1
|
Hamed SA, Hadad AFE. The effect of anticholinergic drugs on cognition of patients with Parkinson's disease: a cohort study from the Egyptian population. Expert Rev Clin Pharmacol 2024:1-11. [PMID: 38781022 DOI: 10.1080/17512433.2024.2359955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Cognitive dysfunction is a non-motor manifestation of Parkinson's disease (PD). We aimed to determine the frequency and patterns of cognitive dysfunction in treated patients with PD and their predictors. RESEARCH DESIGN AND METHODS This study included 80 patients (male = 48; female = 32) and 30 healthy individuals. They underwent neuropsychiatric evaluations. Measurements included Beck's depression inventory - II (BDI-II), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). RESULTS Patients had mean age of 55.56 ± 9.06 yrs, duration of PD of 4.86 ± 2.71 yrs and Hoehn and Yahr Scoring of 2.19 ± 0.89. They were on levodopa/carbidopa therapy and adjuvant therapy with benztropine mesylate, an anticholinergic drug, (n = 51) or amantadine sulfate, a dopaminergic drug, (n = 29). Sixteen (20%) had moderate depressive symptoms. Mild and moderate cognitive impairments were reported in 38.8% and 28.8% (by MMSE) and 46.3% and 31.3% (by MoCA). Patients had lower global cognitive scoring (p = 0.0001) and scorings of different cognitive functions (naming, attention, language, abstraction, memory and orientation) than controls. Patients treated with benztropine had lower cognition than with amantadine. Correlation analyses showed that lower cognition was only associated with chronic PD and its treatment (p = 0.0001). CONCLUSIONS Cognitive dysfunction is common with PD (77.5%) particularly with anticholinergic drugs. De-prescription of anticholinergics is recommended for patients with PD.
Collapse
Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
| |
Collapse
|
2
|
Pastor V, Medina JH. α7 nicotinic acetylcholine receptor in memory processing. Eur J Neurosci 2024; 59:2138-2154. [PMID: 36634032 DOI: 10.1111/ejn.15913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Information storage in the brain involves different memory types and stages that are processed by several brain regions. Cholinergic pathways through acetylcholine receptors actively participate on memory modulation, and their disfunction is associated with cognitive decline in several neurological disorders. During the last decade, the role of α7 subtype of nicotinic acetylcholine receptors in different memory stages has been studied. However, the information about their role in memory processing is still scarce. In this review, we attempt to identify brain areas where α7 nicotinic receptors have an essential role in different memory types and stages. In addition, we discuss recent work implicating-or not-α7 nicotinic receptors as promising pharmacological targets for memory impairment associated with neurological disorders.
Collapse
Affiliation(s)
- Verónica Pastor
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis" (IBCN), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
- Facultad de Medicina, Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jorge H Medina
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis" (IBCN), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto Tecnológico de Buenos Aires (ITBA), Buenos Aires, Argentina
| |
Collapse
|
3
|
Staer K, Iranzo A, Terkelsen MH, Stokholm MG, Danielsen EH, Østergaard K, Serradell M, Otto M, Svendsen KB, Garrido A, Vilas D, Santamaria J, Møller A, Gaig C, Brooks DJ, Borghammer P, Tolosa E, Pavese N. Progression of brain cholinergic dysfunction in patients with isolated rapid eye movement sleep behavior disorder. Eur J Neurol 2024; 31:e16101. [PMID: 37847229 DOI: 10.1111/ene.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Reduced cortical acetylcholinesterase activity, as measured by 11 C-donepezil positron emission tomography (PET), has been reported in patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD). However, its progression and clinical implications have not been fully investigated. Here, we explored the relationship between longitudinal changes in brain acetylcholinesterase activity and cognitive function in iRBD. METHODS Twelve iRBD patients underwent 11 C-donepezil PET at baseline and after 3 years. PET images were interrogated with statistical parametric mapping (SPM) and a regions of interest (ROI) approach. Clinical progression was assessed with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III (MDS-UPDRS-III). Cognitive function was rated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). RESULTS From baseline to follow-up, the mean 11 C-donepezil distribution volume ratio (DVR) decreased in the cortex (p = 0.006), thalamus (p = 0.013), and caudate (p = 0.013) ROI. Despite no significant changes in the group mean MMSE or MoCA scores being observed, individually, seven patients showed a decline in their scores on these cognitive tests. Subgroup analysis showed that only the subgroup of patients with a decline in cognitive scores had a significant reduction in mean cortical 11 C-donepezil DVR. CONCLUSIONS Our results show that severity of brain cholinergic dysfunction in iRBD patients increases significantly over 3 years, and those changes are more severe in those with a decline in cognitive test scores.
Collapse
Affiliation(s)
- Kristian Staer
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Alex Iranzo
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
- Sleep Disorders Center, Hospital Clinic, Barcelona, Spain
| | - Miriam Højholt Terkelsen
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Gersel Stokholm
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Karen Østergaard
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
| | - Mónica Serradell
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Sleep Disorders Center, Hospital Clinic, Barcelona, Spain
| | - Marit Otto
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Alicia Garrido
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia, Spain
| | - Dolores Vilas
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia, Spain
| | - Joan Santamaria
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
- Sleep Disorders Center, Hospital Clinic, Barcelona, Spain
| | - Arne Møller
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Carles Gaig
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
- Sleep Disorders Center, Hospital Clinic, Barcelona, Spain
| | - David J Brooks
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Per Borghammer
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Eduardo Tolosa
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia, Spain
| | - Nicola Pavese
- Department of Nuclear Medicine & PET, Institute of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Okkels N, Horsager J, Labrador-Espinosa M, Kjeldsen PL, Damholdt MF, Mortensen J, Vestergård K, Knudsen K, Andersen KB, Fedorova TD, Skjærbæk C, Gottrup H, Hansen AK, Grothe MJ, Borghammer P. Severe cholinergic terminal loss in newly diagnosed dementia with Lewy bodies. Brain 2023; 146:3690-3704. [PMID: 37279796 DOI: 10.1093/brain/awad192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
Cholinergic changes play a fundamental role in the natural history of dementia with Lewy bodies and Lewy body disease in general. Despite important achievements in the field of cholinergic research, significant challenges remain. We conducted a study with four main objectives: (i) to examine the integrity of cholinergic terminals in newly diagnosed dementia with Lewy bodies; (ii) to disentangle the cholinergic contribution to dementia by comparing cholinergic changes in Lewy body patients with and without dementia; (iii) to investigate the in vivo relationship between cholinergic terminal loss and atrophy of cholinergic cell clusters in the basal forebrain at different stages of Lewy body disease; and (iv) to test whether any asymmetrical degeneration in cholinergic terminals would correlate with motor dysfunction and hypometabolism. To achieve these objectives, we conducted a comparative cross-sectional study of 25 newly diagnosed dementia with Lewy bodies patients (age 74 ± 5 years, 84% male), 15 healthy control subjects (age 75 ± 6 years, 67% male) and 15 Parkinson's disease patients without dementia (age 70 ± 7 years, 60% male). All participants underwent 18F-fluoroetoxybenzovesamicol PET and high-resolution structural MRI. In addition, we collected clinical 18F-fluorodeoxyglucose PET images. Brain images were normalized to standard space and regional tracer uptake and volumetric indices of basal forebrain degeneration were extracted. Patients with dementia showed spatially distinct reductions in cholinergic terminals across the cerebral cortex, limbic system, thalamus and brainstem. Also, cholinergic terminal binding in cortical and limbic regions correlated quantitatively and spatially with atrophy of the basal forebrain. In contrast, patients without dementia showed decreased cholinergic terminal binding in the cerebral cortex despite preserved basal forebrain volumes. In patients with dementia, cholinergic terminal reductions were most severe in limbic regions and least severe in occipital regions compared to those without dementia. Interhemispheric asymmetry of cholinergic terminals correlated with asymmetry of brain metabolism and lateralized motor function. In conclusion, this study provides robust evidence for severe cholinergic terminal loss in newly diagnosed dementia with Lewy bodies, which correlates with structural imaging measures of cholinergic basal forebrain degeneration. In patients without dementia, our findings suggest that loss of cholinergic terminal function occurs 'before' neuronal cell degeneration. Moreover, the study supports that degeneration of the cholinergic system is important for brain metabolism and may be linked with degeneration in other transmitter systems. Our findings have implications for understanding how cholinergic system pathology contributes to the clinical features of Lewy body disease, changes in brain metabolism and disease progression patterns.
Collapse
Affiliation(s)
- Niels Okkels
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jacob Horsager
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Miguel Labrador-Espinosa
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pernille L Kjeldsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
- Department of Neurology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Malene F Damholdt
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Janne Mortensen
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Karsten Vestergård
- Department of Neurology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Katrine B Andersen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Casper Skjærbæk
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Hanne Gottrup
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| |
Collapse
|
5
|
Okkels N, Horsager J, Labrador-Espinosa MA, Hansen FO, Andersen KB, Just MK, Fedorova TD, Skjærbæk C, Munk OL, Hansen KV, Gottrup H, Hansen AK, Grothe MJ, Borghammer P. Distribution of cholinergic nerve terminals in the aged human brain measured with [ 18F]FEOBV PET and its correlation with histological data. Neuroimage 2023; 269:119908. [PMID: 36720436 DOI: 10.1016/j.neuroimage.2023.119908] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION [18F]fluoroetoxybenzovesamicol ([18F]FEOBV) is a positron emission topography (PET) tracer for the vesicular acetylcholine transporter (VAChT), a protein located predominantly in synaptic vesicles in cholinergic nerve terminals. We aimed to use [18F]FEOBV PET to study the cholinergic topography of the healthy human brain. MATERIALS AND METHODS [18F]FEOBV PET brain data volumes of healthy elderly humans were normalized to standard space and intensity-normalized to the white matter. Stereotactic atlases of regions of interest were superimposed to describe and quantify tracer distribution. The spatial distribution of [18F]FEOBV PET uptake was compared with histological and gene expression data. RESULTS Twenty participants of both sexes and a mean age of 73.9 ± 6.0 years, age-range [64; 86], were recruited. Highest tracer binding was present in the striatum, some thalamic nuclei, and the basal forebrain. Intermediate binding was found in most nuclei of the brainstem, thalamus, and hypothalamus; the vermis and flocculonodular lobe; and the hippocampus, amygdala, insula, cingulate, olfactory cortex, and Heschl's gyrus. Lowest binding was present in most areas of the cerebral cortex, and in the cerebellar nuclei and hemispheres. The spatial distribution of tracer correlated with immunohistochemical post-mortem data, as well as with regional expression levels of SLC18A3, the VAChT coding gene. DISCUSSION Our in vivo findings confirm the regional cholinergic distribution in specific brain structures as described post-mortem. A positive spatial correlation between tracer distribution and regional gene expression levels further corroborates [18F]FEOBV PET as a validated tool for in vivo cholinergic imaging. The study represents an advancement in the continued efforts to delineate the spatial topography of the human cholinergic system in vivo.
Collapse
Affiliation(s)
- Niels Okkels
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
| | - Jacob Horsager
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Miguel A Labrador-Espinosa
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Frederik O Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Katrine B Andersen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mie Kristine Just
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Casper Skjærbæk
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole L Munk
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kim V Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Gottrup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
6
|
Sperling SA, Druzgal J, Blair JC, Flanigan JL, Stohlman SL, Barrett MJ. Cholinergic nucleus 4 grey matter density is associated with apathy in Parkinson's disease. Clin Neuropsychol 2023; 37:676-694. [PMID: 35443870 DOI: 10.1080/13854046.2022.2065362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: The generation and maintenance of goal-directed behavior is subserved by multiple brain regions that receive cholinergic inputs from the cholinergic nucleus 4 (Ch4). It is unknown if Ch4 degeneration contributes to apathy in Parkinson's disease (PD). Method: We analyzed data from 106 pre-surgical patients with PD who had brain MRIs and completed the Frontal Systems Behavior Scales (FrSBe). Eighty-eight patients also completed the Beck Depression Inventory-2nd Edition. Cholinergic basal forebrain grey matter densities (GMD) were measured by applying probabilistic maps to T1 MPRAGE sequences processed using voxel-based morphometry methods. We used linear and hierarchical regression modelling to examine the association between Ch4 GMD and the FrSBe Apathy subscale scores. We used similar methods to assess the specificity of this association and potential associations between Ch4 target regions and apathy. Results: Ch4 GMD (p = .021) and Ch123 GMD (p = .032) were significantly associated with Apathy subscale scores on univariate analysis. Ch4 GMD, but not Ch123 GMD, remained significantly associated with apathy when adjusting for age, sex, levodopa equivalent doses, and disease duration. Centromedial amygdala GMD, which receives cholinergic inputs from Ch4, was also associated with apathy. Ch4 GMD was not associated with depression or disinhibition, nor was it associated with executive dysfunction when adjusting for clinical and demographic variables. Conclusions: Ch4 GMD is specifically associated with apathy in PD. Ch4 degeneration results in cholinergic denervation of multiple cortical and limbic regions, which may contribute to the cognitive and emotional-affective processing deficits that underlie the behavioral symptoms of apathy.
