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Monchi O, Pinilla-Monsalve GD, Almgren H, Ghahremani M, Kibreab M, Maarouf N, Kathol I, Boré A, Rheault F, Descoteaux M, Ismail Z. White Matter Microstructural Underpinnings of Mild Behavioral Impairment in Parkinson's Disease. Mov Disord 2024. [PMID: 38661496 DOI: 10.1002/mds.29804] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/13/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) experience changes in behavior, personality, and cognition that can manifest even in the initial stages of the disease. Previous studies have suggested that mild behavioral impairment (MBI) should be considered an early marker of cognitive decline. However, the precise neurostructural underpinnings of MBI in early- to mid-stage PD remain poorly understood. OBJECTIVE The aim was to explore the changes in white matter microstructure linked to MBI and mild cognitive impairment (MCI) in early- to mid-stage PD using diffusion magnetic resonance imaging (dMRI). METHODS A total of 91 PD patients and 36 healthy participants were recruited and underwent anatomical MRI and dMRI, a comprehensive neuropsychological battery, and the completion of the Mild Behavioral Impairment-Checklist. Metrics of white matter integrity included tissue fractional anisotropy (FAt) and radial diffusivity (RDt), free water (FW), and fixel-based apparent fiber density (AFD). RESULTS The connection between the left amygdala and the putamen was disrupted when comparing PD patients with MBI (PD-MBI) to PD-non-MBI, as evidenced by increased RDt (η2 = 0.09, P = 0.004) and both decreased AFD (η2 = 0.05, P = 0.048) and FAt (η2 = 0.12, P = 0.014). Compared to controls, PD patients with both MBI and MCI demonstrated increased FW for the connection between the left orbitofrontal gyrus (OrG) and the hippocampus (η2 = 0.22, P = 0.008), augmented RDt between the right OrG and the amygdala (η2 = 0.14, P = 0.008), and increased RDt (η2 = 0.25, P = 0.028) with decreased AFD (η2 = 0.10, P = 0.046) between the right OrG and the caudate nucleus. CONCLUSION MBI is associated with abnormal microstructure of connections involving the orbitofrontal cortex, putamen, and amygdala. To our knowledge, this is the first assessment of the white matter microstructure in PD-MBI using dMRI. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Oury Monchi
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
- Département de radiologie, radio-oncologie et médicine nucléaire, Université de Montréal, Montreal, Quebec, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Gabriel D Pinilla-Monsalve
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
- Département de radiologie, radio-oncologie et médicine nucléaire, Université de Montréal, Montreal, Quebec, Canada
| | - Hannes Almgren
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Maryam Ghahremani
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mekale Kibreab
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nadia Maarouf
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Iris Kathol
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Arnaud Boré
- Département d'informatique, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Rheault
- Département d'informatique, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maxime Descoteaux
- Département d'informatique, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Souza R, Winder A, Stanley EAM, Vigneshwaran V, Camacho M, Camicioli R, Monchi O, Wilms M, Forkert ND. Identifying Biases in a Multicenter MRI Database for Parkinson's Disease Classification: Is the Disease Classifier a Secret Site Classifier? IEEE J Biomed Health Inform 2024; 28:2047-2054. [PMID: 38198251 DOI: 10.1109/jbhi.2024.3352513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Sharing multicenter imaging datasets can be advantageous to increase data diversity and size but may lead to spurious correlations between site-related biological and non-biological image features and target labels, which machine learning (ML) models may exploit as shortcuts. To date, studies analyzing how and if deep learning models may use such effects as a shortcut are scarce. Thus, the aim of this work was to investigate if site-related effects are encoded in the feature space of an established deep learning model designed for Parkinson's disease (PD) classification based on T1-weighted MRI datasets. Therefore, all layers of the PD classifier were frozen, except for the last layer of the network, which was replaced by a linear layer that was exclusively re-trained to predict three potential bias types (biological sex, scanner type, and originating site). Our findings based on a large database consisting of 1880 MRI scans collected across 41 centers show that the feature space of the established PD model (74% accuracy) can be used to classify sex (75% accuracy), scanner type (79% accuracy), and site location (71% accuracy) with high accuracies despite this information never being explicitly provided to the PD model during original training. Overall, the results of this study suggest that trained image-based classifiers may use unwanted shortcuts that are not meaningful for the actual clinical task at hand. This finding may explain why many image-based deep learning models do not perform well when applied to data from centers not contributing to the training set.
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Jones-Tabah J, He K, Senkevich K, Karpilovsky N, Deyab G, Cousineau Y, Nikanorova D, Goldsmith T, Del-Cid Pellitero E, Chen CX, Luo W, You Z, Abdian N, Pietrantonio I, Goiran T, Ahmad J, Ruskey JA, Asayesh F, Spiegelman D, Waters C, Monchi O, Dauvilliers Y, Dupre N, Miliukhina I, Timofeeva A, Emelyanov A, Pchelina S, Greenbaum L, HassinBaer S, Alcalay RN, Milnerwood A, Durcan TM, Gan-Or Z, Fon EA. The Parkinson's disease risk gene cathepsin B promotes fibrillar alpha-synuclein clearance, lysosomal function and glucocerebrosidase activity in dopaminergic neurons. RESEARCH SQUARE 2024:rs.3.rs-3979098. [PMID: 38562709 PMCID: PMC10984014 DOI: 10.21203/rs.3.rs-3979098/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Variants in the CTSB gene encoding the lysosomal hydrolase cathepsin B (catB) are associated with increased risk of Parkinson's disease (PD). However, neither the specific CTSB variants driving these associations nor the functional pathways that link catB to PD pathogenesis have been characterized. CatB activity contributes to lysosomal protein degradation and regulates signaling processes involved in autophagy and lysosome biogenesis. Previous in vitro studies have found that catB can cleave monomeric and fibrillar alpha-synuclein, a key protein involved in the pathogenesis of PD that accumulates in the brains of PD patients. However, truncated synuclein isoforms generated by catB cleavage have an increased propensity to aggregate. Thus, catB activity could potentially contribute to lysosomal degradation and clearance of pathogenic alpha synuclein from the cell, but also has the potential of enhancing synuclein pathology by generating aggregation-prone truncations. Therefore, the mechanisms linking catB to PD pathophysiology remain to be clarified. Methods Here, we conducted genetic analyses of the association between common and rare CTSB variants and risk of PD. We then used genetic and pharmacological approaches to manipulate catB expression and function in cell lines and induced pluripotent stem cell-derived dopaminergic neurons and assessed lysosomal activity and the handling of aggregated synuclein fibrils. Results We first identified specific non-coding variants in CTSB that drive the association with PD and are linked to changes in brain CTSB expression levels. Using iPSC-derived dopaminergic neurons we then find that catB inhibition impairs autophagy, reduces glucocerebrosidase (encoded by GBA1) activity, and leads to an accumulation of lysosomal content. Moreover, in cell lines, reduction of CTSB gene expression impairs the degradation of pre-formed alpha-synuclein fibrils, whereas CTSB gene activation enhances fibril clearance. Similarly, in midbrain organoids and dopaminergic neurons treated with alpha-synuclein fibrils, catB inhibition or knockout potentiates the formation of inclusions which stain positively for phosphorylated alpha-synuclein. Conclusions The results of our genetic and functional studies indicate that the reduction of catB function negatively impacts lysosomal pathways associated with PD pathogenesis, while conversely catB activation could promote the clearance of pathogenic alpha-synuclein.
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Affiliation(s)
| | - Kathy He
- Montreal Neurological Institute-Hospital
| | | | | | | | | | | | | | | | | | - Wen Luo
- Montreal Neurological Institute-Hospital
| | | | | | | | | | | | | | | | | | - Cheryl Waters
- Columbia University Medical Center: Columbia University Irving Medical Center
| | - Oury Monchi
- Université de Montréal: Universite de Montreal
| | | | | | - Irina Miliukhina
- Institute of the Human Brain RAS: FGBUN Institut mozga celoveka im N P Behterevoj Rossijskoj akademii nauk
| | | | | | | | - Lior Greenbaum
- Sheba Medical Center: Sheba Medical Center at Tel Hashomer
| | | | - Roy N Alcalay
- Tel Aviv Ichilov-Sourasky Medical Center: Tel Aviv Sourasky Medical Center
| | | | | | - Ziv Gan-Or
- Montreal Neurological Institute-Hospital
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Zadeh AK, Raghuram H, Shrestha S, Kibreab M, Kathol I, Martino D, Pike GB, Pichardo S, Monchi O. The effect of transcranial ultrasound pulse repetition frequency on sustained inhibition in the human primary motor cortex: A double-blind, sham-controlled study. Brain Stimul 2024; 17:476-484. [PMID: 38621645 DOI: 10.1016/j.brs.2024.04.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Non-invasive brain stimulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation hold promise for inducing brain plasticity. However, their limited precision may hamper certain applications. In contrast, Transcranial Ultrasound Stimulation (TUS), known for its precision and deep brain targeting capabilities, requires further investigation to establish its efficacy in producing enduring effects for treating neurological and psychiatric disorders. OBJECTIVE To investigate the enduring effects of different pulse repetition frequencies (PRF) of TUS on motor corticospinal excitability. METHODS T1-, T2-weighted, and zero echo time magnetic resonance imaging scans were acquired from 21 neurologically healthy participants for neuronavigation, skull reconstruction, and the performance of transcranial ultrasound and thermal modelling. The effects of three different TUS PRFs (10, 100, and 1000 Hz) with a constant duty cycle of 10 % on corticospinal excitability in the primary motor cortex were assessed using TMS-induced motor evoked potentials (MEPs). Each PRF and sham condition was evaluated on separate days, with measurements taken 5-, 30-, and 60-min post-TUS. RESULTS A significant decrease in MEP amplitude was observed with a PRF of 10 Hz (p = 0.007), which persisted for at least 30 min, and with a PRF of 100 Hz (p = 0.001), lasting over 60 min. However, no significant changes were found for the PRF of 1000 Hz and the sham conditions. CONCLUSION This study highlights the significance of PRF selection in TUS and underscores its potential as a non-invasive approach to reduce corticospinal excitability, offering valuable insights for future clinical applications.
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Affiliation(s)
- Ali K Zadeh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Shirshak Shrestha
- Department of Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Iris Kathol
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - G Bruce Pike
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Samuel Pichardo
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montreal, QC, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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Camacho M, Wilms M, Almgren H, Amador K, Camicioli R, Ismail Z, Monchi O, Forkert ND. Exploiting macro- and micro-structural brain changes for improved Parkinson's disease classification from MRI data. NPJ Parkinsons Dis 2024; 10:43. [PMID: 38409244 PMCID: PMC10897162 DOI: 10.1038/s41531-024-00647-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease. Accurate PD diagnosis is crucial for effective treatment and prognosis but can be challenging, especially at early disease stages. This study aimed to develop and evaluate an explainable deep learning model for PD classification from multimodal neuroimaging data. The model was trained using one of the largest collections of T1-weighted and diffusion-tensor magnetic resonance imaging (MRI) datasets. A total of 1264 datasets from eight different studies were collected, including 611 PD patients and 653 healthy controls (HC). These datasets were pre-processed and non-linearly registered to the MNI PD25 atlas. Six imaging maps describing the macro- and micro-structural integrity of brain tissues complemented with age and sex parameters were used to train a convolutional neural network (CNN) to classify PD/HC subjects. Explainability of the model's decision-making was achieved using SmoothGrad saliency maps, highlighting important brain regions. The CNN was trained using a 75%/10%/15% train/validation/test split stratified by diagnosis, sex, age, and study, achieving a ROC-AUC of 0.89, accuracy of 80.8%, specificity of 82.4%, and sensitivity of 79.1% on the test set. Saliency maps revealed that diffusion tensor imaging data, especially fractional anisotropy, was more important for the classification than T1-weighted data, highlighting subcortical regions such as the brainstem, thalamus, amygdala, hippocampus, and cortical areas. The proposed model, trained on a large multimodal MRI database, can classify PD patients and HC subjects with high accuracy and clinically reasonable explanations, suggesting that micro-structural brain changes play an essential role in the disease course.
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Affiliation(s)
- Milton Camacho
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.
- Department of Radiology, University of Calgary, Calgary, AB, Canada.
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Hannes Almgren
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Kimberly Amador
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Souza R, Stanley EAM, Camacho M, Camicioli R, Monchi O, Ismail Z, Wilms M, Forkert ND. A multi-center distributed learning approach for Parkinson's disease classification using the traveling model paradigm. Front Artif Intell 2024; 7:1301997. [PMID: 38384277 PMCID: PMC10879577 DOI: 10.3389/frai.2024.1301997] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Distributed learning is a promising alternative to central learning for machine learning (ML) model training, overcoming data-sharing problems in healthcare. Previous studies exploring federated learning (FL) or the traveling model (TM) setup for medical image-based disease classification often relied on large databases with a limited number of centers or simulated artificial centers, raising doubts about real-world applicability. This study develops and evaluates a convolution neural network (CNN) for Parkinson's disease classification using data acquired by 83 diverse real centers around the world, mostly contributing small training samples. Our approach specifically makes use of the TM setup, which has proven effective in scenarios with limited data availability but has never been used for image-based disease classification. Our findings reveal that TM is effective for training CNN models, even in complex real-world scenarios with variable data distributions. After sufficient training cycles, the TM-trained CNN matches or slightly surpasses the performance of the centrally trained counterpart (AUROC of 83% vs. 80%). Our study highlights, for the first time, the effectiveness of TM in 3D medical image classification, especially in scenarios with limited training samples and heterogeneous distributed data. These insights are relevant for situations where ML models are supposed to be trained using data from small or remote medical centers, and rare diseases with sparse cases. The simplicity of this approach enables a broad application to many deep learning tasks, enhancing its clinical utility across various contexts and medical facilities.
