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Hastings A, Cullinane P, Wrigley S, Revesz T, Morris HR, Dickson JC, Jaunmuktane Z, Warner TT, De Pablo-Fernández E. Neuropathologic Validation and Diagnostic Accuracy of Presynaptic Dopaminergic Imaging in the Diagnosis of Parkinsonism. Neurology 2024; 102:e209453. [PMID: 38759132 DOI: 10.1212/wnl.0000000000209453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Degeneration of the presynaptic nigrostriatal dopaminergic system is one of the main biological features of Parkinson disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which can be measured using single-photon emission CT imaging for diagnostic purposes. Despite its widespread use in clinical practice and research, the diagnostic properties of presynaptic nigrostriatal dopaminergic (DAT) imaging in parkinsonism have never been evaluated against the diagnostic gold standard of neuropathology. The aim of this study was to evaluate the diagnostic parameters of DAT imaging compared with pathologic diagnosis in patients with parkinsonism. METHODS Retrospective cohort study of patients with DAT imaging for the investigation of a clinically uncertain parkinsonism with brain donation between 2010 and 2021 to the Queen Square Brain Bank (London). Patients with DAT imaging for investigation of pure ataxia or dementia syndromes without parkinsonism were excluded. Those with a pathologic diagnosis of PD, MSA, PSP, or CBD were considered presynaptic dopaminergic parkinsonism, and other pathologies were considered postsynaptic for the analysis. DAT imaging was performed in routine clinical practice and visually classified by hospital nuclear medicine specialists as normal or abnormal. The results were correlated with neuropathologic diagnosis to calculate diagnostic accuracy parameters for the diagnosis of presynaptic dopaminergic parkinsonism. RESULTS All of 47 patients with PD, 41 of 42 with MSA, 68 of 73 with PSP, and 6 of 10 with CBD (sensitivity 100%, 97.6%, 93.2%, and 60%, respectively) had abnormal presynaptic dopaminergic imaging. Eight of 17 patients with presumed postsynaptic parkinsonism had abnormal scans (specificity 52.9%). DISCUSSION DAT imaging has very high sensitivity and negative predictive value for the diagnosis of presynaptic dopaminergic parkinsonism, particularly for PD. However, patients with CBD, and to a lesser extent PSP (of various phenotypes) and MSA (with predominant ataxia), can show normal DAT imaging. A range of other neurodegenerative disorders may have abnormal DAT scans with low specificity in the differential diagnosis of parkinsonism. DAT imaging is a useful diagnostic tool in the differential diagnosis of parkinsonism, although clinicians should be aware of its diagnostic properties and limitations. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that DAT imaging does not accurately distinguish between presynaptic dopaminergic parkinsonism and non-presynaptic dopaminergic parkinsonism.
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Affiliation(s)
- Alexandra Hastings
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Patrick Cullinane
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Sarah Wrigley
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Tamas Revesz
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Huw R Morris
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - John C Dickson
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Zane Jaunmuktane
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Thomas T Warner
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
| | - Eduardo De Pablo-Fernández
- From the Queen Square Brain Bank for Neurological Disorders (A.H., P.C., S.W., T.R., Z.J., T.T.W., E.D.P.-F.) and Department of Clinical and Movement Neurosciences (H.R.M.), University College London Queen Square Institute of Neurology; and Institute of Nuclear Medicine (J.C.D.), University College London Hospitals NHS Trust, UK
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Chow TK, Ma KM. Loss of Mickey Mouse Ears' Sign in Progressive Supranuclear Palsy. Clin Nucl Med 2024; 49:551-553. [PMID: 38598736 DOI: 10.1097/rlu.0000000000005229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
ABSTRACT Progressive supranuclear palsy (PSP) is the most prevalent form of degenerative atypical parkinsonism. Clinical manifestations of PSP commonly encompass deficits in vertical gaze, postural stability, akinesia, and cognitive impairment. The characteristic metabolic pattern observed in PSP through FDG PET displays hypometabolism in the midbrain, striatum, thalamus, and frontal lobe. However, visual interpretation of midbrain hypometabolism poses challenges. In this report, we aim to elucidate a novel observation termed the "loss of Mickey Mouse ears' sign," which signifies midbrain hypometabolism as detected through visual assessment of FDG PET images.
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Affiliation(s)
- Tsz-Kit Chow
- From the Nuclear Medicine Unit, Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong
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Qu J, Tian M, Zhu R, Song C, Wu Y, Xu G, Liu Y, Wang D. Aberrant dynamic functional network connectivity in progressive supranuclear palsy. Neurobiol Dis 2024; 195:106493. [PMID: 38579913 DOI: 10.1016/j.nbd.2024.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The clinical symptoms of progressive supranuclear palsy (PSP) may be mediated by aberrant dynamic functional network connectivity (dFNC). While earlier research has found altered functional network connections in PSP patients, the majority of those studies have concentrated on static functional connectivity. Nevertheless, in this study, we sought to evaluate the modifications in dynamic characteristics and establish the correlation between these disease-related changes and clinical variables. METHODS In our study, we conducted a study on 53 PSP patients and 65 normal controls. Initially, we employed a group independent component analysis (ICA) to derive resting-state networks (RSNs), while employing a sliding window correlation approach to produce dFNC matrices. The K-means algorithm was used to cluster these matrices into distinct dynamic states, and then state analysis was subsequently employed to analyze the dFNC and temporal metrics between the two groups. Finally, we made a correlation analysis. RESULTS PSP patients showed increased connectivity strength between medulla oblongata (MO) and visual network (VN) /cerebellum network (CBN) and decreased connections were found between default mode network (DMN) and VN/CBN, subcortical cortex network (SCN) and CBN. In addition, PSP patients spend less fraction time and shorter dwell time in a diffused state, especially the MO and SCN. Finally, the fraction time and mean dwell time in the distributed connectivity state (state 2) is negatively correlated with duration, bulbar and oculomotor symptoms. DISCUSSION Our findings were that the altered connectivity was mostly concentrated in the CBN and MO. In addition, PSP patients had different temporal dynamics, which were associated with bulbar and oculomotor symptoms in PSPRS. It suggest that variations in dynamic functional network connectivity properties may represent an essential neurological mechanism in PSP.
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Affiliation(s)
- Junyu Qu
- Department of Radiology, Qilu Hospital of Shandong University; Qilu Medical Imaging Institute of Shandong University, Ji'nan, China
| | - Min Tian
- Department of Neurology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Rui Zhu
- Department of Radiology, Qilu Hospital of Shandong University; Qilu Medical Imaging Institute of Shandong University, Ji'nan, China
| | - Chengyuan Song
- Department of Neurology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Yongsheng Wu
- Department of Radiology, Qilu Hospital of Shandong University; Qilu Medical Imaging Institute of Shandong University, Ji'nan, China
| | - Guihua Xu
- Department of Radiology, Qilu Hospital of Shandong University; Qilu Medical Imaging Institute of Shandong University, Ji'nan, China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital of Shandong University, Ji'nan, China.
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University; Qilu Medical Imaging Institute of Shandong University, Ji'nan, China; Research Institute of Shandong University: Magnetic Field-free Medicine & Functional Imaging, Ji'nan, China; Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging (MF), Ji'nan, China.
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Ma JH, Dong C, Qiao HW, Barret O, Tamagnan GD, Mao W, Xu EH, Zhang C, Lu J, Chan P, Liu SY. Striatal and Extrastriatal Monoaminergic Disruption in Progressive Supranuclear Palsy. Mov Disord 2024; 39:847-854. [PMID: 38477228 DOI: 10.1002/mds.29769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND As a biomarker targeting vesicular monoamine transporter 2 (VMAT2), 18F-9-fluoropropyldihydrotetrabenazine (18F-FP-DTBZ) positron emission tomography (PET) is highly accurate in diagnosing Parkinson's disease (PD) and assessing its severity. However, evidence is insufficient in patients with progressive supranuclear palsy (PSP). OBJECTIVE We evaluated the striatal and extrastriatal monoaminergic disruption of PSP and differences in patterns between patients with PSP, PD, and healthy controls (HCs) using 18F-FP-DTBZ PET, as well as its correlations with the clinical characteristics of PSP. METHODS We recruited 58 patients with PSP, 23 age- and duration-matched patients with PD, as well as 17 HCs. Patients were scanned using 18F-FP-DTBZ PET/computed tomography, and images were spatially normalized and analyzed based on the volume of interest. RESULTS VMAT2 binding differed significantly in the striatum and substantia nigra among the groups (P < 0.001). A more severe disruption in the caudate was noted in the PSP group (P < 0.001) than in the PD group. However, no differences were found in the nucleus accumbens, hippocampus, amygdala, or raphe between the PD and PSP groups. Within the PSP group, striatal VMAT2 binding was significantly associated with the fall/postural stability subscore of the PSP Rating Scale, especially in the putamen. Furthermore, VMAT2 binding was correlated with Mini-Mental State Examination or Montreal Cognitive Assessment in the hippocampus. CONCLUSIONS Caudate disruptions showed prominent differences among the groups. VAMT2 binding in the striatum and hippocampus reflects the severity of fall/postural stability and cognition, respectively. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jing-Hong Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chong Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Wen Qiao
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Olivier Barret
- Université Paris-Saclay, CEA, CNRS, MIRCen, Laboratoire des Maladies Neurodégénératives, Paris, France
| | - Gilles D Tamagnan
- National Clinical Research Center for Geriatric Diseases, Beijing, China
- XingImaging LLC, New Haven, Connecticut, USA
| | - Wei Mao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Er-He Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chun Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shu-Ying Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
- Chinese Institute for Brain Research (CIBR), Beijing, China
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Shiina A, Ishikawa D, Ishizawa K, Kasahara H, Fujita Y, Mizuta I, Yoshida T, Ikeda Y. Alexander disease with a novel GFAP insertion-deletion mutation mimicking progressive supranuclear palsy. Clin Neurol Neurosurg 2024; 240:108261. [PMID: 38599043 DOI: 10.1016/j.clineuro.2024.108261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
This report presents a case of Alexander disease showing clinical characteristics mimicking progressive supranuclear palsy (PSP). A 67-year-old woman complaining of motor disturbance exhibited severe atrophy of medulla, spinal cord, and midbrain tegmentum, as well as periventricular hyperintensity on cerebral MRI. Genetic analysis identified a novel in-frame deletion/insertion mutation in the exon 3 of the GFAP gene. Interestingly, neurological findings and decreased striatal uptake in dopamine transporter SPECT were suggestive of PSP. A novel GFAP gene mutation found in the present case may cause the unique clinical phenotype, which should be differentiated from PSP.
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Affiliation(s)
- Aoi Shiina
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Daisuke Ishikawa
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kunihiko Ishizawa
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomokatsu Yoshida
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Neurology, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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Nigro S, Filardi M, Tafuri B, Nicolardi M, De Blasi R, Giugno A, Gnoni V, Milella G, Urso D, Zoccolella S, Logroscino G. Deep Learning-based Approach for Brainstem and Ventricular MR Planimetry: Application in Patients with Progressive Supranuclear Palsy. Radiol Artif Intell 2024; 6:e230151. [PMID: 38506619 DOI: 10.1148/ryai.230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Purpose To develop a fast and fully automated deep learning (DL)-based method for the MRI planimetric segmentation and measurement of the brainstem and ventricular structures most affected in patients with progressive supranuclear palsy (PSP). Materials and Methods In this retrospective study, T1-weighted MR images in healthy controls (n = 84) were used to train DL models for segmenting the midbrain, pons, middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), third ventricle, and frontal horns (FHs). Internal, external, and clinical test datasets (n = 305) were used to assess segmentation model reliability. DL masks from test datasets were used to automatically extract midbrain and pons areas and the width of MCP, SCP, third ventricle, and FHs. Automated measurements were compared with those manually performed by an expert radiologist. Finally, these measures were combined to calculate the midbrain to pons area ratio, MR parkinsonism index (MRPI), and MRPI 2.0, which were used to differentiate patients with PSP (n = 71) from those with Parkinson disease (PD) (n = 129). Results Dice coefficients above 0.85 were found for all brain regions when comparing manual and DL-based segmentations. A strong correlation was observed between automated and manual measurements (Spearman ρ > 0.80, P < .001). DL-based measurements showed excellent performance in differentiating patients with PSP from those with PD, with an area under the receiver operating characteristic curve above 0.92. Conclusion The automated approach successfully segmented and measured the brainstem and ventricular structures. DL-based models may represent a useful approach to support the diagnosis of PSP and potentially other conditions associated with brainstem and ventricular alterations. Keywords: MR Imaging, Brain/Brain Stem, Segmentation, Quantification, Diagnosis, Convolutional Neural Network Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Mohajer in this issue.
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Affiliation(s)
- Salvatore Nigro
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Marco Filardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Benedetta Tafuri
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Martina Nicolardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Roberto De Blasi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Alessia Giugno
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Valentina Gnoni
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giammarco Milella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Daniele Urso
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Stefano Zoccolella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giancarlo Logroscino
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
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Shah A, Prasad S, Indoria A, Pal PK, Saini J, Ingalhalikar M. Free water imaging in Parkinson's disease and atypical parkinsonian disorders. J Neurol 2024; 271:2521-2528. [PMID: 38265472 DOI: 10.1007/s00415-024-12184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Free water (FW)-corrected diffusion measures are more precise compared to standard diffusion measures. This study comprehensively evaluates FW and corrected diffusion metrics for whole brain white and deep gray matter (WM, GM) structures in patients with Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) and attempts to ascertain the probable patterns of WM abnormalities. METHOD Diffusion MRI was acquired for subjects with PD (n = 133), MSA (n = 25), PSP (n = 30) and matched healthy controls (HC) (n = 99, n = 24, n = 12). Diffusion metrics of FA, MD, AD, RD were generated and FW, corrected FA maps were calculated using a bi-tensor model. TBSS was carried out at 5000 permutations with significance at p < 0.05. For GM, diffusivity maps were extracted from the basal ganglia, and analyzed at an FDR with p < 0.05. RESULTS Compared to HC, PD showed focal changes in FW. MSA showed changes in the cerebellum and brainstem, and PSP showed increase in FW involving supratentorial WM and midbrain. All three showed increased substantia nigra FW. MSA, PSP demonstrated increased FW in bilateral putamen. PD showed increased FW in left GP externa, and bilateral thalamus. Compared to HC, MSA had increased FW in bilateral GP interna, and left thalamic. PSP had an additional increase in FW of the right GP externa, right GP interna, and bilateral thalamus. CONCLUSION The present study demonstrated definitive differences in the patterns of FW alterations between PD and atypical parkinsonian disorders suggesting the possibility of whole brain FW maps being used as markers for diagnosis of these disorders.