Collapse
Affiliation(s)
- Scott A Sperling
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Jamie C Blair
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Shelby L Stohlman
- Curry School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
7
|
Liu H, Huang Z, Deng B, Chang Z, Yang X, Guo X, Yuan F, Yang Q, Wang L, Zou H, Li M, Zhu Z, Jin K, Wang Q. QEEG Signatures are Associated with Nonmotor Dysfunctions in Parkinson's Disease and Atypical Parkinsonism: An Integrative Analysis. Aging Dis 2023; 14:204-218. [PMID: 36818554 PMCID: PMC9937709 DOI: 10.14336/ad.2022.0514] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Parkinson's disease (PD) and atypical parkinsonism (AP), including progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), share similar nonmotor symptoms. Quantitative electroencephalography (QEEG) can be used to examine the nonmotor symptoms. This study aimed to characterize the patterns of QEEG and functional connectivity (FC) that differentiate PD from PSP or MSA, and explore the correlation between the differential QEEG indices and nonmotor dysfunctions in PD and AP. We enrolled 52 patients with PD, 31 with MSA, 22 with PSP, and 50 age-matched health controls to compare QEEG indices among specific brain regions. One-way analysis of variance was applied to assess QEEG indices between groups; Spearman's correlations were used to examine the relationship between QEEG indices and nonmotor symptoms scale (NMSS) and mini-mental state examination (MMSE). FCs using weighted phase lag index were compared between patients with PD and those with MSA/PSP. Patients with PSP revealed higher scores on the NMSS and lower MMSE scores than those with PD and MSA, with similar disease duration. The delta and theta powers revealed a significant increase in PSP, followed by PD and MSA. Patients with PD presented a significantly lower slow-to-fast ratio than those with PSP in the frontal region, while patients with PD presented significantly higher EEG-slowing indices than patients with MSA. The frontal slow-to-fast ratio showed a negative correlation with MMSE scores in patients with PD and PSP, and a positive correlation with NMSS in the perception and mood domain in patients with PSP but not in those with PD. Compared to PD, MSA presented enhanced FC in theta and delta bands in the posterior region, while PSP revealed decreased FC in the delta band within the frontal-temporal cortex. These findings suggest that QEEG might be a useful tool for evaluating the nonmotor dysfunctions in PD and AP. Our QEEG results suggested that with similar disease duration, the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by those with PD, and lastly in patients with MSA.
Collapse
Affiliation(s)
- Hailing Liu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Zifeng Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Zihan Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Xingfang Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Feilan Yuan
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Qin Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Liming Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Haiqiang Zou
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangdong, China.
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Zhaohua Zhu
- Clinical Research Centre, Orthopedic Centre, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Correspondence should be addressed to: Dr. Qing Wang, Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. .
| |
Collapse
|
8
|
Horsager J, Okkels N, Hansen AK, Damholdt MF, Andersen KH, Fedorova TD, Munk OL, Danielsen EH, Pavese N, Brooks DJ, Borghammer P. Mapping Cholinergic Synaptic Loss in Parkinson's Disease: An [18F]FEOBV PET Case-Control Study. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2493-2506. [PMID: 36336941 DOI: 10.3233/jpd-223489] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cholinergic degeneration is strongly associated with cognitive decline in patients with Parkinson's disease (PD) but may also cause motor symptoms and olfactory dysfunction. Regional differences are striking and may reflect different PD related symptoms and disease progression patterns. OBJECTIVE To map and quantify the regional cerebral cholinergic alterations in non-demented PD patients. METHODS We included 15 non-demented PD patients in early-moderate disease stage and 15 age- and sex-matched healthy controls for [18F]FEOBV positron emission tomography imaging. We quantitated regional variations using VOI-based analyses which were supported by a vertex-wise cluster analysis. Correlations between imaging data and clinical and neuropsychological data were explored. RESULTS We found significantly decreased [18F]FEOBV uptake in global neocortex (38%, p = 0.0002). The most severe reductions were seen in occipital and posterior temporo-parietal regions (p < 0.0001). The vertex-wise cluster analysis corroborated these findings. All subcortical structures showed modest non-significant reductions. Motor symptoms (postural instability and gait difficulty) and cognition (executive function and composite z-score) correlated with regional [18F]FEOBV uptake (thalamus and cingulate cortex/insula/hippocampus, respectively), but the correlations were not statistically significant after multiple comparison correction. A strong correlation was found between interhemispheric [18F]FEOBV asymmetry, and motor symptom asymmetry of the extremities (r = 0.84, p = 0.0001). CONCLUSION Cortical cholinergic degeneration is prominent in non-demented PD patients, but more subtle in subcortical structures. Regional differences suggest uneven involvement of cholinergic nuclei in the brain and may represent a window to follow disease progression. The correlation between asymmetric motor symptoms and neocortical [18F]FEOBV asymmetry indicates that unilateral cholinergic degeneration parallels ipsilateral dopaminergic degeneration.
Collapse
Affiliation(s)
- Jacob Horsager
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Okkels
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Allan K Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Katrine H Andersen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Lajord Munk
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Erik H Danielsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Pavese
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Institute of Translational and Clinical Research, University of Newcastle upon Tyne, UK
| | - David J Brooks
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Institute of Translational and Clinical Research, University of Newcastle upon Tyne, UK
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
9
|
Bohnen NI, Roytman S, Kanel P, Müller MLTM, Scott PJH, Frey KA, Albin RL, Koeppe RA. Progression of regional cortical cholinergic denervation in Parkinson's disease. Brain Commun 2022; 4:fcac320. [PMID: 36569603 PMCID: PMC9772878 DOI: 10.1093/braincomms/fcac320] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
Cortical cholinergic deficits contribute to cognitive decline and other deficits in Parkinson's disease. Cross-sectional imaging studies suggest a stereotyped pattern of posterior-to-anterior cortical cholinergic denervation accompanying disease progression in Parkinson's disease. We used serial acetylcholinesterase PET ligand imaging to characterize the trajectory of regional cholinergic synapse deficits in Parkinson's disease, testing the hypothesis of posterior-to-anterior progression of cortical cholinergic deficits. The 16 Parkinson's disease subjects (4 females/12 males; mean age: 64.4 ± 6.7 years; disease duration: 5.5 ± 4.2 years; Hoehn & Yahr stage: 2.3 ± 0.6 at entry) completed serial 11C-methyl-4-piperidinyl propionate acetylcholinesterase PET scans over a 4-8 year period (median 5 years). Three-dimensional stereotactic cortical surface projections and volume-of-interest analyses were performed. Cholinergic synapse integrity was assessed by the magnitude, k 3, of acetylcholinesterase hydrolysis of 11C-methyl-4-piperidinyl propionate. Based on normative data, we generated Z-score maps for both the k 3 and the k 1 parameters, the latter as a proxy for regional cerebral blood flow. Compared with control subjects, baseline scans showed predominantly posterior cortical k 3 deficits in Parkinson's disease subjects. Interval change analyses showed evidence of posterior-to-anterior progression of cholinergic cortical deficits in the posterior cortices. In frontal cortices, an opposite gradient of anterior-to-posterior progression of cholinergic deficits was found. The topography of k 3 changes exhibited regionally specific disconnection from k 1 changes. Interval-change analysis based on k 3/k 1 ratio images (k 3 adjustment for regional cerebral blood flow changes) showed interval reductions (up to 20%) in ventral frontal, anterior cingulate and Brodmann area 6 cortices. In contrast, interval k 3 reductions in the posterior cortices, especially Brodmann areas 17-19, were largely proportional to k 1 changes. Our results partially support the hypothesis of progressive posterior-to-cortical cholinergic denervation in Parkinson's disease. This pattern appears characteristic of posterior cortices. In frontal cortices, an opposite pattern of anterior-to-posterior progression of cholinergic deficits was found. The progressive decline of posterior cortical acetylcholinesterase activity was largely proportional to declining regional cerebral blood flow, suggesting that posterior cortical cholinergic synapse deficits are part of a generalized loss of synapses. The disproportionate decline in regional frontal cortical acetylcholinesterase activity relative to regional cerebral blood flow suggests preferential loss or dysregulation of cholinergic synapses in these regions. Our observations suggest that cortical cholinergic synapse vulnerability in Parkinson's disease is mediated by both diffuse processes affecting cortical synapses and processes specific to subpopulations of cortical cholinergic afferents.
Collapse
Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson Consortium, Critical Path Institute, Tucson, AZ 85718, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
10
|
Wang Y, Zhan M, Roebroeck A, De Weerd P, Kashyap S, Roberts MJ. Inconsistencies in atlas-based volumetric measures of the human nucleus basalis of Meynert: A need for high-resolution alternatives. Neuroimage 2022; 259:119421. [PMID: 35779763 DOI: 10.1016/j.neuroimage.2022.119421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022] Open
Abstract
The nucleus basalis of Meynert (nbM) is the major source of cortical acetylcholine (ACh) and has been related to cognitive processes and to neurological disorders. However, spatially delineating the human nbM in MRI studies remains challenging. Due to the absence of a functional localiser for the human nbM, studies to date have localised it using nearby neuroanatomical landmarks or using probabilistic atlases. To understand the feasibility of MRI of the nbM we set our four goals; our first goal was to review current human nbM region-of-interest (ROI) selection protocols used in MRI studies, which we found have reported highly variable nbM volume estimates. Our next goal was to quantify and discuss the limitations of existing atlas-based volumetry of nbM. We found that the identified ROI volume depends heavily on the atlas used and on the probabilistic threshold set. In addition, we found large disparities even for data/studies using the same atlas and threshold. To test whether spatial resolution contributes to volume variability, as our third goal, we developed a novel nbM mask based on the normalized BigBrain dataset. We found that as long as the spatial resolution of the target data was 1.3 mm isotropic or above, our novel nbM mask offered realistic and stable volume estimates. Finally, as our last goal we tried to discern nbM using publicly available and novel high resolution structural MRI ex vivo MRI datasets. We find that, using an optimised 9.4T quantitative T2⁎ ex vivo dataset, the nbM can be visualised using MRI. We conclude caution is needed when applying the current methods of mapping nbM, especially for high resolution MRI data. Direct imaging of the nbM appears feasible and would eliminate the problems we identify, although further development is required to allow such imaging using standard (f)MRI scanning.
Collapse
Affiliation(s)
- Yawen Wang
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.
| | - Minye Zhan
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands; U992 (Cognitive neuroimaging unit), NeuroSpin, INSERM-CEA, Gif sur Yvette, France
| | - Alard Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Peter De Weerd
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sriranga Kashyap
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands; Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mark J Roberts
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.
| |
Collapse
|
11
|
Dion C, Tanner JJ, Formanski EM, Davoudi A, Rodriguez K, Wiggins ME, Amin M, Penney D, Davis R, Heilman KM, Garvan C, Libon DJ, Price CC. The functional connectivity and neuropsychology underlying mental planning operations: data from the digital clock drawing test. Front Aging Neurosci 2022; 14:868500. [PMID: 36204547 PMCID: PMC9530582 DOI: 10.3389/fnagi.2022.868500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
We examined the construct of mental planning by quantifying digital clock drawing digit placement accuracy in command and copy conditions, and by investigating its underlying neuropsychological correlates and functional connectivity. We hypothesized greater digit misplacement would associate with attention, abstract reasoning, and visuospatial function, as well as functional connectivity from a major source of acetylcholine throughout the brain: the basal nucleus of Meynert (BNM). Participants (n = 201) included non-demented older adults who completed all metrics within 24 h of one another. A participant subset met research criteria for mild cognitive impairment (MCI; n = 28) and was compared to non-MCI participants on digit misplacement accuracy and expected functional connectivity differences. Digit misplacement and a comparison dissociate variable of total completion time were acquired for command and copy conditions. a priori fMRI seeds were the bilateral BNM. Command digit misplacement is negatively associated with semantics, visuospatial, visuoconstructional, and reasoning (p's < 0.01) and negatively associated with connectivity from the BNM to the anterior cingulate cortex (ACC; p = 0.001). Individuals with MCI had more misplacement and less BNM-ACC connectivity (p = 0.007). Total completion time involved posterior and cerebellar associations only. Findings suggest clock drawing digit placement accuracy may be a unique metric of mental planning and provide insight into neurodegenerative disease.
