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Dobreva I, Thomas J, Marr A, O'Connell R, Roche M, Hannaway N, Dore C, Rose S, Liu K, Bhome R, Baldwin-Jones S, Roberts J, Archibald N, Alston D, Amar K, Edwards E, Foley JA, Haunton VJ, Henderson EJ, Jha A, Lindop F, Magee C, Massey L, Ruiz-Mendoza E, Mohamed B, Patterson K, Ramaswamy B, Schrag A, Silverdale M, Suárez-González A, Subramanian I, Foltynie T, Williams-Gray CH, Yarnall AJ, Carroll C, Bale C, Hugill C, Weil RS. Improving Conversations about Parkinson's Dementia. Mov Disord Clin Pract 2024. [PMID: 38696333 DOI: 10.1002/mdc3.14054] [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: 11/17/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia. OBJECTIVES To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia. METHODS We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources. RESULTS While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals. CONCLUSION Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia.
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Affiliation(s)
- Ivelina Dobreva
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Joanne Thomas
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Anne Marr
- Central Saint Martins, University of the Arts, London, United Kingdom
| | | | - Moïse Roche
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naomi Hannaway
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Charlotte Dore
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Sian Rose
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Ken Liu
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Rohan Bhome
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | | | | | - Neil Archibald
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | - Khaled Amar
- Royal Bournemouth Hospital, NHS Foundation Trust, Bournemouth, United Kingdom
| | | | - Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
| | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Older People's Unit, Royal United Hospitals NHS Foundation Trust, Bath, United Kingdom
| | - Ashwani Jha
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
| | - Fiona Lindop
- Parkinson's UK, London, United Kingdom
- Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
| | - Cathy Magee
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Luke Massey
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Eladia Ruiz-Mendoza
- North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom
| | - Biju Mohamed
- University Hospital of Wales, Cardiff, United Kingdom
| | - Katherine Patterson
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Bhanu Ramaswamy
- Parkinson's UK, London, United Kingdom
- Sheffield Hallam University, Sheffield, United Kingdom
| | - Anette Schrag
- Department of Clinical Neuroscience, Institute of Neurology, UCL, London, United Kingdom
| | - Monty Silverdale
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Aida Suárez-González
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, California, USA
| | - Tom Foltynie
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Caroline H Williams-Gray
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Drake Circus, Plymouth, United Kingdom
| | | | | | - Rimona S Weil
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Bhome R, Verdi S, Martin SA, Hannaway N, Dobreva I, Oxtoby NP, Castro Leal G, Rutherford S, Marquand AF, Weil RS, Cole JH. A neuroimaging measure to capture heterogeneous patterns of atrophy in Parkinson's disease and dementia with Lewy bodies. Neuroimage Clin 2024; 42:103596. [PMID: 38554485 PMCID: PMC10995913 DOI: 10.1016/j.nicl.2024.103596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Parkinson's disease (PD) and Dementia with Lewy bodies (DLB) show heterogeneous brain atrophy patterns which group-average analyses fail to capture. Neuroanatomical normative modelling overcomes this by comparing individuals to a large reference cohort. Patient-specific atrophy patterns are measured objectively and summarised to index overall neurodegeneration (the 'total outlier count'). We aimed to quantify patterns of neurodegenerative dissimilarity in participants with PD and DLB and evaluate the potential clinical relevance of total outlier count by testing its association with key clinical measures in PD and DLB. MATERIALS AND METHODS We included 108 participants with PD and 61 with DLB. PD participants were subclassified into high and low visual performers as this has previously been shown to stratify those at increased dementia risk. We generated z-scores from T1w-MRI scans for each participant relative to normative regional cortical thickness and subcortical volumes, modelled in a reference cohort (n = 58,836). Outliers (z < -1.96) were aggregated across 169 brain regions per participant. To measure dissimilarity, individuals' Hamming distance scores were calculated. We also examined total outlier counts between high versus low visual performance in PD; and PD versus DLB; and tested associations between these and cognition. RESULTS There was significantly greater inter-individual dissimilarity in brain-outlier patterns in PD poor compared to high visual performers (W = 522.5; p < 0.01) and in DLB compared to PD (W = 5649; p < 0.01). PD poor visual performers had significantly greater total outlier counts compared to high (β = -4.73 (SE = 1.30); t = -3.64; p < 0.01) whereas a conventional group-level GLM failed to identify differences. Higher total outlier counts were associated with poorer MoCA (β = -0.55 (SE = 0.27), t = -2.04, p = 0.05) and composite cognitive scores (β = -2.01 (SE = 0.79); t = -2.54; p = 0.02) in DLB, and visuoperception (β = -0.67 (SE = 0.19); t = -3.59; p < 0.01), in PD. CONCLUSIONS Neuroanatomical normative modelling shows promise as a clinically informative technique in PD and DLB, where patterns of atrophy are variable.
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Affiliation(s)
- R Bhome
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, United Kingdom; UCL Centre for Medical Image Computing, Department of Computer Science, University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - S Verdi
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, United Kingdom; UCL Centre for Medical Image Computing, Department of Computer Science, University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - S A Martin
- UCL Centre for Medical Image Computing, Department of Computer Science, University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - N Hannaway
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, United Kingdom
| | - I Dobreva
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, United Kingdom
| | - N P Oxtoby
- UCL Centre for Medical Image Computing, Department of Computer Science, University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - G Castro Leal
- UCL Centre for Medical Image Computing, Department of Computer Science, University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - S Rutherford
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Radboud University Medical Center, Kapittelweg 29, 6525 EN Nijmegen, the Netherlands; Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - A F Marquand
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Radboud University Medical Center, Kapittelweg 29, 6525 EN Nijmegen, the Netherlands
| | - R S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, United Kingdom; Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom
| | - J H Cole
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, United Kingdom; UCL Centre for Medical Image Computing, Department of Computer Science, University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
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Thomas GEC, Hannaway N, Zarkali A, Shmueli K, Weil RS. Longitudinal Associations of Magnetic Susceptibility with Clinical Severity in Parkinson's Disease. Mov Disord 2024; 39:546-559. [PMID: 38173297 DOI: 10.1002/mds.29702] [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: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Dementia is common in Parkinson's disease (PD), but there is wide variation in its timing. A critical gap in PD research is the lack of quantifiable markers of progression, and methods to identify early stages of dementia. Atrophy-based magnetic resonance imaging (MRI) has limited sensitivity in detecting or tracking changes relating to PD dementia, but quantitative susceptibility mapping (QSM), sensitive to brain tissue iron, shows potential for these purposes. OBJECTIVE The objective of the paper is to study, for the first time, the longitudinal relationship between cognition and QSM in PD in detail. METHODS We present a longitudinal study of clinical severity in PD using QSM, including 59 PD patients (without dementia at study onset), and 22 controls over 3 years. RESULTS In PD, increased baseline susceptibility in the right temporal cortex, nucleus basalis of Meynert, and putamen was associated with greater cognitive severity after 3 years; and increased baseline susceptibility in basal ganglia, substantia nigra, red nucleus, insular cortex, and dentate nucleus was associated with greater motor severity after 3 years. Increased follow-up susceptibility in these regions was associated with increased follow-up cognitive and motor severity, with further involvement of hippocampus relating to cognitive severity. However, there were no consistent increases in susceptibility over 3 years. CONCLUSIONS Our study suggests that QSM may predict changes in cognitive severity many months prior to overt cognitive involvement in PD. However, we did not find robust longitudinal changes in QSM over the course of the study. Additional tissue metrics may be required together with QSM for it to monitor progression in clinical practice and therapeutic trials. © 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)
| | - Naomi Hannaway
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Angelika Zarkali
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Rimona S Weil
- Dementia Research Centre, UCL Institute of Neurology, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Movement Disorders Consortium, University College London, London, UK
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Tunnicliffe L, Weil RS, Breuer J, Rodriguez-Barradas MC, Smeeth L, Rentsch CT, Warren-Gash C. Herpes Zoster and Risk of Incident Parkinson's Disease in US Veterans: A Matched Cohort Study. Mov Disord 2024; 39:438-444. [PMID: 38226430 PMCID: PMC10922272 DOI: 10.1002/mds.29701] [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: 07/14/2023] [Revised: 11/13/2023] [Accepted: 12/11/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Although some systemic infections are associated with Parkinson's disease (PD), the relationship between herpes zoster (HZ) and PD is unclear. OBJECTIVE The objective is to investigate whether HZ is associated with incident PD risk in a matched cohort study using data from the US Department of Veterans Affairs. METHODS We compared the risk of PD between individuals with incident HZ matched to up to five individuals without a history of HZ using Cox proportional hazards regression. In sensitivity analyses, we excluded early outcomes. RESULTS Among 198,099 individuals with HZ and 976,660 matched individuals without HZ (median age 67.0 years (interquartile range [IQR 61.4-75.7]); 94% male; median follow-up 4.2 years [IQR 1.9-6.6]), HZ was not associated with an increased risk of incident PD overall (adjusted HR 0.95, 95% CI 0.90-1.01) or in any sensitivity analyses. CONCLUSION We found no evidence that HZ was associated with increased risk of incident PD in this cohort. © 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)
- Louis Tunnicliffe
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Rimona S. Weil
- Institute of Neurology, University College London, London, UK
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases Section, Department of Medicine, Michael E. DeBakey VAMC, Baylor College of Medicine, Houston, TX, US
| | - Liam Smeeth
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Christopher T. Rentsch
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
- VA Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, US
| | - Charlotte Warren-Gash
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
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5
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Gonzalez-Robles C, Bartlett M, Burnell M, Clarke CS, Haar S, Hu MT, Huxford B, Jha A, Lawton M, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, van Wamelen D, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Weil RS, Schrag A. Embedding Patient Input in Outcome Measures for Long-Term Disease-Modifying Parkinson Disease Trials. Mov Disord 2024; 39:433-438. [PMID: 38140767 DOI: 10.1002/mds.29691] [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: 06/22/2023] [Revised: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Clinical trials of disease-modifying therapies in PD require valid and responsive primary outcome measures that are relevant to patients. OBJECTIVES The objective is to select a patient-centered primary outcome measure for disease-modification trials over three or more years. METHODS Experts in Parkinson's disease (PD), statistics, and health economics and patient and public involvement and engagement (PPIE) representatives reviewed and discussed potential outcome measures. A larger PPIE group provided input on their key considerations for such an endpoint. Feasibility, clinimetric properties, and relevance to patients were assessed and synthesized. RESULTS Although initial considerations favored the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in Off, feasibility, PPIE input, and clinimetric properties supported the MDS-UPDRS Part II. However, PPIE input also highlighted the importance of nonmotor symptoms, especially in the longer term, leading to the selection of the MDS-UPDRS Parts I + II sum score. CONCLUSIONS The MDS-UPDRS Parts I + II sum score was chosen as the primary outcome for large 3-year disease-modification trials. © 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)
- Cristina Gonzalez-Robles
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Caroline S Clarke
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Shlomi Haar
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Brook Huxford
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Ashwani Jha
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Lynn Rochester
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
| | - Carroll Siu
- Expert by experience, Canterbury, United Kingdom
| | - Daniel van Wamelen
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, King's College London, London, United Kingdom
| | | | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Camille B Carroll
- Translational and Clinical Research Institute Clinical Ageing Research Unit, Newcastle University, Newcastle, United Kingdom
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rimona S Weil
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Dementia Research Centre, Movement Disorders Centre, University College London, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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Dobson R, Rehill N, Weil RS. Democratising access to dementia research. Adv Clin Neurosci Rehabil 2023; 22:12-15. [PMID: 38445268 PMCID: PMC7615713 DOI: 10.47795/sqwe8437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
As the UK population ages, dementia affects an increasing proportion of the population. There is a drive to accelerate dementia research, however access to research is not equitably distributed. We examine access to dementia research and discuss some enabling factors and barriers. High recruitment is frequently driven by a person (or people) dedicated to improving research participation. Barriers are commonly structural, rather than lack of willingness or knowledge. A recurring issue was lack of time and/or resources. Leveraging existing infrastructure, such as streamlined and efficient governance frameworks, is a clear part of the solution. Research teams need to ensure inclusion/exclusion criteria serve the target population, and that any intervention is accessible to a range of patients. An injection of resources is crucial to support the recruitment process on the ground.