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Affiliation(s)
- Apurva Shah
- Symbiosis Center for Medical Image Analysis and Symbiosis Institute of Technology, Symbiosis International University, Lavale, Mulshi, Pune, 412115, Maharashtra, India
| | - Shweta Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Abhilasha Indoria
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis and Symbiosis Institute of Technology, Symbiosis International University, Lavale, Mulshi, Pune, 412115, Maharashtra, India.
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Chougar L, Faucher A, Faouzi J, Lejeune FX, Gama Lobo G, Jovanovic C, Cormier F, Dupont G, Vidailhet M, Corvol JC, Colliot O, Lehéricy S, Grabli D, Degos B. Contribution of MRI for the Early Diagnosis of Parkinsonism in Patients with Diagnostic Uncertainty. Mov Disord 2024; 39:825-835. [PMID: 38486423 DOI: 10.1002/mds.29760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/16/2024] [Accepted: 02/16/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND International clinical criteria are the reference for the diagnosis of degenerative parkinsonism in clinical research, but they may lack sensitivity and specificity in the early stages. OBJECTIVES To determine whether magnetic resonance imaging (MRI) analysis, through visual reading or machine-learning approaches, improves diagnostic accuracy compared with clinical diagnosis at an early stage in patients referred for suspected degenerative parkinsonism. MATERIALS Patients with initial diagnostic uncertainty between Parkinson's disease (PD), progressive supranuclear palsy (PSP), and multisystem atrophy (MSA), with brain MRI performed at the initial visit (V1) and available 2-year follow-up (V2), were included. We evaluated the accuracy of the diagnosis established based on: (1) the international clinical diagnostic criteria for PD, PSP, and MSA at V1 ("Clin1"); (2) MRI visual reading blinded to the clinical diagnosis ("MRI"); (3) both MRI visual reading and clinical criteria at V1 ("MRI and Clin1"), and (4) a machine-learning algorithm ("Algorithm"). The gold standard diagnosis was established by expert consensus after a 2-year follow-up. RESULTS We recruited 113 patients (53 with PD, 31 with PSP, and 29 with MSA). Considering the whole population, compared with clinical criteria at the initial visit ("Clin1": balanced accuracy, 66.2%), MRI visual reading showed a diagnostic gain of 14.3% ("MRI": 80.5%; P = 0.01), increasing to 19.2% when combined with the clinical diagnosis at the initial visit ("MRI and Clin1": 85.4%; P < 0.0001). The algorithm achieved a diagnostic gain of 9.9% ("Algorithm": 76.1%; P = 0.08). CONCLUSION Our study shows the use of MRI analysis, whether by visual reading or machine-learning methods, for early differentiation of parkinsonism. © 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)
- Lydia Chougar
- Department of Neuroradiology, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Paris, France
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
- Department of Neuroradiology, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Paris, France
| | - Alice Faucher
- Assistance Publique Hôpitaux de Paris, Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Sorbonne Paris Nord, NS-PARK/FCRIN Network, Bobigny, France
| | - Johann Faouzi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
- CREST, ENSAI, Campus de Ker-Lann, Bruz, France
| | - François-Xavier Lejeune
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
- ICM, Data Analysis Core (DAC), Paris, France
| | - Gonçalo Gama Lobo
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Carna Jovanovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Florence Cormier
- Département de Neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Clinique des Mouvements Anormaux, Clinical Investigation Center for Neurosciences, Paris, France
| | - Gwendoline Dupont
- Université de Bourgogne, Dijon, France
- Département de Neurologie, Centre Hospitalier Universitaire François Mitterrand, Dijon, France
| | - Marie Vidailhet
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
- Département de Neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Clinique des Mouvements Anormaux, Clinical Investigation Center for Neurosciences, Paris, France
| | - Olivier Colliot
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
- Department of Neuroradiology, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Paris, France
| | - David Grabli
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
- Département de Neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Clinique des Mouvements Anormaux, Clinical Investigation Center for Neurosciences, Paris, France
| | - Bertrand Degos
- Assistance Publique Hôpitaux de Paris, Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Sorbonne Paris Nord, NS-PARK/FCRIN Network, Bobigny, France
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
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Lu J, Ge J, Yu H, Zhao G, Chen X. Colocalization of Increased Midbrain Signals in Neuroinflammation and Tau PET Imaging Suggests the Diagnosis of Progressive Supranuclear Palsy. Clin Nucl Med 2024; 49:346-347. [PMID: 38271226 DOI: 10.1097/rlu.0000000000005062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Clinical overlap with multiple other neurological diseases makes the diagnosis of autoimmune encephalitis challenging; consequently, a broad range of neurological diseases are misdiagnosed as autoimmune encephalitis. A 58-year-old man presented with abnormal behavior, irritability for 3 years, oculomotor disturbance, unsteady walking, and dysphagia and was suspected as having anti-dipeptidyl-peptidase-like protein 6 (DPPX) encephalitis as the anti-DPPX antibody was positive in the serum. However, the therapeutic effect of immunotherapy was unsatisfactory. Subsequently, colocalization of increased midbrain signals was observed in neuroinflammation PET using [ 18 F]DPA-714 and in tau PET using [ 18 F]florzolotau, suggesting the diagnosis of progressive supranuclear palsy.
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Sankhla C, Gursahani R, Shah N. Progressive supranuclear palsy phenotypic presentation associated with anti MA2 antibody. Acta Neurol Belg 2024; 124:709-711. [PMID: 37606808 DOI: 10.1007/s13760-023-02358-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Charulata Sankhla
- Department of Neurology, PD Hinduja National Hospital and Medical Research Center, Mumbai, Maharastra, India.
| | - Roopkumar Gursahani
- Department of Neurology, PD Hinduja National Hospital and Medical Research Center, Mumbai, Maharastra, India
| | - Nen Shah
- Department of Neurology, PD Hinduja National Hospital and Medical Research Center, Mumbai, Maharastra, India
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Sjöström H, van Westen D, Hall S, Tjerkaski J, Westman E, Muehlboeck S, Hansson O, Svenningsson P, Granberg T. Putaminal T1/T2-weighted ratio is increased in PSP compared to PD and healthy controls, a multi-cohort study. Parkinsonism Relat Disord 2024; 121:106047. [PMID: 38368753 DOI: 10.1016/j.parkreldis.2024.106047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/13/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Differentiating Parkinson's disease (PD) from progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) is a common clinical problem. We aimed to apply the T1-/T2-weighted ratio imaging technique, based on standard clinical MRI, to reveal differences in neurodegeneration in three large cohorts. METHODS Three cohorts, with a total of 405 participants (269 PD, 44 PSP, 38 MSA, 54 controls), were combined and T1/T2-weighted ratio image analyses were carried out. A combination of automatic segmentation and atlas-based ROI were used in this study. The cohorts were combined using the ComBat batch correction procedure. RESULTS Group differences were found in the putamen (p = 0.040), with higher T1/T2-weighted ratio in this region in PSP compared to PD and healthy controls (p-values 0.010 and 0.007 respectively). Using putaminal T1/T2-weighted ratio for diagnostic separation, a fair performance was found in separating PSP from healthy controls, with an area under the receiver operating characteristic curve of 0.701. CONCLUSION Different patterns of T1/T2-weighted ratio, reflecting differences in underlying pathophysiology, were found between the groups. Since T1/T2-weighted ratio can be applied to standard clinical MRI sequences to allow more quantitative analyses, this seems to be a promising biomarker for diagnostics and treatment evaluation of parkinsonian disorders for clinical trials.
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Affiliation(s)
- Henrik Sjöström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden; Center for Neurology, Academic Specialist Center, 113 65, Stockholm, Sweden.
| | - Danielle van Westen
- Department of Clinical Sciences, Diagnostic Radiology, Lund University, 221 85, Lund, Sweden; Department for Image and Function, Skåne University Hospital, 221 85, Lund, Sweden
| | - Sara Hall
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, 221 00, Lund, Sweden; Memory Clinic, Skåne University Hospital, 205 02, Malmö, Sweden
| | - Jonathan Tjerkaski
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, WC2R 2LS, London, England, UK
| | - Sebastian Muehlboeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, 221 00, Lund, Sweden; Memory Clinic, Skåne University Hospital, 205 02, Malmö, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, 141 86, Stockholm, Sweden
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Yamahara N, Yoshikura N, Shimohata T. [Clinical features and effects of shunt surgery in patients with progressive supranuclear palsy and idiopathic normal pressure hydrocephalus]. Rinsho Shinkeigaku 2024; 64:113-116. [PMID: 38246604 DOI: 10.5692/clinicalneurol.cn-001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This study aimed to retrospectively review the frequency and clinical features of 13 patients with progressive supranuclear palsy (PSP) and idiopathic normal pressure hydrocephalus (iNPH). All patients were found to have PSP-Richardson's syndrome (PSP-RS). Shunt surgery was effective in 5 of 11 patients (45.5%). A comparison of these 5 patients who responded to shunt surgery versus the remaining 6 patients revealed a significant difference in the reduction of frontal lobe blood flow on cerebral perfusion single-photon emission computed tomography (SPECT) (P = 0.018). These results suggest that PSP-RS is common in patients with PSP and iNPH and indicate the usefulness of cerebral perfusion SPECT in estimating the effect of shunt surgery.
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Affiliation(s)
- Naoki Yamahara
- Department of Neurology, Gifu University Graduate School of Medicine
| | - Nobuaki Yoshikura
- Department of Neurology, Gifu University Graduate School of Medicine
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Wen Y, Zhou H, Xia M, Liu Q, Quan H, Fang L. Differentiating progressive supranuclear palsy from other movement disorders using transcranial sonography: a systematic review and meta-analysis. Neurol Sci 2024; 45:455-465. [PMID: 37819487 DOI: 10.1007/s10072-023-07107-x] [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: 07/26/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
Progressive supranuclear palsy (PSP) is an atypical parkinsonism that presents with different phenotypes. There are still no validated diagnostic biomarkers for early diagnosis of PSP. Transcranial sonography (TCS) is a promising tool in the differential diagnosis of parkinsonian disorders; however, there are no systematic investigations about the application of TCS in PSP patients. Therefore, we performed a systematic review and meta-analysis to discuss the role of TCS in diagnosing PSP by systematically searching PubMed, Cochrane Library, Chinese National Knowledge Infrastructure and Wan Fang databases. Of 66 obtained records, 16 articles, including 366 patients with PSP, were included. Our results showed the estimated random-effects pooled prevalence of substantia nigra hyperechogenicity in patients with PSP was 22% (95% CI 12-32%), lenticular nucleus hyperechogenicity was 70% (95% CI 52-82%), and enlarged third ventricle was 71% (95% CI 55-85%). Additionally, a normal echogenicity substantia nigra in TCS showed 70% sensitivity (95% CI 56-81%) and 86% specificity (95% CI 75-86%) to differentiate PSP from Parkinson's disease. In conclusion, TCS is an important supplementary biomarker for diagnosing PSP. At the same time, the diagnostic value of TCS in discriminating PSP from other atypical parkinsonism and between different PSP phenotypes needs further exploration.
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Affiliation(s)
- Yafei Wen
- Department of Ultrasound, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Hui Zhou
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, China
| | - Mengwen Xia
- Department of Ultrasound, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Qianqian Liu
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, China
| | - Hongzhi Quan
- Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, China.
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Krishnan S, George SS, Radhakrishnan V, Raghavan S, Thomas B, Thulaseedharan JV, Puthenveedu DK. Quantitative susceptibility mapping from basal ganglia and related structures: correlation with disease severity in progressive supranuclear palsy. Acta Neurol Belg 2024; 124:151-160. [PMID: 37580639 DOI: 10.1007/s13760-023-02352-5] [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: 01/10/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE We examined whether mean magnetic susceptibility values from deep gray matter structures in patients with progressive supranuclear palsy (PSP) differed from those in patients with Parkinson's disease (PD) and healthy volunteers, and correlated with the PSP rating scale. METHODS Head of caudate nucleus, putamen, globus pallidus, substantia nigra and red nucleus were the regions of interest. Mean susceptibility values from these regions in PSP patients were estimated using quantitative susceptibility mapping. Correlations with clinical severity of disease as measured by the PSP rating scale were examined. The mean susceptibility values were also compared with those from healthy volunteers and age- and disease duration-matched patients with PD. RESULTS Data from 26 healthy volunteers, 26 patients with PD and 27 patients with PSP, were analysed. Patients with PSP had higher mean susceptibility values from all regions of interest when compared to both the other groups. The PSP rating scale scores correlated strongly with mean susceptibility values from the red nucleus and moderately with those from the putamen and substantia nigra. The scores did not correlate with mean susceptibility values from the caudate nucleus or globus pallidus. In patients with PD, the motor deficits correlated moderately with mean susceptibility values from substantia nigra. CONCLUSIONS In patients with PSP, mean susceptibility values indicating the severity of mineralization of basal ganglia and related structures correlate with disease severity, the correlation of red nucleus being the strongest. Further studies are warranted to explore whether mean susceptibility values could serve as biomarkers for PSP.
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Affiliation(s)
- Syam Krishnan
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Sneha Susan George
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Vineeth Radhakrishnan
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sheelakumari Raghavan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Divya Kalikavil Puthenveedu
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Badihian N, Ali F, Botha H, Savica R, Machulda MM, Clark HM, Stierwalt JAG, Pham NTT, Baker MC, Rademakers R, Lowe V, Whitwell JL, Josephs KA. The MAPT p.E342K and p.R406W mutations are associated with progressive supranuclear palsy with atypical features. Parkinsonism Relat Disord 2024; 119:105962. [PMID: 38134678 PMCID: PMC10842922 DOI: 10.1016/j.parkreldis.2023.105962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) is an atypical parkinsonism caused by the intracerebral aggregation of the microtubule-associated protein tau (MAPT) which is encoded by MAPT gene. Although PSP is a sporadic disease, MAPT mutations have been reported in rare cases. METHODS Among 190 patients with PSP who were recruited by the Neurodegenerative Research Group at Mayo Clinic during 2009-2023, we identified two patients who fulfilled diagnostic criteria for PSP-Richardson's syndrome (PSP-RS) and harbor novel MAPT mutations. To better investigate the potential effects of these mutations, we compared the clinical, and neuroimaging characteristics of these two patients to 20 randomly selected patients with PSP-RS without a MAPT mutation. RESULTS MAPT c.1024G > A, p. Glu342Lys, and MAPT c.1217 G > A, p. Arg406Gln mutations were found in 2 men who developed PSP-RS with atypical features at the ages of 60 and 62 years, respectively. Glu342Lys mutation was associated with features resembling alpha-synucleinopathies (autonomic dysfunction, dream enactment behavior), while both mutations were associated with features suggestive of Alzheimer's disease with poorer performance on tests of episodic memory. Comparison of 18F-flortaucipir uptake between the two MAPT mutation cases with 20 patients without a mutation revealed increased signal on flortaucipir-PET in bilateral medial temporal lobe regions (amygdala, entorhinal cortices, hippocampus, parahippocampus) but not in PSP-related regions (globus pallidum, midbrain, superior frontal cortex and dentate nucleus of the cerebellum). CONCLUSION Glu342Lys and Arg406Gln mutations appear to modify the PSP-RS phenotype by targeting the medial temporal lobe regions resulting in more memory loss and greater flortaucipir uptake.