Collapse
Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Erin M Formanski
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Margaret E Wiggins
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Manish Amin
- Department of Physics, University of Florida, Gainesville, FL, United States
| | - Dana Penney
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, United States
| | - Kenneth M Heilman
- Department of Neurology, University of Florida, & North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - David J Libon
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, United States
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| |
Collapse
|
12
|
Vercouillie J, Buron F, Sérrière S, Rodrigues N, Gulhan Z, Chartier A, Chicheri G, Marzag H, Oury A, Percina N, Bodard S, Ben Othman R, Busson J, Suzenet F, Guilloteau D, Marchivie M, Emond P, Routier S, Chalon S. Development and preclinical evaluation of [18F]FBVM as a new potent PET tracer for vesicular acetylcholine transporter. Eur J Med Chem 2022; 244:114794. [DOI: 10.1016/j.ejmech.2022.114794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
|
13
|
Byun JI, Cha KS, Kim M, Lee WJ, Lee HS, Sunwoo JS, Shin JW, Kim TJ, Jun JS, Kim HJ, Shin WC, Schenck CH, Lee SK, Jung KY. Association of Nucleus Basalis of Meynert Functional Connectivity and Cognition in Idiopathic Rapid-Eye-Movement Sleep Behavior Disorder. J Clin Neurol 2022; 18:562-570. [PMID: 36062774 PMCID: PMC9444555 DOI: 10.3988/jcn.2022.18.5.562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Cognitive impairments are common in isolated rapid-eye-movement sleep behavior disorder (iRBD), in which the cholinergic system may play an important role. This study aimed to characterize the cortical cholinergic activity using resting-state functional connectivity (FC) of the nucleus basalis of Meynert (NBM) according to the cognitive status of iRBD patients. Methods In this cross-sectional study, 33 patients with polysomnography-confirmed iRBD and 20 controls underwent neuropsychological evaluations and resting-state functional magnetic resonance imaging. Thirteen of the iRBD patients had mild cognitive impairment (iRBD-MCI), and the others were age-matched patients with normal cognition (iRBD-NC). The seed-to-voxel NBM–cortical FC was compared among the patients with iRBD-MCI, patients with iRBD-NC, and controls. Correlations between average values of significant clusters and cognitive function scores were calculated in the patients with iRBD. Results There were group differences in the FC of the NBM with the left lateral occipital cortex and lingual gyrus (adjusted for age, sex, and education level). The strength of FC was lower in the iRBD-MCI group than in the iRBD-NC and control groups (each post-hoc p<0.001). The average NBM–lateral occipital cortex FC was positively correlated with the memory-domain score in iRBD patients. Conclusions The results obtained in this study support that cortical cholinergic activity is impaired in iRBD patients with MCI. FC between NBM and posterior regions may play a central role in the cognitive function of these patients.
Collapse
Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kwang Su Cha
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung-Won Shin
- Department of Neurology, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Chul Shin
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
14
|
Tiepolt S, Meyer PM, Patt M, Deuther-Conrad W, Hesse S, Barthel H, Sabri O. PET Imaging of Cholinergic Neurotransmission in Neurodegenerative Disorders. J Nucl Med 2022; 63:33S-44S. [PMID: 35649648 DOI: 10.2967/jnumed.121.263198] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
As a neuromodulator, the neurotransmitter acetylcholine plays an important role in cognitive, mood, locomotor, sleep/wake, and olfactory functions. In the pathophysiology of most neurodegenerative diseases, such as Alzheimer disease (AD) or Lewy body disorder (LBD), cholinergic receptors, transporters, or enzymes are involved and relevant as imaging targets. The aim of this review is to summarize current knowledge on PET imaging of cholinergic neurotransmission in neurodegenerative diseases. For PET imaging of presynaptic vesicular acetylcholine transporters (VAChT), (-)-18F-fluoroethoxybenzovesamicol (18F-FEOBV) was the first PET ligand that could be successfully translated to clinical application. Since then, the number of 18F-FEOBV PET investigations on patients with AD or LBD has grown rapidly and provided novel, important findings concerning the pathophysiology of AD and LBD. Regarding the α4β2 nicotinic acetylcholine receptors (nAChRs), various second-generation PET ligands, such as 18F-nifene, 18F-AZAN, 18F-XTRA, (-)-18F-flubatine, and (+)-18F-flubatine, were developed and successfully translated to human application. In neurodegenerative diseases such as AD and LBD, PET imaging of α4β2 nAChRs is of special value for monitoring disease progression and drugs directed to α4β2 nAChRs. For PET of α7 nAChR, 18F-ASEM and 11C-MeQAA were successfully applied in mild cognitive impairment and AD, respectively. The highest potential for α7 nAChR PET is seen in staging, in evaluating disease progression, and in therapy monitoring. PET of selective muscarinic acetylcholine receptors (mAChRs) is still in an early stage, as the development of subtype-selective radioligands is complicated. Promising radioligands to image mAChR subtypes M1 (11C-LSN3172176), M2 (18F-FP-TZTP), and M4 (11C-MK-6884) were developed and successfully translated to humans. PET imaging of mAChRs is relevant for the assessment and monitoring of therapies in AD and LBD. PET of acetylcholine esterase activity has been investigated since the 1990s. Many PET studies with 11C-PMP and 11C-MP4A demonstrated cortical cholinergic dysfunction in dementia associated with AD and LBD. Recent studies indicated a solid relationship between subcortical and cortical cholinergic dysfunction and noncognitive dysfunctions such as balance and gait in LBD. Taken together, PET of distinct components of cholinergic neurotransmission is of great interest for diagnosis, disease monitoring, and therapy monitoring and to gain insight into the pathophysiology of different neurodegenerative disorders.
Collapse
Affiliation(s)
- Solveig Tiepolt
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; and
| | - Philipp M Meyer
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; and
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; and
| | | | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; and
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany; and
| |
Collapse
|
15
|
Neurotoxicological Profiling of Paraquat in Zebrafish Model. Neurochem Res 2022; 47:2294-2306. [PMID: 35562624 DOI: 10.1007/s11064-022-03615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
Paraquat is a polar herbicide protecting plant products against invasive species, it requires careful manipulation and restricted usage because of its harmful potentials. Exposure to paraquat triggers oxidative damage in dopaminergic neurons and subsequently causes a behavioral defect in vivo. Thereby, persistent exposure to paraquat is known to increase Parkinson's disease risk by dysregulating dopaminergic systems in humans. Therefore, most studies have focused on the dopaminergic systems to elucidate the neurotoxicological mechanism of paraquat poisoning, and more comprehensive neurochemistry including histaminergic, serotonergic, cholinergic, and GABAergic systems has remained unclear. Therefore, in this study, we investigated the toxicological potential of paraquat poisoning using a variety of approaches such as toxicokinetic profiles, behavioral effects, neural activity, and broad-spectrum neurochemistry in zebrafish larvae after short-term exposure to paraquat and we performed the molecular modeling approach. Our results showed that paraquat was slowly absorbed in the brain of zebrafish after oral administration of paraquat. In addition, paraquat toxicity resulted in behavioral impairments, namely, reduced motor activity and led to abnormal neural activities in zebrafish larvae. This locomotor deficit came with a dysregulation of dopamine synthesis induced by the inhibition of tyrosine hydroxylase activity, which was also indirectly confirmed by molecular modeling studies. Furthermore, short-term exposure to paraquat also caused simultaneous dysregulation of other neurochemistry including cholinergic and serotonergic systems in zebrafish larvae. The present study suggests that this neurotoxicological profiling could be a useful tool for understanding the brain neurochemistry of neurotoxic agents that might be a potential risk to human and environmental health.
Collapse
|
16
|
Sinclair L, Brenton J, Liu AKL, MacLachlan R, Gentleman SM, Love S. Possible Contribution of Altered Cholinergic Activity in the Visual Cortex in Visual Hallucinations in Parkinson's Disease. J Neuropsychiatry Clin Neurosci 2022; 34:168-176. [PMID: 34961331 DOI: 10.1176/appi.neuropsych.21040103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Up to one-third of patients with Parkinson's disease (PD) experience visual hallucinations (VHs). Lewy bodies are sparse in the visual cortices and seem unlikely to explain the hallucinations. Some neuroimaging studies have found that perfusion is reduced in the occipital lobe in individuals with VHs. Recent work has suggested that decreased cholinergic input may directly lead to the decreased perfusion. The investigators hypothesized that individuals with PD and VHs would have biochemical evidence of reduced microvascular perfusion and reduced cholinergic activity in areas of the brain that process visual images. METHODS Tissue from Brodmann's area (BA) 18 and BA 19 was obtained from a well-characterized cohort matched for age, gender, and postmortem interval in 69 individuals (PD without VHs, N=11; PD without dementia plus VHs N=10, N=10; PD with dementia plus VHs, N=16; and control subjects, N=32). Von Willebrand factor, vascular endothelial growth factor A, and myelin-associated glycoprotein:proteolipid protein-1 (MAG:PLP1) ratio-a measure of tissue oxygenation relative to metabolic demand, acetylcholinesterase (AChE), butyrylcholinesterase (BChE), choline acetyltransferase, and α-synuclein-were quantified by enzyme-linked immunosorbent assay. The primary outcome was the MAG:PLP1 ratio. RESULTS There was no biochemical evidence of chronic hypoperfusion in PD, although microvessel density was decreased in ventral BA 18 and BA 19. There was no between-group difference in BChE in either dorsal BA 18 or BA 19. AChE concentration was reduced in individuals with PD compared with control subjects in dorsal and ventral BA 18 and dorsal BA 19, and it was increased in ventral BA 19. These changes were most marked in the PD plus VHs group. CONCLUSIONS These results suggest that changes in cholinergic activity rather than chronic hypoperfusion may underlie VHs in PD.
Collapse
Affiliation(s)
- Lindsey Sinclair
- Dementia Research Group, University of Bristol, United Kingdom (Sinclair, Brenton, MacLachlan, Love); Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (Liu); and Neuropathology Unit, Department of Brain Sciences, Imperial College London (Liu, Gentleman)
| | - Jake Brenton
- Dementia Research Group, University of Bristol, United Kingdom (Sinclair, Brenton, MacLachlan, Love); Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (Liu); and Neuropathology Unit, Department of Brain Sciences, Imperial College London (Liu, Gentleman)
| | - Alan King Lun Liu
- Dementia Research Group, University of Bristol, United Kingdom (Sinclair, Brenton, MacLachlan, Love); Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (Liu); and Neuropathology Unit, Department of Brain Sciences, Imperial College London (Liu, Gentleman)
| | - Rob MacLachlan
- Dementia Research Group, University of Bristol, United Kingdom (Sinclair, Brenton, MacLachlan, Love); Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (Liu); and Neuropathology Unit, Department of Brain Sciences, Imperial College London (Liu, Gentleman)
| | - Steve M Gentleman
- Dementia Research Group, University of Bristol, United Kingdom (Sinclair, Brenton, MacLachlan, Love); Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (Liu); and Neuropathology Unit, Department of Brain Sciences, Imperial College London (Liu, Gentleman)
| | - Seth Love
- Dementia Research Group, University of Bristol, United Kingdom (Sinclair, Brenton, MacLachlan, Love); Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (Liu); and Neuropathology Unit, Department of Brain Sciences, Imperial College London (Liu, Gentleman)
| |
Collapse
|
17
|
The role of the autonomic nervous system in cerebral blood flow regulation in dementia: A review. Auton Neurosci 2022; 240:102985. [DOI: 10.1016/j.autneu.2022.102985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/28/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
|
18
|
Abstract
Dementia-related psychosis (DRP) is prevalent across dementias and typically manifests as delusions and/or hallucinations. The mechanisms underlying psychosis in dementia are unknown; however, neurobiological and pharmacological evidence has implicated multiple signaling pathways and brain regions. Despite differences in dementia pathology, the neurobiology underlying psychosis appears to involve dysregulation of a cortical and limbic pathway involving serotonergic, gamma-aminobutyric acid ergic, glutamatergic, and dopaminergic signaling. Thus, an imbalance in cortical and mesolimbic excitatory tone may drive symptoms of psychosis. Delusions and hallucinations may result from (1) hyperactivation of pyramidal neurons within the visual cortex, causing visual hallucinations and (2) hyperactivation of the mesolimbic pathway, causing both delusions and hallucinations. Modulation of the 5-HT2A receptor may mitigate hyperactivity at both psychosis-associated pathways. Pimavanserin, an atypical antipsychotic, is a selective serotonin inverse agonist/antagonist at 5-HT2A receptors. Pimavanserin may prove beneficial in treating the hallucinations and delusions of DRP without worsening cognitive or motor function.