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Wagner SK, Romero-Bascones D, Cortina-Borja M, Williamson DJ, Struyven RR, Zhou Y, Patel S, Weil RS, Antoniades CA, Topol EJ, Korot E, Foster PJ, Balaskas K, Ayala U, Barrenechea M, Gabilondo I, Schapira AHV, Khawaja AP, Patel PJ, Rahi JS, Denniston AK, Petzold A, Keane PA. Retinal Optical Coherence Tomography Features Associated With Incident and Prevalent Parkinson Disease. Neurology 2023; 101:e1581-e1593. [PMID: 37604659 PMCID: PMC10585674 DOI: 10.1212/wnl.0000000000207727] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 01/24/2023] [Accepted: 06/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cadaveric studies have shown disease-related neurodegeneration and other morphological abnormalities in the retina of individuals with Parkinson disease (PD); however, it remains unclear whether this can be reliably detected with in vivo imaging. We investigated inner retinal anatomy, measured using optical coherence tomography (OCT), in prevalent PD and subsequently assessed the association of these markers with the development of PD using a prospective research cohort. METHODS This cross-sectional analysis used data from 2 studies. For the detection of retinal markers in prevalent PD, we used data from AlzEye, a retrospective cohort of 154,830 patients aged 40 years and older attending secondary care ophthalmic hospitals in London, United Kingdom, between 2008 and 2018. For the evaluation of retinal markers in incident PD, we used data from UK Biobank, a prospective population-based cohort where 67,311 volunteers aged 40-69 years were recruited between 2006 and 2010 and underwent retinal imaging. Macular retinal nerve fiber layer (mRNFL), ganglion cell-inner plexiform layer (GCIPL), and inner nuclear layer (INL) thicknesses were extracted from fovea-centered OCT. Linear mixed-effects models were fitted to examine the association between prevalent PD and retinal thicknesses. Hazard ratios for the association between time to PD diagnosis and retinal thicknesses were estimated using frailty models. RESULTS Within the AlzEye cohort, there were 700 individuals with prevalent PD and 105,770 controls (mean age 65.5 ± 13.5 years, 51.7% female). Individuals with prevalent PD had thinner GCIPL (-2.12 μm, 95% CI -3.17 to -1.07, p = 8.2 × 10-5) and INL (-0.99 μm, 95% CI -1.52 to -0.47, p = 2.1 × 10-4). The UK Biobank included 50,405 participants (mean age 56.1 ± 8.2 years, 54.7% female), of whom 53 developed PD at a mean of 2,653 ± 851 days. Thinner GCIPL (hazard ratio [HR] 0.62 per SD increase, 95% CI 0.46-0.84, p = 0.002) and thinner INL (HR 0.70, 95% CI 0.51-0.96, p = 0.026) were also associated with incident PD. DISCUSSION Individuals with PD have reduced thickness of the INL and GCIPL of the retina. Involvement of these layers several years before clinical presentation highlight a potential role for retinal imaging for at-risk stratification of PD.
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Affiliation(s)
- Siegfried Karl Wagner
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom.
| | - David Romero-Bascones
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Mario Cortina-Borja
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Dominic J Williamson
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Robbert R Struyven
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Yukun Zhou
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Salil Patel
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Rimona S Weil
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Chrystalina A Antoniades
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Eric J Topol
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Edward Korot
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Paul J Foster
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Konstantinos Balaskas
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Unai Ayala
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Maitane Barrenechea
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Iñigo Gabilondo
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Anthony H V Schapira
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Anthony P Khawaja
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Praveen J Patel
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Jugnoo S Rahi
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Alastair K Denniston
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Axel Petzold
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
| | - Pearse Andrew Keane
- From the Institute of Ophthalmology (S.K.W., D.J.W., R.R.S., Y.Z., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.P., P.A.K.), University College London; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (S.K.W., D.R.-B., D.J.W., R.R.S., Y.Z., E.K., P.J.F., K.B., A.P.K., P.J.P., J.S.R., A.K.D., A.P., P.A.K.), London, United Kingdom; Biomedical Engineering Department (D.R.-B., E.K., U.A., M.B.), Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Spain; Great Ormond Street Institute of Child Health (M.C.-B., J.S.R.), and Centre for Medical Image Computing (D.J.W., R.R.S., Y.Z.), Department of Computer Science, University College London; NeuroMetrology Lab (S.P., C.A.A.), Nuffield Department of Clinical Neurosciences, University of Oxford; Dementia Research Centre (R.S.W.), University College London, United Kingdom; Department of Molecular Medicine (E.J.T.), Scripps Research, La Jolla, CA; Byers Eye Institute (E.K.), Stanford University, Palo Alto, CA; Biocruces Bizkaia Health Research Institute (I.G.), Barakaldo; IKERBASQUE: The Basque Foundation for Science (I.G.), Bilbao, Spain; Department of Clinical and Movement Neurosciences (A.H.V.S.), UCL Queen Square Institute of Neurology; Great Ormond Street Hospital NHS Foundation Trust (J.S.R.); Ulverscroft Vision Research Group (J.S.R.), University College London; NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital (J.S.R.), London; University of Birmingham (A.K.D.); University Hospitals Birmingham NHS Foundation Trust (A.K.D.); NIHR Birmingham Biomedical Research Centre (A.K.D.), University of Birmingham; and Queen Square Institute of Neurology (A.P.), University College London, United Kingdom
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Jiang J, Johnson JCS, Requena-Komuro MC, Benhamou E, Sivasathiaseelan H, Chokesuwattanaskul A, Nelson A, Nortley R, Weil RS, Volkmer A, Marshall CR, Bamiou DE, Warren JD, Hardy CJD. Comprehension of acoustically degraded speech in Alzheimer's disease and primary progressive aphasia. Brain 2023; 146:4065-4076. [PMID: 37184986 PMCID: PMC10545509 DOI: 10.1093/brain/awad163] [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: 12/05/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Successful communication in daily life depends on accurate decoding of speech signals that are acoustically degraded by challenging listening conditions. This process presents the brain with a demanding computational task that is vulnerable to neurodegenerative pathologies. However, despite recent intense interest in the link between hearing impairment and dementia, comprehension of acoustically degraded speech in these diseases has been little studied. Here we addressed this issue in a cohort of 19 patients with typical Alzheimer's disease and 30 patients representing the three canonical syndromes of primary progressive aphasia (non-fluent/agrammatic variant primary progressive aphasia; semantic variant primary progressive aphasia; logopenic variant primary progressive aphasia), compared to 25 healthy age-matched controls. As a paradigm for the acoustically degraded speech signals of daily life, we used noise-vocoding: synthetic division of the speech signal into frequency channels constituted from amplitude-modulated white noise, such that fewer channels convey less spectrotemporal detail thereby reducing intelligibility. We investigated the impact of noise-vocoding on recognition of spoken three-digit numbers and used psychometric modelling to ascertain the threshold number of noise-vocoding channels required for 50% intelligibility by each participant. Associations of noise-vocoded speech intelligibility threshold with general demographic, clinical and neuropsychological characteristics and regional grey matter volume (defined by voxel-based morphometry of patients' brain images) were also assessed. Mean noise-vocoded speech intelligibility threshold was significantly higher in all patient groups than healthy controls, and significantly higher in Alzheimer's disease and logopenic variant primary progressive aphasia than semantic variant primary progressive aphasia (all P < 0.05). In a receiver operating characteristic analysis, vocoded intelligibility threshold discriminated Alzheimer's disease, non-fluent variant and logopenic variant primary progressive aphasia patients very well from healthy controls. Further, this central hearing measure correlated with overall disease severity but not with peripheral hearing or clear speech perception. Neuroanatomically, after correcting for multiple voxel-wise comparisons in predefined regions of interest, impaired noise-vocoded speech comprehension across syndromes was significantly associated (P < 0.05) with atrophy of left planum temporale, angular gyrus and anterior cingulate gyrus: a cortical network that has previously been widely implicated in processing degraded speech signals. Our findings suggest that the comprehension of acoustically altered speech captures an auditory brain process relevant to daily hearing and communication in major dementia syndromes, with novel diagnostic and therapeutic implications.
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Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Jeremy C S Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Maï-Carmen Requena-Komuro
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
- Kidney Cancer Program, UT Southwestern Medical Centre, Dallas, TX 75390, USA
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Harri Sivasathiaseelan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Annabel Nelson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Ross Nortley
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough SL2 4HL, UK
| | - Rimona S Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCL/UCLH Biomedical Research Centre, National Institute of Health Research, University College London, London WC1X 8EE, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
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9
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Bayram E, Batzu L, Tilley B, Gandhi R, Jagota P, Biundo R, Garon M, Prasertpan T, Lazcano-Ocampo C, Chaudhuri KR, Weil RS. Clinical trials for cognition in Parkinson's disease: Where are we and how can we do better? Parkinsonism Relat Disord 2023; 112:105385. [PMID: 37031010 PMCID: PMC10330317 DOI: 10.1016/j.parkreldis.2023.105385] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Cognitive impairment is common in Parkinson's disease (PD) and has a substantial impact on quality of life. Despite numerous trials targeting various PD features, we still lack effective treatments for cognition beyond cholinesterase inhibitors. OBJECTIVE To identify the gaps in recent clinical trials with cognitive outcomes in PD and consider areas for improvement. METHODS We examined recent clinical trials with cognitive outcomes in PD registered on ClinicalTrials.gov, excluding trials without cognitive outcomes, non-interventional studies, and in atypical Parkinsonian disorders. Included trials were categorized by treatment approach (investigational medicinal product, behavioral, physical activity, device-based). Details of trial design and outcomes were collected. RESULTS 178 trials at different stages of trial completion were considered. 46 trials were completed, 25 had available results. Mean follow-up duration was 29.9 weeks. Most common cognitive measure was Montreal Cognitive Assessment. Most were performed in North America or Europe. Majority of the participants identified as non-Hispanic and White. Only eight trials showed improvement in cognition, none showed improvement beyond four months. These included trials of international medicinal products, cognitive and physical interventions and devices. GRADE certainty levels ranged from Moderate to Very Low. Only mevidalen had a Moderate certainty for potential clinical effectiveness. CONCLUSIONS Amongst a large number of trials for cognition in PD, only a small proportion were completed. Few showed significant improvement, with no proven long-lasting effects. Trial design, lack of enrichment for at-risk groups, short follow-up duration, insensitive outcome measures likely contribute to lack of detectable benefit and should be considered in future trials.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
| | - Bension Tilley
- Dementia Research Centre, University College London, London, UK; Department of Brain Sciences, Imperial College London, London, UK
| | - Rhea Gandhi
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy; Study Center for Neurodegeneration (CESNE), University of Padua, Padua, Italy
| | - Michela Garon
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Tittaya Prasertpan
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Claudia Lazcano-Ocampo
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Hospital Sotero del Rio, Santiago, Chile
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK; Movement Disorders Centre, University College London, London, UK
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10
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Collerton D, Barnes J, Diederich NJ, Dudley R, Ffytche D, Friston K, Goetz CG, Goldman JG, Jardri R, Kulisevsky J, Lewis SJG, Nara S, O'Callaghan C, Onofrj M, Pagonabarraga J, Parr T, Shine JM, Stebbins G, Taylor JP, Tsuda I, Weil RS. Understanding visual hallucinations: a new synthesis. Neurosci Biobehav Rev 2023; 150:105208. [PMID: 37141962 DOI: 10.1016/j.neubiorev.2023.105208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023]
Abstract
Despite decades of research, we do not definitively know how people sometimes see things that are not there. Eight models of complex visual hallucinations have been published since 2000, including Deafferentation, Reality Monitoring, Perception and Attention Deficit, Activation, Input, and Modulation, Hodological, Attentional Networks, Active inference, and Thalamocortical Dysrhythmia Default Mode Network Decoupling. Each was derived from different understandings of brain organisation. To reduce this variability, representatives from each research group agreed an integrated Visual Hallucination Framework that is consistent with current theories of veridical and hallucinatory vision. The Framework delineates cognitive systems relevant to hallucinations. It allows a systematic, consistent, investigation of relationships between the phenomenology of visual hallucinations and changes in underpinning cognitive structures. The episodic nature of hallucinations highlights separate factors associated with the onset, persistence, and end of specific hallucinations suggesting a complex relationship between state and trait markers of hallucination risk. In addition to a harmonised interpretation of existing evidence, the Framework highlights new avenues of research, and potentially, new approaches to treating distressing hallucinations.