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Affiliation(s)
- Negin Badihian
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Rosa Rademakers
- VIB Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
| | - Val Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Onder H, Comoglu S. Alternating unilateral blepharospasm with apraxia of eyelid opening in a patient with progressive supranuclear palsy. Neurol Sci 2024; 45:331-333. [PMID: 37736851 DOI: 10.1007/s10072-023-07021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/13/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Halil Onder
- Neurology Clinic, Etlik City Hospital, Varlık, Halil Sezai Erkut Street No: 5, 06170, Yenimahalle, Ankara, Turkey.
| | - Selcuk Comoglu
- Neurology Clinic, Etlik City Hospital, Varlık, Halil Sezai Erkut Street No: 5, 06170, Yenimahalle, Ankara, Turkey
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Strobel J, Müller HP, Ludolph AC, Beer AJ, Sollmann N, Kassubek J. New Perspectives in Radiological and Radiopharmaceutical Hybrid Imaging in Progressive Supranuclear Palsy: A Systematic Review. Cells 2023; 12:2776. [PMID: 38132096 PMCID: PMC10742083 DOI: 10.3390/cells12242776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by four-repeat tau deposition in various cell types and anatomical regions, and can manifest as several clinical phenotypes, including the most common phenotype, Richardson's syndrome. The limited availability of biomarkers for PSP relates to the overlap of clinical features with other neurodegenerative disorders, but identification of a growing number of biomarkers from imaging is underway. One way to increase the reliability of imaging biomarkers is to combine different modalities for multimodal imaging. This review aimed to provide an overview of the current state of PSP hybrid imaging by combinations of positron emission tomography (PET) and magnetic resonance imaging (MRI). Specifically, combined PET and MRI studies in PSP highlight the potential of [18F]AV-1451 to detect tau, but also the challenge in differentiating PSP from other neurodegenerative diseases. Studies over the last years showed a reduced synaptic density in [11C]UCB-J PET, linked [11C]PK11195 and [18F]AV-1451 markers to disease progression, and suggested the potential role of [18F]RO948 PET for identifying tau pathology in subcortical regions. The integration of quantitative global and regional gray matter analysis by MRI may further guide the assessment of reduced cortical thickness or volume alterations, and diffusion MRI could provide insight into microstructural changes and structural connectivity in PSP. Challenges in radiopharmaceutical biomarkers and hybrid imaging require further research targeting markers for comprehensive PSP diagnosis.
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Affiliation(s)
- Joachim Strobel
- Department of Nuclear Medicine, University Hospital Ulm, 89081 Ulm, Germany;
| | - Hans-Peter Müller
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (H.-P.M.); (A.C.L.); (J.K.)
| | - Albert C. Ludolph
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (H.-P.M.); (A.C.L.); (J.K.)
- German Center for Neurodegenerative Diseases (DZNE), Ulm University, 89081 Ulm, Germany
| | - Ambros J. Beer
- Department of Nuclear Medicine, University Hospital Ulm, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany;
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (H.-P.M.); (A.C.L.); (J.K.)
- German Center for Neurodegenerative Diseases (DZNE), Ulm University, 89081 Ulm, Germany
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18
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Lim SH, Ferdousi M, Bhattacharjee S, Kalteniece A, Mahfoud ZR, Petropoulos IN, Malik RA, Kobylecki C, Silverdale M. Corneal confocal microscopy demonstrates varying degrees of neurodegeneration in atypical parkinsonian disorders. Parkinsonism Relat Disord 2023; 117:105899. [PMID: 37948830 DOI: 10.1016/j.parkreldis.2023.105899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE We have used corneal confocal microscopy (CCM) to identify corneal nerve loss as a potential marker of neurodegeneration in participants with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). METHODS Patients with PD (n = 19), PSP (n = 11), MSA (n = 8) and healthy controls (n = 18) underwent neurological assessment and CCM. RESULTS Corneal nerve fibre density was significantly lower in participants with PD (p = 0.005), PSP (p = 0.005) and MSA (p = 0.0003) compared to controls. Corneal nerve branch density was significantly lower in participants with PD (p = 0.01) and MSA (p = 0.019), but not in participants with PSP (p = 0.662), compared to controls. Corneal nerve fibre length was significantly lower in participants with PD (p = 0.002) and MSA (p = 0.001) but not in participants with PSP (p = 0.191) compared to controls. CONCLUSION CCM detects corneal nerve loss in participants with PD and MSA and to a lesser extent in PSP compared to healthy controls.
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Affiliation(s)
- Sze Hway Lim
- Department of Neurology, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Shakya Bhattacharjee
- Department of Neurology, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | | | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, Division of Cardiovascular Sciences, University of Manchester, Manchester, UK; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Christopher Kobylecki
- Department of Neurology, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Monty Silverdale
- Department of Neurology, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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El Ouartassi A, Giordana C, Schiazza A, Chardin D, Darcourt J. [ 18F]-FDopa positron emission tomography imaging in corticobasal syndrome. Brain Imaging Behav 2023; 17:619-627. [PMID: 37474673 DOI: 10.1007/s11682-023-00789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE First, to investigate the patterns of [18F]-FDOPA positron emission tomography imaging in corticobasal syndrome using visual and semi-quantitative analysis and to compare them with patterns found in Parkinson's disease and progressive supranuclear palsy. Then, to search for correlations with clinical features and [18F]-FDG positron emission tomography imaging. METHODS 27 corticobasal syndrome patients who underwent [18F]-FDOPA positron emission tomography imaging were retrospectively studied. They were compared to 27 matched Parkinson's disease patients, 12 progressive supranuclear palsy patients and 53 normal controls. Scans were visually assigned to one of the following patterns: normal; unilateral homogeneous striatal uptake reduction; putamen uptake reduction with putamen-caudate gradient. A semi-quantitative analysis of striatal regional uptake and asymmetry was performed and correlated to clinical features and [18F]-FDG positron emission tomography patterns. RESULTS [18F]-FDOPA positron emission tomography appeared visually abnormal in only 33.5% of corticobasal syndrome patients. However, semi-quantitative analysis found putaminal asymmetry in 63%. Striatal uptake was homogeneously reduced in both putamen and caudate nucleus in corticobasal syndrome patients unlike in Parkinson's disease and progressive supranuclear palsy. No correlation was found between [18F]-FDOPA positron emission tomography and clinical features. Half of corticobasal syndrome patients presented a corticobasal degeneration pattern on [18F]-FDG positron emission tomography. CONCLUSION: [18F]-FDOPA positron emission tomography can often be normal in corticobasal syndrome patients. Semi-quantitative analysis is useful to unmask a significant asymmetry in many of them. Homogeneous striatal uptake reduction contralateral to the clinical signs is highly suggestive of corticobasal syndrome. This finding can be helpful to better characterize this syndrome with respect to Parkinson's disease and progressive supranuclear palsy.
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Affiliation(s)
- Anaïs El Ouartassi
- Movement Disorders Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.
- Neurology Department, Centre Hospitalier d'Antibes, 107 Avenue de Nice, Antibes, France.
| | - Caroline Giordana
- Movement Disorders Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Aurélie Schiazza
- Nuclear Medicine Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
- Research Group, UMR 4320, CEA-Université Côte d'Azur, Nice, France
| | - David Chardin
- Nuclear Medicine Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
- Research Group, UMR 4320, CEA-Université Côte d'Azur, Nice, France
| | - Jacques Darcourt
- Nuclear Medicine Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
- Research Group, UMR 4320, CEA-Université Côte d'Azur, Nice, France
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20
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Sako W, Suda A, Taniguchi D, Kamagata K, Shindo A, Ogawa T, Oji Y, Nishikawa N, Hatano T, Aoki S, Hattori N. Midbrain atrophy in pathologically diagnosed Lewy body disease and clinically diagnosed Parkinson's disease. J Neurol Sci 2023; 454:120821. [PMID: 37832378 DOI: 10.1016/j.jns.2023.120821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Midbrain atrophy is considered specific to progressive supranuclear palsy (PSP) compared with Parkinson's disease (PD). We aimed to determine how often midbrain atrophy is observed in pathologically diagnosed Lewy body disease (LBD) and clinically diagnosed PD and the robustness of midbrain atrophy assessed by the One-Line Method previously developed for the diagnosis of PSP. METHODS We studied two separate cohorts with MRI: the first pathologically diagnosed cohort consisted of patients with LBD (n = 13), PSP (n = 6), multiple system atrophy (MSA, n = 7), and corticobasal degeneration (CBD, n = 2); the second cohort consisted of patients with PD (n = 122). Midbrain length was measured using the One-Line Method and FreeSurfer estimated volumes of the subcortical nuclei. RESULTS The area under the curve of midbrain length differentiating PSP from LBD, MSA, and CBD in a pathologically diagnosed cohort was 0.91. Midbrain length with cut-off values of 10.5 mm and 9.5 mm had a sensitivity of 100% and 67% and a specificity of 68% and 96%, respectively. In the first cohort, 7.7% and 23.0% of patients with LBD showed midbrain lengths <9.5 mm and 10.5 mm, respectively, and in the second cohort, 4.9% and 19.7% showed midbrain lengths <9.5 mm and 10.5 mm, respectively. INTERPRETATION Midbrain length measured using the One-Line Method is helpful in the diagnosis of PSP. Some cases of pathologically diagnosed LBD and clinically diagnosed PD present with midbrain atrophy.
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Affiliation(s)
- Wataru Sako
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
| | - Akimitsu Suda
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daisuke Taniguchi
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Atsuhiko Shindo
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Ogawa
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yutaka Oji
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Noriko Nishikawa
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Taku Hatano
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo University, Tokyo, Japan; Neurodegenerative Disorders Collaborative laboratory, RIKEN Center for Brain Science, Saitama, Japan.
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21
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Hong J, Lu J, Liu F, Wang M, Li X, Clement C, Lopes L, Brendel M, Rominger A, Yen TC, Guan Y, Tian M, Wang J, Zuo C, Shi K. Uncovering distinct progression patterns of tau deposition in progressive supranuclear palsy using [ 18F]Florzolotau PET imaging and subtype/stage inference algorithm. EBioMedicine 2023; 97:104835. [PMID: 37839135 PMCID: PMC10590768 DOI: 10.1016/j.ebiom.2023.104835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a primary 4-repeat tauopathy with diverse clinical phenotypes. Previous post-mortem studies examined tau deposition sequences in PSP, but in vivo scrutiny is lacking. METHODS We conducted [18F]Florzolotau tau positron emission tomography (PET) scans on 148 patients who were clinically diagnosed with PSP and 20 healthy controls. We employed the Subtype and Stage Inference (SuStaIn) algorithm to identify PSP subtype/stage and related tau patterns, comparing clinical features across subtypes and assessing PSP stage-clinical severity association. We also evaluated functional connectivity differences among subtypes through resting-state functional magnetic resonance imaging. FINDINGS We identified two distinct subtypes of PSP: Subtype1 and Subtype2. Subtype1 typically exhibits a sequential progression of the disease, starting from subcortical and gradually moving to cortical regions. Conversely, Subtype2 is characterized by an early, simultaneous onset in both regions. Interestingly, once the disease is initiated, Subtype1 tends to spread more rapidly within each region compared to Subtype2. Individuals categorized as Subtype2 are generally older and exhibit less severe dysfunctions in areas such as cognition, bulbar, limb motor, and general motor functions compared to those with Subtype1. Moreover, they have a more favorable prognosis in terms of limb motor function. We found significant correlations between several clinical variables and the identified PSP SuStaIn stages. Furthermore, Subtype2 displayed a remarkable reduction in functional connectivity compared to Subtype1. INTERPRETATION We present the evidence of distinct in vivo spatiotemporal tau trajectories in PSP. Our findings can contribute to precision medicine advancements for PSP. FUNDING This work was supported by grants from the National Natural Science Foundation of China (number 82272039, 81971641, 82021002, and 92249302); Swiss National Science Foundation (number 188350); the STI2030-Major Project of China (number 2022ZD0211600); the Clinical Research Plan of Shanghai Hospital Development Center of China (number SHDC2020CR1038B); and the National Key R&D Program of China (number 2022YFC2009902, 2022YFC2009900), the China Scholarship Council (number 202006100181); the Deutsche Forschungsgemeinschaft (DFG) under Germany's Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy, ID 390857198).
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Affiliation(s)
- Jimin Hong
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | - Jiaying Lu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland; National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fengtao Liu
- National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Wang
- Institute of Biomedical Engineering, School of Life Science, Shanghai University, Shanghai, China; Department of Informatics, Technical University of Munich, Munich, Germany
| | - Xinyi Li
- National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Christoph Clement
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | - Leonor Lopes
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | - Matthias Brendel
- Department of Nuclear Medicine, University of Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland
| | | | - Yihui Guan
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Tian
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; Human Phenome Institute, Fudan University, Shanghai, China; International Human Phenome Institutes (Shanghai), Shanghai, China
| | - Jian Wang
- National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Chuantao Zuo
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China; Human Phenome Institute, Fudan University, Shanghai, China.