Collapse
|
19
|
Richter N, David LS, Grothe MJ, Teipel S, Dietlein M, Tittgemeyer M, Neumaier B, Fink GR, Onur OA, Kukolja J. Age and Anterior Basal Forebrain Volume Predict the Cholinergic Deficit in Patients with Mild Cognitive Impairment due to Alzheimer’s Disease. J Alzheimers Dis 2022; 86:425-440. [DOI: 10.3233/jad-210261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Early and severe neuronal loss in the cholinergic basal forebrain is observed in Alzheimer’s disease (AD). To date, cholinomimetics play a central role in the symptomatic treatment of AD dementia. Although basic research indicates that a cholinergic deficit is present in AD before dementia, the efficacy of cholinomimetics in mild cognitive impairment (MCI) remains controversial. Predictors of cholinergic impairment could guide individualized therapy. Objective: To investigate if the extent of the cholinergic deficit, measured using positron emission tomography (PET) and the tracer 11C-N-methyl-4-piperidyl acetate (MP4A), could be predicted from the volume of cholinergic basal forebrain nuclei in non-demented AD patients. Methods: Seventeen patients with a high likelihood of MCI due to AD and 18 age-matched cognitively healthy adults underwent MRI-scanning. Basal forebrain volume was assessed using voxel-based morphometry and a cytoarchitectonic atlas of cholinergic nuclei. Cortical acetylcholinesterase (AChE) activity was measured using MP4A-PET. Results: Cortical AChE activity and nucleus basalis of Meynert (Ch4 area) volume were significantly decreased in MCI. The extent of the cholinergic deficit varied considerably across patients. Greater volumes of anterior basal forebrain nuclei (Ch1/2 area) and younger age (Spearman’s rho (17) = –0.596, 95% -CI [–0.905, –0.119] and 0.593, 95% -CI [0.092, 0.863])) were associated with a greater cholinergic deficit. Conclusion: Data suggest that less atrophy of the Ch1/2 area and younger age are associated with a more significant cholinergic deficit in MCI due to AD. Further investigations are warranted to determine if the individual response to cholinomimetics can be inferred from these measures.
Collapse
Affiliation(s)
- Nils Richter
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
- Max-Planck-Institute for Metabolism Research, Cologne, Cologne, Germany
| | - Lara-Sophia David
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Michel J. Grothe
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Movement Disorders Group, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Marc Tittgemeyer
- Max-Planck-Institute for Metabolism Research, Cologne, Cologne, Germany
| | - Bernd Neumaier
- Max-Planck-Institute for Metabolism Research, Cologne, Cologne, Germany
- Nuclear Chemistry, Institute of Neuroscience and Medicine (INM-5), Research Center Jülich, Jülich, Germany
- Institute for Radiochemistry and Experimental Molecular Imaging, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Gereon R. Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Oezguer A. Onur
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Juraj Kukolja
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
- Department of Neurology, Medical Faculty and University Hospital of Cologne, Cologne, Germany
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
20
|
Cholinergic systems, attentional-motor integration, and cognitive control in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:345-371. [PMID: 35248201 PMCID: PMC8957710 DOI: 10.1016/bs.pbr.2022.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dysfunction and degeneration of CNS cholinergic systems is a significant component of multi-system pathology in Parkinson's disease (PD). We review the basic architecture of human CNS cholinergic systems and the tools available for studying changes in human cholinergic systems. Earlier post-mortem studies implicated abnormalities of basal forebrain corticopetal cholinergic (BFCC) and pedunculopontine-laterodorsal tegmental (PPN-LDT) cholinergic projections in cognitive deficits and gait-balance deficits, respectively. Recent application of imaging methods, particularly molecular imaging, allowed more sophisticated correlation of clinical features with regional cholinergic deficits. BFCC projection deficits correlate with general and domain specific cognitive deficits, particularly for attentional and executive functions. Detailed analyses suggest that cholinergic deficits within the salience and cingulo-opercular task control networks, including both neocortical, thalamic, and striatal nodes, are a significant component of cognitive deficits in non-demented PD subjects. Both BFCC and PPN-LDT cholinergic projection systems, and striatal cholinergic interneuron (SChI), abnormalities are implicated in PD gait-balance disorders. In the context of experimental studies, these results indicate that disrupted attentional functions of BFCC and PPN-LDT cholinergic systems underlie impaired gait-balance functions. SChI dysfunction likely impairs intra-striatal integration of attentional and motor information. Thalamic and entorhinal cortex cholinergic deficits may impair multi-sensory integration. Overt degeneration of CNS systems may be preceded by increased activity of cholinergic neurons compensating for nigrostriatal dopaminergic deficits. Subsequent dysfunction and degeneration of cholinergic systems unmasks and exacerbates functional deficits secondary to dopaminergic denervation. Research on CNS cholinergic systems dysfunctions in PD requires a systems-level approach to understanding PD pathophysiology.
Collapse
|
21
|
Orso B, Arnaldi D, Peira E, Famá F, Giorgetti L, Girtler N, Brugnolo A, Mattioli P, Biassoni E, Donniaquio A, Massa F, Bauckneht M, Miceli A, Morbelli S, Nobili F, Pardini M. The Role of Monoaminergic Tones and Brain Metabolism in Cognition in De Novo Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1945-1955. [PMID: 35811536 DOI: 10.3233/jpd-223308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cognitive impairment is frequent in Parkinson's disease (PD) and several neurotransmitter changes have been reported since the time of diagnosis, although seldom investigated altogether in the same patient cohort. OBJECTIVE Our aim was to evaluate the association between neurotransmitter impairment, brain metabolism, and cognition in a cohort of de novo, drug-naïve PD patients. METHODS We retrospectively selected 95 consecutive drug-naïve PD patients (mean age 71.89±7.53) undergoing at the time of diagnosis a brain [18F]FDG-PET as a marker of brain glucose metabolism and proxy measure of neurodegeneration, [123I]FP-CIT-SPECT as a marker and dopaminergic deafferentation in the striatum and frontal cortex, as well as a marker of serotonergic deafferentation in the thalamus, and quantitative electroencephalography (qEEG) as an indirect measure of cholinergic deafferentation. Patients also underwent a complete neuropsychological battery. RESULTS Positive correlations were observed between (i) executive functions and left cerebellar cortex metabolism, (ii) prefrontal dopaminergic tone and working memory (r = 0.304, p = 0.003), (iii) qEEG slowing in the posterior leads and both memory (r = 0.299, p = 0.004) and visuo-spatial functions (r = 0.357, p < 0.001). CONCLUSIONS In subjects with PD, the impact of regional metabolism and diffuse projection systems degeneration differs across cognitive domains. These findings suggest possible tailored approaches to the treatment of cognitive deficits in PD.
Collapse
Affiliation(s)
- Beatrice Orso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Enrico Peira
- Istituto nazionale di Fisica Nucleare (IN FN), Genoa section, Genoa, Italy
| | - Francesco Famá
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | | | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Andrea Brugnolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Erica Biassoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Andrea Donniaquio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Alberto Miceli
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| |
Collapse
|
22
|
Pasquini J, Brooks DJ, Pavese N. The Cholinergic Brain in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:1012-1026. [PMID: 34631936 DOI: 10.1002/mdc3.13319] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
The central cholinergic system includes the basal forebrain nuclei, mainly projecting to the cortex, the mesopontine tegmental nuclei, mainly projecting to the thalamus and subcortical structures, and other groups of projecting neurons and interneurons. This system regulates many functions of human behavior such as cognition, locomotion, and sleep. In Parkinson's disease (PD), disruption of central cholinergic transmission has been associated with cognitive decline, gait problems, freezing of gait (FOG), falls, REM sleep behavior disorder (RBD), neuropsychiatric manifestations, and olfactory dysfunction. Neuropathological and neuroimaging evidence suggests that basal forebrain pathology occurs simultaneously with nigrostriatal denervation, whereas pathology in the pontine nuclei may occur before the onset of motor symptoms. These studies have also detailed the clinical implications of cholinergic dysfunction in PD. Degeneration of basal forebrain nuclei and consequential cortical cholinergic denervation are associated with and may predict the subsequent development of cognitive decline and neuropsychiatric symptoms. Gait problems, FOG, and falls are associated with a complex dysfunction of both pontine and basal forebrain nuclei. Olfactory impairment is associated with cholinergic denervation of the limbic archicortex, specifically hippocampus and amygdala. Available evidence suggests that cholinergic dysfunction, alongside failure of the dopaminergic and other neurotransmitters systems, contributes to the generation of a specific set of clinical manifestations. Therefore, a "cholinergic phenotype" can be identified in people presenting with cognitive decline, falls, and RBD. In this review, we will summarize the organization of the central cholinergic system and the clinical correlates of cholinergic dysfunction in PD.
Collapse
Affiliation(s)
- Jacopo Pasquini
- Department of Pathophysiology and Transplantation University of Milan Milan Italy.,Clinical Ageing Research Unit Newcastle University Newcastle upon Tyne United Kingdom
| | - David J Brooks
- Positron Emission Tomography Centre Newcastle University Newcastle upon Tyne United Kingdom.,Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
| | - Nicola Pavese
- Clinical Ageing Research Unit Newcastle University Newcastle upon Tyne United Kingdom.,Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
| |
Collapse
|
23
|
Molecular Imaging of the Cholinergic System in Alzheimer and Lewy Body Dementias: Expanding Views. Curr Neurol Neurosci Rep 2021; 21:52. [PMID: 34545424 DOI: 10.1007/s11910-021-01140-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Brain cholinergic denervation is a major feature of Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). We reviewed the topography assessed by a cholinergic molecular imaging study in these two major types of dementia. A small meta-analysis directly comparing vesicular acetylcholine transporter (VAChT) PET scans of AD vs. DLB patients is presented. RECENT FINDINGS VAChT PET studies showed evidence of extensive cortical cholinergic denervation in both forms of dementia, while multiple subcortical structures were also in DLB. Novel analysis revealed evidence of metathalamic denervation in AD, and epithalamus, premotor/sensorimotor cortical, and striatal losses in DLB. Topographically distinct cortical and subcortical cholinergic lesions can distinguish AD and DLB, and new structures have been highlighted here. Differential vulnerability of specific cholinergic projections is likely associated with specific clinical features of these disorders. Improved understanding of the mechanisms and roles of cholinergic neurotransmission in regions with cholinergic deficits may lead to symptomatic therapies.
Collapse
|
24
|
Bidesi NSR, Vang Andersen I, Windhorst AD, Shalgunov V, Herth MM. The role of neuroimaging in Parkinson's disease. J Neurochem 2021; 159:660-689. [PMID: 34532856 PMCID: PMC9291628 DOI: 10.1111/jnc.15516] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that affects millions of people worldwide. Two hallmarks of PD are the accumulation of alpha-synuclein and the loss of dopaminergic neurons in the brain. There is no cure for PD, and all existing treatments focus on alleviating the symptoms. PD diagnosis is also based on the symptoms, such as abnormalities of movement, mood, and cognition observed in the patients. Molecular imaging methods such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) can detect objective alterations in the neurochemical machinery of the brain and help diagnose and study neurodegenerative diseases. This review addresses the application of functional MRI, PET, and SPECT in PD patients. We provide an overview of the imaging targets, discuss the rationale behind target selection, the agents (tracers) with which the imaging can be performed, and the main findings regarding each target's state in PD. Molecular imaging has proven itself effective in supporting clinical diagnosis of PD and has helped reveal that PD is a heterogeneous disorder, which has important implications for the development of future therapies. However, the application of molecular imaging for early diagnosis of PD or for differentiation between PD and atypical parkinsonisms has remained challenging. The final section of the review is dedicated to new imaging targets with which one can detect the PD-related pathological changes upstream from dopaminergic degeneration. The foremost of those targets is alpha-synuclein. We discuss the progress of tracer development achieved so far and challenges on the path toward alpha-synuclein imaging in humans.