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Affiliation(s)
- Raissa Souza
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Emma A. M. Stanley
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Milton Camacho
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Oury Monchi
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Matthias Wilms
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nils D. Forkert
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Sokołowski A, Bhagwat N, Chatelain Y, Dugré M, Hanganu A, Monchi O, McPherson B, Wang M, Poline JB, Sharp M, Glatard T. Longitudinal brain structure changes in Parkinson's disease: A replication study. PLoS One 2024; 19:e0295069. [PMID: 38295031 PMCID: PMC10830012 DOI: 10.1371/journal.pone.0295069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/13/2023] [Indexed: 02/02/2024] Open
Abstract
CONTEXT An existing major challenge in Parkinson's disease (PD) research is the identification of biomarkers of disease progression. While magnetic resonance imaging is a potential source of PD biomarkers, none of the magnetic resonance imaging measures of PD are robust enough to warrant their adoption in clinical research. This study is part of a project that aims to replicate 11 PD studies reviewed in a recent survey (JAMA neurology, 78(10) 2021) to investigate the robustness of PD neuroimaging findings to data and analytical variations. OBJECTIVE This study attempts to replicate the results in Hanganu et al. (Brain, 137(4) 2014) using data from the Parkinson's Progression Markers Initiative (PPMI). METHODS Using 25 PD subjects and 18 healthy controls, we analyzed the rate of change of cortical thickness and of the volume of subcortical structures, and we measured the relationship between structural changes and cognitive decline. We compared our findings to the results in the original study. RESULTS (1) Similarly to the original study, PD patients with mild cognitive impairment (MCI) exhibited increased cortical thinning over time compared to patients without MCI in the right middle temporal gyrus, insula, and precuneus. (2) The rate of cortical thinning in the left inferior temporal and precentral gyri in PD patients correlated with the change in cognitive performance. (3) There were no group differences in the change of subcortical volumes. (4) We did not find a relationship between the change in subcortical volumes and the change in cognitive performance. CONCLUSION Despite important differences in the dataset used in this replication study, and despite differences in sample size, we were able to partially replicate the original results. We produced a publicly available reproducible notebook allowing researchers to further investigate the reproducibility of the results in Hanganu et al. (2014) when more data is added to PPMI.
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Affiliation(s)
- Andrzej Sokołowski
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Canada
| | - Nikhil Bhagwat
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Yohan Chatelain
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Canada
| | - Mathieu Dugré
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Canada
| | - Alexandru Hanganu
- Département de Psychologie, Université de Montréal, Montréal, Canada
| | - Oury Monchi
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montréal, Canada
| | - Brent McPherson
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Michelle Wang
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | | | - Madeleine Sharp
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Tristan Glatard
- Department of Computer Science and Software Engineering, Concordia University, Montreal, Canada
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Souza R, Wilms M, Camacho M, Pike GB, Camicioli R, Monchi O, Forkert ND. Image-encoded biological and non-biological variables may be used as shortcuts in deep learning models trained on multisite neuroimaging data. J Am Med Inform Assoc 2023; 30:1925-1933. [PMID: 37669158 PMCID: PMC10654841 DOI: 10.1093/jamia/ocad171] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE This work investigates if deep learning (DL) models can classify originating site locations directly from magnetic resonance imaging (MRI) scans with and without correction for intensity differences. MATERIAL AND METHODS A large database of 1880 T1-weighted MRI scans collected across 41 sites originally for Parkinson's disease (PD) classification was used to classify sites in this study. Forty-six percent of the datasets are from PD patients, while 54% are from healthy participants. After preprocessing the T1-weighted scans, 2 additional data types were generated: intensity-harmonized T1-weighted scans and log-Jacobian deformation maps resulting from nonlinear atlas registration. Corresponding DL models were trained to classify sites for each data type. Additionally, logistic regression models were used to investigate the contribution of biological (age, sex, disease status) and non-biological (scanner type) variables to the models' decision. RESULTS A comparison of the 3 different types of data revealed that DL models trained using T1-weighted and intensity-harmonized T1-weighted scans can classify sites with an accuracy of 85%, while the model using log-Jacobian deformation maps achieved a site classification accuracy of 54%. Disease status and scanner type were found to be significant confounders. DISCUSSION Our results demonstrate that MRI scans encode relevant site-specific information that models could use as shortcuts that cannot be removed using simple intensity harmonization methods. CONCLUSION The ability of DL models to exploit site-specific biases as shortcuts raises concerns about their reliability, generalization, and deployability in clinical settings.
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Affiliation(s)
- Raissa Souza
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Matthias Wilms
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Milton Camacho
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - G Bruce Pike
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Nils D Forkert
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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9
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Jones-Tabah J, He K, Senkevich K, Karpilovsky N, Deyab G, Cousineau Y, Nikanorova D, Goldsmith T, Pellitero EDC, Chen CXQ, Luo W, You Z, Abdian N, Pietrantonio I, Goiran T, Ahmad J, Ruskey JA, Asayesh F, Spiegelman D, Waters C, Monchi O, Dauvilliers Y, Dupré N, Miliukhina I, Timofeeva A, Emelyanov A, Pchelina S, Greenbaum L, Hassin-Baer S, Alcalay RN, Milnerwood A, Durcan TM, Gan-Or Z, Fon EA. The Parkinson's disease risk gene cathepsin B promotes fibrillar alpha-synuclein clearance, lysosomal function and glucocerebrosidase activity in dopaminergic neurons. bioRxiv 2023:2023.11.11.566693. [PMID: 38014143 PMCID: PMC10680785 DOI: 10.1101/2023.11.11.566693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Variants in the CTSB gene encoding the lysosomal hydrolase cathepsin B (catB) are associated with increased risk of Parkinson's disease (PD). However, neither the specific CTSB variants driving these associations nor the functional pathways that link catB to PD pathogenesis have been characterized. CatB activity contributes to lysosomal protein degradation and regulates signaling processes involved in autophagy and lysosome biogenesis. Previous in vitro studies have found that catB can cleave monomeric and fibrillar alpha-synuclein, a key protein involved in the pathogenesis of PD that accumulates in the brains of PD patients. However, truncated synuclein isoforms generated by catB cleavage have an increased propensity to aggregate. Thus, catB activity could potentially contribute to lysosomal degradation and clearance of pathogenic alpha synuclein from the cell, but also has the potential of enhancing synuclein pathology by generating aggregation-prone truncations. Therefore, the mechanisms linking catB to PD pathophysiology remain to be clarified. Here, we conducted genetic analyses of the association between common and rare CTSB variants and risk of PD. We then used genetic and pharmacological approaches to manipulate catB expression and function in cell lines and induced pluripotent stem cell-derived dopaminergic neurons and assessed lysosomal activity and the handling of aggregated synuclein fibrils. We find that catB inhibition impairs autophagy, reduces glucocerebrosidase (encoded by GBA1 ) activity, and leads to an accumulation of lysosomal content. In cell lines, reduction of CTSB gene expression impairs the degradation of pre-formed alpha-synuclein fibrils, whereas CTSB gene activation enhances fibril clearance. In midbrain organoids and dopaminergic neurons treated with alpha-synuclein fibrils, catB inhibition potentiates the formation of inclusions which stain positively for phosphorylated alpha-synuclein. These results indicate that the reduction of catB function negatively impacts lysosomal pathways associated with PD pathogenesis, while conversely catB activation could promote the clearance of pathogenic alpha-synuclein.
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10
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Senkevich K, Beletskaia M, Dworkind A, Yu E, Ahmad J, Ruskey JA, Asayesh F, Spiegelman D, Fahn S, Waters C, Monchi O, Dauvilliers Y, Dupré N, Greenbaum L, Hassin-Baer S, Nagornov I, Tyurin A, Miliukhina I, Timofeeva A, Emelyanov A, Trempe JF, Zakharova E, Alcalay RN, Pchelina S, Gan-Or Z. Association of Rare Variants in ARSA with Parkinson's Disease. Mov Disord 2023; 38:1806-1812. [PMID: 37381728 PMCID: PMC10615669 DOI: 10.1002/mds.29521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Several lysosomal genes are associated with Parkinson's disease (PD), yet the association between PD and ARSA remains unclear. OBJECTIVES To study rare ARSA variants in PD. METHODS To study rare ARSA variants (minor allele frequency < 0.01) in PD, we performed burden analyses in six independent cohorts with 5801 PD patients and 20,475 controls, followed by a meta-analysis. RESULTS We found evidence for associations between functional ARSA variants and PD in four cohorts (P ≤ 0.05 in each) and in the meta-analysis (P = 0.042). We also found an association between loss-of-function variants and PD in the United Kingdom Biobank cohort (P = 0.005) and in the meta-analysis (P = 0.049). These results should be interpreted with caution as no association survived multiple comparisons correction. Additionally, we describe two families with potential co-segregation of ARSA p.E382K and PD. CONCLUSIONS Rare functional and loss-of-function ARSA variants may be associated with PD. Further replications in large case-control/familial cohorts are required. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Konstantin Senkevich
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
| | - Mariia Beletskaia
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Aliza Dworkind
- Department of Physiology, McGill University, Montréal, QC, Canada
| | - Eric Yu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Jamil Ahmad
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
| | - Jennifer A. Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Dan Spiegelman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
| | - Cheryl Waters
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
| | - Oury Monchi
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, T2N 4N1 Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Nicolas Dupré
- Division of Neurosciences, CHU de Québec, Université Laval, Quebec City, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Lior Greenbaum
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilya Nagornov
- Research Centre for Medical Genetics, Moscow, Russia
| | - Alexandr Tyurin
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | | | - Alla Timofeeva
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Anton Emelyanov
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Jean-François Trempe
- Department of Pharmacology and Therapeutics and Centre de Recherche en Biologie Structurale, McGill University, Montreal H3A 1A3, Canada
| | | | - Roy N. Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
- Division of Movement Disorders, Tel Aviv Sourasky Medical Center; Tel Aviv, Israel
| | - Sofya Pchelina
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
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11
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Almgren H, Camacho M, Hanganu A, Kibreab M, Camicioli R, Ismail Z, Forkert ND, Monchi O. Machine learning-based prediction of longitudinal cognitive decline in early Parkinson's disease using multimodal features. Sci Rep 2023; 13:13193. [PMID: 37580407 PMCID: PMC10425414 DOI: 10.1038/s41598-023-37644-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/25/2023] [Indexed: 08/16/2023] Open
Abstract
Patients with Parkinson's Disease (PD) often suffer from cognitive decline. Accurate prediction of cognitive decline is essential for early treatment of at-risk patients. The aim of this study was to develop and evaluate a multimodal machine learning model for the prediction of continuous cognitive decline in patients with early PD. We included 213 PD patients from the Parkinson's Progression Markers Initiative (PPMI) database. Machine learning was used to predict change in Montreal Cognitive Assessment (MoCA) score using the difference between baseline and 4-years follow-up data as outcome. Input features were categorized into four sets: clinical test scores, cerebrospinal fluid (CSF) biomarkers, brain volumes, and genetic variants. All combinations of input feature sets were added to a basic model, which consisted of demographics and baseline cognition. An iterative scheme using RReliefF-based feature ranking and support vector regression in combination with tenfold cross validation was used to determine the optimal number of predictive features and to evaluate model performance for each combination of input feature sets. Our best performing model consisted of a combination of the basic model, clinical test scores and CSF-based biomarkers. This model had 12 features, which included baseline cognition, CSF phosphorylated tau, CSF total tau, CSF amyloid-beta1-42, geriatric depression scale (GDS) scores, and anxiety scores. Interestingly, many of the predictive features in our model have previously been associated with Alzheimer's disease, showing the importance of assessing Alzheimer's disease pathology in patients with Parkinson's disease.
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Affiliation(s)
- Hannes Almgren
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Milton Camacho
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Alexandru Hanganu
- Département de Psychologie, Université de Montréal, Pavillon Marie-Victorin, 90 Vincent d'Indy Ave, Montreal, QC, H2V 2S9, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 chemin Queen Mary, Montreal, QC, H3W 1W5, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, 7-112 Clinical Sciences Building 11350 83rd Avenue, Edmonton, AB, T6G 2G3, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Psychiatry, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, Heritage Medical Research Building, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 chemin Queen Mary, Montreal, QC, H3W 1W5, Canada
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Département de radiologie, radio-oncologie et médecine nucléaire, Faculté de médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard. Édouard-Montpetit, Montreal, QC, H3T 1A4, Canada
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12
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Rahayel S, Tremblay C, Vo A, Misic B, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Gagnon JF, Postuma RB, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Hansen AK, Monchi O, Gan-Or Z, Dagher A. Mitochondrial function-associated genes underlie cortical atrophy in prodromal synucleinopathies. Brain 2023; 146:3301-3318. [PMID: 36826230 PMCID: PMC10393413 DOI: 10.1093/brain/awad044] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Isolated rapid eye movement sleep behaviour disorder (iRBD) is a sleep disorder characterized by the loss of rapid eye movement sleep muscle atonia and the appearance of abnormal movements and vocalizations during rapid eye movement sleep. It is a strong marker of incipient synucleinopathy such as dementia with Lewy bodies and Parkinson's disease. Patients with iRBD already show brain changes that are reminiscent of manifest synucleinopathies including brain atrophy. However, the mechanisms underlying the development of this atrophy remain poorly understood. In this study, we performed cutting-edge imaging transcriptomics and comprehensive spatial mapping analyses in a multicentric cohort of 171 polysomnography-confirmed iRBD patients [67.7 ± 6.6 (49-87) years; 83% men] and 238 healthy controls [66.6 ± 7.9 (41-88) years; 77% men] with T1-weighted MRI to investigate the gene expression and connectivity patterns associated with changes in cortical thickness and surface area in iRBD. Partial least squares regression was performed to identify the gene expression patterns underlying cortical changes in iRBD. Gene set enrichment analysis and virtual histology were then done to assess the biological processes, cellular components, human disease gene terms, and cell types enriched in these gene expression patterns. We then used structural and functional neighbourhood analyses to assess whether the atrophy patterns in iRBD were constrained by the brain's structural and functional connectome. Moreover, we used comprehensive spatial mapping analyses to assess the specific neurotransmitter systems, functional networks, cytoarchitectonic classes, and cognitive brain systems associated with cortical changes in iRBD. All comparisons were tested against null models that preserved spatial autocorrelation between brain regions and compared to Alzheimer's disease to assess the specificity of findings to synucleinopathies. We found that genes involved in mitochondrial function and macroautophagy were the strongest contributors to the cortical thinning occurring in iRBD. Moreover, we demonstrated that cortical thinning was constrained by the brain's structural and functional connectome and that it mapped onto specific networks involved in motor and planning functions. In contrast with cortical thickness, changes in cortical surface area were related to distinct genes, namely genes involved in the inflammatory response, and to different spatial mapping patterns. The gene expression and connectivity patterns associated with iRBD were all distinct from those observed in Alzheimer's disease. In summary, this study demonstrates that the development of brain atrophy in synucleinopathies is constrained by specific genes and networks.