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland; Department of Informatics, Technical University of Munich, Munich, Germany
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22
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Ye R, Hezemans FH, O'Callaghan C, Tsvetanov KA, Rua C, Jones PS, Holland N, Malpetti M, Murley AG, Barker RA, Williams-Gray CH, Robbins TW, Passamonti L, Rowe JB. Locus Coeruleus Integrity Is Linked to Response Inhibition Deficits in Parkinson's Disease and Progressive Supranuclear Palsy. J Neurosci 2023; 43:7028-7040. [PMID: 37669861 PMCID: PMC10586538 DOI: 10.1523/jneurosci.0289-22.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023] Open
Abstract
Parkinson's disease (PD) and progressive supranuclear palsy (PSP) both impair response inhibition, exacerbating impulsivity. Inhibitory control deficits vary across individuals and are linked with worse prognosis, and lack improvement on dopaminergic therapy. Motor and cognitive control are associated with noradrenergic innervation of the cortex, arising from the locus coeruleus (LC) noradrenergic system. Here we test the hypothesis that structural variation of the LC explains response inhibition deficits in PSP and PD. Twenty-four people with idiopathic PD, 14 with PSP-Richardson's syndrome, and 24 age- and sex-matched controls undertook a stop-signal task and ultrahigh field 7T magnetization-transfer-weighted imaging of the LC. Parameters of "race models" of go- versus stop-decisions were estimated using hierarchical Bayesian methods to quantify the cognitive processes of response inhibition. We tested the multivariate relationship between LC integrity and model parameters using partial least squares. Both disorders impaired response inhibition at the group level. PSP caused a distinct pattern of abnormalities in inhibitory control with a paradoxically reduced threshold for go responses, but longer nondecision times, and more lapses of attention. The variation in response inhibition correlated with the variability of LC integrity across participants in both clinical groups. Structural imaging of the LC, coupled with behavioral modeling in parkinsonian disorders, confirms that LC integrity is associated with response inhibition and LC degeneration contributes to neurobehavioral changes. The noradrenergic system is therefore a promising target to treat impulsivity in these conditions. The optimization of noradrenergic treatment is likely to benefit from stratification according to LC integrity.SIGNIFICANCE STATEMENT Response inhibition deficits contribute to clinical symptoms and poor outcomes in people with Parkinson's disease and progressive supranuclear palsy. We used cognitive modeling of performance of a response inhibition task to identify disease-specific mechanisms of abnormal inhibitory control. Response inhibition in both patient groups was associated with the integrity of the noradrenergic locus coeruleus, which we measured in vivo using ultra-high field MRI. We propose that the imaging biomarker of locus coeruleus integrity provides a trans-diagnostic tool to explain individual differences in response inhibition ability beyond the classic nosological borders and diagnostic criteria. Our data suggest a potential new stratified treatment approach for Parkinson's disease and progressive supranuclear palsy.
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Affiliation(s)
- Rong Ye
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, 230032, China
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Frank H Hezemans
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands
| | - Claire O'Callaghan
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2050, New South Wales, Australia
| | - Kamen A Tsvetanov
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
| | - Catarina Rua
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Alexander G Murley
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Wellcome-MRC Stem Cell Institute, University of Cambridge, Cambridge, CB2 0AW, United Kingdom
| | - Caroline H Williams-Gray
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0SZ, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EA, United Kingdom
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23
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Erlinger M, Molina-Ruiz R, Brumby A, Cordas D, Hunter M, Ferreiro Arguelles C, Yus M, Owens-Walton C, Jakabek D, Shaw M, Lopez Valdes E, Looi JCL. Striatal and thalamic automatic segmentation, morphology, and clinical correlates in Parkinsonism: Parkinson's disease, multiple system atrophy and progressive supranuclear palsy. Psychiatry Res Neuroimaging 2023; 335:111719. [PMID: 37806261 DOI: 10.1016/j.pscychresns.2023.111719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP) present similarly with bradykinesia, tremor, rigidity, and cognitive impairments. Neuroimaging studies have found differential changes in the nigrostriatal pathway in these disorders, however whether the volume and shape of specific regions within this pathway can distinguish between atypical Parkinsonian disorders remains to be determined. This paper investigates striatal and thalamic volume and morphology as distinguishing biomarkers, and their relationship to neuropsychiatric symptoms. Automatic segmentation to calculate volume and shape analysis of the caudate nucleus, putamen, and thalamus were performed in 18 PD patients, 12 MSA, 15 PSP, and 20 healthy controls, then correlated with clinical measures. PSP bilateral thalami and right putamen were significantly smaller than controls, but not MSA or PD. The left caudate and putamen significantly correlated with the Neuropsychiatric Inventory total score. Bilateral thalamus, caudate, and left putamen had significantly different morphology between groups, driven by differences between PSP and healthy controls. This study demonstrated that PSP patient striatal and thalamic volume and shape are significantly different when compared with controls. Parkinsonian disorders could not be differentiated on volumetry or morphology, however there are trends for volumetric and morphological changes associated with PD, MSA, and PSP.
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Affiliation(s)
- M Erlinger
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia.
| | | | - A Brumby
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | - D Cordas
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | - M Hunter
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | | | - M Yus
- Hospital Clinico San Carlos, Madrid, Spain
| | - C Owens-Walton
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | - D Jakabek
- Neuroscience Research Australia, Sydney, Australia
| | - M Shaw
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - J C L Looi
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
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24
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Ishibashi K, Kurihara M, Ihara R, Higashihara M, Iwata A, Ishii K. Detailed Assessment of 18F-THK5351 Distribution Pattern in the Midbrain: Comparison With Progressive Supranuclear Palsy and Corticobasal Syndrome. Clin Nucl Med 2023; 48:841-846. [PMID: 37682599 DOI: 10.1097/rlu.0000000000004815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND 18F-THK5351 PET is used to image ongoing astrogliosis by estimating monoamine oxidase B levels. 18F-THK5351 preferentially accumulates around the substantia nigra (SN) and periaqueductal gray (PG) in the midbrain under healthy conditions and exhibits a "trimodal pattern." In progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), the midbrain 18F-THK5351 uptake can be increased by astrogliosis, collapsing the "trimodal pattern." We aimed to elucidate cases in which the "trimodal pattern" collapses in PSP and CBS. PATIENTS AND METHODS Participants in the PSP (n = 11), CBS (n = 17), Alzheimer disease (n = 11), and healthy control (n = 8) groups underwent 18F-THK5351 PET. Volumes of interest (VOIs) were placed on the SN, PG, and their midpoints. The midbrain uptake ratio (MUR) was calculated to assess the trimodal pattern as follows: MUR = (VOI value on the midpoint)/(VOI value on the SN and PG). Approximately, the trimodal pattern can be identified at MUR <1 but not at MUR >1. RESULTS Compared with the healthy control group, MUR significantly increased in the PSP (P < 0.01) and CBS (P < 0.01) groups, but was unchanged in the Alzheimer disease group (P = 0.10). In the PSP group, all patients, including 2 with mild symptoms and a short disease duration, showed MUR >1. In the CBS group, MUR varied widely. CONCLUSIONS In PSP, the trimodal pattern can collapse even in the early phase when symptoms are mild. In CBS, the trimodal pattern may or may not collapse depending on the underlying pathology.
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Affiliation(s)
| | - Masanori Kurihara
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Ryoko Ihara
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Cuoco S, Ponticorvo S, Abate F, Tepedino MF, Erro R, Manara R, Di Salle G, Di Salle F, Pellecchia MT, Esposito F, Barone P, Picillo M. Frequency and imaging correlates of neuropsychiatric symptoms in Progressive Supranuclear Palsy. J Neural Transm (Vienna) 2023; 130:1259-1267. [PMID: 37535119 PMCID: PMC10480260 DOI: 10.1007/s00702-023-02676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
Neuropsychiatric symptoms are intrinsic to Progressive Supranuclear Palsy (PSP) and a spoonful of studies investigated their imaging correlates. Describe (I) the frequency and severity of neuropsychiatric symptoms in PSP and (II) their structural imaging correlates. Twenty-six PSP patients underwent Neuropsychiatric Inventory (NPI) and brain 3D T1-weighted MRI. Spearman's rho with Bonferroni correction was used to investigate correlations between NPI scores and volumes of gray matter regions. More than 80% of patients presented at least one behavioral symptom of any severity. The most frequent and severe were depression/dysphoria, apathy, and irritability/lability. Significant relationships were found between the severity of irritability and right pars opercularis volume (p < 0.001) as well as between the frequency of agitation/aggression and left lateral occipital volume (p < 0.001). Depression, apathy, and irritability are the most common neuropsychiatric symptoms in PSP. Moreover, we found a relationship between specific positive symptoms as irritability and agitation/aggression and greater volume of the right pars opercularis cortex and lower volume of the left occipital cortex, respectively, which deserve further investigations.
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Affiliation(s)
- Sofia Cuoco
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Sara Ponticorvo
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, 2021 6th St. SE, Minneapolis, MN, 55455, USA
| | - Filomena Abate
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Maria Francesca Tepedino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Renzo Manara
- Department of Neurosciences, Neuroradiology Unit, University of Padua, 35128, Padua, Italy
| | - Gianfranco Di Salle
- Scuola Superiore Di Studi Universitari E Perfezionamento Sant'Anna, Classe Di Scienze Sperimentali, Pisa, Italy
| | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy
| | - Marina Picillo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Neuroscience Section, Via Allende, 84081, Baronissi (Salerno), Italy.
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26
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Persely A, Beszedics B, Paloczi K, Piroska M, Alijanpourotaghsara A, Strelnikov D, Vessal A, Szabo H, Hernyes A, Zoldi L, Jokkel Z, Fekete A, Juhasz J, Makra N, Szabo D, Buzas E, Tarnoki AD, Tarnoki DL. Analysis of Genetic and MRI Changes, Blood Markers, and Risk Factors in a Twin Pair Discordant of Progressive Supranuclear Palsy. Medicina (Kaunas) 2023; 59:1696. [PMID: 37893413 PMCID: PMC10608279 DOI: 10.3390/medicina59101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Progressive supranuclear palsy (PSP) is a neurodegenerative disease, a tauopathy, which results in a wide clinical spectrum of neurological symptoms. The diagnosis is mostly based on clinical signs and neuroimaging; however, possible biomarkers for screening have been under investigation, and the role of the gut microbiome is unknown. The aim of our study was to identify potential blood biomarkers and observe variations in the gut microbiome within a PSP discordant monozygotic twin pair. Materials and Methods: Anthropometric measurements, neuropsychological tests, and the neurological state were evaluated. Blood was collected for metabolic profiling and for the detection of neurodegenerative and vascular biomarkers. Both the gut microbiome and brain MRI results were thoroughly examined. Results: We found a relevant difference between alpha-synuclein levels and moderate difference in the levels of MMP-2, MB, Apo-A1, Apo-CIII, and Apo-H. With respect to the ratios, a small difference was observed for ApoA1/SAA and ApoB/ApoA1. Using a microbiome analysis, we also discovered a relative dysbiosis, and the MRI results revealed midbrain and frontoparietal cortical atrophy along with a reduction in overall brain volumes and an increase in white matter lesions in the affected twin. Conclusions: We observed significant differences between the unaffected and affected twins in some risk factors and blood biomarkers, along with disparities in the gut microbiome. Additionally, we detected abnormalities in brain MRI results and alterations in cognitive functions.
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Affiliation(s)
- Aliz Persely
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
- Neurology Department, Medical Centre Hungarian Defence Forces, 1134 Budapest, Hungary
| | - Beatrix Beszedics
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Krisztina Paloczi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary; (K.P.); (E.B.)
| | - Marton Piroska
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Amirreza Alijanpourotaghsara
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - David Strelnikov
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Arsalan Vessal
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Helga Szabo
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
- Central Radiological Diagnostic Department, Medical Centre Hungarian Defence Forces, 1134 Budapest, Hungary
| | - Anita Hernyes
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Luca Zoldi
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Zsofia Jokkel
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Andrea Fekete
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Janos Juhasz
- Institute of Medical Microbiology, Semmelweis University, 1085 Budapest, Hungary; (J.J.); (N.M.); (D.S.)
- Faculty of Information Technology and Bionics, Pazmany Peter Catholic University, 1085 Budapest, Hungary
| | - Nora Makra
- Institute of Medical Microbiology, Semmelweis University, 1085 Budapest, Hungary; (J.J.); (N.M.); (D.S.)
| | - Dora Szabo
- Institute of Medical Microbiology, Semmelweis University, 1085 Budapest, Hungary; (J.J.); (N.M.); (D.S.)
| | - Edit Buzas
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary; (K.P.); (E.B.)
| | - Adam Domonkos Tarnoki
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - David Laszlo Tarnoki
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
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27
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Street D, Jabbari E, Costantini A, Jones PS, Holland N, Rittman T, Jensen MT, Chelban V, Goh YY, Guo T, Heslegrave AJ, Roncaroli F, Klein JC, Ansorge O, Allinson KSJ, Jaunmuktane Z, Revesz T, Warner TT, Lees AJ, Zetterberg H, Russell LL, Bocchetta M, Rohrer JD, Burn DJ, Pavese N, Gerhard A, Kobylecki C, Leigh PN, Church A, Hu MTM, Houlden H, Morris H, Rowe JB. Progression of atypical parkinsonian syndromes: PROSPECT-M-UK study implications for clinical trials. Brain 2023; 146:3232-3242. [PMID: 36975168 PMCID: PMC10393398 DOI: 10.1093/brain/awad105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
The advent of clinical trials of disease-modifying agents for neurodegenerative disease highlights the need for evidence-based end point selection. Here we report the longitudinal PROSPECT-M-UK study of progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), multiple system atrophy (MSA) and related disorders, to compare candidate clinical trial end points. In this multicentre UK study, participants were assessed with serial questionnaires, motor examination, neuropsychiatric and MRI assessments at baseline, 6 and 12 months. Participants were classified by diagnosis at baseline and study end, into Richardson syndrome, PSP-subcortical (PSP-parkinsonism and progressive gait freezing subtypes), PSP-cortical (PSP-frontal, PSP-speech and language and PSP-CBS subtypes), MSA-parkinsonism, MSA-cerebellar, CBS with and without evidence of Alzheimer's disease pathology and indeterminate syndromes. We calculated annual rate of change, with linear mixed modelling and sample sizes for clinical trials of disease-modifying agents, according to group and assessment type. Two hundred forty-three people were recruited [117 PSP, 68 CBS, 42 MSA and 16 indeterminate; 138 (56.8%) male; age at recruitment 68.7 ± 8.61 years]. One hundred and fifty-nine completed the 6-month assessment (82 PSP, 27 CBS, 40 MSA and 10 indeterminate) and 153 completed the 12-month assessment (80 PSP, 29 CBS, 35 MSA and nine indeterminate). Questionnaire, motor examination, neuropsychiatric and neuroimaging measures declined in all groups, with differences in longitudinal change between groups. Neuroimaging metrics would enable lower sample sizes to achieve equivalent power for clinical trials than cognitive and functional measures, often achieving N < 100 required for 1-year two-arm trials (with 80% power to detect 50% slowing). However, optimal outcome measures were disease-specific. In conclusion, phenotypic variance within PSP, CBS and MSA is a major challenge to clinical trial design. Our findings provide an evidence base for selection of clinical trial end points, from potential functional, cognitive, clinical or neuroimaging measures of disease progression.