Collapse
Affiliation(s)
- Natasha S R Bidesi
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Ida Vang Andersen
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Albert D Windhorst
- Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Vladimir Shalgunov
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Matthias M Herth
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
25
|
Gasiorowska A, Wydrych M, Drapich P, Zadrozny M, Steczkowska M, Niewiadomski W, Niewiadomska G. The Biology and Pathobiology of Glutamatergic, Cholinergic, and Dopaminergic Signaling in the Aging Brain. Front Aging Neurosci 2021; 13:654931. [PMID: 34326765 PMCID: PMC8315271 DOI: 10.3389/fnagi.2021.654931] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
The elderly population is growing worldwide, with important health and socioeconomic implications. Clinical and experimental studies on aging have uncovered numerous changes in the brain, such as decreased neurogenesis, increased synaptic defects, greater metabolic stress, and enhanced inflammation. These changes are associated with cognitive decline and neurobehavioral deficits. Although aging is not a disease, it is a significant risk factor for functional worsening, affective impairment, disease exaggeration, dementia, and general disease susceptibility. Conversely, life events related to mental stress and trauma can also lead to accelerated age-associated disorders and dementia. Here, we review human studies and studies on mice and rats, such as those modeling human neurodegenerative diseases, that have helped elucidate (1) the dynamics and mechanisms underlying the biological and pathological aging of the main projecting systems in the brain (glutamatergic, cholinergic, and dopaminergic) and (2) the effect of defective glutamatergic, cholinergic, and dopaminergic projection on disabilities associated with aging and neurodegenerative disorders, such as Alzheimer's and Parkinson's diseases. Detailed knowledge of the mechanisms of age-related diseases can be an important element in the development of effective ways of treatment. In this context, we briefly analyze which adverse changes associated with neurodegenerative diseases in the cholinergic, glutaminergic and dopaminergic systems could be targeted by therapeutic strategies developed as a result of our better understanding of these damaging mechanisms.
Collapse
Affiliation(s)
- Anna Gasiorowska
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Malgorzata Wydrych
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Patrycja Drapich
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Maciej Zadrozny
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Marta Steczkowska
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Wiktor Niewiadomski
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Grazyna Niewiadomska
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
26
|
Dhingra A, Janjua AU, Hack L, Waserstein G, Palanci J, Hermida AP. Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting. J Geriatr Psychiatry Neurol 2021; 34:181-195. [PMID: 32242493 DOI: 10.1177/0891988720915525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.
Collapse
Affiliation(s)
- Amitha Dhingra
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Hack
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella Waserstein
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
27
|
Brooks DJ. Imaging Familial and Sporadic Neurodegenerative Disorders Associated with Parkinsonism. Neurotherapeutics 2021; 18:753-771. [PMID: 33432494 PMCID: PMC8423977 DOI: 10.1007/s13311-020-00994-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
In this paper, the structural and functional imaging changes associated with sporadic and genetic Parkinson's disease and atypical Parkinsonian variants are reviewed. The role of imaging for supporting diagnosis and detecting subclinical disease is discussed, and the potential use and drawbacks of using imaging biomarkers for monitoring disease progression is debated. Imaging changes associated with nonmotor complications of PD are presented. The similarities and differences in imaging findings in Lewy body dementia, Parkinson's disease dementia, and Alzheimer's disease are discussed.
Collapse
Affiliation(s)
- David J Brooks
- Department of Nuclear Medicine, Aarhus University, Aarhus N, 8200, Denmark.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
| |
Collapse
|
28
|
Minoshima S, Mosci K, Cross D, Thientunyakit T. Brain [F-18]FDG PET for Clinical Dementia Workup: Differential Diagnosis of Alzheimer's Disease and Other Types of Dementing Disorders. Semin Nucl Med 2021; 51:230-240. [PMID: 33546814 DOI: 10.1053/j.semnuclmed.2021.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PET imaging with [F-18]FDG has been used extensively for research and clinical applications in dementia. In the brain, [F-18]FDG accumulates around synapses and represents local neuronal activity. Patterns of altered [F-18]FDG uptake reflecting local neuronal dysfunction provide differential diagnostic clues for various dementing disorders. Image interpretation can be accomplished by employing statistical brain mapping techniques. Various guidelines have been published to support the appropriate use of [F-18]FDG PET for clinical dementia workup. PET images with [F-18]FDG demonstrate distinct patterns of decreased uptake for Alzheimer's disease (AD), Dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD) as well as its multiple subtypes such as behavioral variant FTD, primary progressive aphasia (PPA), progressive supranuclear palsy, and corticobasal degeneration to aid in the differential diagnoses. Mixed dementia, not only AD + Vascular Dementia, but also AD + other neurodegenerative disorders, should also be considered when interpreting [F-18]FDG PET images. Brain PET imaging with [F-18]FDG remains a valuable component of dementia workup owing to its relatively low cost, differential diagnostic performance, widespread availability, and physicians' experience over more than 40 years since the initial development.
Collapse
Affiliation(s)
- Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT.
| | - Karina Mosci
- Hospital das Forças Armadas (HFA) and Hospital Santa Lucia, Brasilia, Brazil
| | - Donna Cross
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Tanyaluck Thientunyakit
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| |
Collapse
|
29
|
Bohnen NI. Vulnerabilities of Aging and Biological Effects of Physical Activity Provide New Clues for Interventions in Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2021; 75:687-689. [PMID: 32150615 DOI: 10.1093/gerona/glaa026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Nicolaas I Bohnen
- Departments of Radiology & Neurology, University of Michigan, Morris K. Udall Center of Excellence in Parkinson's Disease Research, University of Michigan & Ann Arbor VAMC
| |
Collapse
|
30
|
Wilson H, de Natale ER, Politis M. Nucleus basalis of Meynert degeneration predicts cognitive impairment in Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:189-205. [DOI: 10.1016/b978-0-12-819975-6.00010-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
31
|
Agrawal Y, Merfeld DM, Horak FB, Redfern MS, Manor B, Westlake KP, Holstein GR, Smith PF, Bhatt T, Bohnen NI, Lipsitz LA. Aging, Vestibular Function, and Balance: Proceedings of a National Institute on Aging/National Institute on Deafness and Other Communication Disorders Workshop. J Gerontol A Biol Sci Med Sci 2020; 75:2471-2480. [PMID: 32617555 PMCID: PMC7662183 DOI: 10.1093/gerona/glaa097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/27/2022] Open
Abstract
Balance impairment and falls are among the most prevalent and morbid conditions affecting older adults. A critical contributor to balance and gait function is the vestibular system; however, there remain substantial knowledge gaps regarding age-related vestibular loss and its contribution to balance impairment and falls in older adults. Given these knowledge gaps, the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders convened a multidisciplinary workshop in April 2019 that brought together experts from a wide array of disciplines, such as vestibular physiology, neuroscience, movement science, rehabilitation, and geriatrics. The goal of the workshop was to identify key knowledge gaps on vestibular function and balance control in older adults and develop a research agenda to make substantial advancements in the field. This article provides a report of the proceedings of this workshop. Three key questions emerged from the workshop, specifically: (i) How does aging impact vestibular function?; (ii) How do we know what is the contribution of age-related vestibular impairment to an older adult's balance problem?; and more broadly, (iii) Can we develop a nosology of balance impairments in older adults that can guide clinical practice? For each of these key questions, the current knowledge is reviewed, and the critical knowledge gaps and research strategies to address them are discussed. This document outlines an ambitious 5- to 10-year research agenda for increasing knowledge related to vestibular impairment and balance control in older adults, with the ultimate goal of linking this knowledge to more effective treatment.
Collapse
Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Merfeld
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland
| | - Mark S Redfern
- Department of Bioengineering, University of Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pennsylvania
| | - Brad Manor
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Gay R Holstein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
- Brain Research New Zealand, Dunedin, New Zealand
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Radiology, University of Michigan, Ann Arbor
| | - Lewis A Lipsitz
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
32
|
Brandão PRP, Munhoz RP, Grippe TC, Cardoso FEC, de Almeida E Castro BM, Titze-de-Almeida R, Tomaz C, Tavares MCH. Cognitive impairment in Parkinson's disease: A clinical and pathophysiological overview. J Neurol Sci 2020; 419:117177. [PMID: 33068906 DOI: 10.1016/j.jns.2020.117177] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
Cognitive dysfunction in Parkinson's disease (PD) has received increasing attention, and, together with other non-motor symptoms, exert a significant functional impact in the daily lives of patients. This article aims to compile and briefly summarize selected published data about clinical features, cognitive evaluation, biomarkers, and pathophysiology of PD-related dementia (PDD). The literature search included articles indexed in the MEDLINE/PubMed database, published in English, over the last two decades. Despite significant progress on clinical criteria and cohort studies for PD-mild cognitive impairment (PD-MCI) and PDD, there are still knowledge gaps about its exact molecular and pathological basis. Here we overview the scientific literature on the role of functional circuits, neurotransmitter systems (monoaminergic and cholinergic), basal forebrain, and brainstem nuclei dysfunction in PD-MCI. Correlations between neuroimaging and cerebrospinal fluid (CSF) biomarkers, clinical outcomes, and pathological results are described to aid in uncovering the neurodegeneration pattern in PD-MCI and PDD.
Collapse
Affiliation(s)
- Pedro Renato P Brandão
- Laboratory of Neuroscience and Behavior, Institute of Biological Sciences, Universidade de Brasília (UnB); Neurology Section, Medical Department, Chamber of Deputies of the Federal Republic of Brazil, Brasília, DF, Brazil.
| | - Renato Puppi Munhoz
- Toronto Western Hospital, Movement Disorders Centre, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Canada.
| | - Talyta Cortez Grippe
- Laboratory of Neuroscience and Behavior, Institute of Biological Sciences, Universidade de Brasília (UnB); Movement Disorders Group, Neurology Unit, Hospital de Base do Distrito Federal; School of Medicine, Centro Universitário de Brasília (UniCEUB), Brasília, DF, Brazil
| | - Francisco Eduardo Costa Cardoso
- Movement Disorders Unit, Internal Medicine Department, Neurology Service, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Ricardo Titze-de-Almeida
- Technology for Gene Therapy Laboratory, Central Institute of Sciences, University of Brasília/FAV, Brasília, DF, Brazil
| | - Carlos Tomaz
- Laboratory of Neuroscience and Behavior and Graduate Program in Environment, CEUMA University - UniCEUMA, São Luís, MA, Brazil.
| | | |
Collapse
|
33
|
Schildt A, de Vries EFJ, Willemsen ATM, Moraga-Amaro R, Lima-Giacobbo B, Sijbesma JWA, Sossi V, Dierckx RAJO, Doorduin J. Modeling of [ 18F]FEOBV Pharmacokinetics in Rat Brain. Mol Imaging Biol 2020; 22:931-939. [PMID: 31907846 DOI: 10.1007/s11307-019-01466-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE [18F]Fluoroethoxybenzovesamicol ([18F]FEOBV) is a radioligand for the vesicular acetylcholine transporter (VAChT), a marker of the cholinergic system. We evaluated the quantification of [18F]FEOBV in rats in control conditions and after partial saturation of VAChT using plasma and reference tissue input models and test-retest reliability. PROCEDURE Ninety-minute dynamic [18F]FEOBV PET scans with arterial blood sampling were performed in control rats and rats pretreated with 10 μg/kg FEOBV. Kinetic analyses were performed using one- (1TCM) and two-tissue compartmental models (2TCM), Logan and Patlak graphical analyses with metabolite-corrected plasma input, reference tissue Patlak with cerebellum as reference tissue, standard uptake value (SUV) and SUV ratio (SUVR) using 60- or 90-min acquisition. To assess test-retest reliability, two dynamic [18F]FEOBV scans were performed 1 week apart. RESULTS The 1TCM did not fit the data. Time-activity curves were more reliably estimated by the irreversible than the reversible 2TCM for 60 and 90 min as the influx rate Ki showed a lower coefficient of variation (COV, 14-24 %) than the volume of distribution VT (16-108 %). Patlak graphical analysis showed a good fit to the data for both acquisition times with a COV (12-27 %) comparable to the irreversible 2TCM. For 60 min, Logan analysis performed comparably to both irreversible models (COV 14-32 %) but showed lower sensitivity to VAChT saturation. Partial saturation of VAChT did not affect model selection when using plasma input. However, poor correlations were found between irreversible 2TCM and SUV and SUVR in partially saturated VAChT states. Test-retest reliability and intraclass correlation for SUV were good. CONCLUSION [18F]FEOBV is best modeled using the irreversible 2TCM or Patlak graphical analysis. SUV should only be used if blood sampling is not possible.