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Affiliation(s)
- Daniel Collerton
- School of Psychology, Faculty of Medical Sciences, Third Floor, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL UK.
| | - James Barnes
- Fatima College of Health Sciences, Department of Psychology, Al Mafraq, Abu Dhabi, UAE.
| | - Nico J Diederich
- Department of Neurology, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg-City, Luxembourg.
| | - Rob Dudley
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - Dominic Ffytche
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, de Crespigny Park, London, SE5 8AF, UK.
| | - Karl Friston
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR.
| | - Christopher G Goetz
- Rush University Medical Center, Suite 755, 1725 W Harrison St, Chicago IL 60612 USA.
| | - Jennifer G Goldman
- Departments of Physical Medicine and Rehabilitation and Neurology; Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders; Feinberg School of Medicine Northwestern University, 355 E. Erie Street, Chicago, IL 60611 USA.
| | - Renaud Jardri
- Lille University, INSERM U-1172, Centre Lille Neuroscience & Cognition, CURE platform, Fontan Hospital, CHU Lille, France.
| | - Jaime Kulisevsky
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau. C/ Mas Casanovas 90. Barcelona (08041) and Universitat Autònoma de Barcelona; CIBERNED (Network Centre for Neurodegenerative Diseases), Spain.
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Shigetoshi Nara
- Dept. Electrical & Electronic Engineering, Okayama University, Tsushima-naka, 3-1-1, Okayama 700-8530, Japan.
| | - Claire O'Callaghan
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Marco Onofrj
- Clinica Neurologica, Department of Neuroscience, Imaging and Clinical Science, University "G.d'Annunzio" of Chieti-Pescara, via Polacchi 39,66100, Chieti, Italy.
| | - Javier Pagonabarraga
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau. C/ Mas Casanovas 90. Barcelona (08041) and Universitat Autònoma de Barcelona; CIBERNED (Network Centre for Neurodegenerative Diseases), Spain.
| | - Thomas Parr
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR.
| | - James M Shine
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Glenn Stebbins
- Rush University Medical Center, Suite 755, 1725 W Harrison St, Chicago IL 60612 USA.
| | - John-Paul Taylor
- Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University NE4 5PL, UK.
| | - Ichiro Tsuda
- Chubu University Academy of Emerging Sciences and Center for Mathematical Science and Artificial Intelligence, Chubu University, Kasugai, Aichi 487-8501, Japan.
| | - Rimona S Weil
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR; Dementia Research Centre; Movement Disorders Centre, University College London, London, WC1N 3BG UK.
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11
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Morinan G, Dushin Y, Sarapata G, Rupprechter S, Peng Y, Girges C, Salazar M, Milabo C, Sibley K, Foltynie T, Cociasu I, Ricciardi L, Baig F, Morgante F, Leyland LA, Weil RS, Gilron R, O’Keeffe J. Computer vision quantification of whole-body Parkinsonian bradykinesia using a large multi-site population. NPJ Parkinsons Dis 2023; 9:10. [PMID: 36707523 PMCID: PMC9883391 DOI: 10.1038/s41531-023-00454-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 08/09/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
Parkinson's disease (PD) is a common neurological disorder, with bradykinesia being one of its cardinal features. Objective quantification of bradykinesia using computer vision has the potential to standardise decision-making, for patient treatment and clinical trials, while facilitating remote assessment. We utilised a dataset of part-3 MDS-UPDRS motor assessments, collected at four independent clinical and one research sites on two continents, to build computer-vision-based models capable of inferring the correct severity rating robustly and consistently across all identifiable subgroups of patients. These results contrast with previous work limited by small sample sizes and small numbers of sites. Our bradykinesia estimation corresponded well with clinician ratings (interclass correlation 0.74). This agreement was consistent across four clinical sites. This result demonstrates how such technology can be successfully deployed into existing clinical workflows, with consumer-grade smartphone or tablet devices, adding minimal equipment cost and time.
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Affiliation(s)
- Gareth Morinan
- Machine Medicine Technologies Ltd., The Leather Market Unit 1.1.1 11/13 Weston Street, London, SE1 3ER UK
| | - Yuriy Dushin
- Machine Medicine Technologies Ltd., The Leather Market Unit 1.1.1 11/13 Weston Street, London, SE1 3ER, UK.
| | - Grzegorz Sarapata
- Machine Medicine Technologies Ltd., The Leather Market Unit 1.1.1 11/13 Weston Street, London, SE1 3ER UK
| | - Samuel Rupprechter
- Machine Medicine Technologies Ltd., The Leather Market Unit 1.1.1 11/13 Weston Street, London, SE1 3ER UK
| | - Yuwei Peng
- Machine Medicine Technologies Ltd., The Leather Market Unit 1.1.1 11/13 Weston Street, London, SE1 3ER UK
| | - Christine Girges
- grid.436283.80000 0004 0612 2631Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG UK
| | - Maricel Salazar
- grid.436283.80000 0004 0612 2631Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG UK
| | - Catherine Milabo
- grid.436283.80000 0004 0612 2631Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG UK
| | - Krista Sibley
- grid.436283.80000 0004 0612 2631Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG UK
| | - Thomas Foltynie
- grid.436283.80000 0004 0612 2631Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG UK
| | - Ioana Cociasu
- grid.264200.20000 0000 8546 682XNeuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Lucia Ricciardi
- grid.264200.20000 0000 8546 682XNeuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Fahd Baig
- grid.264200.20000 0000 8546 682XNeuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Francesca Morgante
- grid.264200.20000 0000 8546 682XNeuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK ,grid.10438.3e0000 0001 2178 8421Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy, Via Consolare Valeria, 98165 Messina, Italy
| | - Louise-Ann Leyland
- grid.436283.80000 0004 0612 2631Dementia Research Center, Institute of Neurology, University College London, Queen Square, London, WC1N 3AR UK
| | - Rimona S. Weil
- grid.436283.80000 0004 0612 2631Dementia Research Center, Institute of Neurology, University College London, Queen Square, London, WC1N 3AR UK
| | - Ro’ee Gilron
- grid.266102.10000 0001 2297 6811The Starr Lab, University of California San Francisco, 513 Parnassus Ave, HSE-823, San Francisco, CA 94143 USA
| | - Jonathan O’Keeffe
- Machine Medicine Technologies Ltd., The Leather Market Unit 1.1.1 11/13 Weston Street, London, SE1 3ER UK
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12
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Gonzalez-Robles C, Weil RS, van Wamelen D, Bartlett M, Burnell M, Clarke CS, Hu MT, Huxford B, Jha A, Lambert C, Lawton M, Mills G, Noyce A, Piccini P, Pushparatnam K, Rochester L, Siu C, Williams-Gray CH, Zeissler ML, Zetterberg H, Carroll CB, Foltynie T, Schrag A. Outcome Measures for Disease-Modifying Trials in Parkinson's Disease: Consensus Paper by the EJS ACT-PD Multi-Arm Multi-Stage Trial Initiative. J Parkinsons Dis 2023; 13:1011-1033. [PMID: 37545260 PMCID: PMC10578294 DOI: 10.3233/jpd-230051] [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] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Multi-arm, multi-stage (MAMS) platform trials can accelerate the identification of disease-modifying treatments for Parkinson's disease (PD) but there is no current consensus on the optimal outcome measures (OM) for this approach. OBJECTIVE To provide an up-to-date inventory of OM for disease-modifying PD trials, and a framework for future selection of OM for such trials. METHODS As part of the Edmond J Safra Accelerating Clinical Trials in Parkinson Disease (EJS ACT-PD) initiative, an expert group with Patient and Public Involvement and Engagement (PPIE) representatives' input reviewed and evaluated available evidence on OM for potential use in trials to delay progression of PD. Each OM was ranked based on aspects such as validity, sensitivity to change, participant burden and practicality for a multi-site trial. Review of evidence and expert opinion led to the present inventory. RESULTS An extensive inventory of OM was created, divided into: general, motor and non-motor scales, diaries and fluctuation questionnaires, cognitive, disability and health-related quality of life, capability, quantitative motor, wearable and digital, combined, resource use, imaging and wet biomarkers, and milestone-based. A framework for evaluation of OM is presented to update the inventory in the future. PPIE input highlighted the need for OM which reflect their experience of disease progression and are applicable to diverse populations and disease stages. CONCLUSION We present a range of OM, classified according to a transparent framework, to aid selection of OM for disease-modifying PD trials, whilst allowing for inclusion or re-classification of relevant OM as new evidence emerges.
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Affiliation(s)
| | | | | | | | - Matthew Burnell
- Medical Research Council Clinical Trials Unit at University College London, London, UK
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13
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Toledo JB, Abdelnour C, Weil RS, Ferreira D, Rodriguez-Porcel F, Pilotto A, Wyman-Chick KA, Grothe MJ, Kane JPM, Taylor A, Rongve A, Scholz S, Leverenz JB, Boeve BF, Aarsland D, McKeith IG, Lewis S, Leroi I, Taylor JP. Dementia with Lewy bodies: Impact of co-pathologies and implications for clinical trial design. Alzheimers Dement 2023; 19:318-332. [PMID: 36239924 PMCID: PMC9881193 DOI: 10.1002/alz.12814] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 04/26/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 02/01/2023]
Abstract
Dementia with Lewy bodies (DLB) is clinically defined by the presence of visual hallucinations, fluctuations, rapid eye movement (REM) sleep behavioral disorder, and parkinsonism. Neuropathologically, it is characterized by the presence of Lewy pathology. However, neuropathological studies have demonstrated the high prevalence of coexistent Alzheimer's disease, TAR DNA-binding protein 43 (TDP-43), and cerebrovascular pathologic cases. Due to their high prevalence and clinical impact on DLB individuals, clinical trials should account for these co-pathologies in their design and selection and the interpretation of biomarkers values and outcomes. Here we discuss the frequency of the different co-pathologies in DLB and their cross-sectional and longitudinal clinical impact. We then evaluate the utility and possible applications of disease-specific and disease-nonspecific biomarkers and how co-pathologies can impact these biomarkers. We propose a framework for integrating multi-modal biomarker fingerprints and step-wise selection and assessment of DLB individuals for clinical trials, monitoring target engagement, and interpreting outcomes in the setting of co-pathologies.
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Affiliation(s)
- Jon B Toledo
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Carla Abdelnour
- Fundació ACE. Barcelona Alzheimer Treatment and Research Center, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Rimona S Weil
- Dementia Research Centre, Wellcome Centre for Human Neuroimaging, Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer's Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Parkinson's Disease Rehabilitation Centre, FERB ONLUS-S, Isidoro Hospital, Trescore Balneario (BG), Italy
| | - Kathryn A Wyman-Chick
- HealthPartners Center for Memory and Aging and Struthers Parkinson's Center, Saint Paul, Minnesota, USA
| | - Michel J Grothe
- Instituto de Biomedicina de Sevilla (IBiS), Unidad de Trastornos del Movimiento, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| | - Arvid Rongve
- Department of Research and Innovation, Institute of Clinical Medicine (K1), Haugesund Hospital, Norway and The University of Bergen, Bergen, Norway
| | - Sonja Scholz
- Department of Neurology, National Institute of Neurological Disorders and Stroke, Neurodegenerative Diseases Research Unit, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bradley F Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Ian G McKeith
- Newcastle University Translational and Clinical Research Institute (NUTCRI, Newcastle upon Tyne, UK
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, School of Medical Sciences, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - John P Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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14
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Thomas GEC, Zeidman P, Sultana T, Zarkali A, Razi A, Weil RS. Changes in both top-down and bottom-up effective connectivity drive visual hallucinations in Parkinson's disease. Brain Commun 2022; 5:fcac329. [PMID: 36601626 PMCID: PMC9798302 DOI: 10.1093/braincomms/fcac329] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Visual hallucinations are common in Parkinson's disease and are associated with a poorer quality of life and a higher risk of dementia. An important and influential model that is widely accepted as an explanation for the mechanism of visual hallucinations in Parkinson's disease and other Lewy body diseases is that these arise due to aberrant hierarchical processing, with impaired bottom-up integration of sensory information and overweighting of top-down perceptual priors within the visual system. This hypothesis has been driven by behavioural data and supported indirectly by observations derived from regional activation and correlational measures using neuroimaging. However, until now, there was no evidence from neuroimaging for differences in causal influences between brain regions measured in patients with Parkinson's hallucinations. This is in part because previous resting-state studies focused on functional connectivity, which is inherently undirected in nature and cannot test hypotheses about the directionality of connectivity. Spectral dynamic causal modelling is a Bayesian framework that allows the inference of effective connectivity-defined as the directed (causal) influence that one region exerts on another region-from resting-state functional MRI data. In the current study, we utilize spectral dynamic causal modelling to estimate effective connectivity within the resting-state visual network in our cohort of 15 Parkinson's disease visual hallucinators and 75 Parkinson's disease non-visual hallucinators. We find that visual hallucinators display decreased bottom-up effective connectivity from the lateral geniculate nucleus to primary visual cortex and increased top-down effective connectivity from the left prefrontal cortex to primary visual cortex and the medial thalamus, as compared with non-visual hallucinators. Importantly, we find that the pattern of effective connectivity is predictive of the presence of visual hallucinations and associated with their severity within the hallucinating group. This is the first study to provide evidence, using resting-state effective connectivity, to support a model of aberrant hierarchical predictive processing as the mechanism for visual hallucinations in Parkinson's disease.