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Affiliation(s)
- Duncan Street
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alyssa Costantini
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - P Simon Jones
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Negin Holland
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Timothy Rittman
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Marte T Jensen
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Viorica Chelban
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Neurobiology and Medical Genetics Laboratory, ‘Nicolae Testemitanu’ State University of Medicine and Pharmacy, Chisinau 2004, Republic of Moldova
| | - Yen Y Goh
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tong Guo
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M6 8HD, UK
| | - Johannes C Klein
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Kieren S J Allinson
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas T Warner
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Andrew J Lees
- Queen Square Brain Bank for Neurological Disorders, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Reta Lila Weston Institute, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, W1T 7NF, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 30 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, 413 45 Goteborg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Shatin, N.T., Hong Kong, China
| | - Lucy L Russell
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Martina Bocchetta
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UB8 3PH, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle, NE4 5PL, UK
| | - Alexander Gerhard
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Departments of Geriatric Medicine and Nuclear Medicine, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, 45356 Essen, Germany
| | - Christopher Kobylecki
- Division of Neuroscience, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, N20 3LJ, UK
- Department of Neurology, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, M13 9NQ, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Alistair Church
- Department of Neurology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Physiology, Anatomy and Genetics, Oxford Parkinson’s Disease Centre, University of Oxford, Oxford, OX1 3QU, UK
| | - Henry Houlden
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neuromuscular Diseases, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Huw Morris
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Movement Disorders Centre, University College London, Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - James B Rowe
- University of Cambridge Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, Cambridge, CB2 OQQ, UK
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK
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28
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Jiang L, Zhu W, Zhao G, Cao L. Spinocerebellar ataxia type 8 presents as progressive supranuclear palsy. Neurosciences (Riyadh) 2023; 28:199-203. [PMID: 37482381 PMCID: PMC10519649 DOI: 10.17712/nsj.2023.3.20230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/22/2023] [Accepted: 06/26/2019] [Indexed: 07/25/2023]
Abstract
Spinocerebellar ataxia type 8 is a progressive neurodegenerative disease induced by expansion of CTA/CTG repeats in an untranslated region of the ATXN8/ATXN8OS gene. We report an elderly female patient presenting with rigidity, bradykinesia, ataxia and oculomotor defect at the disease onset age of 65 years old without family history, and hummingbird sign in cranial MRI, initially diagnosed as progressive supranuclear palsy (PSP). But genetic test showed that one allele of ATXN8OS gene had more than 131 CTA/CTG repeats which was a full penetrance mutant. It's possible that this is a case of PSP with an ATXN8OS gene mutation that doesn't contribute to the phenotype. Whether the ATXN8OS gene CTA/CTG repeats cause PSP phenotype needs further investigation with larger samples and pathological findings.
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Affiliation(s)
- Lina Jiang
- From the Department of Radiology (Jiang), Department of Clinical Laboratory (Zhu), and from the Department of Neurology (Zhao, Cao), the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Weigang Zhu
- From the Department of Radiology (Jiang), Department of Clinical Laboratory (Zhu), and from the Department of Neurology (Zhao, Cao), the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Guohua Zhao
- From the Department of Radiology (Jiang), Department of Clinical Laboratory (Zhu), and from the Department of Neurology (Zhao, Cao), the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Lanxiao Cao
- From the Department of Radiology (Jiang), Department of Clinical Laboratory (Zhu), and from the Department of Neurology (Zhao, Cao), the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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29
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Kim M, Sekiya H, Yao G, Martin NB, Castanedes-Casey M, Dickson DW, Hwang TH, Koga S. Diagnosis of Alzheimer Disease and Tauopathies on Whole-Slide Histopathology Images Using a Weakly Supervised Deep Learning Algorithm. J Transl Med 2023; 103:100127. [PMID: 36889541 DOI: 10.1016/j.labinv.2023.100127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Neuropathologic assessment during autopsy is the gold standard for diagnosing neurodegenerative disorders. Neurodegenerative conditions, such as Alzheimer disease (AD) neuropathological change, are a continuous process from normal aging rather than categorical; therefore, diagnosing neurodegenerative disorders is a complicated task. We aimed to develop a pipeline for diagnosing AD and other tauopathies, including corticobasal degeneration (CBD), globular glial tauopathy, Pick disease, and progressive supranuclear palsy. We used a weakly supervised deep learning-based approach called clustering-constrained-attention multiple-instance learning (CLAM) on the whole-slide images (WSIs) of patients with AD (n = 30), CBD (n = 20), globular glial tauopathy (n = 10), Pick disease (n = 20), and progressive supranuclear palsy (n = 20), as well as nontauopathy controls (n = 21). Three sections (A: motor cortex; B: cingulate gyrus and superior frontal gyrus; and C: corpus striatum) that had been immunostained for phosphorylated tau were scanned and converted to WSIs. We evaluated 3 models (classic multiple-instance learning, single-attention-branch CLAM, and multiattention-branch CLAM) using 5-fold cross-validation. Attention-based interpretation analysis was performed to identify the morphologic features contributing to the classification. Within highly attended regions, we also augmented gradient-weighted class activation mapping to the model to visualize cellular-level evidence of the model's decisions. The multiattention-branch CLAM model using section B achieved the highest area under the curve (0.970 ± 0.037) and diagnostic accuracy (0.873 ± 0.087). A heatmap showed the highest attention in the gray matter of the superior frontal gyrus in patients with AD and the white matter of the cingulate gyrus in patients with CBD. Gradient-weighted class activation mapping showed the highest attention in characteristic tau lesions for each disease (eg, numerous tau-positive threads in the white matter inclusions for CBD). Our findings support the feasibility of deep learning-based approaches for the classification of neurodegenerative disorders on WSIs. Further investigation of this method, focusing on clinicopathologic correlations, is warranted.
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Affiliation(s)
- Minji Kim
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Jacksonville, Florida
| | - Hiroaki Sekiya
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Gary Yao
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Tae Hyun Hwang
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Jacksonville, Florida
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida.
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Tian M, Han Y, Bi Y, Zhang B, Duan R, Song C, Liu Y. Neuronal intranuclear inclusion disease mimicking progressive supranuclear palsy. Neurol Sci 2023; 44:1411-1414. [PMID: 36715780 DOI: 10.1007/s10072-023-06644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Given the variable nature of clinical manifestations, neuronal intranuclear inclusion disease (NIID) is regarded as a heterogeneous disease which is challenging to diagnose early. To the present, progressive supranuclear palsy (PSP)-like symptoms have never been listed in the performance of NIID. CASE PRESENTATION A 58-year-old man presented with progressive Parkinsonism and postural instability for 3 years. Initially, he was considered as probable PSP due to vertical supranuclear gaze palsy, postural instability, and hummingbird sign. No high-intensity signal on diffusion-weighted imaging (DWI) was revealed. Eventually, the diagnosis was revised to NIID by Notch 2 N-terminal like C (NOTCH2NLC) GGC repeat expansions and skin biopsy showing intranuclear eosinophilic inclusions in the vesicles and ductal epithelial cells of sweat glands. CONCLUSION Even if the typical high-intensity along the corticomedullary junction (CMJ) on DWI is lacking, clinicians should be alert to the possibility of NIID when PSP-like symptoms develop. This case report offers new features of NIID and expands its clinical spectrum.
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Affiliation(s)
- Min Tian
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Yinlian Han
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Yiqing Bi
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Bohan Zhang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Ruonan Duan
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Chengyuan Song
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China.
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Han IJ, Kwon HG, Lee WW, Yoon RG, Choi H, Kim HJ. Diffusion tensor tractography of the corticobulbar tract in a dysphagic patient with progressive supranuclear palsy: A case report. Medicine (Baltimore) 2023; 102:e32898. [PMID: 36820538 PMCID: PMC9907945 DOI: 10.1097/md.0000000000032898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
RATIONALE This paper reports the changes over time in the corticobulbar tract (CBT) analyzed using diffusion tensor tractography (DTT) in a dysphagic patient with progressive supranuclear palsy (PSP). PATIENT CONCERNS A 53-year-old man initially presented with dysarthria, gait disturbance, and bradykinesia, and approximately 1-year later, downward gaze paralysis appeared. Initially, there was no dysphagia; however, approximately 2 years after visiting the hospital, symptoms of dysphagia, including difficulty swallowing pills, aspiration, and oral movement impairments appeared. The symptoms gradually progressed, and finally, mouth opening was severely damaged to the extent that it was difficult to orally feed. INTERVENTIONS We performed diffusion tensor imaging 3 times; at 3-month, 20-month, and 41-month from onset. OUTCOMES On 3-month DTT, the left CBT was well reconstructed, whereas the right CBT showed partial tearing. In the 20-month DTT, both CBTs became thinner compared to the 3-month DTT. On 41-month DTT, both CBTs became much thinner than after 3-month and 20-month DTT. LESSONS We observed the degree of CBT injury over time in a dysphagic patient with PSP. These results suggest that the analysis of CBT using DTT is helpful in predicting the degree of dysphagia and prognosis in patients with PSP.
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Affiliation(s)
- In Jun Han
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Hyeok Gyu Kwon
- Department of Physical Therapy, College of Health Science, Eulji University, Gyeonggi, Republic of Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Ra Gyoung Yoon
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Hyoseon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
- * Correspondence: Hyun Jung Kim, Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Republic of Korea (e-mail: )
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Buciuc M, Koga S, Pham NTT, Duffy JR, Knopman DS, Ali F, Boeve BF, Graff-Radford J, Botha H, Lowe VJ, Nguyen A, Reichard RR, Dickson DW, Petersen RC, Whitwell JL, Josephs KA. The many faces of globular glial tauopathy: A clinical and imaging study. Eur J Neurol 2023; 30:321-333. [PMID: 36256511 PMCID: PMC10141553 DOI: 10.1111/ene.15603] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Globular glial tauopathy (GGT) has been associated with frontotemporal dementia syndromes; little is known about the clinical and imaging characteristics of GGT and how they differ from other non-globular glial 4-repeat tauopathies (N4GT) such as progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD). METHODS For this case-control study the Mayo Clinic brain banks were queried for all cases with an autopsy-confirmed diagnosis of GGT between 1 January 2011 and 31 October 2021. Fifty patients with N4GT (30 PSP, 20 CBD) were prospectively recruited and followed by the Neurodegenerative Research Group at Mayo Clinic, Minnesota. Magnetic resonance imaging was used to characterize patterns of gray/white matter atrophy, MR-parkinsonism index, midbrain volume, and white matter hyperintensities.18 F-Fluorodeoxyglucose-, 11 C Pittsburg compound-, and 18 F-flortaucipir-positron emission tomography scans were reviewed. RESULTS Twelve patients with GGT were identified: 83% were women compared to 42% in NG4T (p = 0.02) with median age at death 76.5 years (range: 55-87). The most frequent clinical features were eye movement abnormalities, parkinsonism, behavioral changes followed by pyramidal tract signs and motor speech abnormalities. Lower motor neuron involvement was present in 17% and distinguished GGT from NG4T (p = 0.035). Primary progressive apraxia of speech was the most frequent initial diagnosis (25%); 50% had a Parkinson-plus syndrome before death. Most GGT patients had asymmetric frontotemporal atrophy with matching hypometabolism. GGT patients had more gray matter atrophy in temporal lobes, normal MR-parkinsonism index, and larger midbrain volumes. CONCLUSIONS Female sex, lower motor neuron involvement in the context of a frontotemporal dementia syndrome, and asymmetric brain atrophy with preserved midbrain might be suggestive of underlying GGT.
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Affiliation(s)
- Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shunsuke Koga
- Department of Neurosciences, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aivi Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ross R Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neurosciences, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Katzdobler S, Nitschmann A, Barthel H, Bischof G, Beyer L, Marek K, Song M, Wagemann O, Palleis C, Weidinger E, Nack A, Fietzek U, Kurz C, Häckert J, Stapf T, Ferschmann C, Scheifele M, Eckenweber F, Biechele G, Franzmeier N, Dewenter A, Schönecker S, Saur D, Schroeter ML, Rumpf JJ, Rullmann M, Schildan A, Patt M, Stephens AW, van Eimeren T, Neumaier B, Drzezga A, Danek A, Classen J, Bürger K, Janowitz D, Rauchmann BS, Stöcklein S, Perneczky R, Schöberl F, Zwergal A, Höglinger GU, Bartenstein P, Villemagne V, Seibyl J, Sabri O, Levin J, Brendel M. Additive value of [ 18F]PI-2620 perfusion imaging in progressive supranuclear palsy and corticobasal syndrome. Eur J Nucl Med Mol Imaging 2023; 50:423-434. [PMID: 36102964 PMCID: PMC9816230 DOI: 10.1007/s00259-022-05964-w] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Early after [18F]PI-2620 PET tracer administration, perfusion imaging has potential for regional assessment of neuronal injury in neurodegenerative diseases. This is while standard late-phase [18F]PI-2620 tau-PET is able to discriminate the 4-repeat tauopathies progressive supranuclear palsy and corticobasal syndrome (4RTs) from disease controls and healthy controls. Here, we investigated whether early-phase [18F]PI-2620 PET has an additive value for biomarker based evaluation of 4RTs. METHODS Seventy-eight patients with 4RTs (71 ± 7 years, 39 female), 79 patients with other neurodegenerative diseases (67 ± 12 years, 35 female) and twelve age-matched controls (69 ± 8 years, 8 female) underwent dynamic (0-60 min) [18F]PI-2620 PET imaging. Regional perfusion (0.5-2.5 min p.i.) and tau load (20-40 min p.i.) were measured in 246 predefined brain regions [standardized-uptake-value ratios (SUVr), cerebellar reference]. Regional SUVr were compared between 4RTs and controls by an ANOVA including false-discovery-rate (FDR, p < 0.01) correction. Hypoperfusion in resulting 4RT target regions was evaluated at the patient level in all patients (mean value - 2SD threshold). Additionally, perfusion and tau pattern expression levels were explored regarding their potential discriminatory value of 4RTs against other neurodegenerative disorders, including validation in an independent external dataset (n = 37), and correlated with clinical severity in 4RTs (PSP rating scale, MoCA, activities of daily living). RESULTS Patients with 4RTs had significant hypoperfusion in 21/246 brain regions, most dominant in thalamus, caudate nucleus, and anterior cingulate cortex, fitting to the topology of the 4RT disease spectrum. However, single region hypoperfusion was not specific regarding the discrimination of patients with 4RTs against patients with other neurodegenerative diseases. In contrast, perfusion pattern expression showed promise for discrimination of patients with 4RTs from other neurodegenerative diseases (AUC: 0.850). Discrimination by the combined perfusion-tau pattern expression (AUC: 0.903) exceeded that of the sole tau pattern expression (AUC: 0.864) and the discriminatory power of the combined perfusion-tau pattern expression was replicated in the external dataset (AUC: 0.917). Perfusion but not tau pattern expression was associated with PSP rating scale (R = 0.402; p = 0.0012) and activities of daily living (R = - 0.431; p = 0.0005). CONCLUSION [18F]PI-2620 perfusion imaging mirrors known topology of regional hypoperfusion in 4RTs. Single region hypoperfusion is not specific for 4RTs, but perfusion pattern expression may provide an additive value for the discrimination of 4RTs from other neurodegenerative diseases and correlates closer with clinical severity than tau pattern expression.
