(s)
- Arif Rashid
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA
| | - Ashwin N Ram
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA
| | - Wendy R Kates
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, USA
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA
| | - Moody Wharam
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA
| | - E Mark Mahone
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alena Horska
- Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA
| | - Stephanie Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA.
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Conrad BN, Rogers BP, Abou-Khalil B, Morgan VL. Increased MRI volumetric correlation contralateral to seizure focus in temporal lobe epilepsy. Epilepsy Res 2016; 126:53-61. [PMID: 27429056 DOI: 10.1016/j.eplepsyres.2016.07.001] [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: 03/02/2016] [Revised: 06/17/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
Quantification of volumetric correlation may be sensitive to disease alterations undetected by standard voxel based morphometry (VBM) such as subtle, synchronous alterations in regional volumes, and may provide complementary evidence of the structural impact of temporal lobe epilepsy (TLE) on the brain. The purpose of this study was to quantify differences of regional volumetric correlation in right (RTLE) and left (LTLE) TLE patients compared to healthy controls. A T1 weighted 3T MRI was acquired (1mm(3)) in 44 drug resistant unilateral TLE patients (n=26 RTLE, n=18 LTLE) and 44 individually age and gender matched healthy controls. Images were processed using a standard VBM framework and volumetric correlation was calculated across subjects in 90 regions and compared between patients and controls. Results were summarized across hemispheres and region groups. There was increased correlation involving the contralateral homologues of the seizure foci/network in the limbic, subcortical and temporal regions in both RTLE and LTLE. Outside these regions, results implied widespread correlated alterations across several contralateral lobes in LTLE, with more focal changes in RTLE. These findings complement previous volumetric studies in TLE describing more ipsilateral atrophy, by revealing subtle coordinated volumetric changes to identify a more widespread effect of TLE across the brain.
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Affiliation(s)
- Benjamin N Conrad
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Baxter P Rogers
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | | | - Victoria L Morgan
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA.
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Millichap JG. Relation of Posterior Cerebellar Volume to Cognition in MS. Pediatr Neurol Briefs 2016; 29:53. [PMID: 26933591 PMCID: PMC4747295 DOI: 10.15844/pedneurbriefs-29-7-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Investigators from the Montreal Neurological Institute, York University, Universities of Toronto and McGill, Canada, and University of Pennsylvania, studied the relationship between cerebellar pathology and cognitive function in adolescent and pediatric-onset multiple sclerosis (MS).
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Affiliation(s)
- J Gordon Millichap
- Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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30
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Whitwell JL, Weigand SD, Duffy JR, Strand EA, Machulda MM, Senjem ML, Gunter JL, Lowe VJ, Jack CR, Josephs KA. Clinical and MRI models predicting amyloid deposition in progressive aphasia and apraxia of speech. Neuroimage Clin 2016; 11:90-98. [PMID: 26937376 PMCID: PMC4752814 DOI: 10.1016/j.nicl.2016.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 12/14/2022]
Abstract
Beta-amyloid (Aβ) deposition can be observed in primary progressive aphasia (PPA) and progressive apraxia of speech (PAOS). While it is typically associated with logopenic PPA, there are exceptions that make predicting Aβ status challenging based on clinical diagnosis alone. We aimed to determine whether MRI regional volumes or clinical data could help predict Aβ deposition. One hundred and thirty-nine PPA (n = 97; 15 agrammatic, 53 logopenic, 13 semantic and 16 unclassified) and PAOS (n = 42) subjects were prospectively recruited into a cross-sectional study and underwent speech/language assessments, 3.0 T MRI and C11-Pittsburgh Compound B PET. The presence of Aβ was determined using a 1.5 SUVR cut-point. Atlas-based parcellation was used to calculate gray matter volumes of 42 regions-of-interest across the brain. Penalized binary logistic regression was utilized to determine what combination of MRI regions, and what combination of speech and language tests, best predicts Aβ (+) status. The optimal MRI model and optimal clinical model both performed comparably in their ability to accurately classify subjects according to Aβ status. MRI accurately classified 81% of subjects using 14 regions. Small left superior temporal and inferior parietal volumes and large left Broca's area volumes were particularly predictive of Aβ (+) status. Clinical scores accurately classified 83% of subjects using 12 tests. Phonological errors and repetition deficits, and absence of agrammatism and motor speech deficits were particularly predictive of Aβ (+) status. In comparison, clinical diagnosis was able to accurately classify 89% of subjects. However, the MRI model performed well in predicting Aβ deposition in unclassified PPA. Clinical diagnosis provides optimum prediction of Aβ status at the group level, although regional MRI measurements and speech and language testing also performed well and could have advantages in predicting Aβ status in unclassified PPA subjects. We examine whether MRI or clinical data can predict Aβ deposition in PPA and PAOS. MRI and clinical data accurately classified 81% and 83% of subjects, respectively. Small superior temporal gyri and phonological errors best predicted Aβ deposition. In comparison, clinical diagnosis accurately classified 89% of subjects. MRI and clinical data could predict discordant svPPA, lvPPA and unclassified cases.