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Affiliation(s)
- George E C Thomas
- Dementia Research Centre, UCL Institute of Neurology, WC1N 3AR London, UK
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, WC1N 3AR London, UK
| | - Tajwar Sultana
- Department of Computer and Information Systems Engineering, NED University of Engineering & Technology, Karachi 75270, Pakistan
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi 74800, Pakistan
- Neurocomputation Laboratory, NCAI Computer and Information Systems Department, NED University of Engineering and Technology, Karachi 75270, Pakistan
| | - Angeliki Zarkali
- Dementia Research Centre, UCL Institute of Neurology, WC1N 3AR London, UK
| | - Adeel Razi
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, WC1N 3AR London, UK
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON M5G 1M1, Canada
| | - Rimona S Weil
- Dementia Research Centre, UCL Institute of Neurology, WC1N 3AR London, UK
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, WC1N 3AR London, UK
- Movement Disorders Consortium, UCL, London, UK
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15
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Zarkali A, Luppi AI, Stamatakis EA, Reeves S, McColgan P, Leyland LA, Lees AJ, Weil RS. Changes in dynamic transitions between integrated and segregated states underlie visual hallucinations in Parkinson's disease. Commun Biol 2022; 5:928. [PMID: 36075964 PMCID: PMC9458713 DOI: 10.1038/s42003-022-03903-x] [Citation(s) in RCA: 6] [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: 03/31/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
Hallucinations are a core feature of psychosis and common in Parkinson’s. Their transient, unexpected nature suggests a change in dynamic brain states, but underlying causes are unknown. Here, we examine temporal dynamics and underlying structural connectivity in Parkinson’s-hallucinations using a combination of functional and structural MRI, network control theory, neurotransmitter density and genetic analyses. We show that Parkinson’s-hallucinators spent more time in a predominantly Segregated functional state with fewer between-state transitions. The transition from integrated-to-segregated state had lower energy cost in Parkinson’s-hallucinators; and was therefore potentially preferable. The regional energy needed for this transition was correlated with regional neurotransmitter density and gene expression for serotoninergic, GABAergic, noradrenergic and cholinergic, but not dopaminergic, receptors. We show how the combination of neurochemistry and brain structure jointly shape functional brain dynamics leading to hallucinations and highlight potential therapeutic targets by linking these changes to neurotransmitter systems involved in early sensory and complex visual processing. The examination of temporal dynamics in Parkinson’s-hallucinations reveals that the combination of neurochemistry and brain structure jointly shape functional brain dynamics leading to hallucinations.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
| | - Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, London, W1T 7BN, UK
| | - Peter McColgan
- Huntington's Disease Centre, University College London, Russell Square House, London, WC1B 5EH, UK
| | - Louise-Ann Leyland
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, 1 Wakefield Street, London, WC1N 1PJ, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.,Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK.,Movement Disorders Consortium, University College London, London, WC1N 3BG, UK
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16
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Zarkali A, Weil RS. Using network approaches to unravel the mysteries of visual hallucinations in Lewy body dementia. Brain 2022; 145:1883-1885. [PMID: 35642563 DOI: 10.1093/brain/awac170] [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: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/14/2022] Open
Abstract
This scientific commentary refers to ‘Functional and structural brain network correlates of visual hallucinations in Lewy body dementia’ by Mehraram et al. (https://doi.org/10.1093/brain/awac094).
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Affiliation(s)
| | - Rimona S Weil
- Dementia Research Centre, UCL, London, UK.,Wellcome Centre for Human Neuroimaging, UCL, London, UK
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17
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Zarkali A, McColgan P, Leyland LA, Rees G, Weil RS. 128 White matter fibre loss in Parkinson’s disease hallucinations. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.161] [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: 11/03/2022]
Abstract
Visual hallucinations are common in Parkinson’s (PD) and associated with worse outcomes.1Neuroim- aging shows widespread but non-specific grey matter atrophy in PD-hallucinations1; white matter (WM) loss may be an earlier, more sensitive marker. To detect WM changes in PD-hallucinations we performed diffusion-weighted imaging in 105 patients with PD (n=86 without hallucinations [PD-non-VH], n=19 with hallucinations [PD-VH]), and 35 controls. We performed whole-brain fixel-based analysis,2a novel method that can identify micro- and macro-structural changes at fibre level and examined three measures:apparent fibre density (FD), sensitive to micro-structural changes,fibre bundle cross-section (FC), representing macro-structural changes,combined fibre density and cross-section (FDC).Groups did not differ in age or gender. PD-VH had higher total UPDRS score [63.5±35.6 vs 43.2±20.6 in PD-non-VH, (p=0.003)]; motor scores did not differ. We found macrostructural changes (FC reduction) within the splenium of the corpus callosum and left posterior thalamic radiation in PD/VH. Whilst there were no significant changes in FD, when using the combined FDC metric, we found large reductions within the splenium in PD-VH (>50% reduction compared to PD-non-VH).We demonstrate specific WM tract degeneration affecting posterior thalamic tracts in PD-hallucinations, providing direct mechanistic support for attentional models of visual hallucinations.ReferencesWeil,et al. Visual dysfunction in Parkinson’s disease.Brain2016 Jul 13.Raffelt,et al. Investigating white matter fibre density and morphology using fixel-based analysis.Neu- roimage2017;144:58–73.a.zarkali@ucl.ac.uk
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18
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Zarkali A, McColgan P, Ryten M, Reynolds R, Leyland LA, Lees AJ, Rees G, Weil RS. 129 Network controllability and regional gene expression explain visual hallucinations in Parkinson’s. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.162] [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: 11/04/2022]
Abstract
Visual hallucinations are common in Parkinson’s (PD) and associated with poorer prognosis. Imaging studies have shown white matter and functional changes in PD-hallucinations1 2but the biological factors underlying selective vulnerability of brain regions are unknown.We performed diffusion-weighted imaging in 100 PD patients (81 without hallucinations [PD-non-VH], 19 with hallucinations [PD-VH]) and 34 controls. We used network-based statistics to identify structural con- nectivity changes in PD-VH and performed an analysis of controllability, an emerging technique that allows quantification of influence across the rest of the network. We used the Allen brain atlas to identify regional gene expression patterns associated with affected areas of the network.We identified a subnetwork of reduced connectivity in PD-VH. Within this network, PD-VH showed reduced controllability (influence over other brain regions), than PD-non-VH (U=526, p=0.014) and controls (U=176.5, p=0.003). This subnetwork appears to be critical for brain integration, as even in controls, nodes with high controllability were more likely to be within the subnetwork (U=572.5, p<0.001). Gene expression analysis revealed downregulated genes related to mRNA metabolism and upregulated genes related to membrane localisation.Our findings provide insights into how hallucinations are generated, with breakdown of a key structural subnetwork that exerts control across distributed brain regions.ReferenceShine,et al. The role of dysfunctional attentional control networks in visual misperceptions in Parkinson’s disease. HumBrainMapp;2014.a.zarkali@ucl.ac.uk
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Rodriguez-Porcel F, Wyman-Chick KA, Abdelnour Ruiz C, Toledo JB, Ferreira D, Urwyler P, Weil RS, Kane J, Pilotto A, Rongve A, Boeve B, Taylor JP, McKeith I, Aarsland D, Lewis SJG. Correction: Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations. Transl Neurodegener 2022; 11:29. [PMID: 35578366 PMCID: PMC9112536 DOI: 10.1186/s40035-022-00306-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Federico Rodriguez-Porcel
- Department of Neurology, Medical University of South Carolina, 208b Rutledge Av., Charleston, SC, 29403, USA.
| | - Kathryn A Wyman-Chick
- Department of Neurology, Center for Memory and Aging, HealthPartners, Saint Paul, MN, USA
| | | | - Jon B Toledo
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer's Research, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Prabitha Urwyler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - Joseph Kane
- Centre for Public Health, Queen's University, Belfast, UK
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arvid Rongve
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway.,Institute of Clinical Medicine (K1), The University of Bergen, Bergen, Norway
| | - Bradley Boeve
- Department of Neurology, Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia
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Rodriguez-Porcel F, Wyman-Chick KA, Abdelnour Ruiz C, Toledo JB, Ferreira D, Urwyler P, Weil RS, Kane J, Pilotto A, Rongve A, Boeve B, Taylor JP, McKeith I, Aarsland D, Lewis SJG. Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations. Transl Neurodegener 2022; 11:24. [PMID: 35491418 PMCID: PMC9059356 DOI: 10.1186/s40035-022-00299-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/31/2022] [Indexed: 12/28/2022] Open
Abstract
The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer's or Parkinson's disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials.
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Affiliation(s)
- Federico Rodriguez-Porcel
- Department of Neurology, Medical University of South Carolina, 208b Rutledge Av., Charleston, SC, 29403, USA.
| | - Kathryn A. Wyman-Chick
- grid.280625.b0000 0004 0461 4886Department of Neurology, Center for Memory and Aging, HealthPartners, Saint Paul, MN USA
| | - Carla Abdelnour Ruiz
- grid.7080.f0000 0001 2296 0625Autonomous University of Barcelona, Barcelona, Spain
| | - Jon B. Toledo
- grid.15276.370000 0004 1936 8091Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL USA
| | - Daniel Ferreira
- grid.4714.60000 0004 1937 0626Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer’s Research, Karolinska Institutet, Stockholm, Sweden ,grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, Rochester, MN USA
| | - Prabitha Urwyler
- grid.5734.50000 0001 0726 5157ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rimona S. Weil
- grid.83440.3b0000000121901201Dementia Research Centre, University College London, London, UK
| | - Joseph Kane
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University, Belfast, UK
| | - Andrea Pilotto
- grid.7637.50000000417571846Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arvid Rongve
- grid.413782.bDepartment of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway ,grid.7914.b0000 0004 1936 7443Institute of Clinical Medicine (K1), The University of Bergen, Bergen, Norway
| | - Bradley Boeve
- grid.66875.3a0000 0004 0459 167XDepartment of Neurology, Center for Sleep Medicine, Mayo Clinic, Rochester, MN USA
| | - John-Paul Taylor
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dag Aarsland
- grid.13097.3c0000 0001 2322 6764Department of Old Age Psychiatry Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Simon J. G. Lewis
- grid.1013.30000 0004 1936 834XForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050 Australia
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Costello H, Berry AJ, Reeves S, Weil RS, Joyce EM, Howard R, Roiser JP. Disrupted reward processing in Parkinson's disease and its relationship with dopamine state and neuropsychiatric syndromes: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2022; 93:555-562. [PMID: 34930778 PMCID: PMC9016258 DOI: 10.1136/jnnp-2021-327762] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms are common in Parkinson's disease (PD) and predict poorer outcomes. Reward processing dysfunction is a candidate mechanism for the development of psychiatric symptoms including depression and impulse control disorders (ICDs). We aimed to determine whether reward processing is impaired in PD and its relationship with neuropsychiatric syndromes and dopamine replacement therapy. METHODS The Ovid MEDLINE/PubMed, Embase and PsycInfo databases were searched for articles published up to 5 November 2020. Studies reporting reward processing task performance by patients with PD and healthy controls were included. Summary statistics comparing reward processing between groups were converted to standardised mean difference (SMD) scores and meta-analysed using a random effects model. RESULTS We identified 55 studies containing 2578 participants (1638 PD and 940 healthy controls). Studies assessing three subcomponent categories of reward processing tasks were included: option valuation (n=12), reinforcement learning (n=37) and reward response vigour (n=6). Across all studies, patients with PD on medication exhibited a small-to-medium impairment versus healthy controls (SMD=0.34; 95% CI 0.14 to 0.53), with greater impairments observed off dopaminergic medication in within-subjects designs (SMD=0.43, 95% CI 0.29 to 0.57). Within-subjects subcomponent analysis revealed impaired processing off medication on option valuation (SMD=0.57, 95% CI 0.39 to 0.75) and reward response vigour (SMD=0.36, 95% CI 0.13 to 0.59) tasks. However, the opposite applied for reinforcement learning, which relative to healthy controls was impaired on-medication (SMD=0.45, 95% CI 0.25 to 0.65) but not off-medication (SMD=0.28, 95% CI -0.03 to 0.59). ICD was the only neuropsychiatric syndrome with sufficient studies (n=13) for meta-analysis, but no significant impairment was identified compared tonon-ICD patients (SMD=-0.02, 95% CI -0.43 to 0.39). CONCLUSION Reward processing disruption in PD differs according to subcomponent and dopamine medication state, and warrants further study as a potential treatment target and mechanism underlying associated neuropsychiatric syndromes.