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Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
| | - Christina Tremblay
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Andrew Vo
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Bratislav Misic
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Stéphane Lehéricy
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Isabelle Arnulf
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Marie Vidailhet
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Jean-Christophe Corvol
- Institut du Cerveau–Paris Brain Institute–ICM, INSERM, CNRS, Sorbonne Université, Paris 75013, France
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal H2X 3P2, Canada
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Neurology, Montreal General Hospital, Montreal H3G 1A4, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Canada
- Department of Psychiatry, University of Montreal, Montreal H3T 1J4, Canada
| | - Simon Lewis
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Elie Matar
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
- Department of Kinesiology, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
- Department of Radiology, Radio-Oncology, and Nuclear Medicine, University of Montreal, Montreal H3T 1A4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
- Department of Human Genetics, McGill University, Montreal H3A 0C7, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal H3A 1A1, Canada
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Camacho M, Wilms M, Mouches P, Almgren H, Souza R, Camicioli R, Ismail Z, Monchi O, Forkert ND. Explainable classification of Parkinson's disease using deep learning trained on a large multi-center database of T1-weighted MRI datasets. Neuroimage Clin 2023; 38:103405. [PMID: 37079936 PMCID: PMC10148079 DOI: 10.1016/j.nicl.2023.103405] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/13/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a severe neurodegenerative disease that affects millions of people. Early diagnosis is important to facilitate prompt interventions to slow down disease progression. However, accurate PD diagnosis can be challenging, especially in the early disease stages. The aim of this work was to develop and evaluate a robust explainable deep learning model for PD classification trained from one of the largest collections of T1-weighted magnetic resonance imaging datasets. MATERIALS AND METHODS A total of 2,041 T1-weighted MRI datasets from 13 different studies were collected, including 1,024 datasets from PD patients and 1,017 datasets from age- and sex-matched healthy controls (HC). The datasets were skull stripped, resampled to isotropic resolution, bias field corrected, and non-linearly registered to the MNI PD25 atlas. The Jacobian maps derived from the deformation fields together with basic clinical parameters were used to train a state-of-the-art convolutional neural network (CNN) to classify PD and HC subjects. Saliency maps were generated to display the brain regions contributing the most to the classification task as a means of explainable artificial intelligence. RESULTS The CNN model was trained using an 85%/5%/10% train/validation/test split stratified by diagnosis, sex, and study. The model achieved an accuracy of 79.3%, precision of 80.2%, specificity of 81.3%, sensitivity of 77.7%, and AUC-ROC of 0.87 on the test set while performing similarly on an independent test set. Saliency maps computed for the test set data highlighted frontotemporal regions, the orbital-frontal cortex, and multiple deep gray matter structures as most important. CONCLUSION The developed CNN model, trained on a large heterogenous database, was able to differentiate PD patients from HC subjects with high accuracy with clinically feasible classification explanations. Future research should aim to investigate the combination of multiple imaging modalities with deep learning and on validating these results in a prospective trial as a clinical decision support system.
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Affiliation(s)
- Milton Camacho
- Biomedical Engineering Program, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada.
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada
| | - Pauline Mouches
- Biomedical Engineering Program, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada
| | - Hannes Almgren
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | - Raissa Souza
- Biomedical Engineering Program, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Psychiatry, University of Calgary, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Quebec, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Electrical and Software Engineering, University of Calgary, Canada
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14
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Ronat L, Monchi O, Hanganu A. Corrigendum to "Neuropsychiatric symptoms influence differently cognitive decline in older women and men" [J. Psychiatr. Res. 154 (2022) 1-9]. J Psychiatr Res 2023; 161:476. [PMID: 37062108 DOI: 10.1016/j.jpsychires.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Lucas Ronat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal CIUSSS-CSMTL, Montréal, Québec, Canada; Département de Médecine, Faculté de Médecine, Université de Montréal, Québec, Canada
| | - Oury Monchi
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal CIUSSS-CSMTL, Montréal, Québec, Canada; Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Faculté de Médecine, Université de Montréal, Québec, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Alexandru Hanganu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal CIUSSS-CSMTL, Montréal, Québec, Canada; Département de Psychologie, Faculté des Arts et des Sciences, Université de Montréal, Québec, Canada.
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15
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Senkevich K, Beletskaia M, Dworkind A, Yu E, Ahmad J, Ruskey JA, Asayesh F, Spiegelman D, Fahn S, Waters C, Monchi O, Dauvilliers Y, Dupré N, Greenbaum L, Hassin-Baer S, Nagornov I, Tyurin A, Miliukhina I, Timofeeva A, Emelyanov A, Zakharova E, Alcalay RN, Pchelina S, Gan-Or Z. Association of rare variants in ARSA with Parkinson's disease. medRxiv 2023:2023.03.08.23286773. [PMID: 36993451 PMCID: PMC10055435 DOI: 10.1101/2023.03.08.23286773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Background Several lysosomal genes are associated with Parkinson's disease (PD), yet the association between PD and ARSA , which encodes for the enzyme arylsulfatase A, remains controversial. Objectives To evaluate the association between rare ARSA variants and PD. Methods To study possible association of rare variants (minor allele frequency<0.01) in ARSA with PD, we performed burden analyses in six independent cohorts with a total of 5,801 PD patients and 20,475 controls, using optimized sequence Kernel association test (SKAT-O), followed by a meta-analysis. Results We found evidence for an association between functional ARSA variants and PD in four independent cohorts (P≤0.05 in each) and in the meta-analysis (P=0.042). We also found an association between loss-of-function variants and PD in the UKBB cohort (P=0.005) and in the meta-analysis (P=0.049). However, despite replicating in four independent cohorts, these results should be interpreted with caution as no association survived correction for multiple comparisons. Additionally, we describe two families with potential co-segregation of the ARSA variant p.E384K and PD. Conclusions Rare functional and loss-of-function ARSA variants may be associated with PD. Further replication in large case-control cohorts and in familial studies is required to confirm these associations.
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Affiliation(s)
- Konstantin Senkevich
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
| | - Mariia Beletskaia
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Aliza Dworkind
- Department of Physiology, McGill University, Montréal, QC, Canada
| | - Eric Yu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Jamil Ahmad
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
| | - Jennifer A. Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Dan Spiegelman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
| | - Cheryl Waters
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
| | - Oury Monchi
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, T2N 4N1 Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Guide-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Nicolas Dupré
- Division of Neurosciences, CHU de Québec, Université Laval, Quebec City, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Lior Greenbaum
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Hassin-Baer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilya Nagornov
- Research Centre for Medical Genetics, Moscow, Russia
| | - Alexandr Tyurin
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | | | - Alla Timofeeva
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Anton Emelyanov
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | | | - Roy N. Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, NY, USA
- Division of Movement Disorders, Tel Aviv Sourasky Medical Center; Tel Aviv, Israel
| | - Sofya Pchelina
- First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russia
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Department of Neurology and neurosurgery, McGill University, Montréal, QC, Canada, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
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Almgren H, Hanganu A, Camacho M, Kibreab M, Camicioli R, Ismail Z, Forkert ND, Monchi O. Motor symptoms in Parkinson's disease are related to the interplay between cortical curvature and thickness. Neuroimage Clin 2023; 37:103300. [PMID: 36580712 PMCID: PMC9827056 DOI: 10.1016/j.nicl.2022.103300] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Brain atrophy in Parkinson's disease occurs to varying degrees in different brain regions, even at the early stage of the disease. While cortical morphological features are often considered independently in structural brain imaging studies, research on the co-progression of different cortical morphological measurements could provide new insights regarding the progression of PD. This study's aim was to examine the interplay between cortical curvature and thickness as a function of PD diagnosis, motor symptoms, and cognitive performance. METHODS A total of 359 de novo PD patients and 159 healthy controls (HC) from the Parkinson's Progression Markers Initiative (PPMI) database were included in this study. Additionally, an independent cohort from four databases (182 PD, 132 HC) with longer disease durations was included to assess the effects of PD diagnosis in more advanced cases. Pearson correlation was used to determine subject-specific associations between cortical curvature and thickness estimated from T1-weighted MRI images. General linear modeling (GLM) was then used to assess the effect of PD diagnosis, motor symptoms, and cognitive performance on the curvature-thickness association. Next, longitudinal changes in the curvature-thickness correlation as well as the predictive effect of the cortical curvature-thickness association on changes in motor symptoms and cognitive performance across four years were investigated. Finally, Akaike information criterion (AIC) was used to build a GLM to model PD motor symptom severity cross-sectionally. RESULTS A significant interaction effect between PD motor symptoms and age on the curvature-thickness correlation was found (βstandardized = 0.11; t(350) = 2.12; p = 0.03). This interaction effect showed that motor symptoms in older patients were related to an attenuated curvature-thickness association. No significant effect of PD diagnosis was observed for the PPMI database (β = 0.03; t(510) = 0.35; p = 0.72). However, in patients with a longer disease duration, a significant effect of diagnosis on the curvature-thickness association was found (βstandardized = 0.31; t(306.7) = 3.49; p = 0.0006). Moreover, rigidity, but not tremor, in PD was significantly related to the curvature-thickness correlation (βstandardized = 0.11, t(350) = 2.24, p = 0.03; βstandardized = -0.03, t(350) = -0.58, p = 0.56, respectively). The curvature-thickness association was attenuated over time in both PD and HC, but the two groups did not show a significantly different effect (βstandardized = 0.03, t(184.7) = 0.78, p = 0.44). No predictive effects of the CC-CT correlation on longitudinal changes in cognitive performance or motor symptoms were observed (all p-values > 0.05). The best cross-sectional model for PD motor symptoms included the curvature-thickness correlation, cognitive performance, and putamen dopamine transporter (DAT) binding, which together explained 14 % of variance. CONCLUSION The association between cortical curvature and thickness is related to PD motor symptoms and age. This research shows the potential of modeling the curvature-thickness interplay in PD.
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Affiliation(s)
- Hannes Almgren
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Alexandru Hanganu
- Département de Psychologie, Université de Montréal, Pavillon Marie-Victorin, 90 Vincent d'Indy Ave, Montréal, QC H2V 2S9, Canada; Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen Mary, Montréal, QC H3W 1W5, Canada
| | - Milton Camacho
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, 7-112 Clinical Sciences Building 11350 83(rd) Avenue, Edmonton, Alberta, AB T6G 2G3, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Department of Psychiatry, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen Mary, Montréal, QC H3W 1W5, Canada; Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Département de radiologie, radio-oncologie et médecine nucléaire, Faculté de médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 boulevard, Édouard-Montpetit, Montréal, QC H3T 1A4, Canada.
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17
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Low TA, Lindland K, Kirton A, Carlson HL, Harris AD, Goodyear BG, Monchi O, Hill MD, Dukelow SP. Repetitive transcranial magnetic stimulation (rTMS) combined with multi-modality aphasia therapy for chronic post-stroke non-fluent aphasia: A pilot randomized sham-controlled trial. Brain Lang 2023; 236:105216. [PMID: 36525719 DOI: 10.1016/j.bandl.2022.105216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/22/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) shows promise in improving speech production in post-stroke aphasia. Limited evidence suggests pairing rTMS with speech therapy may result in greater improvements. Twenty stroke survivors (>6 months post-stroke) were randomized to receive either sham rTMS plus multi-modality aphasia therapy (M-MAT) or rTMS plus M-MAT. For the first time, we demonstrate that rTMS combined with M-MAT is feasible, with zero adverse events and minimal attrition. Both groups improved significantly over time on all speech and language outcomes. However, improvements did not differ between rTMS or sham. We found that rTMS and sham groups differed in lesion location, which may explain speech and language outcomes as well as unique patterns of BOLD signal change within each group. We offer practical considerations for future studies and conclude that while combination therapy of rTMS plus M-MAT in chronic post-stroke aphasia is safe and feasible, personalized intervention may be necessary.
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Affiliation(s)
- Trevor A Low
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Lindland
- Department of Allied Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Helen L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley D Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada.
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18
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Rahayel S, Tremblay C, Vo A, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Study Group I, Gagnon JF, Postuma R, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Monchi O, Misic B, Dagher A. Brain atrophy in REM sleep behavior disorder is shaped by gene expression and structural connectivity. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.603] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Senkevich K, Zorca CE, Dworkind A, Rudakou U, Somerville E, Yu E, Ermolaev A, Nikanorova D, Ahmad J, Ruskey JA, Asayesh F, Spiegelman D, Fahn S, Waters C, Monchi O, Dauvilliers Y, Dupré N, Greenbaum L, Hassin-Baer S, Grenn FP, Chiang MSR, Sardi SP, Vanderperre B, Blauwendraat C, Trempe JF, Fon EA, Durcan TM, Alcalay RN, Gan-Or Z. GALC variants affect galactosylceramidase enzymatic activity and risk of Parkinson’s disease. Brain 2022; 146:1859-1872. [PMID: 36370000 PMCID: PMC10151180 DOI: 10.1093/brain/awac413] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The association between glucocerebrosidase (GCase), encoded by GBA, and Parkinson’s disease highlights the role of the lysosome in Parkinson’s disease pathogenesis. Genome-wide association studies (GWAS) in Parkinson’s disease have revealed multiple associated loci, including the GALC locus on chromosome 14. GALC encodes the lysosomal enzyme galactosylceramidase (GalCase), which plays a pivotal role in the glycosphingolipid metabolism pathway. It is still unclear whether GALC is the gene driving the association in the chromosome 14 locus, and if so, by which mechanism.
We first aimed to examine whether variants in the GALC locus and across the genome are associated with GalCase activity. We performed a GWAS in two independent cohorts from a)Columbia University and b)the Parkinson’s Progression Markers Initiative study, followed by a meta-analysis with a total of 976 Parkinson’s disease patients and 478 controls with available data on GalCase activity. We further analyzed the effects of common GALC variants on expression and GalCase activity using genomic colocalization methods. Mendelian randomization was used to study whether GalCase activity may be causal in Parkinson’s disease. To study the role of rare GALC variants we analyzed sequencing data from 5,028 Parkinson’s disease patients and 5,422 controls. Additionally, we studied the functional impact of GALC knock-out on alpha-synuclein accumulation and on GCase activity in neuronal cell models and performed in silico structural analysis of common GALC variants associated with altered GalCase activity.
The top hit in Parkinson's disease GWAS in the GALC locus, rs979812, is associated with increased GalCase activity (b = 1.2; se = 0.06; p = 5.10E-95). No other variants outside the GALC locus were associated with GalCase activity. Colocalization analysis demonstrated that rs979812 was also associated with increased GalCase expression. Mendelian randomization suggested that increased GalCase activity may be causally associated with Parkinson’s disease (b = 0.025, se = 0.007, p = 0.0008). We did not find an association between rare GALC variants and Parkinson’s disease. GALC knockout using CRISPR-Cas9 did not lead to alpha-synuclein accumulation, further supporting that increased rather than reduced GalCase levels may be associated with Parkinson’s disease. The structural analysis demonstrated that the common variant p.I562T may lead to improper maturation of GalCase affecting its activity.