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Affiliation(s)
| | - Stephen D Weigand
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey L Gunter
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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31
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Schenning KJ, Murchison CF, Mattek NC, Silbert LC, Kaye JA, Quinn JF. Surgery is associated with ventricular enlargement as well as cognitive and functional decline. Alzheimers Dement 2015; 12:590-7. [PMID: 26610898 DOI: 10.1016/j.jalz.2015.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/01/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In preclinical studies, surgery/anesthesia contribute to cognitive decline and enhance neuropathologic changes underlying Alzheimer's disease (AD). Nevertheless, the link between surgery, anesthesia, apolipoprotein E ε4 (APOE ε4), and AD remains unclear. METHODS We performed a retrospective cohort analysis of two prospective longitudinal aging studies. Mixed-effects statistical models were used to assess the relationship between surgical/anesthetic exposure, the APOE genotype, and rate of change in measures of cognition, function, and brain volumes. RESULTS The surgical group (n = 182) experienced a more rapid rate of deterioration compared with the nonsurgical group (n = 345) in several cognitive, functional, and brain magnetic resonance imaging measures. Furthermore, there was a significant synergistic effect of anesthesia/surgery exposure and presence of the APOE ε4 allele in the decline of multiple cognitive and functional measures. DISCUSSION These data provide insight into the role of surgical exposure as a risk factor for cognitive and functional decline in older adults.
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Affiliation(s)
- Katie J Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Charles F Murchison
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Nora C Mattek
- Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA
| | - Lisa C Silbert
- Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, USA; Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR, USA
| | - Jeffrey A Kaye
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA; Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, USA; Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR, USA
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, USA; Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR, USA
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Bocchetta M, Gordon E, Manning E, Barnes J, Cash DM, Espak M, Thomas DL, Modat M, Rossor MN, Warren JD, Ourselin S, Frisoni GB, Rohrer JD. Detailed volumetric analysis of the hypothalamus in behavioral variant frontotemporal dementia. J Neurol 2015; 262:2635-42. [PMID: 26338813 PMCID: PMC4655011 DOI: 10.1007/s00415-015-7885-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022]
Abstract
Abnormal eating behaviors are frequently reported in behavioral variant frontotemporal dementia (bvFTD). The hypothalamus is the regulatory center for feeding and satiety but its involvement in bvFTD has not been fully clarified, partly due to its difficult identification on MR images. We measured hypothalamic volume in 18 patients with bvFTD (including 9 MAPT and 6 C9orf72 mutation carriers) and 18 cognitively normal controls using a novel optimized multimodal segmentation protocol, combining 3D T1 and T2-weighted 3T MRIs (intrarater intraclass correlation coefficients ≥0.93). The whole hypothalamus was subsequently segmented into five subunits: the anterior (superior and inferior), tuberal (superior and inferior), and posterior regions. The presence of abnormal eating behavior was assessed with the revised version of the Cambridge Behavioural Inventory (CBI-R). The bvFTD group showed a 17 % lower hypothalamic volume compared with controls (p < 0.001): mean 783 (standard deviation 113) versus 944 (73) mm3 (corrected for total intracranial volume). In the hypothalamic subunit analysis, the superior parts of the anterior and tuberal regions and the posterior region were significantly smaller in the bvFTD group compared with controls. There was a trend for a smaller hypothalamic volume, particularly in the superior tuberal region, in those with severe eating disturbance scores on the CBI-R. Differences were seen between the two genetic subgroups with significantly smaller volumes in the MAPT but not the C9orf72 group compared with controls. In summary, bvFTD patients had lower hypothalamic volumes compared with controls. Different genetic mutations may have a differential impact on the hypothalamus.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK.,Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elizabeth Gordon
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Emily Manning
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Josephine Barnes
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Miklos Espak
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - David L Thomas
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Marc Modat
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sebastien Ourselin
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK.,Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Memory Clinic and Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, 8-11 Queen Square, London, WC1N 3BG, UK.
