Early Cerebellar Network Shifting in Spinocerebellar Ataxia Type 6

Spinocerebellar ataxia 6 (SCA6), an autosomal dominant degenerative disease, is characterized by diplopia, gait ataxia, and incoordination due to severe progressive degeneration of Purkinje cells in the vestibulo- and spinocerebellum. Ocular motor deficits are common, including difficulty fixating on moving objects, nystagmus and disruption of smooth pursuit movements. In presymptomatic SCA6, there are alterations in saccades and smooth-pursuit movements. We sought to assess functional and structural changes in cerebellar connectivity associated with a visual task, hypothesizing that gradual changes would parallel disease progression. We acquired functional magnetic resonance imaging and diffusion tensor imaging data during a passive smooth-pursuit task in 14 SCA6 patients, representing a range of disease duration and severity, and performed a cross-sectional comparison of cerebellar networks compared with healthy controls. We identified a shift in activation from vermis in presymptomatic individuals to lateral cerebellum in moderate-to-severe cases. Concomitantly, effective connectivity between regions of cerebral cortex and cerebellum was at its highest in moderate cases, and disappeared in severe cases. Finally, we noted structural differences in the cerebral and cerebellar peduncles. These unique results, spanning both functional and structural domains, highlight widespread changes in SCA6 and compensatory mechanisms associated with cerebellar physiology that could be utilized in developing new therapies.

A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008–2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.

Virtual brain transplantation (VBT): a method for accurate image registration and parcellation in large cortical stroke

OBJECTIVE

The objective of the current study was to develop a semi-automated method to register and parcellate lesioned brains in a surface space with anatomical accuracy, facilitating group-level fMRI analyses in patients with large cortical strokes.

METHODS

Thirteen chronic patients with a single large left hemisphere stroke were included in the study. Our "virtual brain transplantation" (VBT) approach is based on pre-processing high resolution anatomical T1-weighted brain images by "filling in" the lesion with "transplanted virtual tissue" from the non-stroke hemisphere, providing "normal" anatomical landmarks for standard alignment and inflation algorithms developed for healthy individuals. Biological validation of the approach was performed by quantifying in Freesurfer space the areas of 12 hand-drawn sulci found inside and outside the stroke following "transplantation".

RESULTS

Our results show no difference in the Freesurfer parcellation of 12 different regions when comparing a lesioned hemisphere with the non-lesioned hemisphere, attesting for the validity of the anatomical classification in the stroke hemisphere. As consequence of the anatomical precision, this method permits a more detailed and quantifiable anatomical description of the regions affected directly by the stroke.

CONCLUSIONS

This method permits accurate surface reconstruction of the injured hemisphere after stroke by making it possible to extract the cortical surface from these images and to utilize this in software modules (FreeSurfer) specialized for aligning cortical surfaces using high-dimensionality warping algorithms. In addition, it permits quantifying, within bounds, the extent to which the lesion in question is associated with damage to particular regions of the cortical surface, information that is of explanatory value in models that attempt to explain brain-behavior relations using lesion analysis.

Network activation during bimanual movements in humans

The coordination of movement between the upper limbs is a function highly distributed across the animal kingdom. How the central nervous system generates such bilateral, synchronous movements, and how this differs from the generation of unilateral movements, remain uncertain. Electrophysiologic and functional imaging studies support that the activity of many brain regions during bimanual and unimanual movement is quite similar. Thus, the same brain regions (and indeed the same neurons) respond similarly during unimanual and bimanual movements as measured by electrophysiological responses. How then are different motor behaviors generated? To address this question, we studied unimanual and bimanual movements using fMRI and constructed networks of activation using Structural Equation Modeling (SEM). Our results suggest that (1) the dominant hemisphere appears to initiate activity responsible for bimanual movement; (2) activation during bimanual movement does not reflect the sum of right and left unimanual activation; (3) production of unimanual movement involves a network that is distinct from, and not a mirror of, the network for contralateral unimanual movement; and (4) using SEM, it is possible to obtain robust group networks representative of a population and to identify individual networks which can be used to detect subtle differences both between subjects as well as within a single subject over time. In summary, these results highlight a differential role for the dominant and non-dominant hemispheres during bimanual movements, further elaborating the concept of handedness and dominance. This knowledge increases our understanding of cortical motor physiology in health and after neurological damage.