Our results nominate GALC as the gene associated with Parkinson’s disease in this locus and suggest that the association of variants in the GALC locus may be driven by their effect of increasing GalCase expression and activity. Whether altering GalCase activity could be considered as a therapeutic target should be further studied.
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Affiliation(s)
- Konstantin Senkevich
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
| | - Cornelia E Zorca
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
- Early Drug Discovery Unit (EDDU), Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University , Montreal, Quebec H3A 2B4 , Canada
| | - Aliza Dworkind
- Department of Physiology, McGill University , Montréal, QC, H3A 1A1 , Canada
| | - Uladzislau Rudakou
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
- Department of Human Genetics, McGill University , Montréal, QC, H3A 1A1 , Canada
| | - Emma Somerville
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Human Genetics, McGill University , Montréal, QC, H3A 1A1 , Canada
| | - Eric Yu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Human Genetics, McGill University , Montréal, QC, H3A 1A1 , Canada
| | - Alexey Ermolaev
- Center of Molecular Biotechnology, Russian State Agrarian University-Moscow Timiryazev Agricultural Academy , Moscow, 127550 , Russia
- Bioinformatics Institute , Saint-Petersburg, 194100 , Russia
| | | | - Jamil Ahmad
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
| | - Jennifer A Ruskey
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
| | - Farnaz Asayesh
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Human Genetics, McGill University , Montréal, QC, H3A 1A1 , Canada
| | - Dan Spiegelman
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center , 710 West 168th Street, New York, NY, 10032-3784 USA
| | - Cheryl Waters
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center , 710 West 168th Street, New York, NY, 10032-3784 USA
| | - Oury Monchi
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, 2500 University Drive NW Calgary , Alberta, T2N 1N4 , Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, 3330 Hospital Drive NW Calgary , Alberta, T2N 4N1 Canada
| | - Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier , Inserm U1061, Montpellier , France
| | - Nicolas Dupré
- Neuroscience Axis, CHU de Québec – Université Laval , Quebec City, G1V 4G2 , Canada
- Department of Medicine, Faculty of Medicine, Université Laval , Québec, QC, G1V 0A6 , Canada
| | - Lior Greenbaum
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center , Tel Hashomer, 5265601 , Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center , Tel Hashomer, 52621 , Israel
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, 69978 , Israel
| | - Sharon Hassin-Baer
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, 69978 , Israel
- The Movement Disorders Institute, Department of Neurology, Sheba Medical Center , Tel Hashomer, 52621 , Israel
| | - Francis P Grenn
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health , Bethesda, MD 20814 , USA
| | - Ming Sum Ruby Chiang
- Rare and Neurologic Diseases Therapeutic Area , Sanofi, Framingham, MA 01701 USA
| | - S Pablo Sardi
- Rare and Neurologic Diseases Therapeutic Area , Sanofi, Framingham, MA 01701 USA
| | - Benoît Vanderperre
- Département des sciences biologiques, Université du Québec à Montréal , Montréal, Québec, H2X 1Y4 , Canada
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health , Bethesda, MD 20814 , USA
| | - Jean-François Trempe
- Department of Pharmacology and Therapeutics and Centre de Recherche en Biologie Structurale, McGill University , Montreal, Quebec, H3A 1A3 , Canada
| | - Edward A Fon
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
- Early Drug Discovery Unit (EDDU), Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University , Montreal, Quebec H3A 2B4 , Canada
| | - Thomas M Durcan
- Early Drug Discovery Unit (EDDU), Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University , Montreal, Quebec H3A 2B4 , Canada
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center , 710 West 168th Street, New York, NY, 10032-3784 USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center , New York, NY 10032 , USA
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University , Montreal, Quebec, H3A 2B4 , Canada
- Department of Neurology and neurosurgery, McGill University , Montréal, QC, H3A 2B4 , Canada
- Department of Human Genetics, McGill University , Montréal, QC, H3A 1A1 , Canada
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Rahayel S, Tremblay C, Vo A, Zheng YQ, Lehéricy S, Arnulf I, Vidailhet M, Corvol JC, Gagnon JF, Postuma RB, Montplaisir J, Lewis S, Matar E, Ehgoetz Martens K, Borghammer P, Knudsen K, Hansen A, Monchi O, Misic B, Dagher A. Brain atrophy in prodromal synucleinopathy is shaped by structural connectivity and gene expression. Brain 2022; 145:3162-3178. [PMID: 35594873 DOI: 10.1093/brain/awac187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/23/2021] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
Isolated REM sleep behaviour disorder (iRBD) is a synucleinopathy characterized by abnormal behaviours and vocalizations during REM sleep. Most iRBD patients develop dementia with Lewy bodies, Parkinson's disease, or multiple system atrophy over time. Patients with iRBD exhibit brain atrophy patterns that are reminiscent of those observed in overt synucleinopathies. However, the mechanisms linking brain atrophy to the underlying alpha-synuclein pathophysiology are poorly understood. Our objective was to investigate how the prion-like and regional vulnerability hypotheses of alpha-synuclein might explain brain atrophy in iRBD. Using a multicentric cohort of 182 polysomnography-confirmed iRBD patients who underwent T1-weighted MRI, we performed vertex-based cortical surface and deformation-based morphometry analyses to quantify brain atrophy in patients (67.8 years, 84% men) and 261 healthy controls (66.2 years, 75%) and investigated the morphological correlates of motor and cognitive functioning in iRBD. Next, we applied the agent-based Susceptible-Infected-Removed model (i.e., a computational model that simulates in silico the spread of pathologic alpha-synuclein based on structural connectivity and gene expression) and tested if it recreated atrophy in iRBD by statistically comparing simulated regional brain atrophy to the atrophy observed in patients. The impact of SNCA and GBA gene expression and brain connectivity was then evaluated by comparing the model fit to the one obtained in null models where either gene expression or connectivity was randomized. The results showed that iRBD patients present with cortical thinning and tissue deformation, which correlated with motor and cognitive functioning. Next, we found that the computational model recreated cortical thinning (r = 0.51, p = 0.0007) and tissue deformation (r = 0.52, p = 0.0005) in patients, and that the connectome's architecture along with SNCA and GBA gene expression contributed to shaping atrophy in iRBD. We further demonstrated that the full agent-based model performed better than network measures or gene expression alone in recreating the atrophy pattern in iRBD. In summary, atrophy in iRBD is extensive, correlates with motor and cognitive function, and can be recreated using the dynamics of agent-based modelling, structural connectivity, and gene expression. These findings support the concepts that both prion-like spread and regional susceptibility account for the atrophy observed in prodromal synucleinopathies. Therefore, the agent-based Susceptible-Infected-Removed model may be a useful tool for testing hypotheses underlying neurodegenerative diseases and new therapies aimed at slowing or stopping the spread of alpha-synuclein pathology.
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Affiliation(s)
- Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada
| | - Christina Tremblay
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Andrew Vo
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Ying-Qiu Zheng
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Stéphane Lehéricy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Isabelle Arnulf
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Marie Vidailhet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris 75013, France
| | | | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal H2X 3P2, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Neurology, Montreal General Hospital, Montreal H3G 1A4, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal H4J 1C5, Montreal, Canada.,Department of Psychiatry, Université de Montréal, Montreal H3 T 1J4, Canada
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Elie Matar
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia.,Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo N2L 3G1, Canada
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Allan Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal H3W 1W5, Canada.,Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary T2N 4N1, Canada
| | - Bratislav Misic
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal H3A 2B4, Canada
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21
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Danyluk H, Lang S, Monchi O, Sankar T. Pre-operative Limbic System Functional Connectivity Distinguishes Responders From Non-responders to Surgical Treatment for Trigeminal Neuralgia. Front Neurol 2021; 12:716500. [PMID: 34671309 PMCID: PMC8520903 DOI: 10.3389/fneur.2021.716500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/28/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Trigeminal neuralgia (TN) is a severe facial pain condition often requiring surgical treatment. Unfortunately, even technically successful surgery fails to achieve durable pain relief in many patients. The purpose of this study was to use resting-state functional magnetic resonance imaging (fMRI) to: (1) compare functional connectivity between limbic and accessory sensory networks in TN patients vs. healthy controls; and (2) determine if pre-operative variability in these networks can distinguish responders and non-responders to surgery for TN. Methods: We prospectively recruited 22 medically refractory classic or idiopathic TN patients undergoing surgical treatment over a 3-year period, and 19 age- and sex-matched healthy control subjects. fMRI was acquired within the month prior to surgery for all TN patients and at any time during the study period for controls. Functional connectivity analysis was restricted to six pain-relevant brain regions selected a priori: anterior cingulate cortex (ACC), posterior cingulate cortex, hippocampus, amygdala, thalamus, and insula. Two comparisons were performed: (1) TN vs. controls; and (2) responders vs. non-responders to surgical treatment for TN. Functional connectivity was assessed with a two-sample t-test, using a statistical significance threshold of p < 0.050 with false discovery rate (FDR) correction for multiple comparisons. Results: Pre-operative functional connectivity was increased in TN patients compared to controls between the right insular cortex and both the left thalamus [t (39) = 3.67, p = 0.0007] and right thalamus [t (39) = 3.22, p = 0.0026]. TN patients who were non-responders to surgery displayed increased functional connectivity between limbic structures, including between the left and right hippocampus [t (18) = 2.85, p = 0.0106], and decreased functional connectivity between the ACC and both the left amygdala [t (18) = 2.94, p = 0.0087] and right hippocampus [t (18) = 3.20, p = 0.0049]. Across all TN patients, duration of illness was negatively correlated with connectivity between the ACC and left amygdala (r 2 = 0.34, p = 0.00437) as well as the ACC and right hippocampus (r 2 = 0.21, p = 0.0318). Conclusions: TN patients show significant functional connectivity abnormalities in sensory-salience regions. However, variations in the strength of functional connectivity in limbic networks may explain why some TN patients fail to respond adequately to surgery.
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Affiliation(s)
- Hayden Danyluk
- Division of Surgical Research, University of Alberta, Edmonton, AB, Canada.,Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Stefan Lang
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Health Research Innovation Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Health Research Innovation Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tejas Sankar
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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22
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Rémillard-Pelchat D, Rahayel S, Gaubert M, Postuma RB, Montplaisir J, Pelletier A, Monchi O, Brambati SM, Carrier J, Gagnon JF. Comprehensive Analysis of Brain Volume in REM Sleep Behavior Disorder with Mild Cognitive Impairment. J Parkinsons Dis 2021; 12:229-241. [PMID: 34690149 DOI: 10.3233/jpd-212691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rapid-eye-movement sleep behavior disorder (RBD) is a major risk factor for Parkinson's disease and dementia with Lewy bodies. More than a third of RBD patients have mild cognitive impairment (MCI), but their specific structural brain alterations remain poorly understood. OBJECTIVE This study aimed to investigate the local deformation and volume of gray and white matter tissue underlying MCI in RBD. METHODS Fifty-two idiopathic RBD patients, including 17 with MCI (33%), underwent polysomnography, neuropsychological, neurological, and magnetic resonance imaging assessments. MCI diagnosis was based on a subjective complaint, cognitive impairment on the neuropsychological battery, and preserved daily functioning. Forty-one controls were also included. Deformation-based morphometry (DBM), voxel-based morphometry (VBM), and regional volume analyses of the corpus callosum and basal forebrain cholinergic were performed. Multiple regressions models were also computed using anatomical, cognitive (composite z score), and motor parameters. RESULTS Globally, patients with MCI displayed a widespread pattern of local deformation and volume atrophy in the cortical (bilateral insula, cingulate cortex, precuneus, frontal and temporal regions, right angular gyrus, and mid-posterior segment of the corpus callosum) and subcortical (brainstem, corona radiata, basal ganglia, thalamus, amygdala, and right hippocampus) regions compared to patients without MCI (DBM) or controls (DBM and VBM). Moreover, brain deformation (DBM) in patients were associated with lower performance in attention and executive functions, visuospatial abilities, and higher motor symptoms severity. CONCLUSION The present study identified novel brain structural alterations in RBD patients with MCI which correlated with poorer cognitive performance. These results are consistent with those reported in patients with synucleinopathies-related cognitive impairment.
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Affiliation(s)
- David Rémillard-Pelchat
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Shady Rahayel
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Malo Gaubert
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Oury Monchi
- Department of Radiology, Radio-Oncology, and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada.,Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Simona Maria Brambati
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal -Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
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23
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de Rus Jacquet A, Bogard S, Normandeau CP, Degroot C, Postuma RB, Dupré N, Miyasaki JM, Monchi O, Martino D, Fon EA, Cicchetti F. Clinical perception and management of Parkinson's disease during the COVID-19 pandemic: A Canadian experience. Parkinsonism Relat Disord 2021; 91:66-76. [PMID: 34536727 PMCID: PMC8407944 DOI: 10.1016/j.parkreldis.2021.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
Background The COVID-19 pandemic has necessitated the social isolation of the population and the rapid implementation of remote care for patients with neurodegenerative diseases. The objective of this study was to explore the perceived impact of confinement in patients with Parkinson's disease and document the effects of gender and living environment. Methods We recruited two cohorts from the Canadian provinces of Québec and Alberta, which differed in the dynamics of COVID-19 spreading at the time of the study, and administered a questionnaire on the perceived effects of confinement on daily living and disease management. Results The data reveals that approximately half of the patients experienced a change in one or more clinical symptoms, with differences observed between gender (e.g. day-to-day changes in slowness in men, aggravated headaches in women) and geographic location (e.g. increased depression in Alberta but reduced sleep quality in Québec). Furthermore, participants identifying as women or living in Alberta implemented more frequently home or online exercise. Lastly, high levels of satisfaction with phone or video consultations did not translate into a sustained interest to pursue this mode of healthcare. Conclusions This study suggests that COVID-19-related confinement affected Parkinson's disease manifestation and management. Patients also reported varying levels of interest to continue remote care. A number of differences reported in our study were seemingly related to gender and living environment.
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Affiliation(s)
- Aurelie de Rus Jacquet
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC, Canada; Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada.
| | - Sarah Bogard
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine P Normandeau
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Clotilde Degroot
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ronald B Postuma
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Nicolas Dupré
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC, Canada; Département de Médecine, Faculté de Médicine, Université Laval, Québec, QC, Canada
| | | | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Edward A Fon
- Neurodegenerative Diseases Group, Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, Québec, QC, Canada; Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada.