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Affiliation(s)
- Sabrina Katzdobler
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Alexander Nitschmann
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Henryk Barthel
- grid.411339.d0000 0000 8517 9062Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Gerard Bischof
- grid.411097.a0000 0000 8852 305XDepartment of Nuclear Medicine, University Hospital Cologne, Cologne, Germany ,Molecular Organization of the Brain, Institute for Neuroscience and Medicine, INM-2), Jülich, Germany
| | - Leonie Beyer
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ken Marek
- grid.452597.8InviCRO, LLC, Boston, MA USA ,grid.452597.8Molecular Neuroimaging, A Division of inviCRO, New Haven, CT USA
| | - Mengmeng Song
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Olivia Wagemann
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Endy Weidinger
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Anne Nack
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Urban Fietzek
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Carolin Kurz
- grid.411095.80000 0004 0477 2585Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Jan Häckert
- grid.411095.80000 0004 0477 2585Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Theresa Stapf
- grid.411095.80000 0004 0477 2585Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Christian Ferschmann
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Maximilian Scheifele
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Florian Eckenweber
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Gloria Biechele
- grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Nicolai Franzmeier
- grid.411095.80000 0004 0477 2585Institute for Stroke and Dementia Research, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Anna Dewenter
- grid.411095.80000 0004 0477 2585Institute for Stroke and Dementia Research, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Sonja Schönecker
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Dorothee Saur
- grid.9647.c0000 0004 7669 9786Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Matthias L. Schroeter
- grid.9647.c0000 0004 7669 9786Clinic for Cognitive Neurology, University of Leipzig, Leipzig, Germany ,grid.9647.c0000 0004 7669 9786LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany ,grid.419524.f0000 0001 0041 5028Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jost-Julian Rumpf
- grid.9647.c0000 0004 7669 9786Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Rullmann
- grid.411339.d0000 0000 8517 9062Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Andreas Schildan
- grid.411339.d0000 0000 8517 9062Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Marianne Patt
- grid.411339.d0000 0000 8517 9062Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | | | - Thilo van Eimeren
- grid.411097.a0000 0000 8852 305XDepartment of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Bernd Neumaier
- grid.411097.a0000 0000 8852 305XDepartment of Nuclear Medicine, University Hospital Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute for Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Alexander Drzezga
- grid.411097.a0000 0000 8852 305XDepartment of Nuclear Medicine, University Hospital Cologne, Cologne, Germany ,Molecular Organization of the Brain, Institute for Neuroscience and Medicine, INM-2), Jülich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Adrian Danek
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Joseph Classen
- grid.9647.c0000 0004 7669 9786Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Katharina Bürger
- grid.411095.80000 0004 0477 2585Institute for Stroke and Dementia Research, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Daniel Janowitz
- grid.411095.80000 0004 0477 2585Institute for Stroke and Dementia Research, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Boris-Stephan Rauchmann
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany ,grid.411095.80000 0004 0477 2585Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Sophia Stöcklein
- grid.411095.80000 0004 0477 2585Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Robert Perneczky
- grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany ,grid.7445.20000 0001 2113 8111Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College, London, UK
| | - Florian Schöberl
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Andreas Zwergal
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Günter U. Höglinger
- grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.10423.340000 0000 9529 9877Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Peter Bartenstein
- grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Victor Villemagne
- grid.410678.c0000 0000 9374 3516Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC Australia ,grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - John Seibyl
- grid.452597.8InviCRO, LLC, Boston, MA USA ,grid.452597.8Molecular Neuroimaging, A Division of inviCRO, New Haven, CT USA
| | - Osama Sabri
- grid.411339.d0000 0000 8517 9062Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Johannes Levin
- grid.411095.80000 0004 0477 2585Department of Neurology, University Hospital of Munich, LMU Munich, Munich, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Matthias Brendel
- grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE), Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.411095.80000 0004 0477 2585Department of Nuclear Medicine, University Hospital of Munich, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Forrest SL, Tartaglia MC, Kim A, Alcaide-Leon P, Rogaeva E, Lang A, Kovacs GG. Progressive Supranuclear Palsy Syndrome Associated With a Novel Tauopathy: Case Study. Neurology 2022; 99:1094-1098. [PMID: 36192179 DOI: 10.1212/wnl.0000000000201485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To report a novel tauopathy in a patient with protracted course progressive supranuclear palsy (PC-PSP). METHODS This was a clinical follow-up, gene analysis, neuropathologic study. RESULTS A 73-year-old man presented with diplopia, slowness, shuffling gait, and falls. Neurologic examination revealed slowed saccades, restricted up-gaze, and mild parkinsonism. Three years after onset, he developed personality changes. Slowly progressive parkinsonism was associated with memory and executive deficits. MRI showed subtle bilateral hippocampal and midbrain tegmentum atrophy and hyperintensity in the brainstem tegmentum and white matter of the medial temporal lobe. The duration of illness was 11 years. There were no pathogenic mutations in 80 genes known to be involved in neurodegeneration, including MAPT (H1/H1 haplotype) and APOE (ε3/ε3 genotype). Neuropathology revealed PSP type pathology together with the pathology described in the novel limbic-predominant neuronal inclusion body 4-repeat tauopathy (LNT) correlating well with the signal alterations seen in MRI. DISCUSSION Our observation broadens the spectrum of tau pathology associated with PC-PSP and suggests that memory deficit and hippocampal atrophy may be suggestive of non-Alzheimer disease pathology, including LNT. Understanding the diverse range of tau morphologies may help explain phenotypic heterogeneity seen in PSP.
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Affiliation(s)
- Shelley L Forrest
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada
| | - Maria Carmela Tartaglia
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada
| | - Ain Kim
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada
| | - Paula Alcaide-Leon
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada
| | - Ekaterina Rogaeva
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada
| | - Anthony Lang
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada
| | - Gabor G Kovacs
- From the Dementia Research Centre (S.L.F.), Macquarie Medical School, Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia; Tanz Centre for Research in Neurodegenerative Disease (S.L.F., M.C.T., A.K., E.R., A.L., G.G.K.), University of Toronto, ON, Canada; University Health Network Memory Clinic & Krembil Brain Institute (M.C.T.), University Health Network, Toronto, ON, Canada; Department of Medical Imaging (P.A.-L.), University of Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease (A.L., G.G.K.), Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, ON, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine (G.G.K.), University of Toronto, ON, Canada; and Laboratory Medicine Program & Krembil Brain Institute (G.G.K.), University Health Network, ON, Canada.
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35
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Tagai K, Ikoma Y, Endo H, Debnath OB, Seki C, Matsuoka K, Matsumoto H, Oya M, Hirata K, Shinotoh H, Takahata K, Kurose S, Sano Y, Ono M, Shimada H, Kawamura K, Zhang MR, Takado Y, Higuchi M. An optimized reference tissue method for quantification of tau protein depositions in diverse neurodegenerative disorders by PET with 18F-PM-PBB3 ( 18F-APN-1607). Neuroimage 2022; 264:119763. [PMID: 36427751 DOI: 10.1016/j.neuroimage.2022.119763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/15/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
Positron emission tomography (PET) with 18F-PM-PBB3 (18F-APN-1607, 18F-Florzolotau) enables high-contrast detection of tau depositions in various neurodegenerative dementias, including Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). A simplified method for quantifying radioligand binding in target regions is to employ the cerebellum as a reference (CB-ref) on the assumption that the cerebellum has minimal tau pathologies. This procedure is typically valid in AD, while FTLD disorders exemplified by progressive supranuclear palsy (PSP) are characterized by occasional tau accumulations in the cerebellum, hampering the application of CB-ref. The present study aimed to establish an optimal method for defining reference tissues on 18F-PM-PBB3-PET images of AD and non-AD tauopathy brains. We developed a new algorithm to extract reference voxels with a low likelihood of containing tau deposits from gray matter (GM-ref) or white matter (WM-ref) by a bimodal fit to an individual, voxel-wise histogram of the radioligand retentions and applied it to 18F-PM-PBB3-PET data obtained from age-matched 40 healthy controls (HCs) and 23 CE, 40 PSP, and five other tau-positive FTLD patients. PET images acquired at 90-110 min after injection were averaged and co-registered to corresponding magnetic resonance imaging space. Subsequently, we generated standardized uptake value ratio (SUVR) images estimated by CB-ref, GM-ref and WM-ref, respectively, and then compared the diagnostic performances. GM-ref and WM-ref covered a broad area in HCs and were free of voxels located in regions known to bear high tau burdens in AD and PSP patients. However, radioligand retentions in WM-ref exhibited age-related declines. GM-ref was unaffected by aging and provided SUVR images with higher contrast than CB-ref in FTLD patients with suspected and confirmed corticobasal degeneration. The methodology for determining reference tissues as optimized here improves the accuracy of 18F-PM-PBB3-PET measurements of tau burdens in a wide range of neurodegenerative illnesses.
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Affiliation(s)
- Kenji Tagai
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan; Department of Psychiatry, The Jikei University of Medicine, Tokyo 105-8461, Japan.
| | - Yoko Ikoma
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Hironobu Endo
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Oiendrila Bhowmik Debnath
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Chie Seki
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Kiwamu Matsuoka
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Hideki Matsumoto
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Masaki Oya
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Kosei Hirata
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Hitoshi Shinotoh
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Keisuke Takahata
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan; Department of Psychiatry, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Shin Kurose
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan; Department of Psychiatry, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Yasunori Sano
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan; Department of Psychiatry, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Maiko Ono
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Hitoshi Shimada
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan; Department of Functional Neurology & Neurosurgery, Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Kazunori Kawamura
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Ming-Rong Zhang
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
| | - Yuhei Takado
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan.
| | - Makoto Higuchi
- Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Institute for Quantum Medical Science, Chiba 263-8555, Japan
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Tessema AW, Lee H, Gong Y, Cho H, Adem HM, Lyu I, Lee JH, Cho H. Automated volumetric determination of high R 2 * regions in substantia nigra: A feasibility study of quantifying substantia nigra atrophy in progressive supranuclear palsy. NMR Biomed 2022; 35:e4795. [PMID: 35775868 DOI: 10.1002/nbm.4795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
The establishment of an unbiased protocol for the automated volumetric measurement of iron-rich regions in the substantia nigra (SN) is clinically important for diagnosing neurodegenerative diseases exhibiting midbrain atrophy, such as progressive supranuclear palsy (PSP). This study aimed to automatically quantify the volume and surface properties of the iron-rich 3D regions in the SN using the quantitative MRI-R2 * map. Three hundred and sixty-seven slices of R2 * map and susceptibility-weighted imaging (SWI) at 3-T MRI from healthy control (HC) individuals and Parkinson's disease (PD) patients were used to train customized U-net++ convolutional neural network based on expert-segmented masks. Age- and sex-matched participants were selected from HC, PD, and PSP groups to automate the volumetric determination of iron-rich areas in the SN. Dice similarity coefficient values between expert-segmented and detected masks from the proposed network were 0.91 ± 0.07 for R2 * maps and 0.89 ± 0.08 for SWI. Reductions in iron-rich SN volume from the R2 * map (SWI) were observed in PSP with area under the receiver operating characteristic curve values of 0.96 (0.89) and 0.98 (0.92) compared with HC and PD, respectively. The mean curvature of the PSP showed SN deformation along the side closer to the red nucleus. We demonstrated the automated volumetric measurement of iron-rich regions in the SN using deep learning can quantify the SN atrophy in PSP compared with PD and HC.
