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Oltra J, Segura B, Strafella AP, van Eimeren T, Ibarretxe-Bilbao N, Diez-Cirarda M, Eggers C, Lucas-Jiménez O, Monté-Rubio GC, Ojeda N, Peña J, Ruppert MC, Sala-Llonch R, Theis H, Uribe C, Junque C. A multi-site study on sex differences in cortical thickness in non-demented Parkinson's disease. NPJ Parkinsons Dis 2024; 10:69. [PMID: 38521776 PMCID: PMC10960793 DOI: 10.1038/s41531-024-00686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
Clinical, cognitive, and atrophy characteristics depending on sex have been previously reported in Parkinson's disease (PD). However, though sex differences in cortical gray matter measures in early drug naïve patients have been described, little is known about differences in cortical thickness (CTh) as the disease advances. Our multi-site sample comprised 211 non-demented PD patients (64.45% males; mean age 65.58 ± 8.44 years old; mean disease duration 6.42 ± 5.11 years) and 86 healthy controls (50% males; mean age 65.49 ± 9.33 years old) with available T1-weighted 3 T MRI data from four international research centers. Sex differences in regional mean CTh estimations were analyzed using generalized linear models. The relation of CTh in regions showing sex differences with age, disease duration, and age of onset was examined through multiple linear regression. PD males showed thinner cortex than PD females in six frontal (bilateral caudal middle frontal, bilateral superior frontal, left precentral and right pars orbitalis), three parietal (bilateral inferior parietal and left supramarginal), and one limbic region (right posterior cingulate). In PD males, lower CTh values in nine out of ten regions were associated with longer disease duration and older age, whereas in PD females, lower CTh was associated with older age but with longer disease duration only in one region. Overall, male patients show a more widespread pattern of reduced CTh compared with female patients. Disease duration seems more relevant to explain reduced CTh in male patients, suggesting worse prognostic over time. Further studies should explore sex-specific cortical atrophy trajectories using large longitudinal multi-site data.
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Affiliation(s)
- Javier Oltra
- Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of Barcelona, Faculty of Medicine, Clínic Campus, Carrer de Casanova, 143, Ala Nord, 5th floor, 08036, Barcelona, Catalonia, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Catalonia, Spain
| | - Barbara Segura
- Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of Barcelona, Faculty of Medicine, Clínic Campus, Carrer de Casanova, 143, Ala Nord, 5th floor, 08036, Barcelona, Catalonia, Spain.
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Hospital Clínic Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Catalonia, Spain.
| | - Antonio P Strafella
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College St., M5T 1R8, Toronto, ON, Canada
- Edmond J. Safra Parkinson Disease Program, Neurology Division, Toronto Western Hospital & Krembil Brain Institute, University Health Network, University of Toronto, 399 Bathurst Street, M5T 2S8, Toronto, ON, Canada
| | - Thilo van Eimeren
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Medical Center Cologne, Kerpener Straße, 62, 50937, Cologne, Germany
- Department of Neurology, University Medical Center Cologne, Kerpener Straße, 62, 50937, Cologne, Germany
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avenida de las Universidades, 24, 48007, Bilbao, Basque Country, Spain
| | - Maria Diez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos, Health Research Institute 'San Carlos' (IdISCC), Complutense University of Madrid, Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - Carsten Eggers
- Department of Neurology, University Medical Center Cologne, Kerpener Straße, 62, 50937, Cologne, Germany
- Department of Neurology, University Hospital of Giessen and Marburg, Center for Mind, Brain and Behavior, University of Marburg and Giessen Universiy, Hans-Meerwein-Straße, 6, 35043, Marburg, Germany