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Affiliation(s)
- Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Alex J Berry
- Division of Psychiatry, University College London, London, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London, UK
| | - Rimona S Weil
- Institute of Neurology, University College London, London, UK
| | - Eileen M Joyce
- Institute of Neurology, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
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22
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Bohnen NI, Yarnall AJ, Weil RS, Moro E, Moehle MS, Borghammer P, Bedard MA, Albin RL. Cholinergic system changes in Parkinson's disease: emerging therapeutic approaches. Lancet Neurol 2022; 21:381-392. [PMID: 35131038 PMCID: PMC8985079 DOI: 10.1016/s1474-4422(21)00377-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [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: 08/17/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 01/16/2023]
Abstract
In patients with Parkinson's disease, heterogeneous cholinergic system changes can occur in different brain regions. These changes correlate with a range of clinical features, both motor and non-motor, that are refractory to dopaminergic therapy, and can be conceptualised within a systems-level framework in which nodal deficits can produce circuit dysfunctions. The topographies of cholinergic changes overlap with neural circuitries involved in sleep and cognitive, motor, visuo-auditory perceptual, and autonomic functions. Cholinergic deficits within cognition network hubs predict cognitive deficits better than do total brain cholinergic changes. Postural instability and gait difficulties are associated with cholinergic system changes in thalamic, caudate, limbic, neocortical, and cerebellar nodes. Cholinergic system deficits can involve also peripheral organs. Hypercholinergic activity of mesopontine cholinergic neurons in people with isolated rapid eye movement (REM) sleep behaviour disorder, as well as in the hippocampi of cognitively normal patients with Parkinson's disease, suggests early compensation during the prodromal and early stages of Parkinson's disease. Novel pharmacological and neurostimulation approaches could target the cholinergic system to treat motor and non-motor features of Parkinson's disease.
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Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Neurology Service, Ann Arbor, MI, USA; VA Geriatric Research Education and Clinical Center, Ann Arbor, MI, USA; Ann Arbor VAMC, Ann Arbor, MI, USA.
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble, France; Grenoble Alpes University, and INSERM u1216, Grenoble, France
| | - Mark S Moehle
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marc-André Bedard
- Cognitive Pharmacology Research Unit, UQAM, Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada; Research Centre for Studies in Aging, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Roger L Albin
- VA Geriatric Research Education and Clinical Center, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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23
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Tsitsipa E, Rogers J, Casalotti S, Belessiotis-Richards C, Zubko O, Weil RS, Howard R, Bisby JA, Reeves S. Selective 5HT3 antagonists and sensory processing: a systematic review. Neuropsychopharmacology 2022; 47:880-890. [PMID: 35017671 PMCID: PMC8882165 DOI: 10.1038/s41386-021-01255-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 12/04/2022]
Abstract
Ondansetron is a selective serotonin (5HT3) receptor antagonist that is under evaluation as an adjunctive treatment for schizophrenia, and a novel treatment for hallucinations in Parkinson's disease. Ondansetron reverses sensory gating deficits and improves visuoperceptual processing in animal models of psychosis, but it is unclear to what extent preclinical findings have been replicated in humans. We systematically reviewed human studies that evaluated the effects of ondansetron and other 5HT3 receptor antagonists on sensory gating deficits or sensory processing. Of 11 eligible studies, eight included patients with schizophrenia who were chronically stable on antipsychotic medication; five measured sensory gating using the P50 suppression response to a repeated auditory stimulus; others included tests of visuoperceptual function. Three studies in healthy participants included tests of visuoperceptual and sensorimotor function. A consistent and robust finding (five studies) was that ondansetron and tropisetron (5HT3 antagonist and α7-nicotinic receptor partial agonist) improved sensory gating in patients with schizophrenia. Tropisetron also improved sustained visual attention in non-smoking patients. There was inconsistent evidence of the effects of 5HT3 antagonists on other measures of sensory processing, but interpretation was limited by the small number of studies, methodological heterogeneity and the potential confounding effects of concomitant medication in patients. Despite these limitations, we found strong evidence that selective 5HT3 antagonists (with or without direct α7-nicotinic partial agonist effects) improved sensory gating. Future studies should investigate how this relates to potential improvement in neurocognitive symptoms in antipsychotic naive patients with prodromal or milder symptoms, in order to understand the clinical implications.
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Affiliation(s)
- Eirini Tsitsipa
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Jonathan Rogers
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX UK
| | - Sebastian Casalotti
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Clara Belessiotis-Richards
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Olga Zubko
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Rimona S. Weil
- grid.83440.3b0000000121901201Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR UK ,grid.83440.3b0000000121901201Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR UK ,grid.436283.80000 0004 0612 2631Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3AR UK
| | - Robert Howard
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - James A. Bisby
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF, UK.
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Vignando M, Ffytche D, Lewis SJG, Lee PH, Chung SJ, Weil RS, Hu MT, Mackay CE, Griffanti L, Pins D, Dujardin K, Jardri R, Taylor JP, Firbank M, McAlonan G, Mak HKF, Ho SL, Mehta MA. Author Correction: Mapping brain structural differences and neuroreceptor correlates in Parkinson's disease visual hallucinations. Nat Commun 2022; 13:971. [PMID: 35169136 PMCID: PMC8847348 DOI: 10.1038/s41467-022-28491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Miriam Vignando
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Dominic Ffytche
- Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Phil Hyu Lee
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1M 3BG, UK
- Wellcome Centre for Neuroimaging, University College London, London, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clare E Mackay
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Delphine Pins
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Renaud Jardri
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - John-Paul Taylor
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Grainne McAlonan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Henry K F Mak
- Division of Neurology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Shu Leong Ho
- Division of Neurology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mitul A Mehta
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Vignando M, Ffytche D, Lewis SJG, Lee PH, Chung SJ, Weil RS, Hu MT, Mackay CE, Griffanti L, Pins D, Dujardin K, Jardri R, Taylor JP, Firbank M, McAlonan G, Mak HKF, Ho SL, Mehta MA. Mapping brain structural differences and neuroreceptor correlates in Parkinson's disease visual hallucinations. Nat Commun 2022; 13:519. [PMID: 35082285 PMCID: PMC8791961 DOI: 10.1038/s41467-022-28087-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 02/23/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022] Open
Abstract
Parkinson's psychosis (PDP) describes a spectrum of symptoms that may arise in Parkinson's disease (PD) including visual hallucinations (VH). Imaging studies investigating the neural correlates of PDP have been inconsistent in their findings, due to differences in study design and limitations of scale. Here we use empirical Bayes harmonisation to pool together structural imaging data from multiple research groups into a large-scale mega-analysis, allowing us to identify cortical regions and networks involved in VH and their relation to receptor binding. Differences of morphometrics analysed show a wider cortical involvement underlying VH than previously recognised, including primary visual cortex and surrounding regions, and the hippocampus, independent of its role in cognitive decline. Structural covariance analyses point to the involvement of the attentional control networks in PD-VH, while associations with receptor density maps suggest neurotransmitter loss may be linked to the cortical changes.
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Affiliation(s)
- Miriam Vignando
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Dominic Ffytche
- Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Phil Hyu Lee
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1M 3BG, UK
- Wellcome Centre for Neuroimaging, University College London, London, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clare E Mackay
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- Oxford Parkinson's Disease Centre, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Delphine Pins
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - Renaud Jardri
- Univ. Lille, Inserm, CHU Lille, U1172 - Centre Lille Neuroscience & Cognition, 59000, Lille, France
| | - John-Paul Taylor
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Newcastle University, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, NE4 5PL, UK
| | - Grainne McAlonan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Henry K F Mak
- Division of Neurology, Dept of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Shu Leong Ho
- Division of Neurology, Dept of Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mitul A Mehta
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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26
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Bhome R, Zarkali A, Thomas GEC, Iglesias JE, Cole JH, Weil RS. Thalamic white matter macrostructure and subnuclei volumes in Parkinson's disease depression. NPJ Parkinsons Dis 2022; 8:2. [PMID: 35013327 PMCID: PMC8748828 DOI: 10.1038/s41531-021-00270-y] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/20/2021] [Indexed: 12/04/2022] Open
Abstract
Depression is a common non-motor feature of Parkinson's disease (PD) which confers significant morbidity and is challenging to treat. The thalamus is a key component in the basal ganglia-thalamocortical network critical to the pathogenesis of PD and depression but the precise thalamic subnuclei involved in PD depression have not been identified. We performed structural and diffusion-weighted imaging (DWI) on 76 participants with PD to evaluate the relationship between PD depression and grey and white matter thalamic subnuclear changes. We used a thalamic segmentation method to divide the thalamus into its 50 constituent subnuclei (25 each hemisphere). Fixel-based analysis was used to calculate mean fibre cross-section (FC) for white matter tracts connected to each subnucleus. We assessed volume and FC at baseline and 14-20 months follow-up. A generalised linear mixed model was used to evaluate the relationship between depression, subnuclei volume and mean FC for each thalamic subnucleus. We found that depression scores in PD were associated with lower right pulvinar anterior (PuA) subnucleus volume. Antidepressant use was associated with higher right PuA volume suggesting a possible protective effect of treatment. After follow-up, depression scores were associated with reduced white matter tract macrostructure across almost all tracts connected to thalamic subnuclei. In conclusion, our work implicates the right PuA as a relevant neural structure in PD depression and future work should evaluate its potential as a therapeutic target for PD depression.
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Affiliation(s)
- R Bhome
- Dementia Research Centre, University College London, London, UK.
| | - A Zarkali
- Dementia Research Centre, University College London, London, UK
| | - G E C Thomas
- Dementia Research Centre, University College London, London, UK
| | - J E Iglesias
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Cambridge, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, USA
| | - J H Cole
- Dementia Research Centre, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - R S Weil
- Dementia Research Centre, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, London, UK
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27
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Wagen AZ, Zarkali A, Coath W, Buchanan SM, Keuss SE, Keshavan A, Lu K, James S, Pavisic IM, Street RE, Parker TD, Lane CA, Murray‐Smith H, Cash DM, Malone IB, Wong A, Richards M, Fox NC, Altmann A, Cole JH, Weil RS, Schott JM. Fixel‐based analysis of the effect of amyloid beta on white matter tracts in neurologically normal 70 year olds. Alzheimers Dement 2021. [DOI: 10.1002/alz.056187] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aaron Z. Wagen
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Angeliki Zarkali
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - William Coath
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Sarah M. Buchanan
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Sarah E. Keuss
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Ashvini Keshavan
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Kirsty Lu
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Sarah‐Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL London United Kingdom
| | - Ivanna M. Pavisic
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
- Dementia Research Institute UCL London United Kingdom
| | - Rebecca E. Street
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Thomas D. Parker
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Christopher A. Lane
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Heidi Murray‐Smith
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - David M. Cash
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Ian B. Malone
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL London United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL London United Kingdom
| | - Nick C. Fox
- Dementia Research Centre London United Kingdom
| | - Andre Altmann
- Centre for Medical Image Computing University College London London United Kingdom
| | - James H. Cole
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
- Centre of Medical Image Computing UCL Department of Medical Physics London United Kingdom
| | - Rimona S. Weil
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Jonathan M. Schott
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
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28
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Thomas GEC, Zarkali A, Ryten M, Shmueli K, Gil-Martinez AL, Leyland LA, McColgan P, Acosta-Cabronero J, Lees AJ, Weil RS. Regional brain iron and gene expression provide insights into neurodegeneration in Parkinson's disease. Brain 2021; 144:1787-1798. [PMID: 33704443 PMCID: PMC8320305 DOI: 10.1093/brain/awab084] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/20/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
The mechanisms responsible for the selective vulnerability of specific neuronal populations in Parkinson's disease are poorly understood. Oxidative stress secondary to brain iron accumulation is one postulated mechanism. We measured iron deposition in 180 cortical regions of 96 patients with Parkinson's disease and 35 control subjects using quantitative susceptibility mapping. We estimated the expression of 15 745 genes in the same regions using transcriptomic data from the Allen Human Brain Atlas. Using partial least squares regression, we then identified the profile of gene transcription in the healthy brain that underlies increased cortical iron in patients with Parkinson's disease relative to controls. Applying gene ontological tools, we investigated the biological processes and cell types associated with this transcriptomic profile and identified the sets of genes with spatial expression profiles in control brains that correlated significantly with the spatial pattern of cortical iron deposition in Parkinson's disease. Gene ontological analyses revealed that these genes were enriched for biological processes relating to heavy metal detoxification, synaptic function and nervous system development and were predominantly expressed in astrocytes and glutamatergic neurons. Furthermore, we demonstrated that the genes differentially expressed in Parkinson's disease are associated with the pattern of cortical expression identified in this study. Our findings provide mechanistic insights into regional selective vulnerabilities in Parkinson's disease, particularly the processes involving iron accumulation.