Collapse
Affiliation(s)
- Anna Schildt
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
| | - Antoon T M Willemsen
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
| | - Rodrigo Moraga-Amaro
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
| | - Bruno Lima-Giacobbo
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
| | - Jürgen W A Sijbesma
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
| | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, P.O Box 30.001, Groningen, 9700RB, The Netherlands.
| |
Collapse
|
34
|
Kormas C, Zalonis I, Evdokimidis I, Kapaki E, Potagas C. The severity of executive dysfunction among different PD-MCI subtypes. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:546-550. [PMID: 32633669 DOI: 10.1080/23279095.2020.1786832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aim to examine the severity of executive dysfunction among different Parkinson's disease (PD)-mild cognitive impairment (MCI) subtypes in the early stages of the disease. The final sample consisted of 65 patients with mild PD progression. Based on neuropsychological measures, our sample was categorized into three PD-MCI subtypes: (1) PD-MCI executive group (n = 24), (2) PD-MCI executive plus memory group (n = 22), and (3) PD-MCI executive plus visuospatial group (n = 19). Patients' executive functions were evaluated with the Trail Making Test-Part B (TMT-B) and Stroop Neuropsychological Screening Test (SNST) for mental flexibility and inhibitory control, respectively. One-way ANOVA results indicated significant differences among the three subgroups on TMT-B and SNST performance. Post hoc Tukey honestly significant different (HSD) tests revealed that the PD-MCI executive plus visuospatial group had lower performances on both executive measures than the other two groups. Contrastingly, no significant differences were observed between the PD-MCI executive group and PD-MCI executive plus memory group. Our results indicated that the severity of executive dysfunction varies across different PD-MCI subtypes. These findings are discussed within the framework of the dual syndrome hypothesis and highlight the utility of determination of executive impairment severity for effective clinical management of patients with PD.
Collapse
Affiliation(s)
- Constantinos Kormas
- First Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
| | - Ioannis Zalonis
- First Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
| | - Elisabeth Kapaki
- First Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
| | - Constantin Potagas
- First Department of Neurology, National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
| |
Collapse
|
35
|
Yang D, Ding C, Qi G, Feldmeyer D. Cholinergic and Adenosinergic Modulation of Synaptic Release. Neuroscience 2020; 456:114-130. [PMID: 32540364 DOI: 10.1016/j.neuroscience.2020.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/14/2023]
Abstract
In this review we will discuss the effect of two neuromodulatory transmitters, acetylcholine (ACh) and adenosine, on the synaptic release probability and short-term synaptic plasticity. ACh and adenosine differ fundamentally in the way they are released into the extracellular space. ACh is released mostly from synaptic terminals and axonal bouton of cholinergic neurons in the basal forebrain (BF). Its mode of action on synaptic release probability is complex because it activate both ligand-gated ion channels, so-called nicotinic ACh receptors and G-protein coupled muscarinic ACh receptors. In contrast, adenosine is released from both neurons and glia via nucleoside transporters or diffusion over the cell membrane in a non-vesicular, non-synaptic fashion; its receptors are exclusively G-protein coupled receptors. We show that ACh and adenosine effects are highly specific for an identified synaptic connection and depend mostly on the presynaptic but also on the postsynaptic receptor type and discuss the functional implications of these differences.
Collapse
Affiliation(s)
- Danqing Yang
- Research Centre Juelich, Institute of Neuroscience and Medicine 10, Leo-Brandt-Strasse, Juelich, Germany
| | - Chao Ding
- Research Centre Juelich, Institute of Neuroscience and Medicine 10, Leo-Brandt-Strasse, Juelich, Germany
| | - Guanxiao Qi
- Research Centre Juelich, Institute of Neuroscience and Medicine 10, Leo-Brandt-Strasse, Juelich, Germany
| | - Dirk Feldmeyer
- Research Centre Juelich, Institute of Neuroscience and Medicine 10, Leo-Brandt-Strasse, Juelich, Germany; RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen, Germany; Jülich-Aachen Research Alliance Brain - JARA Brain, Germany.
| |
Collapse
|
36
|
Miwa D, Kitamura Y, Kozaka T, Shigeno T, Ogawa K, Taki J, Kinuya S, Shiba K. (-)-o-[ 11 C]methyl-trans-decalinvesamicol ((-)-[ 11 C]OMDV) as a PET ligand for the vesicular acetylcholine transporter. Synapse 2020; 74:e22176. [PMID: 32500935 DOI: 10.1002/syn.22176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Abstract
To develop a PET imaging agent to visualize brain cholinergic neurons and synaptic changes caused by Alzheimer's disease, (-)- and (+)-o-[11 C]methyl-trans-decalinvesamicol ([11 C]OMDV) were isolated and investigated for differences in not only their binding affinity and selectivity to vesicular acetylcholine transporter (VAChT), but also their in vivo activities. [11 C]OMDV has a high binding affinity for VAChT both in vitro and in vivo. Racemic OMDV and o-trimethylstannyl-trans-decalinvesamicol (OTDV), which are precursors for synthesis of [11 C]OMDV, were separated into (-)-optical isomers ((-)-OMDV and (-)-OTDV) and (+)-optical isomers ((+)-OMDV and (+)-OTDV) by HPLC. In the in vitro binding assay, (-)-OMDV(7.2 nM) showed eight times higher binding affinity (Ki) to VAChT than that of (+)-OMDV(57.5 nM). In the biodistribution study, the blood-brain barrier permeability of both enantiomers ((-)-[11 C]OMDV and (+)-[11 C]OMDV) was similarly high (about 1.0%ID/g) at 2 min post-injection. However, (+)-[11 C]OMDV clearance from the brain was faster than (-)-[11 C]OMDV. In the in vivo blocking study, accumulation of (-)-[11 C]OMDV in the cortex was markedly decreased (approximately 30% of control) by coadministration of vesamicol, and brain uptake of (-)-[11 C]OMDV was not significantly altered by coadministration of (+)-pentazocine or (+)-3-(3-hydroxyphenyl)-N-propylpiperidine ((+)-3-PPP). PET-CT imaging revealed inhibition of the rat brain uptake of (-)-[11 C]OMDV by coadministration of vesamicol. In conclusion, (-)-[11 C]OMDV, which is an enantiomer of OMDV, selectively binds to VAChT with high affinity in the rat brain in vivo. (-)-[11 C]OMDV may be utilized as a potential PET ligand for studying presynaptic cholinergic neurons in the brain.
Collapse
Affiliation(s)
- Daisuke Miwa
- Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| | - Yoji Kitamura
- Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| | - Takashi Kozaka
- Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| | - Taiki Shigeno
- Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| | - Kazuma Ogawa
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Junichi Taki
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuhiro Shiba
- Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
37
|
Mecheri G, Marie-Cardine M, Sappey-Marinier D, Bonmartin H, Albrand G, Ferry G, Coppard-Meyer N, Courpron P. In vivo hippocampal 31P NMR metabolites in Alzheimer's disease and ageing. Eur Psychiatry 2020; 12:140-8. [DOI: 10.1016/s0924-9338(97)80203-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/1996] [Accepted: 03/11/1997] [Indexed: 11/16/2022] Open
Abstract
SummaryMemory loss is the most common early symptom of Alzheimer's disease (AD). For this study, we chose the hippocampi as regions of interest. The hippocampus, which is closely associated with memory processing, is known to be vulnerable to damage in the early stage of AD. We considered both inter-group (patients vs controls) and intra-group (right vs left hippocampus) comparisons. We examined seven patients meeting the DSM-III-R criteria of senile dementia and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS — ADRDA) criteria of probable AD, and II aged controls. This study focused on the measurement of phosphorus 31 (31P) Nuclear Magnetic Resonance (NMR) spectroscopy metabolites in each hippocampus. We found significant differences in phosphorus metabolites for both intra-group comparison (pH shifted towards relative alkalosis in the left hippocampus of patients) and inter-group consideration (reduced phosphodiesters [Pde]and elevated gamma adenosine triphosphate (ATP) in the right hippocampus, higher inorganic phosphate (pHi) in the left hippocampus for patients as compared to controls). We suggest energy failure and membrane functional breakdown in patients compared to aged controls.
Collapse
|
38
|
Cognition Deficits in Parkinson's Disease: Mechanisms and Treatment. PARKINSONS DISEASE 2020; 2020:2076942. [PMID: 32269747 PMCID: PMC7128056 DOI: 10.1155/2020/2076942] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/08/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder mainly in middle-elderly population, which represents diverse nonmotor symptoms (NMS) besides such well-documented motor symptoms as bradykinesia, resting tremor, rigidity, and postural instability. With the advancement of aging trend worldwide, the global prevalence of PD is mounting up year after year. Nowadays, accumulating lines of studies have given a comprehensive and thorough coverage of motor symptoms in PD. Yet much less attention as compared has been paid to the nonmotor symptoms of PD, such as cognition deficits. Of note, a patient with PD who suffers from cognitive impairment may harbour a statistically significantly higher risk of progressing toward dementia, which negatively affects their life expectancy and daily functioning and overall lowers the global quality of life. Furthermore, it is a widely held view that cognitive dysfunction does not just occur in the late stage of PD. On the basis of numerous studies, mild cognitive impairment (MCI) is a harbinger of dementia in PD, which is observed as an intermediate state with considerable variability; some patients remain stable and some even revert to normal cognition. Considered that the timing, profile, and rate of cognitive impairment vary greatly among PD individuals, it is extremely urgent for researchers and clinicians alike to identify and predict future cognitive decline in this population. Simultaneously, early screening and canonical management of PD with cognitive deficits are very imperative to postpone the disease progression and improve the prognosis of patients. In our review, we focus on a description of cognitive decline in PD, expound emphatically the pathological mechanisms underlying cognition deficits in PD, then give a comprehensive overview of specific therapeutic strategies, and finally dissect what fresh insights may bring new exciting prospect for the subfield.
Collapse
|
39
|
Liu H, Luo Z, Gu J, Su Y, Flores H, Parsons SM, Zhou Y, Perlmutter JS, Tu Z. The impact of dopamine D 2-like agonist/antagonist on [ 18F]VAT PET measurement of VAChT in the brain of nonhuman primates. Eur J Pharm Sci 2020; 143:105152. [PMID: 31740395 PMCID: PMC6980745 DOI: 10.1016/j.ejps.2019.105152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/15/2019] [Accepted: 11/14/2019] [Indexed: 01/11/2023]
Abstract
Vesicular acetylcholine transporter (VAChT) is a promising target for a PET measure of cholinergic deficits which contribute to cognitive impairments. Dopamine D2-like agonists and antagonists are frequently used in the elderly and could alter cholinergic function and VAChT level. Therefore, pretreatment with dopamine D2-like drugs may interfere with PET measures using [18F]VAT, a specific VAChT radioligand. Herein, we investigated the impact of dopaminergic D2-like antagonist/agonist on VAChT level in the brain of macaques using [18F]VAT PET. PET imaging studies were carried out on macaques at baseline or pretreatment conditions. For pretreatment, animals were injected using a VAChT inhibitor (-)-vesamicol, a D2-like antagonist (-)-eticlopride, and a D2-like agonist (-)-quinpirole, separately. (-)-Vesamicol was injected at escalating doses of 0.025, 0.05, 0.125, 0.25 and 0.35 mg/kg; (-)-eticlopride was injected at escalating doses of 0.01, 0.10 and 0.30 mg/kg; (-)-quinpirole was injected at escalating doses of 0.20, 0.30, and 0.50 mg/kg. PET data showed [18F]VAT uptake declined in a dose-dependent manner by (-)-vesamicol pretreatment, demonstrating [18F]VAT uptake is sensitive to reflect the availability of VAChT binding sites. Furthermore, (-)-eticlopride increased [18F]VAT striatal uptake in a dose-dependent manner, while (-)-quinpirole decreased its uptake, suggesting striatal VAChT levels can be regulated by D2-like drug administration. Our findings confirmed [18F]VAT offers a reliable tool to in vivo assess the availability of VAChT binding sites. More importantly, PET with [18F]VAT successfully quantified the impact of dopaminergic D2-like drugs on striatal VAChT level, suggesting [18F]VAT has great potential for investigating the interaction between dopaminergic and cholinergic systems in vivo.