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avenida de las Universidades, 24, 48007, Bilbao, Basque Country, Spain
| | - Gemma C Monté-Rubio
- Centre for Comparative Medicine and Bioimaging (CMCiB), Gemans Trias i Pujol Research Institute (IGTP), Camí de les Escoles, s/n, 08916, Badalona, Catalonia, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avenida de las Universidades, 24, 48007, Bilbao, Basque Country, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avenida de las Universidades, 24, 48007, Bilbao, Basque Country, Spain
| | - Marina C Ruppert
- Department of Neurology, University Hospital of Giessen and Marburg, Center for Mind, Brain and Behavior, University of Marburg and Giessen Universiy, Hans-Meerwein-Straße, 6, 35043, Marburg, Germany
| | - Roser Sala-Llonch
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Catalonia, Spain
- Department of Biomedicine, Institute of Neurosciences, University of Barcelona, Faculty of Medicine, Clínic Campus, Carrer de Casanova, 143, Ala Nord, 5th floor, 08036, Barcelona, Catalonia, Spain
- Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN: CB06/01/1039-ISCIII), Carrer de Casanova, 143, 08036, Barcelona, Catalonia, Spain
| | - Hendrik Theis
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Medical Center Cologne, Kerpener Straße, 62, 50937, Cologne, Germany
- Department of Neurology, University Medical Center Cologne, Kerpener Straße, 62, 50937, Cologne, Germany
| | - Carme Uribe
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College St., M5T 1R8, Toronto, ON, Canada
| | - Carme Junque
- Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of Barcelona, Faculty of Medicine, Clínic Campus, Carrer de Casanova, 143, Ala Nord, 5th floor, 08036, Barcelona, Catalonia, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Hospital Clínic Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Catalonia, Spain
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2
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Steidel K, Ruppert MC, Greuel A, Tahmasian M, Maier F, Hammes J, van Eimeren T, Timmermann L, Tittgemeyer M, Drzezga A, Pedrosa DJ, Eggers C. Longitudinal trimodal imaging of midbrain-associated network degeneration in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:79. [PMID: 35732679 PMCID: PMC9218128 DOI: 10.1038/s41531-022-00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/24/2022] [Indexed: 11/20/2022] Open
Abstract
The prevailing network perspective of Parkinson’s disease (PD) emerges not least from the ascending neuropathology traceable in histological studies. However, whether longitudinal in vivo correlates of network degeneration in PD can be observed remains unresolved. Here, we applied a trimodal imaging protocol combining 18F-fluorodeoxyglucose (FDG)- and 18F-fluoro-L-Dopa- (FDOPA)-PET with resting-state functional MRI to assess longitudinal changes in midbrain metabolism, striatal dopamine depletion and striatocortical dysconnectivity in 17 well-characterized PD patients. Whole-brain (un)paired-t-tests with focus on midbrain or striatum were performed between visits and in relation to 14 healthy controls (HC) in PET modalities. Resulting clusters of FDOPA-PET comparisons provided volumes for seed-based functional connectivity (FC) analyses between visits and in relation to HC. FDG metabolism in the left midbrain decreased compared to baseline along with caudatal FDOPA-uptake. This caudate cluster exhibited a longitudinal FC decrease to sensorimotor and frontal areas. Compared to healthy subjects, dopamine-depleted putamina indicated stronger decline in striatocortical FC at follow-up with respect to baseline. Increasing nigrostriatal deficits and striatocortical decoupling were associated with deterioration in motor scores between visits in repeated-measures correlations. In summary, our results demonstrate the feasibility of in-vivo tracking of progressive network degeneration using a multimodal imaging approach. Specifically, our data suggest advancing striatal and widespread striatocortical dysfunction via an anterior-posterior gradient originating from a hypometabolic midbrain cluster within a well-characterized and only mild to moderately affected PD cohort during a relatively short period.