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Ciric I, Farhat H. The early versus late magnetic resonance imaging debate. World Neurosurg 2014; 83:471-2. [PMID: 25169747 DOI: 10.1016/j.wneu.2014.08.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ivan Ciric
- Evanston Hospital, Neurosurgery, Evanston, Illinois, USA; Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA.
| | - Hamad Farhat
- Evanston Hospital, Neurosurgery, Evanston, Illinois, USA; Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
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Patel KS, Kazam J, Tsiouris AJ, Anand VK, Schwartz TH. Utility of early postoperative high-resolution volumetric magnetic resonance imaging after transsphenoidal pituitary tumor surgery. World Neurosurg 2014; 82:777-80. [PMID: 25045791 DOI: 10.1016/j.wneu.2014.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 11/27/2013] [Revised: 02/12/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Controversy exists over the utility of early postoperative magnetic resonance imaging (MRI) after transsphenoidal pituitary surgery for macroadenomas. We investigate whether valuable information can be derived from current greater resolution scans. METHODS Volumetric MRI scans were obtained in the early (<10 days) and late (>30 days) postoperative periods in a series of patients undergoing transsphenoidal pituitary surgery. The volume of the residual tumor, resection cavity, and corresponding visual field tests were recorded at each time point. Statistical analyses of changes in tumor volume and cavity size were calculated using the late MRI as the gold standard. RESULTS A total of 40 patients met the inclusion criteria. Preoperative tumor volume averaged 8.8 cm(3). Early postoperative assessment of average residual tumor volume (1.18 cm(3)) was quite accurate and did not differ statistically from late postoperative volume (1.23 cm(3), P = 0.64), indicating the utility of early scans to measure residual tumor. Early scans were 100% sensitive and 91% specific for predicting ≥ 98% resection (P < 0.001, Fisher exact test). The average percent decrease in cavity volume from preoperative MRI (tumor volume) to early postoperative imaging was 45% with decreases in all but 3 patients. There was no correlation between the size of the early cavity and the visual outcome. CONCLUSIONS Early, high-resolution volumetric MRI is valuable in determining the presence or absence of residual tumor. Cavity volume almost always decreases after surgery, and a lack of decrease should alert the surgeon to possible persistent compression of the optic apparatus that may warrant reoperation.
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Affiliation(s)
- Kunal S Patel
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Jacob Kazam
- Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Apostolos J Tsiouris
- Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurology and Neuroscience, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
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Shoemaker RC, House D, Ryan JC. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water-damaged buildings: a volumetric MRI study using NeuroQuant®. Neurotoxicol Teratol 2014; 45:18-26. [PMID: 24946038 DOI: 10.1016/j.ntt.2014.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 12/22/2022]
Abstract
Executive cognitive and neurologic abnormalities are commonly seen in patients with a chronic inflammatory response syndrome (CIRS) acquired following exposure to the interior environment of water-damaged buildings (WDB), but a clear delineation of the physiologic or structural basis for these abnormalities has not been defined. Symptoms of affected patients routinely include headache, difficulty with recent memory, concentration, word finding, numbness, tingling, metallic taste and vertigo. Additionally, persistent proteomic abnormalities in inflammatory parameters that can alter permeability of the blood-brain barrier, such as C4a, TGFB1, MMP9 and VEGF, are notably present in cases of CIRS-WDB compared to controls, suggesting a consequent inflammatory injury to the central nervous system. Findings of gliotic areas in MRI scans in over 45% of CIRS-WDB cases compared to 5% of controls, as well as elevated lactate and depressed ratios of glutamate to glutamine, are regularly seen in MR spectroscopy of cases. This study used the volumetric software program NeuroQuant® (NQ) to determine specific brain structure volumes in consecutive patients (N=17) seen in a medical clinic specializing in inflammatory illness. Each of these patients presented for evaluation of an illness thought to be associated with exposure to WDB, and received an MRI that was evaluated by NQ. When compared to those of a medical control group (N=18), statistically significant differences in brain structure proportions were seen for patients in both hemispheres of two of the eleven brain regions analyzed; atrophy of the caudate nucleus and enlargement of the pallidum. In addition, the left amygdala and right forebrain were also enlarged. These volumetric abnormalities, in conjunction with concurrent abnormalities in inflammatory markers, suggest a model for structural brain injury in "mold illness" based on increased permeability of the blood-brain barrier due to chronic, systemic inflammation.