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24
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Sondergaard RE, Rockel CP, Cortese F, Jasaui Y, Pringsheim TM, Sarna JR, Monchi O, Sadikot AF, Pike BG, Martino D. Microstructural Abnormalities of the Dentatorubrothalamic Tract in Cervical Dystonia. Mov Disord 2021; 36:2192-2198. [PMID: 34050556 DOI: 10.1002/mds.28649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/21/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The dentatorubrothalamic tract (DRTT) remains understudied in idiopathic cervical dystonia (CD), despite evidence that the pathway is relevant in the pathophysiology of the disorder. OBJECTIVE The aim of this study was to examine the DRTT in patients with CD using diffusion tensor imaging (DTI)-based tractography. METHODS Magnetic resonance imaging scans from 67 participants were collected to calculate diffusion tractography metrics using a binary tractography-based DRTT template. Fractional anisotropy and diffusivity measures of left and right DRTT were computed and compared between 32 subjects with CD and 35 age-matched healthy volunteers. RESULTS Fractional anisotropy of right DRTT and mean and axial diffusivity of left DRTT were significantly reduced in patients with CD. Similar abnormalities were observed in patients with focal CD and patients with CD without tremor. DTI metrics did not correlate with disease duration or severity. CONCLUSIONS Significant reductions in DTI measures suggest microstructural abnormalities within the DRTT in CD, characterized by a tractography pattern consistent with decreased axonal integrity. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rachel E Sondergaard
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Conrad P Rockel
- Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Filomeno Cortese
- Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Neuroimaging Research Unit, Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yamile Jasaui
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Continuing Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Justyna R Sarna
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Abbas F Sadikot
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Bruce G Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
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25
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Gan-Or Z, Rao T, Leveille E, Degroot C, Chouinard S, Cicchetti F, Dagher A, Das S, Desautels A, Drouin-Ouellet J, Durcan T, Gagnon JF, Genge A, Karamchandani J, Lafontaine AL, Sun SLW, Langlois M, Levesque M, Melmed C, Panisset M, Parent M, Poline JB, Postuma RB, Pourcher E, Rouleau GA, Sharp M, Monchi O, Dupré N, Fon EA. The Quebec Parkinson Network: A Researcher-Patient Matching Platform and Multimodal Biorepository. J Parkinsons Dis 2021; 10:301-313. [PMID: 31868683 PMCID: PMC7029361 DOI: 10.3233/jpd-191775] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genetic, biologic and clinical data suggest that Parkinson's disease (PD) is an umbrella for multiple disorders with clinical and pathological overlap, yet with different underlying mechanisms. To better understand these and to move towards neuroprotective treatment, we have established the Quebec Parkinson Network (QPN), an open-access patient registry, and data and bio-samples repository. OBJECTIVE To present the QPN and to perform preliminary analysis of the QPN data. METHODS A total of 1,070 consecutively recruited PD patients were included in the analysis. Demographic and clinical data were analyzed, including comparisons between males and females, PD patients with and without RBD, and stratified analyses comparing early and late-onset PD and different age groups. RESULTS QPN patients exhibit a male:female ratio of 1.8:1, an average age-at-onset of 58.6 years, an age-at-diagnosis of 60.4 years, and average disease duration of 8.9 years. REM-sleep behavior disorder (RBD) was more common among men, and RBD was associated with other motor and non-motor symptoms including dyskinesia, fluctuations, postural hypotension and hallucinations. Older patients had significantly higher rates of constipation and cognitive impairment, and longer disease duration was associated with higher rates of dyskinesia, fluctuations, freezing of gait, falls, hallucinations and cognitive impairment. Since QPN's creation, over 60 studies and 30 publications have included patients and data from the QPN. CONCLUSIONS The QPN cohort displays typical PD demographics and clinical features. These data are open-access upon application (http://rpq-qpn.ca/en/), and will soon include genetic, imaging and bio-samples. We encourage clinicians and researchers to perform studies using these resources.
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Affiliation(s)
- Ziv Gan-Or
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Trisha Rao
- Clinical Research Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Etienne Leveille
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Clotilde Degroot
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Sylvain Chouinard
- Unité des trouves du mouvement André Barbeau, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec, Axe Neurosciences, Québec, QC, Canada.,Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Samir Das
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, Montreal, QC, Canada
| | - Alex Desautels
- Centre d'Études Avancées en Médecine du Sommeil and Neurology Service, H-pital du Sacré-C-eur de Montréal, Montréal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | | | - Thomas Durcan
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jean-François Gagnon
- Centre d'Études Avancées en Médecine du Sommeil and Neurology Service, H-pital du Sacré-C-eur de Montréal, Montréal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Angela Genge
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Clinical Research Unit, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jason Karamchandani
- Department of Pathology, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Anne-Louise Lafontaine
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Neurology, McGill University Medical Centre, Montréal, QC, Canada
| | - Sonia Lai Wing Sun
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Mélanie Langlois
- Division of Neurosciences, CHU de Québec, Université Laval, Québec City, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Martin Levesque
- Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada
| | - Calvin Melmed
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Michel Panisset
- Unité des trouves du mouvement André Barbeau, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Parent
- Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada
| | | | - Ronald B Postuma
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Emmanuelle Pourcher
- Division of Neurosciences, CHU de Québec, Université Laval, Québec City, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada.,Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Madeleine Sharp
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Oury Monchi
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Departments of Clinical Neurosciences and Radiology, University of Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nicolas Dupré
- Division of Neurosciences, CHU de Québec, Université Laval, Québec City, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Edward A Fon
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Montreal Neurological Institute, McGill University, Montréal, QC, Canada
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26
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Yoon EJ, Monchi O. Probable REM sleep behavior disorder is associated with longitudinal cortical thinning in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:19. [PMID: 33654107 PMCID: PMC7925528 DOI: 10.1038/s41531-021-00164-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/22/2020] [Accepted: 01/14/2021] [Indexed: 12/23/2022] Open
Abstract
REM sleep behavior disorder (RBD) has a poor prognostic implication in both motor and non-motor functions in Parkinson’s disease (PD) patients. However, to the best of our knowledge no study to date investigated the longitudinal cerebral changes underlying RBD symptoms in PD. We performed the longitudinal study to investigate the association between probable RBD and cortical and subcortical changes in early, de novo PD patients. We studied 78 participants from the Parkinson’s Progression Marker Initiative who underwent structural MRI at baseline and after 2 years. The presence of probable RBD (pRBD) was evaluated using the RBD screening questionnaire. We compared the cross-sectional and longitudinal cortical thickness and subcortical volume changes, between PD patients with and without pRBD. At baseline, we found bilateral inferior temporal cortex thinning in the PD-pRBD group compared with the PD-noRBD group. Longitudinally, the PD-pRBD group revealed a significant increase in the rate of thinning in the left insula compared with the PD-noRBD group, and the increased thinning correlated with decreased cognitive performance. In subcortical volume analyses, the presence of pRBD was linked with volume decrease over time in the left caudate nucleus, pallidum and amygdala. The volume changes in the left caudate nucleus revealed correlations with global cognition. These results support the idea that RBD is an important marker of rapid progression in PD motor and non-motor symptoms and suggest that the atrophy in the left insula and caudate nucleus might be the underlying neurobiological mechanisms of the poorer prognosis in PD patients with RBD.
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Affiliation(s)
- Eun Jin Yoon
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada. .,Department of Radiology, University of Calgary, Calgary, AB, Canada. .,Centre de Recherche Institut, Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
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27
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Ramezani M, Mouches P, Yoon E, Rajashekar D, Ruskey JA, Leveille E, Martens K, Kibreab M, Hammer T, Kathol I, Maarouf N, Sarna J, Martino D, Pfeffer G, Gan-Or Z, Forkert ND, Monchi O. Investigating the relationship between the SNCA gene and cognitive abilities in idiopathic Parkinson's disease using machine learning. Sci Rep 2021; 11:4917. [PMID: 33649398 PMCID: PMC7921412 DOI: 10.1038/s41598-021-84316-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/10/2021] [Indexed: 01/16/2023] Open
Abstract
Cognitive impairments are prevalent in Parkinson's disease (PD), but the underlying mechanisms of their development are unknown. In this study, we aimed to predict global cognition (GC) in PD with machine learning (ML) using structural neuroimaging, genetics and clinical and demographic characteristics. As a post-hoc analysis, we aimed to explore the connection between novel selected features and GC more precisely and to investigate whether this relationship is specific to GC or is driven by specific cognitive domains. 101 idiopathic PD patients had a cognitive assessment, structural MRI and blood draw. ML was performed on 102 input features including demographics, cortical thickness and subcortical measures, and several genetic variants (APOE, MAPT, SNCA, etc.). Using the combination of RRELIEFF and Support Vector Regression, 11 features were found to be predictive of GC including sex, rs894280, Edinburgh Handedness Inventory, UPDRS-III, education, five cortical thickness measures (R-parahippocampal, L-entorhinal, R-rostral anterior cingulate, L-middle temporal, and R-transverse temporal), and R-caudate volume. The rs894280 of SNCA gene was selected as the most novel finding of ML. Post-hoc analysis revealed a robust association between rs894280 and GC, attention, and visuospatial abilities. This variant indicates a potential role for the SNCA gene in cognitive impairments of idiopathic PD.
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Affiliation(s)
- Mehrafarin Ramezani
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pauline Mouches
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Eunjin Yoon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deepthi Rajashekar
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Etienne Leveille
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Kristina Martens
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tracy Hammer
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Iris Kathol
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nadia Maarouf
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Justyna Sarna
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gerald Pfeffer
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medical Genetics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute (HBI), Cummings School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Radiology, University of Calgary, Calgary, AB, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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28
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Jin Yoon E, Ismail Z, Kathol I, Kibreab M, Hammer T, Lang S, Ramezani M, Auclair-Ouellet N, Sarna JR, Martino D, Furtado S, Monchi O. Patterns of brain activity during a set-shifting task linked to mild behavioral impairment in Parkinson's disease. Neuroimage Clin 2021; 30:102590. [PMID: 33640685 PMCID: PMC7907973 DOI: 10.1016/j.nicl.2021.102590] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/24/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
PD with mild behavioral impairment revealed deficits in cognitive flexibility. Brain activities during a set-shifting task linked with MBI in PD was evaluated. PD-MBI revealed reduced activity in the prefrontal and posterior parietal cortices. The prefrontal activity was associated with cognitive impairment in PD-MBI. High MBI-C score was associated with reduced deactivation in the hippocampus.
Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later life emergence of sustained neuropsychiatric symptoms, as an at-risk state for incident cognitive decline and dementia. Prior studies have reported that neuropsychiatric symptoms are associated with cognitive abilities in Parkinson’s disease (PD) patients, and we have recently found a strong correlation between MBI and cognitive performance. However, the underlying neural activity patterns of cognitive performance linked to MBI in PD are unknown. Fifty-nine non-demented PD patients and 26 healthy controls were scanned using fMRI during performance of a modified version of the Wisconsin card sorting task. MBI was evaluated using the MBI-checklist, and PD patients were divided into two groups, PD-MBI and PD-noMBI. Compared to the PD-noMBI group and healthy controls, the PD-MBI group revealed less activation in the prefrontal and posterior parietal cortices, and reduced deactivation in the medial temporal region. These results suggest that in PD, MBI reflects deficits in the frontoparietal control network and the hippocampal memory system.
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Affiliation(s)
- Eun Jin Yoon
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada; Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Iris Kathol
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Tracy Hammer
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stefan Lang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mehrafarin Ramezani
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Justyna R Sarna
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sarah Furtado
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
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29
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Ramezani M, Ruskey JA, Martens K, Kibreab M, Javer Z, Kathol I, Hammer T, Cheetham J, Leveille E, Martino D, Sarna JR, Gan-Or Z, Pfeffer G, Ismail Z, Monchi O. Association Between BDNF Val66Met Polymorphism and Mild Behavioral Impairment in Patients With Parkinson's Disease. Front Neurol 2021; 11:587992. [PMID: 33584494 PMCID: PMC7874164 DOI: 10.3389/fneur.2020.587992] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) are common in Parkinson's disease (PD) and have demonstrated an association with the p. Val66Met, a polymorphism in the BDNF gene. Mild behavioral impairment (MBI) is a validated syndrome describing emergent and persistent NPS in older adults as a marker of potential cognitive decline and dementia. This study investigated if PD patients with the Met allele were more likely to have MBI and whether they had impairments in specific domains of MBI using the Mild Behavioral Impairment Checklist (MBI-C) as the MBI ascertainment tool. One hundred forty-six PD patients were screened for neuropsychiatric and cognitive impairments with the MBI-C and the Montreal Cognitive Assessment (MoCA). All participants were genotyped for the BDNF p.Val66Met single-nucleotide polymorphism (SNP) using TaqMan Genotyping Assay. Statistical analysis was performed using multiple linear and logistic regression models. Met carriers had a 2 times higher likelihood of being MBI positive (MBI-C total score ≥8) than Val carriers. Met carriers had significantly higher MBI-C total scores and significantly greater impairments in the mood/anxiety and the psychotic domains of MBI-C compared to Val carriers. These findings indicate that the BDNF Met allele is associated with a higher neuropsychiatric burden in PD.
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Affiliation(s)
- Mehrafarin Ramezani
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer A. Ruskey
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Kristina Martens
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mekale Kibreab
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zainul Javer
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Iris Kathol
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tracy Hammer
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jenelle Cheetham
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Etienne Leveille
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Davide Martino
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Justyna R. Sarna
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Gerald Pfeffer
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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30
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Lang S, Gan LS, Yoon EJ, Hanganu A, Kibreab M, Cheetham J, Hammer T, Kathol I, Sarna J, Martino D, Monchi O. Theta-Burst Stimulation for Cognitive Enhancement in Parkinson's Disease With Mild Cognitive Impairment: A Randomized, Double-Blind, Sham-Controlled Trial. Front Neurol 2021; 11:584374. [PMID: 33408684 PMCID: PMC7779796 DOI: 10.3389/fneur.2020.584374] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/27/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Mild cognitive impairment is a common non-motor symptom of Parkinson's disease (PD-MCI) and has minimal treatment options. Objective: In this double-blind, randomized, sham-controlled trial, we assessed the effect of repeated sessions of intermittent theta-burst stimulation over the left dorsolateral prefrontal cortex on cognition and brain connectivity in subjects with PD-MCI. Methods: Forty-one subjects were randomized to receive real (n = 21) or sham stimulation (n = 20). All subjects underwent neuropsychological assessments before, 1 day, and 1 month after stimulation. Subjects also underwent resting-state functional magnetic resonance imaging before and 48 h after stimulation. The primary outcome was the change in the cognitive domain (executive function, attention, memory, language, and visuospatial abilities) z-scores across time. Results: There was an insignificant effect on cognitive domain z-scores across time when comparing real with sham stimulation and correcting for multiple comparisons across cognitive domains (p > 0.05 Bonferroni correction). However, the real stimulation group demonstrated a trend toward improved executive functioning scores at the 1-month follow-up compared with sham (p < 0.05 uncorrected). After real stimulation, the connectivity of the stimulation site showed decreased connectivity to the left caudate head. There was no change in connectivity within or between the stimulation network (a network of cortical regions connected to the stimulation site) and the striatal network. However, higher baseline connectivity between the stimulation network and the striatal network was associated with improved executive function scores at 1 month. Conclusions: These results suggest that intermittent theta-burst stimulation over the dorsolateral prefrontal cortex in subjects with PD-MCI has minimal effect on cognition compared with sham, although there were trends toward improved executive function. This intervention may be more effective in subjects with higher baseline connectivity between the stimulation network and the striatal network. This trial supports further investigation focusing on executive function and incorporating connectivity-based targeting. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03243214.