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Affiliation(s)
- Kenan Steidel
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.
| | - Marina C Ruppert
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior-CMBB, Universities Marburg and Gießen, Marburg, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Masoud Tahmasian
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty University Hospital Cologne, Cologne, Germany
| | - Thilo van Eimeren
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty University Hospital Cologne, Cologne, Germany.,Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior-CMBB, Universities Marburg and Gießen, Marburg, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany.,Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Alexander Drzezga
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty University Hospital Cologne, Cologne, Germany.,Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Jülich, Germany
| | - David J Pedrosa
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior-CMBB, Universities Marburg and Gießen, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Department of Neurology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
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3
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C. Monte‐Rubio G, Segura B, P. Strafella A, van Eimeren T, Ibarretxe‐Bilbao N, Diez‐Cirarda M, Eggers C, Lucas‐Jiménez O, Ojeda N, Peña J, Ruppert MC, Sala‐Llonch R, Theis H, Uribe C, Junque C. Cover Image. Hum Brain Mapp 2022. [DOI: 10.1002/hbm.25503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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4
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C Monte-Rubio G, Segura B, P Strafella A, van Eimeren T, Ibarretxe-Bilbao N, Diez-Cirarda M, Eggers C, Lucas-Jiménez O, Ojeda N, Peña J, Ruppert MC, Sala-Llonch R, Theis H, Uribe C, Junque C. Parameters from site classification to harmonize MRI clinical studies: Application to a multi-site Parkinson's disease dataset. Hum Brain Mapp 2022; 43:3130-3142. [PMID: 35305545 PMCID: PMC9188966 DOI: 10.1002/hbm.25838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Multi‐site MRI datasets are crucial for big data research. However, neuroimaging studies must face the batch effect. Here, we propose an approach that uses the predictive probabilities provided by Gaussian processes (GPs) to harmonize clinical‐based studies. A multi‐site dataset of 216 Parkinson's disease (PD) patients and 87 healthy subjects (HS) was used. We performed a site GP classification using MRI data. The outcomes estimated from this classification, redefined like Weighted HARMonization PArameters (WHARMPA), were used as regressors in two different clinical studies: A PD versus HS machine learning classification using GP, and a VBM comparison (FWE‐p < .05, k = 100). Same studies were also conducted using conventional Boolean site covariates, and without information about site belonging. The results from site GP classification provided high scores, balanced accuracy (BAC) was 98.39% for grey matter images. PD versus HS classification performed better when the WHARMPA were used to harmonize (BAC = 78.60%; AUC = 0.90) than when using the Boolean site information (BAC = 56.31%; AUC = 0.71) and without it (BAC = 57.22%; AUC = 0.73). The VBM analysis harmonized using WHARMPA provided larger and more statistically robust clusters in regions previously reported in PD than when the Boolean site covariates or no corrections were added to the model. In conclusion, WHARMPA might encode global site‐effects quantitatively and allow the harmonization of data. This method is user‐friendly and provides a powerful solution, without complex implementations, to clean the analyses by removing variability associated with the differences between sites.
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Affiliation(s)
- Gemma C Monte-Rubio
- Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain.,Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Catalonia, Spain
| | - Barbara Segura
- Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain.,Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII) Barcelona, Barcelona, Catalonia, Spain
| | - Antonio P Strafella
- Edmond J. Safra Parkinson Disease Program & Morton and Gloria Shulman Movement Disorder Unit, Neurology Division, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto, Toronto, Ontario, Canada
| | - Thilo van Eimeren
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Maria Diez-Cirarda
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto, Toronto, Ontario, Canada
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Marburg and Gießen, Germany.,Department of Neurology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Marina C Ruppert
- Department of Neurology, University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Marburg and Gießen, Germany
| | - Roser Sala-Llonch
- Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Biomedicine, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Catalonia, Spain
| | - Hendrik Theis
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Carme Uribe
- Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain.,Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto, Toronto, Ontario, Canada
| | - Carme Junque
- Institute of Neurosciences, University of Barcelona, Barcelona, Catalonia, Spain.,Medical Psychology Unit, Department of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII) Barcelona, Barcelona, Catalonia, Spain
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5
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Steidel K, Ruppert MC, Palaghia I, Greuel A, Tahmasian M, Maier F, Hammes J, van Eimeren T, Timmermann L, Tittgemeyer M, Drzezga A, Pedrosa D, Eggers C. Dopaminergic pathways and resting-state functional connectivity in Parkinson's disease with freezing of gait. Neuroimage Clin 2021; 32:102899. [PMID: 34911202 PMCID: PMC8645514 DOI: 10.1016/j.nicl.2021.102899] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022]