Collapse
Affiliation(s)
- Hui Liu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zonghua Luo
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jiwei Gu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yi Su
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hubert Flores
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Stanley M Parsons
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, CA 93106, USA
| | - Yun Zhou
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joel S Perlmutter
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zhude Tu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| |
Collapse
|
40
|
Martin-Rodriguez JF, Mir P. Short-afferent inhibition and cognitive impairment in Parkinson's disease: A quantitative review and challenges. Neurosci Lett 2020; 719:133679. [DOI: 10.1016/j.neulet.2018.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
|
41
|
Tremblay C, François A, Delay C, Freland L, Vandal M, Bennett DA, Calon F. Association of Neuropathological Markers in the Parietal Cortex With Antemortem Cognitive Function in Persons With Mild Cognitive Impairment and Alzheimer Disease. J Neuropathol Exp Neurol 2020; 76:70-88. [PMID: 28158844 PMCID: PMC7526851 DOI: 10.1093/jnen/nlw109] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The associations between cognitive function and neuropathological markers in patients with mild cognitive impairment (MCI) and Alzheimer disease (AD) remain only partly defined. We investigated relationships between antemortem global cognitive scores and β-amyloid (Aβ), tau, TDP-43, synaptic proteins and other key AD neuropathological markers assessed by biochemical approaches in postmortem anterior parietal cortex samples from 36 subjects (12 MCI, 12 AD and 12 not cognitively impaired) from the Religious Orders Study. Overall, the strongest negative correlation coefficients associated with global cognitive scores were obtained for insoluble phosphorylated tau (r2 = -0.484), insoluble Aβ42 (r2 = -0.389) and neurofibrillary tangle counts (r2 = -0.494) (all p < 0.001). Robust inverse associations with cognition scores were also established for TDP-43-positive cytoplasmic inclusions (r2 = -0.476), total insoluble tau (r2 = -0.385) and Aβ plaque counts (r2 = -0.426). Sarkosyl (SK)- or formic acid (FA)-extracted tau showed similar interrelations. On the other hand, synaptophysin (r2 = +0.335), pS403/404 TDP-43 (r2 = +0.265) and septin-3 (r2 = +0.257) proteins positively correlated with cognitive scores. This study suggests that tau and Aβ42 in their insoluble aggregated forms, synaptic proteins and TDP-43 are the markers in the parietal cortex that are most strongly associated with cognitive function. This further substantiates the relevance of investigating these markers to understand the pathogenesis of AD and develop therapeutic tools.
Collapse
Affiliation(s)
- Cyntia Tremblay
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| | - Arnaud François
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| | - Charlotte Delay
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| | - Laure Freland
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| | - Milène Vandal
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| | - David A Bennett
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| | - Frédéric Calon
- From the Faculté de pharmacie, Université Laval, Québec, QC, Canada (CT, AF, LF, MV, FC); Centre Hospitalier Universitaire de Québec (CHU-Q) Research Center, Neuroscience Axis, Québec, QC, Canada (CT, AF, LF, MV, FC); "Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement" (RID-AGE) Research Group, University of Lille, INSERM U1167, Lille University Medical Center, Institut Pasteur de Lille, Lille, France (CD); and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (DAB)
| |
Collapse
|
42
|
Sasikumar S, Strafella AP. Imaging Mild Cognitive Impairment and Dementia in Parkinson's Disease. Front Neurol 2020; 11:47. [PMID: 32082250 PMCID: PMC7005138 DOI: 10.3389/fneur.2020.00047] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/14/2020] [Indexed: 12/11/2022] Open
Abstract
Cognitive dysfunction is a significant non-motor feature of Parkinson's disease, with the risk of dementia increasing with prolonged disease duration. Multiple cognitive domains are affected, and the pathophysiology cannot be explained by dopaminergic loss alone. Sophisticated neuroimaging techniques can detect the nature and extent of extra-nigral involvement by targeting neurotransmitters, abnormal protein aggregates and tissue metabolism. This review identifies the functional and anatomical imaging characteristics that predict cognitive impairment in PD, the limitations that challenge this process, and the avenues of potential research.
Collapse
Affiliation(s)
| | - Antonio P Strafella
- Division of Neurology, University of Toronto, Toronto, ON, Canada.,Morton and Gloria Shulman Movement Disorder Unit & E. J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada.,Research Imaging Centre, Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
43
|
Maiti B, Koller JM, Snyder AZ, Tanenbaum AB, Norris SA, Campbell MC, Perlmutter JS. Cognitive correlates of cerebellar resting-state functional connectivity in Parkinson disease. Neurology 2020; 94:e384-e396. [PMID: 31848257 PMCID: PMC7079688 DOI: 10.1212/wnl.0000000000008754] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate in a cross-sectional study the contributions of altered cerebellar resting-state functional connectivity (FC) to cognitive impairment in Parkinson disease (PD). METHODS We conducted morphometric and resting-state FC-MRI analyses contrasting 81 participants with PD and 43 age-matched healthy controls using rigorous quality assurance measures. To investigate the relationship of cerebellar FC to cognitive status, we compared participants with PD without cognitive impairment (Clinical Dementia Rating [CDR] scale score 0, n = 47) to participants with PD with impaired cognition (CDR score ≥0.5, n = 34). Comprehensive measures of cognition across the 5 cognitive domains were assessed for behavioral correlations. RESULTS The participants with PD had significantly weaker FC between the vermis and peristriate visual association cortex compared to controls, and the strength of this FC correlated with visuospatial function and global cognition. In contrast, weaker FC between the vermis and dorsolateral prefrontal cortex was found in the cognitively impaired PD group compared to participants with PD without cognitive impairment. This effect correlated with deficits in attention, executive functions, and global cognition. No group differences in cerebellar lobular volumes or regional cortical thickness of the significant cortical clusters were observed. CONCLUSION These results demonstrate a correlation between cerebellar vermal FC and cognitive impairment in PD. The absence of significant atrophy in cerebellum or relevant cortical areas suggests that this could be related to local pathophysiology such as neurotransmitter dysfunction.
Collapse
Affiliation(s)
- Baijayanta Maiti
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO
| | - Jonathan M Koller
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO
| | - Abraham Z Snyder
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO
| | - Aaron B Tanenbaum
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO
| | - Scott A Norris
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO
| | - Meghan C Campbell
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO
| | - Joel S Perlmutter
- From the Departments of Neurology (B.M., A.Z.S., A.T., A.B.T., S.A.N., M.C.C., J.S.P.), Radiology (A.Z.S., S.A.N., M.C.C., J.S.P), Psychiatry (J.M.K), and Neuroscience (J.S.P.) and Programs in Occupational Therapy (J.S.P.) and Physical Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|
44
|
Gersel Stokholm M, Iranzo A, Østergaard K, Serradell M, Otto M, Bacher Svendsen K, Garrido A, Vilas D, Fedorova T, Santamaria J, Møller A, Gaig C, Hiraoka K, Brooks D, Okamura N, Borghammer P, Tolosa E, Pavese N. Cholinergic denervation in patients with idiopathic rapid eye movement sleep behaviour disorder. Eur J Neurol 2019; 27:644-652. [DOI: 10.1111/ene.14127] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- M. Gersel Stokholm
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - A. Iranzo
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - K. Østergaard
- Department of Neurology Aarhus University Hospital Aarhus
| | - M. Serradell
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - M. Otto
- Department of Clinical Neurophysiology Aarhus University Hospital Aarhus Denmark
| | | | - A. Garrido
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Movement Disorders Unit Neurology Service Hospital Clínic de Barcelona Catalonia Spain
| | - D. Vilas
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Movement Disorders Unit Neurology Service Hospital Clínic de Barcelona Catalonia Spain
| | - T.D. Fedorova
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - J. Santamaria
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - A. Møller
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - C. Gaig
- Department of Neurology Hospital Clínic de Barcelona Barcelona
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Multidisciplinary Sleep Unit Hospital Clinic Barcelona Spain
| | - K. Hiraoka
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center Tohoku University Sendai Japan
| | - D.J. Brooks
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
- Division of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - N. Okamura
- Division of Pharmacology Faculty of Medicine Tohoku Medical and Pharmaceutical University Sendai Japan
| | - P. Borghammer
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
| | - E. Tolosa
- Centro de Investigación Biomédica en Red sobre Enfermedades eurodegenerativas (CIBERNED) Hospital Clínic IDIBAPS Universitat de Barcelona Catalonia
- Movement Disorders Unit Neurology Service Hospital Clínic de Barcelona Catalonia Spain
| | - N. Pavese
- Department of Nuclear Medicine & PET Centre Aarhus University Hospital Aarhus Denmark
- Division of Neuroscience Newcastle University Newcastle upon Tyne UK
| |
Collapse
|
45
|
Hoskin JL, Al-Hasan Y, Sabbagh MN. Nicotinic Acetylcholine Receptor Agonists for the Treatment of Alzheimer's Dementia: An Update. Nicotine Tob Res 2019; 21:370-376. [PMID: 30137524 DOI: 10.1093/ntr/nty116] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 08/18/2018] [Indexed: 01/08/2023]
Abstract
A significant portion of the clinical phenotype observed in Alzheimer's disease (AD) occurs through nicotinic acetylcholine receptors (nAChRs). Degeneration of cholinergic neurons, combined with aberrant nAChR expression and activation partially through amyloid-beta peptide (Aβ)-nAChR leads to upregulation of pro-inflammatory pathways and subsequently the progressive cognitive decline of AD. Interestingly, the cholinergic anti-inflammatory pathway is also mediated through nAChR particularly α7 nAChR. Thus, agonists of these receptors will likely exert pro-cognitive benefits through multiple mechanisms including stimulating the cholinergic pathway, modulating inflammation, and buffering the effects of amyloid. Despite this promising theoretical use, trials thus far have been complicated by adverse effects or minimal improvement. This review will provide an update on several pharmacological nAChR agonists tested in clinical trials and reasons that further investigation of nAChR agonists is merited. IMPLICATIONS nAChRs have consistently presented a promising theoretical use in the treatment of AD; however, trials thus far have been complicated by adverse effects or minimal improvement. This review will provide an update on several pharmacological nAChR agonists trialed and reasons that further investigation of nAChR agonists is merited.
Collapse
Affiliation(s)
| | | | - Marwan Noel Sabbagh
- Barrow Neurological Institute, Phoenix, AZ.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV
| |
Collapse
|
46
|
Barrett MJ, Sperling SA, Blair JC, Freeman CS, Flanigan JL, Smolkin ME, Manning CA, Druzgal TJ. Lower volume, more impairment: reduced cholinergic basal forebrain grey matter density is associated with impaired cognition in Parkinson disease. J Neurol Neurosurg Psychiatry 2019; 90:1251-1256. [PMID: 31175168 DOI: 10.1136/jnnp-2019-320450] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A major contributor to dementia in Parkinson disease (PD) is degeneration of the cholinergic basal forebrain. This study determined whether cholinergic nucleus 4 (Ch4) density is associated with cognition in early and more advanced PD. METHODS We analysed brain MRIs and neuropsychological test scores for 228 newly diagnosed PD participants from the Parkinson's Progression Markers Initiative (PPMI), 101 healthy controls from the PPMI and 125 more advanced PD patients from a local retrospective cohort. Cholinergic basal forebrain nuclei densities were determined by applying probabilistic maps to MPRAGE T1 sequences processed using voxel-based morphometry methods. Relationships between grey matter densities and cognitive scores were analysed using correlations and linear regression models. RESULTS In more advanced PD, greater Ch4 density was associated with Montreal Cognitive Assessment (MoCA) score (β=14.2; 95% CI=1.5 to 27.0; p=0.03), attention domain z-score (β=3.2; 95% CI=0.8 to 5.5; p=0.008) and visuospatial domain z-score (β=7.9; 95% CI=2.0 to 13.8; p=0.009). In the PPMI PD cohort, higher Ch4 was associated with higher scores on MoCA (β=9.2; 95% CI=1.9 to 16.5; p=0.01), Judgement of Line Orientation (β=20.4; 95% CI=13.8 to 27.0; p<0.001), Letter Number Sequencing (β=16.5; 95% CI=9.5 to 23.4; p<0.001) and Symbol Digit Modalities Test (β=41.8; 95% CI=18.7 to 65.0; p<0.001). These same relationships were observed in 97 PPMI PD participants at 4 years. There were no significant associations between Ch4 density and cognitive outcomes in healthy controls. CONCLUSION In de novo and more advanced PD, lower Ch4 density is associated with impaired global cognition, attention and visuospatial function.
