Microstructural Alterations Analogous to Accelerated Aging of the Cerebral Cortex in Carotid Occlusive Disease

Purpose

To investigate cortical thickness and cortical quantitative T2 values as imaging markers of microstructural tissue damage in patients with unilateral high-grade internal carotid artery occlusive disease (ICAOD).

Methods

A total of 22 patients with ≥70% stenosis (mean age 64.8 years) and 20 older healthy control subjects (mean age 70.8 years) underwent structural magnetic resonance imaging (MRI) and high-resolution quantitative (q)T2 mapping. Generalized linear mixed models (GLMM) controlling for age and white matter lesion volume were employed to investigate the effect of ICAOD on imaging parameters of cortical microstructural integrity in multivariate analyses.

Results

There was a significant main effect (p < 0.05) of the group (patients/controls) on both cortical thickness and cortical qT2 values with cortical thinning and increased cortical qT2 in patients compared to controls, irrespective of the hemisphere. The presence of upstream carotid stenosis had a significant main effect on cortical qT2 values (p = 0.01) leading to increased qT2 in the poststenotic hemisphere, which was not found for cortical thickness. The GLMM showed that in general cortical thickness was decreased and cortical qT2 values were increased with increasing age (p < 0.05).

Conclusion

Unilateral high-grade carotid occlusive disease is associated with widespread cortical thinning and prolongation of cortical qT2, presumably reflecting hypoperfusion-related microstructural cortical damage similar to accelerated aging of the cerebral cortex. Cortical thinning and increase of cortical qT2 seem to reflect different aspects and different pathophysiological states of cortical degeneration. Quantitative T2 mapping might be a sensitive imaging biomarker for early cortical microstructural damage.

Longitudinal intracortical diffusivity changes in de-novo Parkinson's disease: A promising imaging biomarker

Cognitive impairment and dementia in Parkinson's disease (PD) are highly disabling non-motor symptoms with no effective treatment currently available. As cortical degeneration is thought to be involved in the development of these comorbidities, novel imaging biomarkers capable of detecting early cortical deterioration are needed. Recently, an increase in mean diffusivity (MD) within the cerebral cortex has been proposed as a highly sensitive imaging indicator of early microstructural cortical damage in neurodegenerative diseases. Using the Parkinson's Progression Markers Initiative (PPMI), we studied longitudinal changes in intracortical MD in recently-diagnosed and drug-naïve PD patients (n = 64). Compared to healthy controls (n = 20), de novo PD patients showed a higher one-year MD increase in frontal and occipital cortices (p < 0.05, corrected). These PD-specific MD changes correlated with changes in cognitive measures. Importantly, cortical MD increases were widespread in the PD group and loss of cortical thickness was only increased in a small parietal cluster. These results suggest that intracortical MD changes could be promising imaging biomarker in clinical trials targeting the prevention and treatment of early cortical degeneration in PD, but further research confirmation is needed.

Laminar degeneration of frontal and temporal cortex in Parkinson disease dementia

To investigate cortical laminar degeneration in Parkinson's disease (PD) with dementia (PDD). Changes in density of α-synuclein-immunoreactive Lewy bodies (LB), Lewy neurites (LN), and Lewy grains (LG) together with surviving neurons, abnormally enlarged neurons (EN), vacuoles, and glial cell nuclei were measured across cortical laminae of frontal and temporal cortex in fifteen cases of PDD using quantitative methods and polynomial curve-fitting. Most frequently, LB and LN were distributed across all laminae, while LG were distributed in upper cortical laminae. Low densities of EN were present in most cases distributed across all cortical laminae. Densities of vacuoles and glia were greatest in upper and lower cortical laminae, respectively. In most gyri, there were no spatial correlations between the densities of LB, LN, and LG. Cortical degeneration of frontal and temporal lobes in PDD affects all cortical laminae. Laminar distributions may result from the spread of α-synuclein pathology from subcortical regions and subsequent spread via the cortico-cortical pathways. This spread may be a major factor in the development of dementia in PD.