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Affiliation(s)
| | | | - Mina Ryten
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1B 5EH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL, London, WC1N 1EH, UK
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, UCL, London, WC1N 1EH, UK
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, UCL, London, WC1E 6BT, UK
| | - Ana Luisa Gil-Martinez
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1B 5EH, UK
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, UCL, London, WC1N 1EH, UK
| | | | - Peter McColgan
- Huntington’s Disease Centre, UCL Institute of Neurology, London, WC1B 5EH, UK
| | | | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, London, WC1N 1PJ, UK
| | - Rimona S Weil
- Dementia Research Centre, UCL, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, UCL, London, WC1N 3AR, UK
- Movement Disorders Consortium, UCL, London, WC1N 3BG, UK
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29
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Johnson JCS, McWhirter L, Hardy CJD, Crutch SJ, Marshall CR, Mummery CJ, Rohrer JD, Rossor MN, Schott JM, Weil RS, Fox NC, Warren JD. Suspecting dementia: canaries, chameleons and zebras. Pract Neurol 2021; 21:practneurol-2021-003019. [PMID: 34215701 DOI: 10.1136/practneurol-2021-003019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/03/2022]
Abstract
The early and accurate diagnosis of dementia is more important than ever before but remains challenging. Dementia is increasingly the business of neurologists and, with ageing populations worldwide, will become even more so in future. Here we outline a practical, symptom-led, bedside approach to suspecting dementia and its likely diagnosis, inspired by clinical experience and based on recognition of characteristic syndromic patterns. We show how clinical intuition reflects underlying signature profiles of brain involvement by the diseases that cause dementia and suggest next steps that can be taken to define the diagnosis. We propose 'canaries' that provide an early warning signal of emerging dementia and highlight the 'chameleons' that disguise or mimic this, as well as the 'zebras' that herald a rare (and sometimes curable) diagnostic opportunity.
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Affiliation(s)
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, London, UK
- Department of Neurology, Royal London Hospital, London, UK
| | | | | | | | | | | | - Nick C Fox
- Dementia Research Centre, UCL, London, UK
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30
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Zarkali A, Weil RS. Beyond dopamine: Further evidence of cholinergic dysfunction in Parkinson's disease (Commentary on Keo et al., 2021). Eur J Neurosci 2021; 53:3740-3742. [PMID: 33960522 DOI: 10.1111/ejn.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, London, UK
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31
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Abstract
Visual hallucinations have intrigued neurologists and physicians for generations due to patients' vivid and fascinating descriptions. They are most commonly associated with Parkinson's disease and dementia with Lewy bodies, but also occur in people with visual loss, where they are known as Charles Bonnet syndrome. More rarely, they can develop in other neurological conditions, such as thalamic or midbrain lesions, when they are known as peduncular hallucinosis. This review considers the mechanisms underlying visual hallucinations across diagnoses, including visual loss, network dysfunction across the brain and changes in neurotransmitters. We propose a framework to explain why visual hallucinations occur most commonly in Parkinson's disease and dementia with Lewy bodies, and discuss treatment approaches to visual hallucinations in these conditions.
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - A J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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32
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Zarkali A, McColgan P, Leyland L, Lees AJ, Weil RS. Visual Dysfunction Predicts Cognitive Impairment and White Matter Degeneration in Parkinson's Disease. Mov Disord 2021; 36:1191-1202. [PMID: 33421201 PMCID: PMC8248368 DOI: 10.1002/mds.28477] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Visual dysfunction predicts dementia in Parkinson's disease (PD), but whether this translates to structural change is not known. The objectives of this study were to identify longitudinal white matter changes in patients with Parkinson's disease and low visual function and also in those who developed mild cognitive impairment. METHODS We used fixel-based analysis to examine longitudinal white matter change in PD. Diffusion MRI and clinical assessments were performed in 77 patients at baseline (22 low visual function/55 intact vision and 13 PD-mild cognitive impairment/51 normal cognition) and 25 controls and again after 18 months. We compared microstructural changes in fiber density, macrostructural changes in fiber bundle cross-section and combined fiber density and cross-section, across white matter, adjusting for age, sex, and intracranial volume. RESULTS Patients with PD and visual dysfunction showed worse cognitive performance at follow-up and were more likely to develop mild cognitive impairment compared with those with normal vision (P = 0.008). Parkinson's with poor visual function showed diffuse microstructural and macrostructural changes at baseline, whereas those with mild cognitive impairment showed fewer baseline changes. At follow-up, Parkinson's with low visual function showed widespread macrostructural changes, involving the fronto-occipital fasciculi, external capsules, and middle cerebellar peduncles bilaterally. No longitudinal change was seen in those with mild cognitive impairment at baseline or converters, even when the 2 groups were combined. CONCLUSION Parkinson's patients with poor visual function show increased white matter damage over time, providing further evidence for visual function as a marker of imminent cognitive decline. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research CentreUniversity College LondonLondonUnited Kingdom
| | - Peter McColgan
- Huntington's Disease CentreUniversity College LondonLondonUnited Kingdom
| | | | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological StudiesLondonUnited Kingdom
| | - Rimona S. Weil
- Dementia Research CentreUniversity College LondonLondonUnited Kingdom,Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUnited Kingdom,Movement Disorders ConsortiumNational Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
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33
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Oxtoby NP, Leyland LA, Aksman LM, Thomas GEC, Bunting EL, Wijeratne PA, Young AL, Zarkali A, Tan MMX, Bremner FD, Keane PA, Morris HR, Schrag AE, Alexander DC, Weil RS. Sequence of clinical and neurodegeneration events in Parkinson's disease progression. Brain 2021; 144:975-988. [PMID: 33543247 PMCID: PMC8041043 DOI: 10.1093/brain/awaa461] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 06/01/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 02/07/2023] Open
Abstract
Dementia is one of the most debilitating aspects of Parkinson's disease. There are no validated biomarkers that can track Parkinson's disease progression, nor accurately identify patients who will develop dementia and when. Understanding the sequence of observable changes in Parkinson's disease in people at elevated risk for developing dementia could provide an integrated biomarker for identifying and managing individuals who will develop Parkinson's dementia. We aimed to estimate the sequence of clinical and neurodegeneration events, and variability in this sequence, using data-driven statistical modelling in two separate Parkinson's cohorts, focusing on patients at elevated risk for dementia due to their age at symptom onset. We updated a novel version of an event-based model that has only recently been extended to cope naturally with clinical data, enabling its application in Parkinson's disease for the first time. The observational cohorts included healthy control subjects and patients with Parkinson's disease, of whom those diagnosed at age 65 or older were classified as having high risk of dementia. The model estimates that Parkinson's progression in patients at elevated risk for dementia starts with classic prodromal features of Parkinson's disease (olfaction, sleep), followed by early deficits in visual cognition and increased brain iron content, followed later by a less certain ordering of neurodegeneration in the substantia nigra and cortex, neuropsychological cognitive deficits, retinal thinning in dopamine layers, and further deficits in visual cognition. Importantly, we also characterize variation in the sequence. We found consistent, cross-validated results within cohorts, and agreement between cohorts on the subset of features available in both cohorts. Our sequencing results add powerful support to the increasing body of evidence suggesting that visual processing specifically is affected early in patients with Parkinson's disease at elevated risk of dementia. This opens a route to earlier and more precise detection, as well as a more detailed understanding of the pathological mechanisms underpinning Parkinson's dementia.
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Affiliation(s)
- Neil P Oxtoby
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | | | - Leon M Aksman
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - George E C Thomas
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Emma L Bunting
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Peter A Wijeratne
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Angelika Zarkali
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Manuela M X Tan
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
| | - Fion D Bremner
- Neuro-ophthalmology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK
| | - Pearse A Keane
- Institute of Ophthalmology, UCL, London, UK
- Moorfields Eye Hospital, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
| | - Anette E Schrag
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Rimona S Weil
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
- The Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, UCL, London, UK
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34
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Jiang J, Benhamou E, Waters S, Johnson JCS, Volkmer A, Weil RS, Marshall CR, Warren JD, Hardy CJD. Processing of Degraded Speech in Brain Disorders. Brain Sci 2021; 11:394. [PMID: 33804653 PMCID: PMC8003678 DOI: 10.3390/brainsci11030394] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
The speech we hear every day is typically "degraded" by competing sounds and the idiosyncratic vocal characteristics of individual speakers. While the comprehension of "degraded" speech is normally automatic, it depends on dynamic and adaptive processing across distributed neural networks. This presents the brain with an immense computational challenge, making degraded speech processing vulnerable to a range of brain disorders. Therefore, it is likely to be a sensitive marker of neural circuit dysfunction and an index of retained neural plasticity. Considering experimental methods for studying degraded speech and factors that affect its processing in healthy individuals, we review the evidence for altered degraded speech processing in major neurodegenerative diseases, traumatic brain injury and stroke. We develop a predictive coding framework for understanding deficits of degraded speech processing in these disorders, focussing on the "language-led dementias"-the primary progressive aphasias. We conclude by considering prospects for using degraded speech as a probe of language network pathophysiology, a diagnostic tool and a target for therapeutic intervention.
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Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jeremy C. S. Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK;
| | - Rimona S. Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Charles R. Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Chris J. D. Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
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35
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Johnson JCS, Marshall CR, Weil RS, Bamiou DE, Hardy CJD, Warren JD. Hearing and dementia: from ears to brain. Brain 2021; 144:391-401. [PMID: 33351095 PMCID: PMC7940169 DOI: 10.1093/brain/awaa429] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/17/2020] [Indexed: 12/19/2022] Open
Abstract
The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment and prevention. However, the nature of this association has not been defined. We hear with our brains, particularly within the complex soundscapes of everyday life: neurodegenerative pathologies target the auditory brain, and are therefore predicted to damage hearing function early and profoundly. Here we present evidence for this proposition, based on structural and functional features of auditory brain organization that confer vulnerability to neurodegeneration, the extensive, reciprocal interplay between 'peripheral' and 'central' hearing dysfunction, and recently characterized auditory signatures of canonical neurodegenerative dementias (Alzheimer's disease, Lewy body disease and frontotemporal dementia). Moving beyond any simple dichotomy of ear and brain, we argue for a reappraisal of the role of auditory cognitive dysfunction and the critical coupling of brain to peripheral organs of hearing in the dementias. We call for a clinical assessment of real-world hearing in these diseases that moves beyond pure tone perception to the development of novel auditory 'cognitive stress tests' and proximity markers for the early diagnosis of dementia and management strategies that harness retained auditory plasticity.