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Affiliation(s)
- Abel Worku Tessema
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Hansol Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yelim Gong
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Hwapyeong Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Hamdia Murad Adem
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Ilwoo Lyu
- Department of Computer Science and Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Jae-Hyeok Lee
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - HyungJoon Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
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Ye R, O'Callaghan C, Rua C, Hezemans FH, Holland N, Malpetti M, Jones PS, Barker RA, Williams‐Gray CH, Robbins TW, Passamonti L, Rowe J. Locus Coeruleus Integrity from 7 T MRI Relates to Apathy and Cognition in Parkinsonian Disorders. Mov Disord 2022; 37:1663-1672. [PMID: 35576973 PMCID: PMC9541468 DOI: 10.1002/mds.29072] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurodegeneration in the locus coeruleus (LC) contributes to neuropsychiatric symptoms in both Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Spatial precision of LC imaging is improved with ultrahigh field 7 T magnetic resonance imaging. OBJECTIVES This study aimed to characterize the spatial patterns of LC pathological change in PD and PSP and the transdiagnostic relationship between LC signals and neuropsychiatric symptoms. METHODS Twenty-five people with idiopathic PD, 14 people with probable PSP-Richardson's syndrome, and 24 age-matched healthy controls were recruited. Participants underwent clinical assessments and high-resolution (0.08 mm3 ) 7 T-magnetization-transfer imaging to measure LC integrity in vivo. Spatial patterns of LC change were obtained using subregional mean contrast ratios and significant LC clusters; we further correlated the LC contrast with measures of apathy and cognition, using both mixed-effect models and voxelwise analyses. RESULTS PSP and PD groups showed significant LC degeneration in the caudal subregion relative to controls. Mixed-effect models revealed a significant interaction between disease-group and apathy-related correlations with LC degeneration (β = 0.46, SE [standard error] = 0.17, F(1, 35) = 7.46, P = 0.01), driven by a strong correlation in PSP (β = -0.58, SE = 0.21, t(35) = -2.76, P = 0.009). Across both disease groups, voxelwise analyses indicated that lower LC integrity was associated with worse cognition and higher apathy scores. CONCLUSIONS The relationship between LC and nonmotor symptoms highlights a role for noradrenergic dysfunction across both PD and PSP, confirming the potential for noradrenergic therapeutic strategies to address transdiagnostic cognitive and behavioral features in neurodegenerative disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rong Ye
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical SciencesFaculty of Medicine and Health, University of SydneySydneyAustralia
- Department of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
| | - Catarina Rua
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Frank H. Hezemans
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - P. Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Roger A. Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain RepairUniversity of CambridgeCambridgeUnited Kingdom
- Wellcome Trust—Medical Research Council Stem Cell InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Caroline H. Williams‐Gray
- Department of Clinical Neurosciences, John van Geest Centre for Brain RepairUniversity of CambridgeCambridgeUnited Kingdom
| | - Trevor W. Robbins
- Department of PsychologyUniversity of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- Istituto di Bioimmagini e Fisiologia MolecolareConsiglio Nazionale delle RicercheCefalùItaly
| | - James Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
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38
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Malpetti M, Kaalund SS, Tsvetanov KA, Rittman T, Briggs M, Allinson KSJ, Passamonti L, Holland N, Jones PS, Fryer TD, Hong YT, Kouli A, Bevan-Jones WR, Mak E, Savulich G, Spillantini MG, Aigbirhio FI, Williams-Gray CH, O'Brien JT, Rowe JB. In Vivo 18F-Flortaucipir PET Does Not Accurately Support the Staging of Progressive Supranuclear Palsy. J Nucl Med 2022; 63:1052-1057. [PMID: 34795013 PMCID: PMC7612961 DOI: 10.2967/jnumed.121.262985] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/31/2021] [Revised: 10/08/2021] [Indexed: 02/02/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by neuroglial tau pathology. A new staging system for PSP pathology postmortem has been described and validated. We used a data-driven approach to test whether postmortem pathologic staging in PSP can be reproduced in vivo with 18F-flortaucipir PET. Methods: Forty-two patients with probable PSP and 39 controls underwent 18F-flortaucipir PET. Conditional inference tree analyses on regional binding potential values identified absent/present pathology thresholds to define in vivo staging. Following the postmortem staging approach for PSP pathology, we evaluated the combinations of absent/present pathology (or abnormal/normal PET signal) across all regions to assign each participant to in vivo stages. ANOVA was applied to analyze differences among means of disease severity between stages. In vivo staging was compared with postmortem staging in 9 patients who also had postmortem confirmation of the diagnosis and stage. Results: Stage assignment was estimable in 41 patients: 10, 26, and 5 patients were classified in stage I/II, stage III/IV, and stage V/VI, respectively, whereas 1 patient was not classifiable. Explorative substaging identified 2 patients in stage I, 8 in stage II, 9 in stage III, 17 in stage IV, and 5 in stage V. However, the nominal 18F-flortaucipir--derived stage was not associated with clinical severity and was not indicative of pathology staging postmortem. Conclusion:18F-flortaucipir PET in vivo does not correspond to neuropathologic staging in PSP. This analytic approach, seeking to mirror in vivo neuropathology staging with PET-to-autopsy correlational analyses, might enable in vivo staging with next-generation tau PET tracers; however, further evidence and comparisons with postmortem data are needed.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom;
| | - Sanne S Kaalund
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Mayen Briggs
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge University Brain Bank, Cambridge, United Kingdom
| | - Kieren S J Allinson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge University Brain Bank, Cambridge, United Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Consiglio Nazionale delle Ricerche (CNR), Milano, Italy
| | - Negin Holland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Antonina Kouli
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - W Richard Bevan-Jones
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | | | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Caroline H Williams-Gray
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John T O'Brien
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; and
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Freitas LF, de Carvalho VM, Pedroso JL, Duarte ML, Massaud RM. Simultaneous mixed phenotype and neuroimaging of progressive supranuclear palsy, progressive ataxia and palatal tremor: two different faces of tauopathies. Arq Neuropsiquiatr 2022; 80:656-657. [PMID: 35946715 PMCID: PMC9387190 DOI: 10.1590/0004-282x-anp-2021-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/12/2021] [Accepted: 12/29/2021] [Indexed: 06/15/2023]
Affiliation(s)
| | | | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Márcio Luís Duarte
- Universidade Federal de São Paulo, Departamento de Saúde Baseada em Evidências, São Paulo SP, Brazil
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Josephs KA, Tosakulwong N, Weigand SD, Buciuc M, Lowe VJ, Dickson DW, Whitwell JL. Relationship Between 18F-Flortaucipir Uptake and Histologic Lesion Types in 4-Repeat Tauopathies. J Nucl Med 2022; 63:931-935. [PMID: 34556525 PMCID: PMC9157721 DOI: 10.2967/jnumed.121.262685] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are 4-repeat (4R) tauopathies with overlapping, but also morphologically distinct, tau immunoreactive lesions that vary in count by brain region. 18F-flortaucipir PET uptake has been reported to correlate with overall tau burden, and-in 1 CBD case-to have greater affinity to threads than tangles. We determined whether 18F-flortaucipir uptake is associated with histologic lesion type in 4R tauopathies. Methods: We performed semiquantitative regional lesion counts on pretangles/neurofibrillary tangles, threads, oligodendroglial coiled bodies, tufted astrocytes, and astrocytic plaques in 29 cases of autopsied 4R tauopathy (PSP, 16; CBD, 13). Regression models were used for statistical analyses. Results:18F-flortaucipir uptake marginally correlated with threads in the precentral cortex (P = 0.04) and with astrocytic lesions in the red nucleus (P = 0.05). Conclusion: The findings do not support 18F-flortaucipir's having differential affinity to any 4R tau lesion type.
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Affiliation(s)
| | | | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Marina Buciuc
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; and
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Picillo M, Tepedino MF, Abate F, Ponticorvo S, Erro R, Cuoco S, Oksuz N, Di Salle G, Di Salle F, Esposito F, Pellecchia MT, Manara R, Barone P. Uncovering clinical and radiological asymmetry in progressive supranuclear palsy-Richardson's syndrome. Neurol Sci 2022; 43:3677-3682. [PMID: 35106692 PMCID: PMC9119874 DOI: 10.1007/s10072-022-05919-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Richardson's syndrome (RS) is considered the most symmetric phenotype of progressive supranuclear palsy (PSP) as opposed to PSP with predominant corticobasal syndrome (PSP-CBS) or parkinsonism (PSP-P). OBJECTIVES Evaluate asymmetrical motor and higher cortical features in probable PSP-RS and compare the degree of asymmetry of cortical lobes and hemispheres between PSP-RS, PSP-CBS, PSP-P, and age-matched healthy controls (HC). METHODS Asymmetry of motor and higher cortical features evaluated with an extensive videotaped neurologic examination was investigated in 28 PSP-RS, 8 PSP-CBS, and 14 PSP-P. Brain MRI to compute the laterality index (LI) was performed in 36 patients as well as in 56 HC. RESULTS In PSP-RS, parkinsonism was the most common asymmetric motor feature (53.6%), followed by dystonia and myoclonus (21.4% and 17.9%, respectively). Among higher cortical features, limb apraxia was found asymmetric in about one-third of patients. PSP-RS disclosed higher LI for hemispheres compared to HC, indicating a greater degree of asymmetry (p = 0.003). The degree of asymmetry of clinical features was not different between PSP-RS and those qualifying for PSP-CBS or PSP-P. As for imaging, LI was not different between PSP-RS, PSP-CBS, and PSP-P in any cortical region. CONCLUSIONS Motor and higher cortical features are asymmetric in up to 50% of PSP-RS who also present a greater degree of asymmetry in hemispheres compared to age-matched HC. Lateralization of clinical features should be annotated in PSP.
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Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy.
| | - Maria Francesca Tepedino
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy
| | - Filomena Abate
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy
| | - Sara Ponticorvo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, (SA), Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy
| | - Nevra Oksuz
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
| | | | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, (SA), Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, (SA), Italy
- Department of Diagnostic Imaging, University Hospital A.O.U. OO.RR. San Giovanni Di Dio E Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy
| | - Renzo Manara
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience Section, University of Salerno, Fisciano, Italy
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Jia C, Wu M, Yen TC, Li Y, Cui R. Complementary Utility of Dopamine Transporter and Tau PET Imaging in the Diagnosis of Progressive Supranuclear Palsy: A Case Report. Clin Nucl Med 2022; 47:336-338. [PMID: 35020665 DOI: 10.1097/rlu.0000000000003974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 50-year-old woman developed gait disturbances, tendency to fall backwards, bradykinesia, and memory loss over the previous 6 months. Brain 18F-FDG PET/CT was unable to distinguish among APSs (atypical parkinsonian syndromes); PET investigations of dopamine transporter (DAT) function (11C-CFT) and tau pathology (18F-APN-1607) were performed. 11C-CFT PET revealed severe loss of striatal DAT function, whereas significant tau accumulation was observed in the brainstem, basal ganglia, and globus pallidus on 18F-APN-1607 PET. Such finding suggested diagnosis of PSP (progressive supranuclear palsy). This case highlights the value of DAT and tau PET imaging in diagnosis of PSP and differential diagnosis ofAPSs.
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Affiliation(s)
| | | | | | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Illán-Gala I, Nigro S, VandeVrede L, Falgàs N, Heuer HW, Painous C, Compta Y, Martí MJ, Montal V, Pagonabarraga J, Kulisevsky J, Lleó A, Fortea J, Logroscino G, Quattrone A, Quattrone A, Perry DC, Gorno-Tempini ML, Rosen HJ, Grinberg LT, Spina S, La Joie R, Rabinovici GD, Miller BL, Rojas JC, Seeley WW, Boxer AL. Diagnostic Accuracy of Magnetic Resonance Imaging Measures of Brain Atrophy Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Degeneration. JAMA Netw Open 2022; 5:e229588. [PMID: 35486397 PMCID: PMC9055455 DOI: 10.1001/jamanetworkopen.2022.9588] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
Importance The accurate diagnosis of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) is hampered by imperfect clinical-pathological correlations. Objective To assess and compare the diagnostic value of the magnetic resonance parkinsonism index (MRPI) and other magnetic resonance imaging-based measures of cerebral atrophy to differentiate between PSP, CBD, and other neurodegenerative diseases. Design, Setting, and Participants This prospective diagnostic study included participants with 4-repeat tauopathies (4RT), PSP, CBD, other neurodegenerative diseases and available MRI who appeared in the University of California, San Francisco, Memory and Aging Center database. Data were collected from October 27, 1994, to September 29, 2019. Data were analyzed from March 1 to September 14, 2021. Main Outcomes and Measures The main outcome of this study was the neuropathological diagnosis of PSP or CBD. The clinical diagnosis at the time of the MRI acquisition was noted. The imaging measures included the MRPI, cortical thickness, subcortical volumes, including the midbrain, pons, and superior cerebellar peduncle volumes. Multinomial logistic regression models (MLRM) combining different cortical and subcortical regions were defined to discriminate between PSP, CBD, and other pathologies. The areas under the receiver operating characteristic curves (AUROC) and cutoffs were calculated to differentiate between PSP, CBD, and other diseases. Results Of the 326 included participants, 176 (54%) were male, and the mean (SD) age at MRI was 64.1 (8.0) years. The MRPI showed good diagnostic accuracy for the differentiation between PSP and all other pathologies (accuracy, 87%; AUROC, 0.90; 95% CI, 0.86-0.95) and between 4RT and other pathologies (accuracy, 80%; AUROC, 0.82; 95% CI, 0.76-0.87), but did not allow the discrimination of participants with CBD. Its diagnostic accuracy was lower in the subgroup of patients without the canonical PSP-Richardson syndrome (PSP-RS) or probable corticobasal syndrome (CBS) at MRI. MLRM combining cortical and subcortical measurements showed the highest accuracy for the differentiation between PSP and other pathologies (accuracy, 95%; AUROC, 0.98; 95% CI, 0.97-0.99), CBD and other pathologies (accuracy, 83%; AUROC, 0.86; 95% CI, 0.81-0.91), 4RT and other pathologies (accuracy, 89%; AUROC, 0.94; 95% CI, 0.92-0.97), and PSP and CBD (accuracy, 91%; AUROC, 0.95; 95% CI, 0.91-0.99), even in participants without PSP-RS or CBS at MRI. Conclusions and Relevance In this study, the combination of widely available cortical and subcortical measures of atrophy on MRI discriminated between PSP, CBD, and other pathologies and could be used to support the diagnosis of 4RT in clinical practice.