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Affiliation(s)
- Stefan Lang
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Liu Shi Gan
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Eun Jin Yoon
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Alexandru Hanganu
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Institut Universitaire de Gériatrie de Montréal, Centre de Recherche, Montréal, QC, Canada
| | - Mekale Kibreab
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Jenelle Cheetham
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Tracy Hammer
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Iris Kathol
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Justyna Sarna
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Davide Martino
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada.,Institut Universitaire de Gériatrie de Montréal, Centre de Recherche, Montréal, QC, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada
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31
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Rahayel S, Postuma RB, Montplaisir J, Mišić B, Tremblay C, Vo A, Lewis S, Matar E, Ehgoetz Martens K, Blanc F, Yao C, Carrier J, Monchi O, Gaubert M, Dagher A, Gagnon JF. A Prodromal Brain-Clinical Pattern of Cognition in Synucleinopathies. Ann Neurol 2020; 89:341-357. [PMID: 33217037 DOI: 10.1002/ana.25962] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Isolated (or idiopathic) rapid eye movement sleep behavior disorder (iRBD) is associated with dementia with Lewy bodies (DLB) and Parkinson's disease (PD). Biomarkers are lacking to predict conversion to a dementia or a motor-first phenotype. Here, we aimed at identifying a brain-clinical signature that predicts dementia in iRBD. METHODS A brain-clinical signature was identified in 48 patients with polysomnography-confirmed iRBD using partial least squares between brain deformation and 27 clinical variables. The resulting variable was applied to 78 patients with iRBD followed longitudinally to predict conversion to a synucleinopathy, specifically DLB. The deformation scores from patients with iRBD were compared with 207 patients with PD, DLB, or prodromal DLB to assess if scores were higher in DLB compared to PD. RESULTS One latent variable explained 31% of the brain-clinical covariance in iRBD, combining cortical and subcortical deformation and subarachnoid/ventricular expansion to cognitive and motor variables. The deformation score of this signature predicted conversion to a synucleinopathy in iRBD (p = 0.036, odds ratio [OR] = 2.249; 95% confidence interval [CI] = 1.053-4.803), specifically to DLB (OR = 4.754; 95% CI = 1.283-17.618, p = 0.020) and not PD (p = 0.286). Patients with iRBD who developed dementia had scores similar to clinical and prodromal patients with DLB but higher scores compared with patients with PD. The deformation score also predicted cognitive performance over 1, 2, and 4 years in patients with PD. INTERPRETATION We identified a brain-clinical signature that predicts conversion in iRBD to more severe/dementing forms of synucleinopathy. This pattern may serve as a new biomarker to optimize patient care, target risk reduction strategies, and administer neuroprotective trials. ANN NEUROL 2021;89:341-357.
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Affiliation(s)
- Shady Rahayel
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Neurology, Montreal General Hospital, Montreal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Bratislav Mišić
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Christina Tremblay
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Andrew Vo
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Elie Matar
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kaylena Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Frédéric Blanc
- ICube Laboratory and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Université de Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospital of Strasbourg, CM2R (Memory Resource and Research Centre), Day Hospital, Strasbourg, France
| | - Chun Yao
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Oury Monchi
- Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Radio-Oncology, and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | - Malo Gaubert
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Alain Dagher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jean-François Gagnon
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
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Lang ST, Gan LS, Yoon E, Hanganu A, Kibreab M, Cheetham J, Hammer T, Kathol I, Sarna J, Martino D, Monchi O. Theta-burst Stimulation for Cognitive Enhancement in Parkinson's Disease With Mild Cognitive Impairment. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_625] [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: 11/14/2022] Open
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Lang S, Gan LS, McLennan C, Kirton A, Monchi O, Kelly JJP. Preoperative Transcranial Direct Current Stimulation in Glioma Patients: A Proof of Concept Pilot Study. Front Neurol 2020; 11:593950. [PMID: 33329346 PMCID: PMC7710969 DOI: 10.3389/fneur.2020.593950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) has been used extensively in patient populations to facilitate motor network plasticity. However, it has not been studied in patients with brain tumors. We aimed to determine the feasibility of a preoperative motor training and tDCS intervention in patients with glioma. In an exploratory manner, we assessed changes in motor network connectivity following this intervention and related these changes to predicted electrical field strength from the stimulated motor cortex. Methods: Patients with left-sided glioma (n=8) were recruited in an open label proof of concept pilot trial and participated in four consecutive days of motor training combined with tDCS. The motor training consisted of a 60-min period where the subject learned to play the piano with their right hand. Concurrently, they received 40 min of 2 mA anodal tDCS of the left motor cortex. Patients underwent task and resting state fMRI before and after this intervention. Changes in both the connectivity of primary motor cortex (M1) and general connectivity across the brain were assessed. Patient specific finite element models were created and the predicted electrical field (EF) resulting from stimulation was computed. The magnitude of the EF was extracted from left M1 and correlated to the observed changes in functional connectivity. Results: There were no adverse events and all subjects successfully completed the study protocol. Left M1 increased both local and global connectivity. Voxel-wide measures, not constrained by a specific region, revealed increased global connectivity of the frontal pole and decreased global connectivity of the supplementary motor area. The magnitude of EF applied to the left M1 correlated with changes in global connectivity of the right M1. Conclusion: In this proof of concept pilot study, we demonstrate for the first time that tDCS appears to be feasible in glioma patients. In our exploratory analysis, we show preoperative motor training combined with tDCS may alter sensorimotor network connectivity. Patient specific modeling of EF in the presence of tumor may contribute to understanding the dose-response relationship of this intervention. Overall, this suggests the possibility of modulating neural networks in glioma patients.
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Affiliation(s)
- Stefan Lang
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Liu Shi Gan
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Cael McLennan
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Non-invasive Neurostimulation Network, University of Calgary, Calgary, AB, Canada
| | - John J P Kelly
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
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Lang ST, Gan LS, McLennan C, Monchi O, Kelly JJP. Impact of Peritumoral Edema During Tumor Treatment Field Therapy: A Computational Modelling Study. IEEE Trans Biomed Eng 2020; 67:3327-3338. [PMID: 32286953 DOI: 10.1109/tbme.2020.2983653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tumor treatment fields (TTFie-lds) are an approved adjuvant therapy for glioblastoma (GBM). The magnitude of applied electrical field has been shown to be related to the anti-tumoral response. However, peritumoral edema may result in shunting of electrical current around the tumor, thereby reducing the intra-tumoral electric field. In this study, we systematically address this issue with computational simulations. METHODS Finite element models are created of a human head with varying amounts of peritumoral edema surrounding a virtual tumor. The electric field distribution was simulated using the standard TTFields electrode montage. Electric field magnitude was extracted from the tumor and related to edema thickness. Two patient specific models were created to confirm these results. RESULTS The inclusion of peritumoral edema decreased the average magnitude of the electric field within the tumor. In the model considering a frontal tumor and an anterior-posterior electrode configuration, ≥6 mm of peritumoral edema decreased the electric field by 52%. In the patient specific models, peritumoral edema decreased the electric field magnitude within the tumor by an average of 26%. The effect of peritumoral edema on the electric field distribution was spatially heterogenous, being most significant at the tissue interface between edema and tumor. CONCLUSIONS The inclusion of peritumoral edema during TTFields modelling may have a dramatic effect on the predicted electric field magnitude within the tumor. Given the importance of electric field magnitude for the anti-tumoral effects of TTFields, the presence of edema should be considered both in future modelling studies and when planning TTField therapy.
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Saini P, Rudakou U, Yu E, Ruskey JA, Asayesh F, Laurent SB, Spiegelman D, Fahn S, Waters C, Monchi O, Dauvilliers Y, Dupré N, Greenbaum L, Hassin-Baer S, Espay AJ, Rouleau GA, Alcalay RN, Fon EA, Postuma RB, Gan-Or Z. Association study of DNAJC13, UCHL1, HTRA2, GIGYF2, and EIF4G1 with Parkinson's disease. Neurobiol Aging 2020; 100:119.e7-119.e13. [PMID: 33239198 DOI: 10.1016/j.neurobiolaging.2020.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/26/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 12/13/2022]
Abstract
Rare mutations in genes originally discovered in multigenerational families have been associated with increased risk of Parkinson's disease (PD). The involvement of rare variants in DNAJC13, UCHL1, HTRA2, GIGYF2, and EIF4G1 loci has been poorly studied or has produced conflicting results across cohorts. However, they are still being often referred to as "PD genes" and used in different models. To further elucidate the role of these 5 genes in PD, we fully sequenced them using molecular inversion probes in 2408 patients with PD and 3444 controls from 3 different cohorts. A total of 788 rare variants were identified across the 5 genes and 3 cohorts. Burden analyses and optimized sequence Kernel association tests revealed no significant association between any of the genes and PD after correction for multiple comparisons. Our results do not support an association of the 5 tested genes with PD. Combined with previous studies, it is unlikely that any of these genes plays an important role in PD. Their designation as "PARK" genes should be reconsidered.
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Affiliation(s)
- Prabhjyot Saini
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Uladzislau Rudakou
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Eric Yu
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Farnaz Asayesh
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Sandra B Laurent
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Dan Spiegelman
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Cheryl Waters
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Oury Monchi
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Yves Dauvilliers
- Department of Neurology, National Reference Center for Narcolepsy, Sleep Unit, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Inserm U1061, Montpellier, France
| | - Nicolas Dupré
- Division of Neurosciences, CHU de Québec, Université Laval, Quebec City, Quebec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Lior Greenbaum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sharon Hassin-Baer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, The Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Guy A Rouleau
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Edward A Fon
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Ronald B Postuma
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada.
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Saini P, Rudakou U, Yu E, Ruskey J, Asayesh F, Laurent S, Spiegelman D, Fahn S, Waters C, Monchi O, Dauvilliers Y, Dupré N, Greenbaum L, Hassin-Baer S, Espay A, Rouleau G, Alcalay R, Fon E, Gan-Or Z. Sequencing the entire exome of REM sleep behavior and progression to neurodegenerative diseases. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ouled Amar Bencheikh B, Senkevich K, Rudakou U, Yu E, Mufti K, Ruskey JA, Asayesh F, Laurent SB, Spiegelman D, Fahn S, Waters C, Monchi O, Dauvilliers Y, Espay AJ, Dupré N, Greenbaum L, Hassin-Baer S, Rouleau GA, Alcalay RN, Fon EA, Gan-Or Z. Variants in the Niemann-Pick type C gene NPC1 are not associated with Parkinson's disease. Neurobiol Aging 2020; 93:143.e1-143.e4. [PMID: 32371106 PMCID: PMC7302975 DOI: 10.1016/j.neurobiolaging.2020.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 12/27/2022]
Abstract
Biallelic variants in NPC1, a gene coding for a lysosomal transmembrane protein involved in cholesterol trafficking, may cause Niemann-Pick disease type C (NPC). A few cases of NPC1 variant carriers with Parkinson's disease (PD) have been reported. In addition, pathologic studies have demonstrated phosphorylated alpha-synuclein and Lewy pathology in brains of NPC patients. Therefore, we aimed to examine whether NPC1 genetic variants may be associated with PD. Full sequencing of NPC1 was performed in 2657 PD patients and 3647 controls from 3 cohorts, using targeted sequencing with molecular inversion probes. A total of 9 common variants and 126 rare variants were identified across the 3 cohorts. To examine their association with PD, regression models adjusted for age, sex, and origin were performed for common variants, and optimal sequence Kernel association test (SKAT-O) was performed for rare variants. After correction for multiple comparisons, common and rare NPC1 variants were not associated with PD. Our results do not support a link between heterozygous variants in NPC1 and PD.
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Affiliation(s)
- Bouchra Ouled Amar Bencheikh
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Centre de Recherche, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Konstantin Senkevich
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Uladzislau Rudakou
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Eric Yu
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Kheireddin Mufti
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Jennifer A Ruskey
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Farnaz Asayesh
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Sandra B Laurent
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Dan Spiegelman
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Cheryl Waters
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Oury Monchi
- Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada; Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Yves Dauvilliers
- Department of Neurology, National Reference Center for Narcolepsy, Sleep Unit, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Nicolas Dupré
- Division of Neurosciences, CHU de Québec, Université Laval, Quebec City, Quebec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Lior Greenbaum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sharon Hassin-Baer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel; Department of Neurology, The Movement Disorders Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Guy A Rouleau
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Roy N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Edward A Fon
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada; Department of Neurology and neurosurgery, McGill University, Montréal, Quebec, Canada; Department of Human Genetics, McGill University, Montréal, Quebec, Canada.
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Lang S, Ismail Z, Kibreab M, Kathol I, Sarna J, Monchi O. Common and unique connectivity at the interface of motor, neuropsychiatric, and cognitive symptoms in Parkinson's disease: A commonality analysis. Hum Brain Mapp 2020; 41:3749-3764. [PMID: 32476230 PMCID: PMC7416059 DOI: 10.1002/hbm.25084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/11/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 01/13/2023] Open
Abstract
Parkinson's disease (PD) is characterized by overlapping motor, neuropsychiatric, and cognitive symptoms. Worse performance in one domain is associated with worse performance in the other domains. Commonality analysis (CA) is a method of variance partitioning in multiple regression, used to separate the specific and common influence of collinear predictors. We apply, for the first time, CA to the functional connectome to investigate the unique and common neural connectivity underlying the interface of the symptom domains in 74 non-demented PD subjects. Edges were modeled as a function of global motor, cognitive, and neuropsychiatric scores. CA was performed, yielding measures of the unique and common contribution of the symptom domains. Bootstrap confidence intervals were used to determine the precision of the estimates and to directly compare each commonality coefficient. The overall model identified a network with the caudate nucleus as a hub. Neuropsychiatric impairment accounted for connectivity in the caudate-dorsal anterior cingulate and caudate-right dorsolateral prefrontal-right inferior parietal circuits, while caudate-medial prefrontal connectivity reflected a unique effect of both neuropsychiatric and cognitive impairment. Caudate-precuneus connectivity was explained by both unique and shared influence of neuropsychiatric and cognitive symptoms. Lastly, posterior cortical connectivity reflected an interplay of the unique and common effects of each symptom domain. We show that CA can determine the amount of variance in the connectome that is unique and shared amongst motor, neuropsychiatric, and cognitive symptoms in PD, thereby improving our ability to interpret the data while gaining novel insight into networks at the interface of these symptom domains.