Abstract
Freezing of gait is a common phenomenon of advanced Parkinson's disease. Besides locomotor function per se, a role of cognitive deficits has been suggested. Limited evidence of associated dopaminergic deficits points to caudatal denervation. Further, altered functional connectivity within resting-state networks with importance for cognitive functions has been described in freezers. A potential pathophysiological link between both imaging findings has not yet been addressed. The current study sought to investigate the association between dopaminergic pathway dysintegrity and functional dysconnectivity in relation to FOG severity and cognitive performance in a well-characterized PD cohort undergoing high-resolution 6-[18F]fluoro-L-Dopa PET and functional MRI. The freezing of gait questionnaire was applied to categorize patients (n = 59) into freezers and non-freezers. A voxel-wise group comparison of 6-[18F]fluoro-L-Dopa PET scans with focus on striatum was performed between both well-matched and neuropsychologically characterized patient groups. Seed-to-voxel resting-state functional connectivity maps of the resulting dopamine depleted structures and dopaminergic midbrain regions were created and compared between both groups. For a direct between-group comparison of dopaminergic pathway integrity, a molecular connectivity approach was conducted on 6-[18F]fluoro-L-Dopa scans. With respect to striatal regions, freezers showed significant dopaminergic deficits in the left caudate nucleus, which exhibited altered functional connectivity with regions of the visual network. Regarding midbrain structures, the bilateral ventral tegmental area showed altered functional coupling to regions of the default mode network. An explorative examination of the integrity of dopaminergic pathways by molecular connectivity analysis revealed freezing-associated impairments in mesolimbic and mesocortical pathways. This study represents the first characterization of a link between dopaminergic pathway dysintegrity and altered functional connectivity in Parkinson's disease with freezing of gait and hints at a specific involvement of striatocortical and mesocorticolimbic pathways in freezers.
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Affiliation(s)
- Kenan Steidel
- Department of Neurology, University Hospital of Marburg, Germany.
| | - Marina C Ruppert
- Department of Neurology, University Hospital of Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Irina Palaghia
- Department of Neurology, University Hospital of Marburg, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital of Marburg, Germany
| | - Masoud Tahmasian
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
| | - Thilo van Eimeren
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany; Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn- Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany; Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Alexander Drzezga
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn- Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Germany
| | - David Pedrosa
- Department of Neurology, University Hospital of Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
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Rommal A, Vo A, Schindlbeck KA, Greuel A, Ruppert MC, Eggers C, Eidelberg D. Parkinson's disease-related pattern (PDRP) identified using resting-state functional MRI: Validation study. Neuroimage: Reports 2021. [DOI: 10.1016/j.ynirp.2021.100026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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7
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Ruppert MC, Greuel A, Freigang J, Tahmasian M, Maier F, Hammes J, van Eimeren T, Timmermann L, Tittgemeyer M, Drzezga A, Eggers C. The default mode network and cognition in Parkinson's disease: A multimodal resting-state network approach. Hum Brain Mapp 2021; 42:2623-2641. [PMID: 33638213 PMCID: PMC8090788 DOI: 10.1002/hbm.25393] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Involvement of the default mode network (DMN) in cognitive symptoms of Parkinson's disease (PD) has been reported by resting-state functional MRI (rsfMRI) studies. However, the relation to metabolic measures obtained by [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) is largely unknown. We applied multimodal resting-state network analysis to clarify the association between intrinsic metabolic and functional connectivity abnormalities within the DMN and their significance for cognitive symptoms in PD. PD patients were classified into normal cognition (n = 36) and mild cognitive impairment (MCI; n = 12). The DMN was identified by applying an independent component analysis to FDG-PET and rsfMRI data of a matched subset (16 controls and 16 PD patients) of the total cohort. Besides metabolic activity, metabolic and functional connectivity within the DMN were compared between the patients' groups and healthy controls (n = 16). Glucose metabolism was significantly reduced in all DMN nodes in both patient groups compared to controls, with the lowest uptake in PD-MCI (p < .05). Increased metabolic and functional connectivity along fronto-parietal connections was identified in PD-MCI patients compared to controls and unimpaired patients. Functional connectivity negatively correlated with cognitive composite z-scores in patients (r = -.43, p = .005). The current study clarifies the commonalities of metabolic and hemodynamic measures of brain network activity and their individual significance for cognitive symptoms in PD, highlighting the added value of multimodal resting-state network approaches for identifying prospective biomarkers.