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Affiliation(s)
- Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Atlantic Fellow for Equity in Brain Health at the University of California, San Francisco, Department of Neurology, University of California, San Francisco
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
- Institute of Nanotechnology, National Research Council, Lecce, Italy
| | - Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Neus Falgàs
- Atlantic Fellow for Equity in Brain Health at the University of California, San Francisco, Department of Neurology, University of California, San Francisco
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Hilary W. Heuer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Cèlia Painous
- Parkinson’s Disease & Movement Disorders Unit, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, CIBERNED, European Reference Network for Rare Neurological Diseases, Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- Parkinson’s Disease & Movement Disorders Unit, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, CIBERNED, European Reference Network for Rare Neurological Diseases, Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Maria J. Martí
- Parkinson’s Disease & Movement Disorders Unit, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, CIBERNED, European Reference Network for Rare Neurological Diseases, Institut de Neurociències, Universitat de Barcelona, Catalonia, Spain
| | - Victor Montal
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Javier Pagonabarraga
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Movement Disorders Unit, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Movement Disorders Unit, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - David C. Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | | | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Lea T. Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Julio C. Rojas
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Clark HM, Tosakulwong N, Weigand SD, Ali F, Botha H, Pham NTT, Schwarz CG, Reid RI, Senjem ML, Jack CR, Lowe VJ, Ahlskog JE, Josephs KA, Whitwell JL. Gray and White Matter Correlates of Dysphagia in Progressive Supranuclear Palsy. Mov Disord 2021; 36:2669-2675. [PMID: 34426998 PMCID: PMC8595517 DOI: 10.1002/mds.28731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/04/2021] [Accepted: 07/03/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dysphagia is a common symptom of progressive supranuclear palsy often leading to aspiration pneumonia and death. OBJECTIVE The aim of this study was to examine how impairments of the oral and pharyngeal phases of the swallow and airway incursion during liquid swallows relate to gray and white matter integrity. METHODS Thirty-eight participants with progressive supranuclear palsy underwent videofluorographic swallowing assessment and structural and diffusion tensor head magnetic resonance imaging. Penalized linear regression models assessed relationships between swallowing metrics and regional gray matter volumes and white matter fractional anisotropy and mean diffusivity. RESULTS Oral phase impairments were associated with reduced superior parietal volumes and abnormal diffusivity in parietal and sensorimotor white matter, posterior limb of the internal capsule, and superior longitudinal fasciculus. Pharyngeal phase impairments were associated with disruption to medial frontal lobe, corticospinal tract, and cerebral peduncle. No regions were predictive of airway incursion. CONCLUSIONS Differential patterns of neuroanatomical impairment corresponded to oral and pharyngeal phase swallowing impairments. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | | | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN
- Department of Information Technology, Mayo Clinic, Rochester, MN
| | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN
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Torso M, Ridgway GR, Jenkinson M, Chance S. Intracortical diffusion tensor imaging signature of microstructural changes in frontotemporal lobar degeneration. Alzheimers Res Ther 2021; 13:180. [PMID: 34686217 PMCID: PMC8539736 DOI: 10.1186/s13195-021-00914-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is a neuropathological construct with multiple clinical presentations, including the behavioural variant of frontotemporal dementia (bvFTD), primary progressive aphasia-both non-fluent variant (nfvPPA) and semantic variant (svPPA)-progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), characterised by the deposition of abnormal tau protein in the brain. A major challenge for treating FTLD is early diagnosis and accurate discrimination among different syndromes. The main goal here was to investigate the cortical architecture of FTLD syndromes using cortical diffusion tensor imaging (DTI) analysis and to test its power to discriminate between different clinical presentations. METHODS A total of 271 individuals were included in the study: 87 healthy subjects (HS), 31 semantic variant primary progressive aphasia (svPPA), 37 behavioural variant (bvFTD), 30 non-fluent/agrammatic variant primary progressive aphasia (nfvPPA), 47 PSP Richardson's syndrome (PSP-RS) and 39 CBS cases. 3T MRI T1-weighted images and DTI scans were analysed to extract three cortical DTI derived measures (AngleR, PerpPD and ParlPD) and mean diffusivity (MD), as well as standard volumetric measurements. Whole brain and regional data were extracted. Linear discriminant analysis was used to assess the group discrimination capability of volumetric and DTI measures to differentiate the FTLD syndromes. In addition, in order to further investigate differential diagnosis in CBS and PSP-RS, a subgroup of subjects with autopsy confirmation in the training cohort was used to select features which were then tested in the test cohort. Three different challenges were explored: a binary classification (controls vs all patients), a multiclass classification (HS vs bvFTD vs svPPA vs nfvPPA vs CBS vs PSP-RS) and an additional binary classification to differentiate CBS and PSP-RS using features selected in an autopsy confirmed subcohort. RESULTS Linear discriminant analysis revealed that PerpPD was the best feature to distinguish between controls and all patients (ACC 86%). PerpPD regional values were able to classify correctly the different FTLD syndromes with an accuracy of 85.6%. The PerpPD and volumetric values selected to differentiate CBS and PSP-RS patients showed a classification accuracy of 85.2%. CONCLUSIONS (I) PerpPD achieved the highest classification power for differentiating healthy controls and FTLD syndromes and FTLD syndromes among themselves. (II) PerpPD regional values could provide an additional marker to differentiate FTD, PSP-RS and CBS.
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Affiliation(s)
- Mario Torso
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
- Oxford Brain Diagnostics Limited, Oxford, UK.
| | | | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Steven Chance
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Oxford Brain Diagnostics Limited, Oxford, UK
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Sintini I, Kaufman K, Botha H, Martin PR, Loushin SR, Senjem ML, Reid RI, Schwarz CG, Jack CR, Lowe VJ, Josephs KA, Whitwell JL, Ali F. Neuroimaging correlates of gait abnormalities in progressive supranuclear palsy. Neuroimage Clin 2021; 32:102850. [PMID: 34655905 PMCID: PMC8527041 DOI: 10.1016/j.nicl.2021.102850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
Progressive supranuclear palsy is a neurodegenerative disorder characterized primarily by tau inclusions and neurodegeneration in the midbrain, basal ganglia, thalamus, premotor and frontal cortex. Neurodegenerative change in progressive supranuclear palsy has been assessed using MRI. Degeneration of white matter tracts is evident with diffusion tensor imaging and PET methods have been used to assess brain metabolism or presence of tau protein deposits. Patients with progressive supranuclear palsy present with a variety of clinical syndromes; however early onset of gait impairments and postural instability are common features. In this study we assessed the relationship between multimodal imaging biomarkers (i.e., MRI atrophy, white matter tracts degeneration, flortaucipir-PET uptake) and laboratory-based measures of gait and balance abnormalities in a cohort of nineteen patients with progressive supranuclear palsy, using univariate and multivariate statistical analyses. The PSP rating scale and its gait midline sub-score were strongly correlated to gait abnormalities but not to postural imbalance. Principal component analysis on gait variables identified velocity, stride length, gait stability ratio, length of gait phases and dynamic stability as the main contributors to the first component, which was associated with diffusion tensor imaging measures in the posterior thalamic radiation, external capsule, superior cerebellar peduncle, superior fronto-occipital fasciculus, body and splenium of the corpus callosum and sagittal stratum, with MRI volumes in frontal and precentral regions and with flortaucipir-PET uptake in the precentral gyrus. The main contributor to the second principal component was cadence, which was higher in patients presenting more abnormalities on mean diffusivity: this unexpected finding might be related to compensatory gait strategies adopted in progressive supranuclear palsy. Postural imbalance was the main contributor to the third principal component, which was related to flortaucipir-PET uptake in the left paracentral lobule and supplementary motor area and white matter disruption in the superior cerebellar peduncle, putamen, pontine crossing tract and corticospinal tract. A partial least square model identified flortaucipir-PET uptake in midbrain, basal ganglia and thalamus as the main correlate of speed and dynamic component of gait in progressive supranuclear palsy. Although causality cannot be established in this analysis, our study sheds light on neurodegeneration of brain regions and white matter tracts that underlies gait and balance impairment in progressive supranuclear palsy.
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Affiliation(s)
- Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kenton Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Peter R Martin
- Department of Health Science Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Stacy R Loushin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, Rochester MN 55905, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester MN 55905, USA
| | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Oh M, Lee N, Kim C, Son HJ, Sung C, Oh SJ, Lee SJ, Chung SJ, Lee CS, Kim JS. Diagnostic accuracy of dual-phase 18F-FP-CIT PET imaging for detection and differential diagnosis of Parkinsonism. Sci Rep 2021; 11:14992. [PMID: 34294739 PMCID: PMC8298455 DOI: 10.1038/s41598-021-94040-8] [Citation(s) in RCA: 3] [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: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Delayed phase 18F-FP-CIT PET (dCIT) can assess the striatal dopamine transporter binding to detect degenerative parkinsonism (DP). Early phase 18F-FP-CIT (eCIT) can assess the regional brain activity for differential diagnosis among parkinsonism similar with 18F-FDG PET. We evaluated the diagnostic performance of dual phase 18F-FP-CIT PET (dual CIT) and 18F-FDG PET compared with clinical diagnosis in 141 subjects [36 with idiopathic Parkinson's disease (IPD), 77 with multiple system atrophy (MSA), 18 with progressive supranuclear palsy (PSP), and 10 with non-DP)]. Visual assessment of eCIT, dCIT, dual CIT, 18F-FDG and 18F-FDG PET with dCIT was in agreement with the clinical diagnosis in 61.7%, 69.5%, 95.7%, 81.6%, and 97.2% of cases, respectively. ECIT showed about 90% concordance with non-DP and MSA, and 8.3% and 27.8% with IPD and PSP, respectively. DCIT showed ≥ 88% concordance with non-DP, IPD, and PSP, and 49.4% concordance with MSA. Dual CIT showed ≥ 90% concordance in all groups. 18F-FDG PET showed ≥ 90% concordance with non-DP, MSA, and PSP, but only 33.3% concordance with IPD. The combination of 18F-FDG and dCIT yielded ≥ 90% concordance in all groups. Dual CIT may represent a powerful alternative to the combination of 18F-FDG PET and dCIT for differential diagnosis of parkinsonian disorders.
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Affiliation(s)
- Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Narae Lee
- Department of Nuclear Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chanwoo Kim
- Department of Nuclear Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital At Gangdong, Seoul, Korea
| | - Hye Joo Son
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Changhwan Sung
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung Jun Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sang Ju Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Chong Sik Lee
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Wisse LEM, Ravikumar S, Ittyerah R, Lim S, Lane J, Bedard ML, Xie L, Das SR, Schuck T, Grossman M, Lee EB, Tisdall MD, Prabhakaran K, Detre JA, Mizsei G, Trojanowski JQ, Artacho-Pérula E, de Iñiguez de Onzono Martin MM, M Arroyo-Jiménez M, Muñoz Lopez M, Molina Romero FJ, P Marcos Rabal M, Cebada Sánchez S, Delgado González JC, de la Rosa Prieto C, Córcoles Parada M, Wolk DA, Irwin DJ, Insausti R, Yushkevich PA. Downstream effects of polypathology on neurodegeneration of medial temporal lobe subregions. Acta Neuropathol Commun 2021; 9:128. [PMID: 34289895 PMCID: PMC8293481 DOI: 10.1186/s40478-021-01225-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022] Open
Abstract
The medial temporal lobe (MTL) is a nidus for neurodegenerative pathologies and therefore an important region in which to study polypathology. We investigated associations between neurodegenerative pathologies and the thickness of different MTL subregions measured using high-resolution post-mortem MRI. Tau, TAR DNA-binding protein 43 (TDP-43), amyloid-β and α-synuclein pathology were rated on a scale of 0 (absent)-3 (severe) in the hippocampus and entorhinal cortex (ERC) of 58 individuals with and without neurodegenerative diseases (median age 75.0 years, 60.3% male). Thickness measurements in ERC, Brodmann Area (BA) 35 and 36, parahippocampal cortex, subiculum, cornu ammonis (CA)1 and the stratum radiatum lacunosum moleculare (SRLM) were derived from 0.2 × 0.2 × 0.2 mm3 post-mortem MRI scans of excised MTL specimens from the contralateral hemisphere using a semi-automated approach. Spearman's rank correlations were performed between neurodegenerative pathologies and thickness, correcting for age, sex and hemisphere, including all four proteinopathies in the model. We found significant associations of (1) TDP-43 with thickness in all subregions (r = - 0.27 to r = - 0.46), and (2) tau with BA35 (r = - 0.31) and SRLM thickness (r = - 0.33). In amyloid-β and TDP-43 negative cases, we found strong significant associations of tau with ERC (r = - 0.40), BA35 (r = - 0.55), subiculum (r = - 0.42) and CA1 thickness (r = - 0.47). This unique dataset shows widespread MTL atrophy in relation to TDP-43 pathology and atrophy in regions affected early in Braak stageing and tau pathology. Moreover, the strong association of tau with thickness in early Braak regions in the absence of amyloid-β suggests a role of Primary Age-Related Tauopathy in neurodegeneration.
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Affiliation(s)
- L E M Wisse
- Department of Diagnostic Radiology, Lund University, Klinikgatan 13b, Lund, Sweden.
- Department of Radiology, University of Pennsylvania, Philadelphia, USA.
| | - S Ravikumar
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - R Ittyerah
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - S Lim
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - J Lane
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - M L Bedard
- Department of Pharmacology, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - L Xie
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - S R Das
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - T Schuck
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, USA
| | - M Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - E B Lee
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, USA
| | - M D Tisdall
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - K Prabhakaran
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - J A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - G Mizsei
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - J Q Trojanowski
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, USA
| | - E Artacho-Pérula
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | | | - M M Arroyo-Jiménez
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - M Muñoz Lopez
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - F J Molina Romero
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - M P Marcos Rabal
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - S Cebada Sánchez
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - J C Delgado González
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - C de la Rosa Prieto
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - M Córcoles Parada
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - D A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - D J Irwin
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, USA
| | - R Insausti
- Human Neuroanatomy Laboratory, Neuromax CSIC Associated Unit, University of Castilla La Mancha, Albacete, Spain
| | - P A Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
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Malpetti M, Passamonti L, Jones PS, Street D, Rittman T, Fryer TD, Hong YT, Vàsquez Rodriguez P, Bevan-Jones WR, Aigbirhio FI, O'Brien JT, Rowe JB. Neuroinflammation predicts disease progression in progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 2021; 92:769-775. [PMID: 33731439 PMCID: PMC7611006 DOI: 10.1136/jnnp-2020-325549] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/29/2020] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In addition to tau pathology and neuronal loss, neuroinflammation occurs in progressive supranuclear palsy (PSP). However, the prognostic value of the in vivo imaging markers for these processes in PSP remains unclear. We test the primary hypothesis that baseline in vivo imaging assessment of neuroinflammation in subcortical regions predicts clinical progression in patients with PSP. METHODS Seventeen patients with PSP-Richardson's syndrome underwent a baseline multimodal imaging assessment, including [11C]PK11195 positron emission tomography (PET) to index microglial activation, [18F]AV-1451 PET for tau pathology and structural MRI. Disease severity was measured at baseline and serially up to 4 years with the Progressive Supranuclear Palsy Rating Scale (PSPRS) (average interval of 5 months). Regional grey-matter volumes and PET ligand binding potentials were summarised by three principal component analyses (PCAs). A linear mixed-effects model was applied to the longitudinal PSPRS scores. Single-modality imaging predictors were regressed against the individuals' estimated rate of progression to identify the prognostic value of baseline imaging markers. RESULTS PCA components reflecting neuroinflammation and tau burden in the brainstem and cerebellum correlated with the subsequent annual rate of change in the PSPRS. PCA-derived PET markers of neuroinflammation and tau pathology correlated with regional brain volume in the same regions. However, MRI volumes alone did not predict the rate of clinical progression. CONCLUSIONS Molecular imaging with PET for microglial activation and tau pathology can predict clinical progression in PSP. These data encourage the evaluation of immunomodulatory approaches to disease-modifying therapies in PSP and the potential for PET to stratify patients in early phase clinical trials.
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Affiliation(s)
- Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy
| | - Peter Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Timothy D Fryer
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Patricia Vàsquez Rodriguez
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | | | - Franklin I Aigbirhio
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | | | - James Benedict Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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50
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Ishizuchi K, Takizawa T, Tezuka T, Takahata K, Seki M, Tabuchi H, Ueda R, Kubota M, Mimura M, Nakahara J, Ito D. A case of progressive supranuclear palsy with predominant cerebellar ataxia diagnosed by [ 18F]PM-PBB3 tau PET. J Neurol Sci 2021; 425:117440. [PMID: 33866113 DOI: 10.1016/j.jns.2021.117440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kei Ishizuchi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Tezuka
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Takahata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Morinobu Seki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ueda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahito Kubota
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Ito
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
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