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Affiliation(s)
- Jeremy C S Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Charles R Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Rimona S Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Movement Disorders Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Doris-Eva Bamiou
- UCL Ear Institute and UCL/UCLH Biomedical Research Centre, National Institute for Health Research, University College London, London, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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36
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Zarkali A, McColgan P, Leyland LA, Lees AJ, Rees G, Weil RS. Organisational and neuromodulatory underpinnings of structural-functional connectivity decoupling in patients with Parkinson's disease. Commun Biol 2021; 4:86. [PMID: 33469150 PMCID: PMC7815846 DOI: 10.1038/s42003-020-01622-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 01/01/2023] Open
Abstract
Parkinson's dementia is characterised by changes in perception and thought, and preceded by visual dysfunction, making this a useful surrogate for dementia risk. Structural and functional connectivity changes are seen in humans with Parkinson's disease, but the organisational principles are not known. We used resting-state fMRI and diffusion-weighted imaging to examine changes in structural-functional connectivity coupling in patients with Parkinson's disease, and those at risk of dementia. We identified two organisational gradients to structural-functional connectivity decoupling: anterior-to-posterior and unimodal-to-transmodal, with stronger structural-functional connectivity coupling in anterior, unimodal areas and weakened towards posterior, transmodal regions. Next, we related spatial patterns of decoupling to expression of neurotransmitter receptors. We found that dopaminergic and serotonergic transmission relates to decoupling in Parkinson's overall, but instead, serotonergic, cholinergic and noradrenergic transmission relates to decoupling in patients with visual dysfunction. Our findings provide a framework to explain the specific disorders of consciousness in Parkinson's dementia, and the neurotransmitter systems that underlie these.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK.
| | - Peter McColgan
- Huntington's Disease Centre, University College London, Russell Square House, London, WC1B 5EH, UK
| | - Louise-Ann Leyland
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, 1 Wakefield Street, London, WC1N 1PJ, UK
| | - Geraint Rees
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
- Movement Disorders Consortium, University College London, London, WC1N 3BG, UK
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Zarkali A, McColgan P, Ryten M, Reynolds R, Leyland LA, Lees AJ, Rees G, Weil RS. Differences in network controllability and regional gene expression underlie hallucinations in Parkinson's disease. Brain 2020; 143:3435-3448. [PMID: 33118028 PMCID: PMC7719028 DOI: 10.1093/brain/awaa270] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 12/06/2019] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Visual hallucinations are common in Parkinson's disease and are associated with poorer prognosis. Imaging studies show white matter loss and functional connectivity changes with Parkinson's visual hallucinations, but the biological factors underlying selective vulnerability of affected parts of the brain network are unknown. Recent models for Parkinson's disease hallucinations suggest they arise due to a shift in the relative effects of different networks. Understanding how structural connectivity affects the interplay between networks will provide important mechanistic insights. To address this, we investigated the structural connectivity changes that accompany visual hallucinations in Parkinson's disease and the organizational and gene expression characteristics of the preferentially affected areas of the network. We performed diffusion-weighted imaging in 100 patients with Parkinson's disease (81 without hallucinations, 19 with visual hallucinations) and 34 healthy age-matched controls. We used network-based statistics to identify changes in structural connectivity in Parkinson's disease patients with hallucinations and performed an analysis of controllability, an emerging technique that allows quantification of the influence a brain region has across the rest of the network. Using these techniques, we identified a subnetwork of reduced connectivity in Parkinson's disease hallucinations. We then used the Allen Institute for Brain Sciences human transcriptome atlas to identify regional gene expression patterns associated with affected areas of the network. Within this network, Parkinson's disease patients with hallucinations showed reduced controllability (less influence over other brain regions), than Parkinson's disease patients without hallucinations and controls. This subnetwork appears to be critical for overall brain integration, as even in controls, nodes with high controllability were more likely to be within the subnetwork. Gene expression analysis of gene modules related to the affected subnetwork revealed that down-weighted genes were most significantly enriched in genes related to mRNA and chromosome metabolic processes (with enrichment in oligodendrocytes) and upweighted genes to protein localization (with enrichment in neuronal cells). Our findings provide insights into how hallucinations are generated, with breakdown of a key structural subnetwork that exerts control across distributed brain regions. Expression of genes related to mRNA metabolism and membrane localization may be implicated, providing potential therapeutic targets.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Peter McColgan
- Huntington’s Disease Centre, University College London, Russell Square House, London, WC1B 5EH, UK
| | - Mina Ryten
- Department of Neurodegenerative Disease, UCL Institute of Neurology, 10-12 Russell Square House, London, UK
| | - Regina Reynolds
- Department of Neurodegenerative Disease, UCL Institute of Neurology, 10-12 Russell Square House, London, UK
| | - Louise-Ann Leyland
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, 1 Wakefield Street, London, WC1N 1PJ, UK
| | - Geraint Rees
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
- Movement Disorders Consortium, University College London, London WC1N 3BG, UK
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Zarkali A, McColgan P, Ryten M, Reynolds RH, Leyland LA, Lees AJ, Rees G, Weil RS. Dementia risk in Parkinson's disease is associated with interhemispheric connectivity loss and determined by regional gene expression. Neuroimage Clin 2020; 28:102470. [PMID: 33395965 PMCID: PMC7581968 DOI: 10.1016/j.nicl.2020.102470] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/08/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's dementia is a common and devastating part of Parkinson's disease. Whilst timing and severity vary, dementia in Parkinson's is often preceded by visual dysfunction. White matter changes, representing axonal loss, occur early in the disease process. Clarifying which white matter connections are affected in Parkinson's with visual dysfunction and why specific connections are vulnerable will provide important mechanistic insights. Here, we use diffusion tractography in 100 Parkinson's patients (33 low visual performers) and 34 controls to identify patterns of connectivity loss in Parkinson's with visual dysfunction. We examine the relationship between regional transcription and connectivity loss, using the Allen Institute for Brain Science transcriptome atlas. We show that interhemispheric connections are preferentially affected in Parkinson's low visual performers. Interhemispheric connection loss was associated with downweighted genes related to the smoothened signalling pathway (enriched in glutamatergic neurons) and upweighted metabolic genes. Risk genes for Parkinson's but not Alzheimer's or Dementia with Lewy bodies were over-represented in upweighted genes associated with interhemispheric connection loss. Our findings suggest selective vulnerability in Parkinson's patients at highest risk of dementia (those with visual dysfunction), where differences in gene expression and metabolic dysfunction, affecting longer connections with higher metabolic burden, drive connectivity loss.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK.
| | - Peter McColgan
- Huntington's Disease Centre, University College London, Russell Square House, London WC1B 5EH, UK
| | - Mina Ryten
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK; Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK; Department of Neurodegenerative Disease, UCL Institute of Neurology, 10-12 Russell Square House, London WC1B 5EH, UK
| | - Regina H Reynolds
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK; Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK; Department of Neurodegenerative Disease, UCL Institute of Neurology, 10-12 Russell Square House, London WC1B 5EH, UK
| | - Louise-Ann Leyland
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, 1 Wakefield Street, London WC1N 1PJ, UK
| | - Geraint Rees
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London WC1N 3AR, UK; Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London WC1N 3AR, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK; Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London WC1N 3AR, UK; Movement Disorders Consortium, University College London, London WC1N 3BG, UK
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Foley JA, Dore C, Zarkali A, Livingston G, Cipolotti L, Mummery CJ, Weil RS. Evaluation of START (STrAtegies for RelaTives) adapted for carers of people with Lewy body dementia. Future Healthc J 2020; 7:e27-e29. [PMID: 33094242 PMCID: PMC7571743 DOI: 10.7861/fhj.2020-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Family carers of people with Lewy body dementia (LBD) have a particularly high burden of care, as LBD has a faster rate of decline, greater physical dependence and additional neuropsychiatric disturbances compared with other dementias. Despite this, there are no evidence-based support services designed specifically for LBD carers. STrAtegies for RelaTives (START) is an eight-session, individually delivered coping therapy that has been shown in a randomised controlled trial to reduce depression and anxiety symptoms and increase quality of life in carers of people with dementia, with effects lasting several years. We adapted START for LBD, and piloted its use both face-to-face and on the phone with 10 carers to test acceptability and indications of similar effects in this group. Our findings suggest that the therapy was acceptable and feasible using either delivery mode, providing much appreciated and needed strategies, education and support for carers of people with LBD. Trials of effectiveness are now needed.
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Affiliation(s)
- Jennifer A Foley
- ANational Hospital for Neurology and Neurosurgery, London, UK and University College London Institute of Neurology, London, UK,Address for correspondence: Dr Jennifer A Foley, Department of Neuropsychology, Box 37, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Charlotte Dore
- BNational Hospital for Neurology and Neurosurgery, London, UK
| | | | - Gill Livingston
- DUniversity College London, London, UK and Camden and Islington NHS Foundation Trust, London, UK
| | - Lisa Cipolotti
- ENational Hospital for Neurology and Neurosurgery, London, UK
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, University College London, London, United Kingdom.,Movement Disorders Centre, University College London, London, United Kingdom.,Wellcome Centre for Human Neuroimaging, London, United Kingdom.,National Hospital for Neurology & Neurosurgery, London, United Kingdom
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Khoo A, McLoughlin B, Cheema S, Weil RS, Lambert C, Manji H, Zandi MS, Morrow JM. Postinfectious brainstem encephalitis associated with SARS-CoV-2. J Neurol Neurosurg Psychiatry 2020; 91:1013-1014. [PMID: 32636212 DOI: 10.1136/jnnp-2020-323816] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Anthony Khoo
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Benjamin McLoughlin
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Sanjay Cheema
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Rimona S Weil
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Dementia Research Centre, University College London, London, UK
| | - Christian Lambert
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hadi Manji
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael S Zandi
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Jasper M Morrow
- Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
Hallucinations are common in Parkinson's disease and can be distressing to patients and their families. They are associated with higher rates of nursing home placement and with increased mortality. Their underlying mechanisms have been elusive, but recent advances in network imaging provides some intriguing insights into possible underlying drivers. Treatment is complicated by risk of worsening Parkinson's motor symptoms and by higher rates of mortality with antipsychotics, but new therapeutic avenues are emerging that offer potential hope.
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Abstract
Visual hallucinations are a common and often distressing feature of Parkinson's disease; they are ephemeral and capricious, making them difficult to study but tend to be more prominent in dim illumination. Flickering stimuli can induce simple hallucinations even in healthy individuals. We tested a stroboscope and an equivalent full-screen flickering stimulus in 16 participants: 7 patients with Parkinson's and habitual visual hallucinations, 6 Parkinson's patients without hallucinations and 3 controls. Both flicker sources induced varied geometrical hallucinations in 4 participants (25%) and complex hallucinations in 1 but neither induced typical Parkinson's-associated hallucinations.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, London, UK,Correspondence to: Angeliki Zarkali, Dementia Research Centre, University College London, 8-11 Queen Square,
London, WC1N 3AR, UK. Tel.: +44 07833157065; E-mail:
| | - Andrew J. Lees
- Reta Lila Weston Institute, University College London, London, UK
| | - Rimona S. Weil
- Dementia Research Centre, University College London, London, UK,Wellcome Centre for Human Neuroimaging, University College London, London, UK
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Zarkali A, McColgan P, Leyland LA, Lees AJ, Rees G, Weil RS. Fiber-specific white matter reductions in Parkinson hallucinations and visual dysfunction. Neurology 2020; 94:e1525-e1538. [PMID: 32094242 PMCID: PMC7251523 DOI: 10.1212/wnl.0000000000009014] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 07/26/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the microstructural and macrostructural white matter changes that accompany visual hallucinations and low visual performance in Parkinson disease, a risk factor for Parkinson dementia. METHODS We performed fixel-based analysis, a novel technique that provides metrics of specific fiber-bundle populations within a voxel (or fixel). Diffusion MRI data were acquired from patients with Parkinson disease (n = 105, of whom 34 were low visual performers and 19 were hallucinators) and age-matched controls (n = 35). We used whole-brain fixel-based analysis to compare microstructural differences in fiber density (FD), macrostructural differences in fiber bundle cross section (FC), and the combined FD and FC (FDC) metric across all white matter fixels. We then performed a tract-of-interest analysis comparing the most sensitive FDC metric across 11 tracts within the visual system. RESULTS Patients with Parkinson disease hallucinations exhibited macrostructural changes (reduced FC) within the splenium of the corpus callosum and the left posterior thalamic radiation compared to patients without hallucinations. While there were no significant changes in FD, we found large reductions in the combined FDC metric in Parkinson hallucinators within the splenium (>50% reduction compared to nonhallucinators). Patients with Parkinson disease and low visual performance showed widespread microstructural and macrostructural changes within the genu and splenium of the corpus callosum, bilateral posterior thalamic radiations, and left inferior fronto-occipital fasciculus. CONCLUSIONS We demonstrate specific white matter tract degeneration affecting posterior thalamic tracts in patients with Parkinson disease with hallucinations and low visual performance, providing direct mechanistic support for attentional models of visual hallucinations.
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Affiliation(s)
- Angeliki Zarkali
- From the Dementia Research Centre (A.Z., L.-A.L., R.S.W.), Huntington's Disease Centre (P.M.), Institute of Cognitive Neuroscience (G.R.), and Wellcome Centre for Human Neuroimaging (G.R., R.S.W.), University College London; and Reta Lila Weston Institute of Neurological Studies (A.J.L.), London, UK.
