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Cavaliere C, Longarzo M, Fogel S, Engström M, Soddu A. Neuroimaging of Narcolepsy and Primary Hypersomnias. Neuroscientist 2020; 26:310-327. [PMID: 32111133 DOI: 10.1177/1073858420905829] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Advances in neuroimaging open up the possibility for new powerful tools to be developed that potentially can be applied to clinical populations to improve the diagnosis of neurological disorders, including sleep disorders. At present, the diagnosis of narcolepsy and primary hypersomnias is largely limited to subjective assessments and objective measurements of behavior and sleep physiology. In this review, we focus on recent neuroimaging findings that provide insight into the neural basis of narcolepsy and the primary hypersomnias Kleine-Levin syndrome and idiopathic hypersomnia. We describe the role of neuroimaging in confirming previous genetic, neurochemical, and neurophysiological findings and highlight studies that permit a greater understanding of the symptoms of these sleep disorders. We conclude by considering some of the remaining challenges to overcome, the existing knowledge gaps, and the potential role for neuroimaging in understanding the pathogenesis and clinical features of narcolepsy and primary hypersomnias.
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Affiliation(s)
| | | | - Stuart Fogel
- Brain and Mind Institute, Western University, London, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.,Sleep Unit, The Royal's Institute for Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Maria Engström
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Andrea Soddu
- Brain and Mind Institute, Western University, London, Ontario, Canada.,Physics & Astronomy Department, Brain and Mind Institute, Western University, London, Ontario, Canada
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Stevner ABA, Vidaurre D, Cabral J, Rapuano K, Nielsen SFV, Tagliazucchi E, Laufs H, Vuust P, Deco G, Woolrich MW, Van Someren E, Kringelbach ML. Discovery of key whole-brain transitions and dynamics during human wakefulness and non-REM sleep. Nat Commun 2019; 10:1035. [PMID: 30833560 PMCID: PMC6399232 DOI: 10.1038/s41467-019-08934-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/11/2019] [Indexed: 12/02/2022] Open
Abstract
The modern understanding of sleep is based on the classification of sleep into stages defined by their electroencephalography (EEG) signatures, but the underlying brain dynamics remain unclear. Here we aimed to move significantly beyond the current state-of-the-art description of sleep, and in particular to characterise the spatiotemporal complexity of whole-brain networks and state transitions during sleep. In order to obtain the most unbiased estimate of how whole-brain network states evolve through the human sleep cycle, we used a Markovian data-driven analysis of continuous neuroimaging data from 57 healthy participants falling asleep during simultaneous functional magnetic resonance imaging (fMRI) and EEG. This Hidden Markov Model (HMM) facilitated discovery of the dynamic choreography between different whole-brain networks across the wake-non-REM sleep cycle. Notably, our results reveal key trajectories to switch within and between EEG-based sleep stages, while highlighting the heterogeneities of stage N1 sleep and wakefulness before and after sleep. Sleep is composed of a number of different stages, each associated with a different pattern of brain activity. Here, using a data-driven Hidden Markov Model (HMM) of fMRI data, the authors discover a more complex set of neural activity states underlying the conventional stages of non-REM sleep.
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Affiliation(s)
- A B A Stevner
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK. .,Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, 8000, Aarhus, Denmark. .,Center for Music in the Brain (MIB), Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark.