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Affiliation(s)
- Marina C Ruppert
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain, and Behavior-CMBB, Universities of Marburg and Gießen, Marburg, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Julia Freigang
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain, and Behavior-CMBB, Universities of Marburg and Gießen, Marburg, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Franziska Maier
- Medical Faculty, Department of Psychiatry, University Hospital Cologne, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Cologne, Germany
| | - Thilo van Eimeren
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Cologne, Germany.,Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain, and Behavior-CMBB, Universities of Marburg and Gießen, Marburg, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany.,Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Alexander Drzezga
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Jülich, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany.,Center for Mind, Brain, and Behavior-CMBB, Universities of Marburg and Gießen, Marburg, Germany
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8
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Greuel A, Trezzi JP, Glaab E, Ruppert MC, Maier F, Jäger C, Hodak Z, Lohmann K, Ma Y, Eidelberg D, Timmermann L, Hiller K, Tittgemeyer M, Drzezga A, Diederich N, Eggers C. GBA Variants in Parkinson's Disease: Clinical, Metabolomic, and Multimodal Neuroimaging Phenotypes. Mov Disord 2020; 35:2201-2210. [PMID: 32853481 DOI: 10.1002/mds.28225] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Alterations in the GBA gene (NM_000157.3) are the most important genetic risk factor for Parkinson's disease (PD). Biallelic GBA mutations cause the lysosomal storage disorder Gaucher's disease. The GBA variants p.E365K and p.T408M are associated with PD but not with Gaucher's disease. The pathophysiological role of these variants needs to be further explored. OBJECTIVE This study analyzed clinical, neuropsychological, metabolic, and neuroimaging phenotypes of patients with PD carrying the GBA variants p.E365K and p.T408M. METHODS GBA was sequenced in 56 patients with mid-stage PD. Carriers of GBA variants were compared with noncarriers regarding clinical history and symptoms, neuropsychological features, metabolomics, and multimodal neuroimaging. Blood plasma gas chromatography coupled to mass spectrometry, 6-[18 F]fluoro-L-Dopa positron emission tomography (PET), [18 F]fluorodeoxyglucose PET, and resting-state functional magnetic resonance imaging were performed. RESULTS Sequence analysis detected 13 heterozygous GBA variant carriers (7 with p.E365K, 6 with p.T408M). One patient carried a GBA mutation (p.N409S) and was excluded. Clinical history and symptoms were not significantly different between groups. Global cognitive performance was lower in variant carriers. Metabolomic group differences were suggestive of more severe PD-related alterations in carriers versus noncarriers. Both PET scans showed signs of a more advanced disease; [18 F]fluorodeoxyglucose PET and functional magnetic resonance imaging showed similarities with Lewy body dementia and PD dementia in carriers. CONCLUSIONS This is the first study to comprehensively assess (neuro-)biological phenotypes of GBA variants in PD. Metabolomics and neuroimaging detected more significant group differences than clinical and behavioral evaluation. These alterations could be promising to monitor effects of disease-modifying treatments targeting glucocerebrosidase metabolism. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Andrea Greuel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jean-Pierre Trezzi
- Integrated Biobank of Luxembourg, Luxembourg Institute of Health, Dudelange, Luxembourg.,Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Enrico Glaab
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marina C Ruppert
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior, Universities of Marburg and Giessen, Marburg, Germany
| | - Franziska Maier
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Christian Jäger
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Zdenka Hodak
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Yilong Ma
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - David Eidelberg
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Karsten Hiller
- Institute for Biochemistry, Biotechnology and Bioinformatics, University of Braunschweig, Braunschweig, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany.,Cologne Cluster of Excellence in Cellular Stress and Aging-Associated Disease, Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Nico Diederich