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Solomons MR, Jaunmuktane Z, Weil RS, El-Hassan T, Brandner S, Rees JH. Seizure outcomes and survival in adult low-grade glioma over 11 years: living longer and better. Neurooncol Pract 2020; 7:196-201. [PMID: 32206321 PMCID: PMC7081389 DOI: 10.1093/nop/npz056] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There has been a trend toward earlier and more aggressive resection for low-grade gliomas (LGGs). This study set out to compare seizure control and survival of adults with LGG seen in the same neuro-oncology clinic over 11 years and to determine whether a change in surgical philosophy has led to a corresponding improvement in outcomes. METHODS We conducted a retrospective analysis using case-note review of 153 adults with histologically verified or radiologically suspected LGG, collecting data on patient, tumor, and seizure characteristics between 2006 and 2017. RESULTS We studied 79 patients in 2006 and 74 patients in 2017. There was no significant difference between the 2 groups in age at presentation, tumor location, or integrated pathological diagnosis. The numbers of complete or partial resections increased from 21.5% in 2006 to 60.8% in 2017 (P < .05). Five- and 10-year overall survival increased from 81.8% and 51.7% in 2006 to 100% and 95.8% in 2017 (P < .001); similarly, 5- and 10-year progression-free survival increased from 47.0% and 30.7% in 2006 to 93.1% and 68.7% in 2017. The proportion of patients with intractable epilepsy declined from 72.2% in 2006 to 43.2% in 2017 (P < .05). The neurosurgical morbidity rate was identical in both groups (11.8% in 2006 vs 11.1% in 2017). CONCLUSION Management of LGG over the last 11 years has led to substantial improvements in survival and seizure control. This is most likely thanks to a change in surgical philosophy, with early resection now favored over watchful waiting where possible.
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Affiliation(s)
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rimona S Weil
- National Hospital for Neurology and Neurosurgery, London, UK,UCL Queen Square Institute of Neurology, London, UK,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Tedani El-Hassan
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy H Rees
- National Hospital for Neurology and Neurosurgery, London, UK,UCL Queen Square Institute of Neurology, London, UK,Corresponding Author: JH Rees, BSc, MBBS, PhD, FRCP, Mailbox 99, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK ()
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46
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Leyland LA, Bremner FD, Mahmood R, Hewitt S, Durteste M, Cartlidge MRE, Lai MMM, Miller LE, Saygin AP, Keane PA, Schrag AE, Weil RS. Visual tests predict dementia risk in Parkinson disease. Neurol Clin Pract 2020; 10:29-39. [PMID: 32190418 PMCID: PMC7057066 DOI: 10.1212/cpj.0000000000000719] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the role of visual measures and retinal volume to predict the risk of Parkinson disease (PD) dementia. METHODS In this cohort study, we collected visual, cognitive, and motor data in people with PD. Participants underwent ophthalmic examination, retinal imaging using optical coherence tomography, and visual assessment including acuity and contrast sensitivity and high-level visuoperception measures of skew tolerance and biological motion. We assessed the risk of PD dementia using a recently described algorithm that combines age at onset, sex, depression, motor scores, and baseline cognition. RESULTS One hundred forty-six people were included in the study (112 with PD and 34 age-matched controls). The mean disease duration was 4.1 (±2·5) years. None of these participants had dementia. Higher risk of dementia was associated with poorer performance in visual measures (acuity: ρ = 0.29, p = 0.0024; contrast sensitivity: ρ = -0.37, p < 0.0001; skew tolerance: ρ = -0.25, p = 0.0073; and biological motion: ρ = -0.26, p = 0.0054). In addition, higher risk of PD dementia was associated with thinner retinal structure in layers containing dopaminergic cells, measured as ganglion cell layer (GCL) and inner plexiform layer (IPL) thinning (ρ = -0.29, p = 0.0021; ρ = -0.33, p = 0.00044). These relationships were not seen for the retinal nerve fiber layer that does not contain dopaminergic cells and were not seen in unaffected controls. CONCLUSION Visual measures and retinal structure in dopaminergic layers were related to risk of PD dementia. Our findings suggest that visual measures and retinal GCL and IPL volumes may be useful to predict the risk of dementia in PD.
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Affiliation(s)
- Louise-Ann Leyland
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Fion D Bremner
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Ribeya Mahmood
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Sam Hewitt
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Marion Durteste
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Molly R E Cartlidge
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Michelle M-M Lai
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Luke E Miller
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Ayse P Saygin
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Pearse A Keane
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Anette E Schrag
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
| | - Rimona S Weil
- Dementia Research Centre (L-AL, RM, RSW), Institute of Neurology, University College London, United Kingdom; Neuro-ophthalmology (FDB, MM-ML), National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Institute of Neurology (SH, MD, MREC), University College London, UCL, United Kingdom; School of Biomedical Sciences (MREC), Biological Sciences, Leeds University, United Kingdom; ImpAct (LEM), Lyon Neuroscience Research Center, France; Department of Cognitive Science (APS), University of California, San Diego; Kavli Institute for Brain and Mind (APS), University of California, San Diego; Institute of Ophthalmology (PAK), UCL, United Kingdom; Moorfields Eye Hospital (PAK), London, United Kingdom; Department of Clinical Neuroscience (AES), Institute of Neurology, UCL Hampstead Campus, London, United Kingdom; Movement Disorders Consortium (AES, RSW), UCL, United Kingdom; and The Wellcome Centre for Human Neuroimaging (RSW), Institute of Neurology, University College London, United Kingdom
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Zarkali A, Adams RA, Psarras S, Leyland LA, Rees G, Weil RS. Increased weighting on prior knowledge in Lewy body-associated visual hallucinations. Brain Commun 2019; 1:fcz007. [PMID: 31886459 PMCID: PMC6924538 DOI: 10.1093/braincomms/fcz007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 03/11/2019] [Revised: 06/03/2019] [Accepted: 07/26/2019] [Indexed: 01/25/2023] Open
Abstract
Hallucinations are a common and distressing feature of many psychiatric and neurodegenerative conditions. In Lewy body disease, visual hallucinations are a defining feature, associated with worse outcomes; yet their mechanisms remain unclear and treatment options are limited. Here, we show that hallucinations in Lewy body disease are associated with altered integration of top-down predictions with incoming sensory evidence, specifically with an increased relative weighting of prior knowledge. We tested 37 individuals with Lewy body disease, 17 habitual hallucinators and 20 without hallucinations, and 20 age-matched healthy individuals. We employed an image-based learning paradigm to test whether people with Lewy body disease and visual hallucinations show higher dependence on prior knowledge. We used two-tone images that are difficult to disambiguate without any prior information but generate a strong percept when information is provided. We measured discrimination sensitivity before and after this information was provided. We observed that in people with Lewy body disease who experience hallucinations, there was greater improvement in discrimination sensitivity after information was provided, compared to non-hallucinators and controls. This suggests that people with Lewy body disease and hallucinations place higher relative weighting on prior knowledge than those who do not hallucinate. Importantly, increased severity of visual hallucinations was associated with an increased effect of prior knowledge. Together these findings suggest that visual hallucinations in Lewy body disease are linked to a shift towards top-down influences on perception and away from sensory evidence, perhaps due to an increase in sensory noise. This provides important mechanistic insights to how hallucinations develop in Lewy body disease, with potential for revealing new therapeutic targets.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK,Correspondence to: Angeliki Zarkali Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK E-mail:
| | - Rick A Adams
- Max Planck Centre for Computational Psychiatry and Aging Research, University College London, 10-12 Russell Square, London WC1B 5EH, UK,Department of Computer Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Stamatios Psarras
- Space Syntax Laboratory, University College London, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Louise-Ann Leyland
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK
| | - Geraint Rees
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London WC1N 3AR, UK,Welcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London WC1N 3AR, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, 8-11 Queen Square, London WC1N 3AR, UK,Welcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London WC1N 3AR, UK
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48
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Weil RS, Hsu JK, Darby RR, Soussand L, Fox MD. Neuroimaging in Parkinson's disease dementia: connecting the dots. Brain Commun 2019; 1:fcz006. [PMID: 31608325 PMCID: PMC6777517 DOI: 10.1093/braincomms/fcz006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Dementia is a common and devastating symptom of Parkinson's disease but the anatomical substrate remains unclear. Some evidence points towards hippocampal involvement but neuroimaging abnormalities have been reported throughout the brain and are largely inconsistent across studies. Here, we test whether these disparate neuroimaging findings for Parkinson's disease dementia localize to a common brain network. We used a literature search to identify studies reporting neuroimaging correlates of Parkinson's dementia (11 studies, 385 patients). We restricted our search to studies of brain atrophy and hypometabolism that compared Parkinson's patients with dementia to those without cognitive involvement. We used a standard coordinate-based activation likelihood estimation meta-analysis to assess for consistency in the neuroimaging findings. We then used a new approach, coordinate-based network mapping, to test whether neuroimaging findings localized to a common brain network. This approach uses resting-state functional connectivity from a large cohort of normative subjects (n = 1000) to identify the network of regions connected to a reported neuroimaging coordinate. Activation likelihood estimation meta-analysis failed to identify any brain regions consistently associated with Parkinson's dementia, showing major heterogeneity across studies. In contrast, coordinate-based network mapping found that these heterogeneous neuroimaging findings localized to a specific brain network centred on the hippocampus. Next, we tested whether this network showed symptom specificity and stage specificity by performing two further analyses. We tested symptom specificity by examining studies of Parkinson's hallucinations (9 studies, 402 patients) that are frequently co-morbid with Parkinson's dementia. We tested for stage specificity by using studies of mild cognitive impairment in Parkinson's disease (15 studies, 844 patients). Coordinate-based network mapping revealed that correlates of visual hallucinations fell within a network centred on bilateral lateral geniculate nucleus and correlates of mild cognitive impairment in Parkinson's disease fell within a network centred on posterior default mode network. In both cases, the identified networks were distinct from the hippocampal network of Parkinson's dementia. Our results link heterogeneous neuroimaging findings in Parkinson's dementia to a common network centred on the hippocampus. This finding was symptom and stage-specific, with implications for understanding Parkinson's dementia and heterogeneity of neuroimaging findings in general.
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, UCL, London,Wellcome Centre for Human Neuroimaging, UCL, London,Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA,Correspondence to: Rimona S. Weil UCL Dementia Research Centre, 8-11 Queen Square, London WC1N 3BG UK E-mail:
| | - Joey K Hsu
- Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA
| | - Ryan R Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Louis Soussand
- Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA
| | - Michael D Fox
- Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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49
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Weil RS, Winston JS, Leyland L, Pappa K, Mahmood RB, Morris HR, Rees G. Neural correlates of early cognitive dysfunction in Parkinson's disease. Ann Clin Transl Neurol 2019; 6:902-912. [PMID: 31139688 PMCID: PMC6529983 DOI: 10.1002/acn3.767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/09/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Dementia is a common and feared aspect of Parkinson's disease but there are no robust predictors of cognitive outcome. Visuoperceptual deficits are linked to risk of dementia in Parkinson's disease but whether they predict cognitive change is not known, and the neural substrates of visuoperceptual dysfunction in Parkinson's have not yet been identified. METHODS We compared patients with Parkinson's disease and unaffected controls who underwent BOLD fMRI while performing our previously validated visuoperceptual task and tested how functional connectivity between task-specific regions and the rest of the brain differed between patients who performed well and poorly in the task. RESULTS We show that task performance at baseline predicts change in cognition in Parkinson's disease after 1 year. Our task-based fMRI study showed that the performance in this task is associated with activity in the posterior cingulate cortex/precuneus. We found that functional connectivity between this region and dorsomedial prefrontal cortex was reduced in poor performers compared with good performers of this task. INTERPRETATION Our findings suggest that functional connectivity is reduced between posterior and anterior hubs of the default mode network in Parkinson's patients who are likely to progress to worsening cognitive dysfunction. Our work implicates posterior default mode nodes and their connections as key brain regions in early stages of dementia in Parkinson's disease.
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Affiliation(s)
- Rimona S. Weil
- Dementia Research CentreUCLLondonUnited Kingdom,Wellcome Centre for Human NeuroimagingUCLLondonUnited Kingdom
| | - Joel S. Winston
- Wellcome Centre for Human NeuroimagingUCLLondonUnited Kingdom,National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | | | - Katerina Pappa
- Institute of Cognitive NeuroscienceUCLLondonUnited Kingdom
| | | | - Huw R. Morris
- Department of Clinical and Motor NeuroscienceUCL Queen Square Institute of NeurologyLondonUnited Kingdom,Movement Disorders CentreUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Geraint Rees
- Wellcome Centre for Human NeuroimagingUCLLondonUnited Kingdom,Institute of Cognitive NeuroscienceUCLLondonUnited Kingdom
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50
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Abstract
This scientific commentary refers to ‘Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study’ by Postuma et al. (doi:10.1093/brain/awz030).
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UK,UCL Movement Disorders Centre, UCL Queen Square Institute of Neurology, UK,Wellcome Centre for Human Neuroimaging, UCL, London, UK
| | - Huw R Morris
- UCL Movement Disorders Centre, UCL Queen Square Institute of Neurology, UK,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, UK,Correspondence to: Prof Huw Morris Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London WC1N 3BG, UK E-mail:
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