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Affiliation(s)
- Stefan Lang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Center for Brain and Mental Health Research, University of Calgary, Calgary, Alberta, Canada
| | - Mekale Kibreab
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Iris Kathol
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Justyna Sarna
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Oury Monchi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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Rahayel S, Gaubert M, Postuma RB, Montplaisir J, Carrier J, Monchi O, Rémillard-Pelchat D, Bourgouin PA, Panisset M, Chouinard S, Joubert S, Gagnon JF. Brain atrophy in Parkinson's disease with polysomnography-confirmed REM sleep behavior disorder. Sleep 2020; 42:5373066. [PMID: 30854555 DOI: 10.1093/sleep/zsz062] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 11/06/2018] [Accepted: 01/20/2019] [Indexed: 12/16/2022] Open
Abstract
We aimed to investigate cortical and subcortical brain alterations in people with Parkinson's disease with polysomnography-confirmed rapid eye movement (REM) sleep behavior disorder (RBD). Thirty people with Parkinson's disease, including 15 people with RBD, were recruited and compared with 41 healthy controls. Surface-based cortical and subcortical analyses were performed on T1-weighted images to investigate thickness and shape abnormalities between groups, and voxel-based and deformation-based morphometry were performed to investigate local volume. Correlations were performed in patients to investigate the structural correlates of motor activity during REM sleep. People with RBD showed cortical thinning in the right perisylvian and inferior temporal cortices and shape contraction in the putamen compared with people without RBD. Compared with controls, people with RBD had extensive cortical thinning and volume loss, brainstem volume was reduced, and shape contraction was found in the basal ganglia and hippocampus. In comparison to controls, people without RBD showed more restricted thinning in the sensorimotor, parietal, and occipital cortices, reduced volume in the brainstem, temporal and more posterior areas, and shape contraction in the pallidum and hippocampus. In Parkinson's disease, higher tonic and phasic REM sleep motor activity was associated with contraction of the thalamic surface, extensive cortical thinning, and subtle volume reduction in the middle temporal gyrus. In Parkinson's disease, the presence of RBD is associated with extensive cortical and subcortical abnormalities, suggesting more severe neurodegeneration in people with RBD. This provides potential neuroanatomical correlates for the more severe clinical phenotype reported in people with Parkinson's disease with RBD.
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Affiliation(s)
- Shady Rahayel
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Canada
| | - Malo Gaubert
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Neurology, Montreal General Hospital, Montreal, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Canada
| | - Julie Carrier
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Oury Monchi
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Canada.,Department of Radiology, Radio-Oncology, and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Departments of Clinical Neurosciences, Radiology, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - David Rémillard-Pelchat
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Pierre-Alexandre Bourgouin
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Michel Panisset
- Unité des troubles du mouvement André-Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Sylvain Chouinard
- Unité des troubles du mouvement André-Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Sven Joubert
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Canada
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Lang S, Yoon EJ, Kibreab M, Kathol I, Cheetham J, Hammer T, Sarna J, Ismail Z, Monchi O. Mild behavioral impairment in Parkinson's disease is associated with altered corticostriatal connectivity. Neuroimage Clin 2020; 26:102252. [PMID: 32279019 PMCID: PMC7152681 DOI: 10.1016/j.nicl.2020.102252] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/03/2020] [Accepted: 03/20/2020] [Indexed: 12/27/2022]
Abstract
Mild behavioral impairment in PD is linked to altered corticostriatal connectivity. PD-MBI have less connectivity between the striatum and the DMN. PD-MBI have increased atrophy of the SAN. Caudate head and dorsal putamen connectivity is related to MBI-C scores in PD. Caudate head-precuneus connectivity is linked to both MBI and MoCA scores.
Background Mild behavioral impairment (MBI) is a syndrome characterized by later life onset, sustained neuropsychiatric symptoms as a marker of dementia risk. In Parkinson's disease (PD), MBI has been associated with worse cognitive abilities and increased cortical atrophy. However, the circuit level correlates of MBI have not been investigated in this population. Our objective was to investigate the relationship between MBI and corticostriatal connectivity in PD patients. This emphasis on corticostriatal connectivity was due to the significant role of these circuits in neuropsychiatric and cognitive symptoms across disease conditions. Methods Seventy-four non-demented patients with PD were administered the MBI-checklist, and classified as having high MBI (PD-MBI; n = 21) or low MBI scores (PD-noMBI; n = 53). Corticostriatal connectivity was assessed with both an atlas and seed-based analysis. The atlas analysis consisted of calculating the average connectivity between the striatal network and the default mode (DMN), central executive (CEN), and saliency networks (SAN). Structural measurements of cortical thickness and volume were also assessed. PD-MBI and PD-noMBI patients were compared, along with a group of age matched healthy control subjects (HC; n = 28). Subsequently, a seed analysis assessed the relationship of MBI scores with the connectivity of twelve seeds within the striatum while controlling for cognitive ability. A complementary analysis assessed the relationship between striatal connectivity and cognition, while controlling for MBI-C. Results PD-MBI demonstrated decreased connectivity between the striatum and both the DMN and SAN compared to PD-noMBI and HC. The decreased connectivity between the striatum and the SAN was explained partly by increased atrophy within the SAN in PD-MBI. The seed analysis revealed a relationship between higher MBI scores and lower connectivity of the left caudate head to the dorsal anterior cingulate cortex and left middle frontal gyrus. Higher MBI-C scores were also related to decreased connectivity of the right caudate head with the anterior cingulate cortex, precuneus, and left supramarginal gyrus, as well as increased connectivity to the left hippocampus and right cerebellar hemisphere. Caudate-precuneus connectivity was independently associated with both global behavioural and cognitive scores. Conclusion These results suggest PD-MBI is associated with altered corticostriatal connectivity, particularly between the head of the caudate and cortical regions associated with the DMN and SAN. In particular, caudate-precuneus connectivity is associated with both global behavioral and cognitive symptoms in PD.
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Affiliation(s)
- Stefan Lang
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Eun Jin Yoon
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mekale Kibreab
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Iris Kathol
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jenelle Cheetham
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tracy Hammer
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Justyna Sarna
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada; Mathison Center for Brain and Mental Health Research, University of Calgary, Calgary, Canada
| | - Oury Monchi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada.
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Joyce JM, Monchi O, Ismail Z, Kibreab M, Cheetham J, Kathol I, Sarna J, Martino D, Debert CT. The impact of traumatic brain injury on cognitive and neuropsychiatric symptoms of Parkinson's disease. Int Rev Psychiatry 2020; 32:46-60. [PMID: 31631720 DOI: 10.1080/09540261.2019.1656177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective was to determine whether a history of traumatic brain injury (TBI) was associated with Parkinson's Disease (PD) and specific cognitive, motor, and neuropsychiatric symptoms. A cross-sectional cohort study of 120 participants aged 60-85 years old (48 females) were recruited (69 PD and 51 healthy controls). Assessments included demographic information, neuropsychological tests, a motor evaluation, neuropsychiatric questionnaires, and the Brain Injury Screening Questionnaire. A history of TBI or number of TBIs was not significantly related to an increased risk of developing PD or poorer motor scores on the United Parkinson Disease Rating Scale part 3. There was a significant negative correlation between number of TBI's and mean z-scores of global cognition (rs(69) = -0.338, p = 0.004), executive function (rs(69) = -0.251, p = 0.038), memory (rs(69) = -0.262, p = 0.029), and language (rs(69) = -0.245, p = 0.042), and a significant positive correlation on the Beck Depression Inventory II (rs(69) = 0.285, p = 0.018) and the Patient Health Questionnaire-9 (PHQ-9) (rs(69) = 0.326, p = 0.006) in the PD group only. In conclusion, a history of TBI was negatively associated with cognition and positively associated with depressive symptoms in patients with PD, but not with motor symptoms.
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Affiliation(s)
- Julie M Joyce
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Community Health Science, University of Calgary, Calgary, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Jenelle Cheetham
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Iris Kathol
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Justyna Sarna
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada.,Department of Kinesiology, University of Calgary, Calgary, Canada
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Auclair-Ouellet N, Mandl S, Kibreab M, Haffenden A, Hanganu A, Cheetham J, Kathol I, Sarna J, Martino D, Monchi O. Characterization of cognition in mild cognitive impairment with and without Parkinson's disease. Clin Park Relat Disord 2020; 3:100034. [PMID: 34316620 PMCID: PMC8298772 DOI: 10.1016/j.prdoa.2020.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
Screening tests can diagnose PD-MCI but do not give detailed cognitive profiles. Criteria based on a complete neuropsychological battery identify more PD patients with MCI. The overall cognitive profile is similar in PD-MCI and MCI. Neuropsychological batteries and definition of impairment cut-offs should be refined.
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Affiliation(s)
- N Auclair-Ouellet
- School of Communication Sciences and Disorders, Faculty of Medicine, McGill University, Montreal, Canada.,Centre for Research on Brain, Language and Music, Montreal, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada
| | - S Mandl
- Centre for Research on Brain, Language and Music, Montreal, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada.,Cognitive Science Program, Faculty of Arts and Faculty of Science, McGill University, Montreal, Canada
| | - M Kibreab
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A Haffenden
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A Hanganu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada.,Département de Psychologie, Faculté des Arts et des Sciences, Université de Montréal, Montreal, Canada
| | - J Cheetham
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - I Kathol
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - J Sarna
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - D Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - O Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.,Département de Radiologie, Faculté de Médecine, Université de Montréal, Montreal, Canada
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43
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Naude JP, Gill S, Hu S, McGirr A, Forkert ND, Monchi O, Stys PK, Smith EE, Ismail Z. Plasma Neurofilament Light: A Marker of Neurodegeneration in Mild Behavioral Impairment. J Alzheimers Dis 2020; 76:1017-1027. [PMID: 32597801 PMCID: PMC7504997 DOI: 10.3233/jad-200011] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessing neuropsychiatric symptoms (NPS) in older adults is important for determining dementia risk. Mild behavioral impairment (MBI) is an at-risk state for cognitive decline and dementia, characterized by emergent NPS in later life. MBI has significantly higher dementia incidence than late life psychiatric conditions. However, its utility as a proxy for neurodegeneration has not been demonstrated. Plasma neurofilament light (NfL) is a validated biomarker of axonal damage, and has been shown to associate with hallmarks of neurodegeneration. OBJECTIVE The purpose of this investigation was to identify associations between NfL rate of change and the presence of MBI symptomatology. METHODS We evaluated the association of MBI with changes in NfL in a cohort (n = 584; MBI + n = 190, MBI- n = 394) of non-demented participants from the Alzheimer's Disease Neuroimaging Initiative. MBI was determined by transforming Neuropsychiatric Inventory Questionnaire items using a published algorithm. Change in NfL was calculated over 2 years. RESULTS Time*MBI status was the only significant interaction to predict change in NfL concentrations (F(1,574) = 4.59, p = 0.032), even after controlling for age, mild cognitive impairment, and demographics. Analyses reclassifying 64 participants with new onset MBI over 2 years similarly demonstrated greater increases in NfL (F(1,574) = 5.82, p = 0.016). CONCLUSION These findings suggest MBI is a clinical proxy of early phase neurodegeneration with putative utility in identifying those at dementia risk. MBI can be used as a case ascertainment approach to capture those at high risk for cognitive decline and dementia, and is an important construct for clinicians dealing with cognitive and neuropsychiatric symptomatology in older adults.
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Affiliation(s)
- James P. Naude
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sascha Gill
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Hu
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Science, University of Calgary, Calgary, Alberta, Canada
| | - Alexander McGirr
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Nils D. Forkert
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Peter K. Stys
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric E. Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Science, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary
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44
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Pontone GM, Dissanayaka N, Apostolova L, Brown RG, Dobkin R, Dujardin K, Friedman JH, Leentjens AFG, Lenze EJ, Marsh L, Mari L, Monchi O, Richard IH, Schrag A, Strafella AP, Vernaleo B, Weintraub D, Mari Z. Report from a multidisciplinary meeting on anxiety as a non-motor manifestation of Parkinson's disease. NPJ Parkinsons Dis 2019; 5:30. [PMID: 31840044 PMCID: PMC6906437 DOI: 10.1038/s41531-019-0102-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Anxiety is a severe problem for at least one-third of people living with Parkinson's disease (PD). Anxiety appears to have a greater adverse impact on quality of life than motor impairment. Despite its high prevalence and impact on daily life, anxiety is often undiagnosed and untreated. To better address anxiety in PD, future research must improve knowledge about the mechanism of anxiety in PD and address the lack of empirical evidence from clinical trials. In response to these challenges, the Parkinson's Foundation sponsored an expert meeting on anxiety on June 13th and 14th 2018. This paper summarizes the findings from that meeting informed by a review of the existing literature and discussions among patients, caregivers, and an international, clinician-scientist, expert panel working group. The goal is to provide recommendations to improve our understanding and treatment of anxiety in PD.