| | - D Vidaurre
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK
| | - J Cabral
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
| | - K Rapuano
- Department of Psychological and Brain Sciences, Dartmouth College, 03755, Hanover, NH, USA
| | - S F V Nielsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kgs., Lyngby, Denmark
| | - E Tagliazucchi
- Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands.,Department of Neurology, University Hospital Schleswig Holstein, Christian-Alrbrechts-Universität, 24105, Kiel, Germany.,Department of Neurology and Brain Imaging Center, Goethe University, 60528, Frankfurt am Main, Germany
| | - H Laufs
- Department of Neurology, University Hospital Schleswig Holstein, Christian-Alrbrechts-Universität, 24105, Kiel, Germany.,Department of Neurology and Brain Imaging Center, Goethe University, 60528, Frankfurt am Main, Germany
| | - P Vuust
- Center for Music in the Brain (MIB), Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark
| | - G Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona, 08018, Spain.,Institució Catalana de la Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, Barcelona, 08010, Spain.,Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany.,School of Psychological Sciences, Monash University, Melbourne, Clayton, VIC, 3800, Australia
| | - M W Woolrich
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK
| | - E Van Someren
- Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Psychiatry GGZ-InGeest, Amsterdam Neuroscience, VU University and Medical Center, 1081 HV, Amsterdam, The Netherlands
| | - M L Kringelbach
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK.,Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, 8000, Aarhus, Denmark.,Center for Music in the Brain (MIB), Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
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van Dalen JW, Caan MWA, van Gool WA, Richard E. Neuropsychiatric symptoms of cholinergic deficiency occur with degradation of the projections from the nucleus basalis of Meynert. Brain Imaging Behav 2018; 11:1707-1719. [PMID: 27787708 PMCID: PMC5707238 DOI: 10.1007/s11682-016-9631-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study aims to evaluate the relation between a cluster of neuropsychiatric symptoms related to cholinergic deficiency and degradation of the cortical cholinergic projections which project from the nucleus basalis of Meynert to the cerebral cortex. An atlas of the pathway from the nucleus basalis to the cortex (NbM cortical pathway) was constructed using diffusion tensor imaging and tractography in 87 memory clinic patients. Structural degradation was considered to be represented by lower fractional anisotropy (FA) and higher mean diffusivity (MD). Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. A predefined cluster including agitation, anxiety, apathy, delusions, hallucinations, and irritability was labeled as the cholinergic deficiency syndrome (CDS). In regression analyses, lower FA and higher MD in the NbM cortical pathway were associated with CDS symptoms but not with other neuropsychiatric symptoms. These associations were independent of cerebral atrophy and overall FA or MD. There was no association between interruption of the NbM cortical pathway by white matter hyperintensities and CDS symptoms. Cox regression suggested a trend for higher mortality with lower FA in the NbM cortical pathway may exist. These findings provide anatomical support for the hypothesis that degradation of the cholinergic projections from the nucleus basalis of Meynert may lead to a distinct clinical syndrome. Future studies could use our results to test the utility of assessing NbM projection integrity to identify patients who may benefit from cholinergic treatment or with a worse prognosis.
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Affiliation(s)
- Jan Willem van Dalen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Matthan W A Caan
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
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Raikes AC, Bajaj S, Dailey NS, Smith RS, Alkozei A, Satterfield BC, Killgore WDS. Diffusion Tensor Imaging (DTI) Correlates of Self-Reported Sleep Quality and Depression Following Mild Traumatic Brain Injury. Front Neurol 2018; 9:468. [PMID: 29973910 PMCID: PMC6019466 DOI: 10.3389/fneur.2018.00468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Mild traumatic brain injuries (mTBIs) are a significant social, sport, and military health issue. In spite of advances in the clinical management of these injuries, the underlying pathophysiology is not well-understood. There is a critical need to advance objective biomarkers, allowing the identification and tracking of the long-term evolution of changes resulting from mTBI. Diffusion-weighted imaging (DWI) allows for the assessment of white-matter properties in the brain and shows promise as a suitable biomarker of mTBI pathophysiology. Methods: 34 individuals within a year of an mTBI (age: 24.4 ± 7.4) and 18 individuals with no history of mTBI (age: 23.2 ± 3.4) participated in this study. Participants completed self-report measures related to functional outcomes, psychological health, post-injury symptoms, and sleep, and underwent a neuroimaging session that included DWI. Whole-brain white matter was skeletonized using tract-based spatial statistics (TBSS) and compared between groups as well as correlated within-group with the self-report measures. Results: There were no statistically significant anatomical differences between the two groups. After controlling for time since injury, fractional anisotropy (FA) demonstrated a negative correlation with sleep quality scores (higher FA was associated with better sleep quality) and increasing depressive symptoms in the mTBI participants. Conversely, mean (MD) and radial diffusivity (RD) demonstrated positive correlations with sleep quality scores (higher RD was associated with worse sleep quality) and increasing depressive symptoms. These correlations were observed bilaterally in the internal capsule (anterior and posterior limbs), corona radiata (anterior and superior), fornix, and superior fronto-occipital fasciculi. Conclusion: The results of this study indicate that the clinical presentation of mTBI, particularly with respect to depression and sleep, is associated with reduced white-matter integrity in multiple areas of the brain, even after controlling for time since injury. These areas are generally associated not only with sleep and emotion regulation but also cognition. Consequently, the onset of depression and sleep dysfunction as well as cognitive impairments following mTBI may be closely related to each other and to white-matter integrity throughout the brain.
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Affiliation(s)
- Adam C Raikes
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sahil Bajaj
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Natalie S Dailey
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan S Smith
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Anna Alkozei
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Brieann C Satterfield
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive, and Affective Neuroscience Laboratory, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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