Collapse
Affiliation(s)
| | - Scott A Sperling
- Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Jamie C Blair
- Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Cody S Freeman
- Neurology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Mark E Smolkin
- Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Carol A Manning
- Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - T Jason Druzgal
- Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
47
|
Tiepolt S, Patt M, Aghakhanyan G, Meyer PM, Hesse S, Barthel H, Sabri O. Current radiotracers to image neurodegenerative diseases. EJNMMI Radiopharm Chem 2019; 4:17. [PMID: 31659510 PMCID: PMC6660543 DOI: 10.1186/s41181-019-0070-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022] Open
Abstract
The term of neurodegenerative diseases covers a heterogeneous group of disorders that are distinguished by progressive degeneration of the structure and function of the nervous system such as dementias, movement disorders, motor neuron disorders, as well as some prion disorders. In recent years, a paradigm shift started for the diagnosis of neurodegenerative diseases, for which successively clinical testing is supplemented by biomarker information. In research scenarios, it was even proposed recently to substitute the current syndromic by a biological definition of Alzheimer's diseases. PET examinations with various radiotracers play an important role in providing non-invasive biomarkers and co-morbidity information in neurodegeneration. Information on co-morbidity, e.g. Aβ plaques and Lewy-bodies or Aβ plaques in patients with aphasia or the absence of Aβ plaques in clinical AD patients are of interest to expand our knowledge about the pathogenesis of different phenotypically defined neurodegenerative diseases. Moreover, this information is also important in therapeutic trials targeting histopathological abnormalities.The aim of this review is to present an overview of the currently available radiotracers for imaging neurodegenerative diseases in research and in routine clinical settings. In this context, we also provide a short summary of the most frequent neurodegenerative diseases from a nuclear medicine point of view, their clinical and pathophysiological as well as nuclear imaging characteristics, and the resulting need for new radiotracers.
Collapse
Affiliation(s)
- Solveig Tiepolt
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Gayane Aghakhanyan
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Philipp M. Meyer
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| |
Collapse
|
48
|
Sabri O, Meyer PM, Gräf S, Hesse S, Wilke S, Becker GA, Rullmann M, Patt M, Luthardt J, Wagenknecht G, Hoepping A, Smits R, Franke A, Sattler B, Tiepolt S, Fischer S, Deuther-Conrad W, Hegerl U, Barthel H, Schönknecht P, Brust P. Cognitive correlates of α4β2 nicotinic acetylcholine receptors in mild Alzheimer's dementia. Brain 2019; 141:1840-1854. [PMID: 29672680 PMCID: PMC5972585 DOI: 10.1093/brain/awy099] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/19/2018] [Indexed: 12/22/2022] Open
Abstract
In early Alzheimer's dementia, there is a need for PET biomarkers of disease progression with close associations to cognitive dysfunction that may aid to predict further cognitive decline and neurodegeneration. Amyloid biomarkers are not suitable for that purpose. The α4β2 nicotinic acetylcholine receptors (α4β2-nAChRs) are widely abundant in the human brain. As neuromodulators they play an important role in cognitive functions such as attention, learning and memory. Post-mortem studies reported lower expression of α4β2-nAChRs in more advanced Alzheimer's dementia. However, there is ongoing controversy whether α4β2-nAChRs are reduced in early Alzheimer's dementia. Therefore, using the recently developed α4β2-nAChR-specific radioligand (-)-18F-flubatine and PET, we aimed to quantify the α4β2-nAChR availability and its relationship to specific cognitive dysfunction in mild Alzheimer's dementia. Fourteen non-smoking patients with mild Alzheimer's dementia, drug-naïve for cholinesterase therapy, were compared with 15 non-smoking healthy controls matched for age, sex and education by applying (-)-18F-flubatine PET together with a neuropsychological test battery. The one-tissue compartment model and Logan plot method with arterial input function were used for kinetic analysis to obtain the total distribution volume (VT) as the primary, and the specific binding part of the distribution volume (VS) as the secondary quantitative outcome measure of α4β2-nAChR availability. VS was determined by using a pseudo-reference region. Correlations between VT within relevant brain regions and Z-scores of five cognitive functions (episodic memory, executive function/working memory, attention, language, visuospatial function) were calculated. VT (and VS) were applied for between-group comparisons. Volume of interest and statistical parametric mapping analyses were carried out. Analyses revealed that in patients with mild Alzheimer's dementia compared to healthy controls, there was significantly lower VT, especially within the hippocampus, fronto-temporal cortices, and basal forebrain, which was similar to comparisons of VS. VT decline in Alzheimer's dementia was associated with distinct domains of impaired cognitive functioning, especially episodic memory and executive function/working memory. Using (-)-18F-flubatine PET in patients with mild Alzheimer's dementia, we show for the first time a cholinergic α4β2-nAChR deficiency mainly present within the basal forebrain-cortical and septohippocampal cholinergic projections and a relationship between lower α4β2-nAChR availability and impairment of distinct cognitive domains, notably episodic memory and executive function/working memory. This shows the potential of (-)-18F-flubatine as PET biomarker of cholinergic α4β2-nAChR dysfunction and specific cognitive decline. Thus, if validated by longitudinal PET studies, (-)-18F-flubatine might become a PET biomarker of progression of neurodegeneration in Alzheimer's dementia.
Collapse
Affiliation(s)
- Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Philipp M Meyer
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Susanne Gräf
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.,Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Stephan Wilke
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Michael Rullmann
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.,Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Julia Luthardt
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Gudrun Wagenknecht
- Central Institute for Engineering, Electronics and Analytics-Electronic Systems (ZEA-2), Forschungszentrum Jülich, Jülich, Germany
| | | | - Rene Smits
- ABX Advanced Biochemical Compounds GmbH, Radeberg, Germany
| | - Annegret Franke
- Centre for Clinical Trials Leipzig, University of Leipzig, Leipzig, Germany
| | - Bernhard Sattler
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Solveig Tiepolt
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Steffen Fischer
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Research Site Leipzig, Leipzig, Germany
| | - Winnie Deuther-Conrad
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Research Site Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Peter Schönknecht
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Peter Brust
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Research Site Leipzig, Leipzig, Germany
| |
Collapse
|
49
|
Richter N, Beckers N, Onur OA, Dietlein M, Tittgemeyer M, Kracht L, Neumaier B, Fink GR, Kukolja J. Effect of cholinergic treatment depends on cholinergic integrity in early Alzheimer's disease. Brain 2019; 141:903-915. [PMID: 29309600 DOI: 10.1093/brain/awx356] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/08/2017] [Indexed: 02/04/2023] Open
Abstract
In early Alzheimer's disease, which initially presents with progressive loss of short-term memory, neurodegeneration especially affects cholinergic neurons of the basal forebrain. Pharmacotherapy of Alzheimer's disease therefore often targets the cholinergic system. In contrast, cholinergic pharmacotherapy of mild cognitive impairment is debated since its efficacy to date remains controversial. We here investigated the relationship between cholinergic treatment effects and the integrity of the cholinergic system in mild cognitive impairment due to Alzheimer's disease. Fourteen patients with high likelihood of mild cognitive impairment due to Alzheimer's disease and 16 age-matched cognitively normal adults performed an episodic memory task during functional magnetic resonance imaging under three conditions: (i) without pharmacotherapy; (ii) with placebo; and (iii) with a single dose of rivastigmine (3 mg). Cortical acetylcholinesterase activity was measured using PET with the tracer 11C-N-methyl-4-piperidyl acetate (MP4A). Cortical acetylcholinesterase activity was significantly decreased in patients relative to controls, especially in the lateral temporal lobes. Without pharmacotherapy, mild cognitive impairment was associated with less memory-related neural activation in the fusiform gyrus and impaired deactivation in the posterior cingulate cortex, relative to controls. These differences were attenuated under cholinergic stimulation with rivastigmine: patients showed increased neural activation in the right fusiform gyrus but enhanced deactivation of the posterior cingulate cortex under rivastigmine, compared to placebo. Conversely, controls showed reduced activation of the fusiform gyrus and reduced deactivation of the posterior cingulate under rivastigmine, compared to placebo. In both groups, the change in neural activation in response to rivastigmine was negatively associated with local acetylcholinesterase activity. At the behavioural level, an analysis of covariance revealed a significant group × treatment interaction in episodic memory performance when accounting for hippocampal grey matter atrophy and function. Our results indicate that rivastigmine differentially affects memory-related neural activity in patients with mild cognitive impairment and cognitively normal, age-matched adults, depending on acetylcholinesterase activity as a marker for the integrity of the cortical cholinergic system. Furthermore, hippocampal integrity showed an independent association with the response of memory performance to acetylcholinesterase inhibition.
Collapse
Affiliation(s)
- Nils Richter
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany.,Max-Planck-Institute for Metabolism Research, 50937 Cologne, Germany
| | - Nora Beckers
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Oezguer A Onur
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University Hospital Cologne, 50937 Cologne, Germany
| | - Marc Tittgemeyer
- Max-Planck-Institute for Metabolism Research, 50937 Cologne, Germany
| | - Lutz Kracht
- Max-Planck-Institute for Metabolism Research, 50937 Cologne, Germany.,Department of Nuclear Medicine, University Hospital Cologne, 50937 Cologne, Germany
| | - Bernd Neumaier
- Nuclear Chemistry, Institute of Neuroscience and Medicine (INM-5), Research Center Jülich, 52425 Jülich, Germany.,Institute for Radiochemistry and Experimental Molecular Imaging, University Hospital Cologne, 50937 Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
| | - Juraj Kukolja
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany
| |
Collapse
|
50
|
Hirano S, Shinotoh H, Shimada H, Ota T, Sato K, Tanaka N, Zhang MR, Higuchi M, Fukushi K, Irie T, Kuwabara S, Suhara T. Voxel-Based Acetylcholinesterase PET Study in Early and Late Onset Alzheimer's Disease. J Alzheimers Dis 2019; 62:1539-1548. [PMID: 29562505 DOI: 10.3233/jad-170749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disorder characterized by chronic progressive cognitive decline and displays underlying brain cholinergic dysfunction, providing a rationale for treatment with cholinomimetic medication. The clinical presentations and courses of AD patients may differ by age of onset. OBJECTIVE The objective of the present study was to illustrate the regional differences of brain acetylcholinesterase (AChE) activity as quantified by N-[11C]methylpiperidinyl-4-acetate ([11C]MP4A) and PET using parametric whole brain analysis and clarify those differences as a function of age. METHODS 22 early onset AD (EOAD) with age at onset under 65, the remaining 26 as late onset AD (LOAD), and 16 healthy controls (HC) were enrolled. Voxel-based AChE activity estimation of [11C]MP4A PET images was conducted by arterial input and unconstrained nonlinear least-squares method with subsequent parametrical analyses. Statistical threshold was set as Family Wise Error corrected, p-value <0.05 on cluster-level and cluster extent over 30 voxels. RESULTS Voxel-based group comparison showed that, compared to HC, both EOAD and LOAD showed cortical AChE decrement in parietal, temporal, and occipital cortices, with wider and stringent cortical involvement in the EOAD group, most prominently demonstrated in the temporal region. There was no significant correlation between age and regional cerebral AChE activity except for a small left superior temporal region in the AD group (Brodmann's area 22, Zmax = 5.13, 396 voxels), whereas no significant cluster was found in the HC counterpart. CONCLUSION Difference in cortical cholinergic dysfunction between EOAD and LOAD may shed some light on the cholinomimetic drug efficacy in AD.
Collapse
Affiliation(s)
- Shigeki Hirano
- Department of Functional Brain Imaging Research, Clinical Research Cluster, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hitoshi Shinotoh
- Department of Functional Brain Imaging Research, Clinical Research Cluster, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Neurology Clinic Chiba, Chiba, Japan
| | - Hitoshi Shimada
- Department of Functional Brain Imaging Research, Clinical Research Cluster, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tsuneyoshi Ota
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Koichi Sato
- Department of Psychiatry, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Noriko Tanaka
- Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, Tokyo, Japan
| | - Ming-Rong Zhang
- Department of Radiopharmaceuticals Development, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging Research, Clinical Research Cluster, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kiyoshi Fukushi
- Department of Radiopharmaceuticals Development, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Toshiaki Irie
- Department of Radiopharmaceuticals Development, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuya Suhara
- Department of Functional Brain Imaging Research, Clinical Research Cluster, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| |
Collapse
|