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Affiliation(s)
- Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Woman’s Hospital, Brisbane, Australia
| | - Liana Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Richard G. Brown
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders, Lille University Medical Center, Lille, France
| | - Joseph H. Friedman
- Movement Disorders Program, Butler Hospital; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX USA
- Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - Lynda Mari
- Person Holistic Innovation, Las Vegas, NV USA
| | - Oury Monchi
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Irene H. Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH; University of Toronto, Ontario, Canada
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Movement Disorders Program, Las Vegas, NV USA
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van Eimeren T, Antonini A, Berg D, Bohnen N, Ceravolo R, Drzezga A, Höglinger GU, Higuchi M, Lehericy S, Lewis S, Monchi O, Nestor P, Ondrus M, Pavese N, Peralta MC, Piccini P, Pineda-Pardo JÁ, Rektorová I, Rodríguez-Oroz M, Rominger A, Seppi K, Stoessl AJ, Tessitore A, Thobois S, Kaasinen V, Wenning G, Siebner HR, Strafella AP, Rowe JB. Neuroimaging biomarkers for clinical trials in atypical parkinsonian disorders: Proposal for a Neuroimaging Biomarker Utility System. Alzheimers Dement (Amst) 2019; 11:301-309. [PMID: 30984816 PMCID: PMC6446052 DOI: 10.1016/j.dadm.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Therapeutic strategies targeting protein aggregations are ready for clinical trials in atypical parkinsonian disorders. Therefore, there is an urgent need for neuroimaging biomarkers to help with the early detection of neurodegenerative processes, the early differentiation of the underlying pathology, and the objective assessment of disease progression. However, there currently is not yet a consensus in the field on how to describe utility of biomarkers for clinical trials in atypical parkinsonian disorders. METHODS To promote standardized use of neuroimaging biomarkers for clinical trials, we aimed to develop a conceptual framework to characterize in more detail the kind of neuroimaging biomarkers needed in atypical parkinsonian disorders, identify the current challenges in ascribing utility of these biomarkers, and propose criteria for a system that may guide future studies. RESULTS As a consensus outcome, we describe the main challenges in ascribing utility of neuroimaging biomarkers in atypical parkinsonian disorders, and we propose a conceptual framework that includes a graded system for the description of utility of a specific neuroimaging measure. We included separate categories for the ability to accurately identify an intention-to-treat patient population early in the disease (Early), to accurately detect a specific underlying pathology (Specific), and the ability to monitor disease progression (Progression). DISCUSSION We suggest that the advancement of standardized neuroimaging in the field of atypical parkinsonian disorders will be furthered by a well-defined reference frame for the utility of biomarkers. The proposed utility system allows a detailed and graded description of the respective strengths of neuroimaging biomarkers in the currently most relevant areas of application in clinical trials.
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Affiliation(s)
- Thilo van Eimeren
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Berg
- Department of Neurology, UKSH, Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - Nico Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, and VAMC, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- VAMC, Ann Arbor, MI, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alexander Drzezga
- Multimodal Neuroimaging, Department of Nuclear Medicine, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Forschungszentrum Jülich, INM-2, Jülich, Germany
| | - Günter U. Höglinger
- German Centre for Neurodegenerative Diseases (DZNE), and Technical University Munich, Department of Neurology, Munich, Germany
| | - Makoto Higuchi
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Stephane Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, ICM Team “Movement Investigations and Therapeutics”, Sorbonne Universités, Inserm U1127, CNRS UMR, Paris, France
| | - Simon Lewis
- Brain & Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
- Mater Hospital, South Brisbane, QLD, Australia
| | - Matej Ondrus
- AXON Neuroscience CRM Services SE, Bratislava, Slovak Republic
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - María Cecilia Peralta
- Center for Medical Education and Clinical Research, Section of Neurology, Buenos Aires, Argentina
| | - Paola Piccini
- Department of Medicine, Imperial College London, London, United Kingdom
| | - José Ángel Pineda-Pardo
- hmCINAC, University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Irena Rektorová
- First Department of Neurology – Faculty of Medicine and CEITEC MU, Masaryk University, Brno, Czech Republic
| | | | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, Canada
| | - Alessandro Tessitore
- Department of Medical, Surgery, Neurological, Metabolic and Aging Sciences, University of Campania, “L. Vanvitelli”, Caserta CE, Italy
| | - Stephane Thobois
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Medecine Lyon Sud Charles Merieux, Lyon, France
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C, Lyon, France
- CNRS, Institut des Sciences Cognitives, Bron, France
| | - Valtteri Kaasinen
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Gregor Wenning
- Division of Clinical Neurology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hartwig R. Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN, Toronto, Ontario, Canada
- Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Stilling J, Paxman E, Mercier L, Gan LS, Wang M, Amoozegar F, Dukelow SP, Monchi O, Debert C. Treatment of Persistent Post-Traumatic Headache and Post-Concussion Symptoms Using Repetitive Transcranial Magnetic Stimulation: A Pilot, Double-Blind, Randomized Controlled Trial. J Neurotrauma 2019; 37:312-323. [PMID: 31530227 DOI: 10.1089/neu.2019.6692] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Persistent post-traumatic headache (PTH) after mild traumatic brain injury is one of the most prominent and highly reported persistent post-concussion symptoms (PPCS). Non-pharmacological treatments, including non-invasive neurostimulation technologies, have been proposed for use. Our objective was to evaluate headache characteristics at 1 month after repetitive transcranial magnetic stimulation (rTMS) treatment in participants with PTH and PPCS. A double-blind, randomized, sham-controlled, pilot clinical trial was performed on 20 participants (18-65 years) with persistent PTH (International Classification of Headache Disorders, 3rd edition) and PPCS (International Classification of Diseases, Tenth Revision). Ten sessions of rTMS therapy (10 Hz, 600 pulses, 70% resting motor threshold amplitude) were delivered to the left dorsolateral pre-frontal cortex. The primary outcome was a change in headache frequency or severity at 1 month post-rTMS. Two-week-long daily headache diaries and clinical questionnaires assessing function, PPCS, cognition, quality of life, and mood were completed at baseline, post-treatment, and at 1, 3, and 6 months post-rTMS. A two-way (treatment × time) mixed analyisis of variance indicated a significant overall time effect for average headache severity (F(3,54) = 3.214; p = 0.03) and a reduction in headache frequency at 1 month post-treatment (#/2 weeks, REAL -5.2 [standard deviation {SD} = 5.8]; SHAM, -3.3 [SD = 7.7]). Secondary outcomes revealed an overall time interaction for headache impact, depression, post-concussion symptoms, and quality of life. There was a significant reduction in depression rating in the REAL group between baseline and 1 month post-treatment, with no change in the SHAM group (Personal Health Questionnaire-9; REAL, -4.3 [SD = 3.7[ p = 0.020]; SHAM, -0.7 [SD = 4.7; p = 1.0]; Bonferroni corrected). In the REAL group, 60% returned to work whereas only 10% returned in the SHAM group (p = 0.027). This pilot study demonstrates an overall time effect on headache severity, functional impact, depression, PPCS, and quality of life after rTMS treatment in participants with persistent PTH; however, findings were below clinical significance thresholds. There was a 100% response rate, no dropouts, and minimal adverse effects, warranting a larger phase II study. Clinicaltrials.gov: NCT03691272.
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Affiliation(s)
- Joan Stilling
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Eric Paxman
- University of Calgary, Calgary, Alberta, Canada.,University of Alberta, Department of Medicine, Edmonton, Alberta, Canada
| | - Leah Mercier
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Liu Shi Gan
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Meng Wang
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Farnaz Amoozegar
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean P Dukelow
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Oury Monchi
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Chantel Debert
- University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Alberta, Canada
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Yoon EJ, Ismail Z, Hanganu A, Kibreab M, Hammer T, Cheetham J, Kathol I, Sarna JR, Martino D, Furtado S, Monchi O. Mild behavioral impairment is linked to worse cognition and brain atrophy in Parkinson disease. Neurology 2019; 93:e766-e777. [PMID: 31320470 DOI: 10.1212/wnl.0000000000007968] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the associations of mild behavioral impairment (MBI) with cognitive deficits and patterns of gray matter changes in Parkinson disease (PD). METHODS Sixty patients with PD without dementia and 29 healthy controls underwent a cognitive neuropsychological evaluation and structural MRI scan. MBI was evaluated with the MBI Checklist (MBI-C), a rating scale designed to elicit emergent neuropsychiatric symptoms in accordance with MBI criteria. We divided the patients with PD into 2 groups: 1 group with high MBI-C scores (PD-MBI) and the other with low MBI-C scores (PD-noMBI). RESULTS Among 60 patients with PD, 20 were categorized as having PD-MBI (33.33%). In healthy controls, no participants met the MBI cut-point threshold. The PD-MBI group had significantly lower Montreal Cognitive Assessment and z scores in all 5 domains and the global score compared to healthy controls and those with PD-noMBI. In addition, all cognitive domains except language and global cognition negatively correlated with the MBI-C total score in all patients with PD. For cortical structures, the PD-MBI group revealed middle temporal cortex thinning and decreased volume compared with the PD-noMBI group, and decreased volume in this area negatively correlated with the MBI-C total score. CONCLUSIONS The impaired cognitive function over all domains and atrophy in the temporal area in the PD-MBI group are in line with posterior cortical circuit deficits in PD, which have been associated with a faster rate of progression to dementia. These initial results suggest that MBI might be an early and important marker for incident cognitive decline and dementia in patients with PD.
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Affiliation(s)
- Eun Jin Yoon
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Zahinoor Ismail
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Alexandru Hanganu
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Mekale Kibreab
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Tracy Hammer
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Jenelle Cheetham
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Iris Kathol
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Justyna R Sarna
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Davide Martino
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Sarah Furtado
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada
| | - Oury Monchi
- From the Department of Clinical Neurosciences (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.) and Departments of Psychiatry and Community Health Sciences (Z.I.), University of Calgary; Hotchkiss Brain Institute (E.J.Y., Z.I., A.H., M.K., T.H., J.C., I.K., J.R.S., D.M., S.F., O.M.), Cumming School of Medicine, Calgary, Alberta; Centre de Recherche (A.H., O.M.), Institut Universitaire de Gériatrie de Montréal; and Department of Psychology (A.H.), University of Montréal, Québec, Canada.
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Trung J, Hanganu A, Jobert S, Degroot C, Mejia-Constain B, Kibreab M, Bruneau MA, Lafontaine AL, Strafella A, Monchi O. Transcranial magnetic stimulation improves cognition over time in Parkinson's disease. Parkinsonism Relat Disord 2019; 66:3-8. [PMID: 31300260 DOI: 10.1016/j.parkreldis.2019.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/19/2019] [Accepted: 07/06/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cognitive impairment can occur in the early phase of Parkinson's disease and increases the risk of developing dementia. Cognitive deficits were shown to be associated with functional alterations in the dorsolateral prefrontal cortex (DLPFC) and caudate nucleus. Two previous transcranial magnetic stimulation studies over the left DLPFC showed short-term improvement in cognitive performance and focused on specific task. METHODS 28 patients with idiopathic Parkinson's disease and mild cognitive impairment received intermittent "theta burst" stimulation (iTBS) (active, N = 14; or sham, N = 14) over the left DLPFC, twice a day for three days with 1-2 days in between. Detailed neuropsychological assessment of five cognitive domains was performed before iTBS and on days 1, 10, and 30 after the last iTBS session. Composite Z-scores were calculated for each domain and for overall cognition. RESULTS Our results showed an increase in overall cognition up to one month in both groups but this effect was only significant in the active group. Improvements were seen in the attention domain for both groups and in the visuospatial domain in the active group only. No significant differences were found between the groups. CONCLUSION These preliminary findings suggest that active iTBS might improve overall cognitive performance in patients with Parkinson's disease with mild cognitive impairment and that this effect can last up to one month. This cognitive improvement, is likely mediated by improvement on visuospatial abilities. Further studies are needed to explore the potential of iTBS as a therapeutical tool to slow cognitive decline in patients with Parkinson's disease.
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Affiliation(s)
- Jessica Trung
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Alexandru Hanganu
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Stevan Jobert
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Clotilde Degroot
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; McGill University, Montreal, QC, Canada
| | - Beatriz Mejia-Constain
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Marie-Andrée Bruneau
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | | | - Antonio Strafella
- Department of Medicine, Division of Neurology, University of Toronto, ON, Canada
| | - Oury Monchi
- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada; McGill University, Montreal, QC, Canada.
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Bourgouin PA, Rahayel S, Gaubert M, Postuma RB, Montplaisir J, Carrier J, Monchi O, Pelletier A, Gagnon JF. Gray matter substrates of depressive and anxiety symptoms in idiopathic REM sleep behavior disorder. Parkinsonism Relat Disord 2019; 62:163-170. [DOI: 10.1016/j.parkreldis.2018.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/21/2018] [Accepted: 12/16/2018] [Indexed: 12/14/2022]
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Goubault E, Nguyen HP, Bogard S, Blanchet PJ, Bézard E, Vincent C, Sarna J, Monchi O, Duval C. Remnants of Cardinal Symptoms of Parkinson's Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living. Front Neurol 2019; 10:256. [PMID: 30967832 PMCID: PMC6440171 DOI: 10.3389/fneur.2019.00256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/21/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. This cross-sectional study aimed at determining the effect of LID and cardinal motor symptoms of PD on ADL in patients who were experiencing peak-dose choreic-type LID. Method: One hundred and twenty-one patients diagnosed with PD known to experience choreic-type LID were recruited for the study. Patients were asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing of gait (FoG) were measured using 17 inertial sensors design to capture full body movements, while rigidity, and postural instability were assessed using clinical evaluations. Cognition was also assessed using the mini-mental state examination. Success criteria were set for each ADL using the time needed to perform the task and errors measured in 69 age-gender-matched healthy controls. Binary logistic regressions were used to identify symptoms influencing success or failure for each activity. Receiver operating characteristic curves were computed on each significant symptom, and Youden indexes were calculated to determine the critical level of symptomatology at which the performance significantly changed. Results: Results show that 97.7% of patients who presented with LID during the experiment also presented with at least one cardinal motor symptom. On average, patients took more time and did more errors during ADL. Multivariate analyses revealed that for the great majority of ADL, LID were not associated with worsening of performance; however, postural instability, tremor, rigidity, and cognitive decline significantly decreased the odds of success. Conclusions: Residual symptoms of PD, such as tremor, rigidity, and postural instability still present at peak-dose were more problematic than LID in the performance of ADL for patients experiencing slight-to-moderate LID. We also found that cognitive decline was associated with decreased performance in certain tasks. Therefore, a strategy using lower doses of medication to manage LID may be counterproductive since it would not address most of these symptoms already present in patients.
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Affiliation(s)
- Etienne Goubault
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Hung P Nguyen
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Sarah Bogard
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Pierre J Blanchet
- Département de Stomatologie, Faculté de Médecine Dentaire, Université de Montréal, Montréal, QC, Canada.,Département de Médecine, CHU Montréal, Montréal, QC, Canada
| | - Erwan Bézard
- Laboratoire de Neurophysiologie, Université de Bordeaux, Institut des Maladies Neurodégénératives, Bordeaux, France.,Unité Mixte de Recherche 5293, Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Claude Vincent
- Département de Réadaptation, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Justyna Sarna
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Christian Duval
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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