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Carsten Eggers
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior, Universities of Marburg and Giessen, Marburg, Germany
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Ruppert MC, Greuel A, Tahmasian M, Schwartz F, Stürmer S, Maier F, Hammes J, Tittgemeyer M, Timmermann L, van Eimeren T, Drzezga A, Eggers C. Network degeneration in Parkinson’s disease: multimodal imaging of nigro-striato-cortical dysfunction. Brain 2020; 143:944-959. [DOI: 10.1093/brain/awaa019] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
The spreading hypothesis of neurodegeneration assumes an expansion of neural pathologies along existing neural pathways. Multimodal neuroimaging studies have demonstrated distinct topographic patterns of cerebral pathologies in neurodegeneration. For Parkinson’s disease the hypothesis so far rests largely on histopathological evidence of α-synuclein spreading in a characteristic pattern and progressive nigrostriatal dopamine depletion. Functional consequences of nigrostriatal dysfunction on cortical activity remain to be elucidated. Our goal was to investigate multimodal imaging correlates of degenerative processes in Parkinson’s disease by assessing dopamine depletion and its potential effect on striatocortical connectivity networks and cortical metabolism in relation to parkinsonian symptoms. We combined 18F-DOPA-PET, 18F-fluorodeoxyglucose (FDG)-PET and resting state functional MRI to multimodally characterize network alterations in Parkinson’s disease. Forty-two patients with mild-to-moderate stage Parkinson’s disease and 14 age-matched healthy control subjects underwent a multimodal imaging protocol and comprehensive clinical examination. A voxel-wise group comparison of 18F-DOPA uptake identified the exact location and extent of putaminal dopamine depletion in patients. Resulting clusters were defined as seeds for a seed-to-voxel functional connectivity analysis. 18F-FDG metabolism was compared between groups at a whole-brain level and uptake values were extracted from regions with reduced putaminal connectivity. To unravel associations between dopaminergic activity, striatocortical connectivity, glucose metabolism and symptom severity, correlations between normalized uptake values, seed-to-cluster β-values and clinical parameters were tested while controlling for age and dopaminergic medication. Aside from cortical hypometabolism, 18F-FDG-PET data for the first time revealed a hypometabolic midbrain cluster in patients with Parkinson’s disease that comprised caudal parts of the bilateral substantia nigra pars compacta. Putaminal dopamine synthesis capacity was significantly reduced in the bilateral posterior putamen and correlated with ipsilateral nigral 18F-FDG uptake. Resting state functional MRI data indicated significantly reduced functional connectivity between the dopamine depleted putaminal seed and cortical areas primarily belonging to the sensorimotor network in patients with Parkinson’s disease. In the inferior parietal cortex, hypoconnectivity in patients was significantly correlated with lower metabolism (left P = 0.021, right P = 0.018). Of note, unilateral network alterations quantified with different modalities corresponded with contralateral motor impairments. In conclusion, our results support the hypothesis that degeneration of nigrostriatal fibres functionally impairs distinct striatocortical connections, disturbing the efficient interplay between motor processing areas and impairing motor control in patients with Parkinson’s disease. The present study is the first to reveal trimodal evidence for network-dependent degeneration in Parkinson’s disease by outlining the impact of functional nigrostriatal pathway impairment on striatocortical functional connectivity networks and cortical metabolism.
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Affiliation(s)
- Marina C Ruppert
- Department of Neurology, University Hospital of Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital of Marburg, Germany
| | - Masoud Tahmasian
- Institue of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Frank Schwartz
- Department of Neurology, Hospital of the Brothers of Mercy, Trier, Germany
| | - Sophie Stürmer
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Thilo van Eimeren
- Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Alexander Drzezga
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
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