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Affiliation(s)
- Ritchie C Shoemaker
- Center for Research on Biotoxin Associated Illnesses, Pocomoke, MD, United States.
| | - Dennis House
- Center for Research on Biotoxin Associated Illnesses, Pocomoke, MD, United States
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Reginold W, Lang AE, Marras C, Heyn C, Alharbi M, Mikulis DJ. Longitudinal quantitative MRI in multiple system atrophy and progressive supranuclear palsy. Parkinsonism Relat Disord 2013; 20:222-5. [PMID: 24239142 DOI: 10.1016/j.parkreldis.2013.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 07/16/2013] [Revised: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE MRI has been used in parkinsonism to assess atrophy, tissue water diffusivity, and mineral deposition but usually at a single time-point. However, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) are progressive diseases. This study assessed the value of longitudinal MRI in characterizing the time course of the degenerative process. METHODS Two serial MRIs (mean 23 months apart) were retrospectively analyzed in 12 MSA, 6 PSP, and 18 age and sex matched controls. Assessment included selected cross-sectional areas, regional apparent diffusion coefficient (ADC) and gradient echo (GRE) intensity ratios of the lateral ventricles, caudate, putamen, middle cerebellar peduncle, pons and midbrain. RESULTS On follow-up imaging, there was a larger ADC increase in the putamen in PSP over time compared to controls (p = 0.02). In MSA there was greater volume loss in the pons over time compared to controls (p = 0.002). In MSA the changes in middle cerebellar peduncle ADC were correlated with motor symptom severity according to the Unified Parkinson's Disease Rating Scale Part III (p = 0.005). CONCLUSIONS Evidence of progressive neurodegeneration can be observed on MRI in MSA and PSP within two years consisting of increasing putaminal ADC in PSP and pontine atrophy in MSA.
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Affiliation(s)
- William Reginold
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada; Department of Medical Imaging, Toronto Western Hospital, the Joint Department of Medical Imaging, and The University of Toronto, Canada.
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada; Department of Medicine (Neurology), University of Toronto, Canada.
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada; Department of Medicine (Neurology), University of Toronto, Canada.
| | - Chris Heyn
- Department of Medical Imaging, Toronto Western Hospital, the Joint Department of Medical Imaging, and The University of Toronto, Canada.
| | - Mohammed Alharbi
- Department of Medical Imaging, Toronto Western Hospital, the Joint Department of Medical Imaging, and The University of Toronto, Canada.
| | - David J Mikulis
- Department of Medical Imaging, Toronto Western Hospital, the Joint Department of Medical Imaging, and The University of Toronto, Canada.
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Barron DS, Fox PM, Laird AR, Robinson JL, Fox PT. Thalamic medial dorsal nucleus atrophy in medial temporal lobe epilepsy: A VBM meta-analysis. Neuroimage Clin 2012; 2:25-32. [PMID: 24179755 PMCID: PMC3777772 DOI: 10.1016/j.nicl.2012.11.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/20/2012] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
Abstract
Purpose Medial temporal lobe epilepsy (MTLE) is associated with MTLE network pathology within and beyond the hippocampus. The purpose of this meta-analysis was to identify consistent MTLE structural change to guide subsequent targeted analyses of these areas. Methods We performed an anatomic likelihood estimation (ALE) meta-analysis of 22 whole-brain voxel-based morphometry experiments from 11 published studies. We grouped these experiments in three ways. We then constructed a meta-analytic connectivity model (MACM) for regions of consistent MTLE structural change as reported by the ALE analysis. Key findings ALE reported spatially consistent structural change across VBM studies only in the epileptogenic hippocampus and the bilateral thalamus; within the thalamus, the medial dorsal nucleus of the thalamus (MDN thalamus) represented the greatest convergence (P < 0.05 corrected for multiple comparisons). The subsequent MACM for the hippocampus and ipsilateral MDN thalamus demonstrated that the hippocampus and ipsilateral MDN thalamus functionally co-activate and are nodes within the same network, suggesting that MDN thalamic damage could result from MTLE network excitotoxicity. Significance Notwithstanding our large sample of studies, these findings are more restrictive than previous reports and demonstrate the utility of our inclusion filters and of recently modified meta-analytic methods in approximating clinical relevance. Thalamic pathology is commonly observed in animal and human studies, suggesting it could be a clinically useful indicator. Thalamus-specific research as a clinical marker awaits further investigation.
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Affiliation(s)
- Daniel S Barron
- Research Imaging Institute, UT Health Science Center, San Antonio, TX, USA
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