Patterns of diffusion kurtosis changes in Parkinson's disease subtypes

Abstract

Background: Diffusion kurtosis imaging has been applied to evaluate white matter and basal ganglia microstructure in mixed Parkinson's disease (PD) groups with inconclusive results. Objectives: To evaluate specific patterns of kurtosis changes in PD and to assess the utility of diffusion imaging in differentiating between healthy subjects and cognitively normal PD, and between PD with and without mild cognitive impairment. Methods: Diffusion scans were obtained in 92 participants using 3T MRI. Differences in white matter were tested by tract-based spatial statistics. Gray matter was evaluated in basal ganglia, thalamus, hippocampus, and motor and premotor cortices. Brain atrophy was also assessed. Multivariate logistic regression was used to identify a combination of diffusion parameters with the highest discrimination power between groups. Results: Diffusion kurtosis metrics showed a significant increase in substantia nigra (p = 0.037, Hedges' g = 0.89), premotor (p = 0.009, Hedges' g = 0.85) and motor (p = 0.033, Hedges' g = 0.87) cortices in PD with normal cognition compared to healthy participants. Combined diffusion markers in gray matter reached 81% accuracy in differentiating between both groups. Significant white matter microstructural changes, and kurtosis decreases in the cortex were present in cognitively impaired versus cognitively normal PD. Diffusion parameters from white and gray matter differentiated between both PD phenotypes with 78% accuracy. Conclusions: Increased kurtosis in gray matter structures in cognitively normal PD reflects increased hindrance to water diffusion caused probably by alpha-synuclein-related microstructural changes. In cognitively impaired PD, the changes are mostly driven by decreased white matter integrity. Our results support the utility of diffusion kurtosis imaging for PD diagnostics.

The Anterior Attentional–Intentional System in Patients with Parkinson’s Disease—A Pilot and Feasibility Study

“…However, we found that PD-MCI can maintain attention; we speculate that the general slowness might be related to impairment of the intention system caused by a delay in motor system activation, as indicated by RT slowness being independent of the difficulty of the task. At the same time, this seems to be consistent with the results of Berman's study, indicating that the changes that occur in cognitively impaired PD are mostly driven by alterations in white matter integrity [23]. Furthermore, Yang et al demonstrated that despite no observed impairment in performance in behavioral attentional tasks, individuals with PD-MCI may have alterations in the attention functional network and present unique cerebellum and middle frontal gyrus activation as an effective compensatory mechanism for attentional tasks [24].…”

Diffusion kurtosis imaging detects the time‐dependent progress of pathological changes in the oral rotenone mouse model of Parkinson's disease

“…Results from our recent cross‐sectional human DKI study in PD patients with various phenotypes (with and without cognitive impairment and gross cortical brain atrophy) are in accord with the current findings thus further supporting the utility of DKI measures as a translational biomarker. In that study, increases of DKI parameters were present in cortical and subcortical brain regions engaged in the motor basal ganglia circuitry in the PD motor subtype with no cognitive deterioration or brain atrophy as compared to age‐matched healthy controls, whereas in the more malignant subtype with mild cognitive impairment (MCI) and frontal lobe atrophy, the DKI measures were not significantly different from those in healthy age‐matched controls (HC) (Minsterova et al., 2020).…”

“…However, the study also found opposite results, i.e., decrease in MK and FA in corpus callosum, cingulum, and inferior longitudinal fasciculus (Kamagata et al., 2014). Of note, Sejnoha‐Minsterova et al., (2020) reported decreases in MK and FA and increases in MD throughout the whole white matter skeleton only in patients with the malignant PD subtype with MCI and brain atrophy, while no differences were observed in the motor subtype as compared to HC (34). Unfortunately, we do not know much about white matter changes in our intragastric ROT mouse model.…”

“…The study found a positive correlation of MK with Hoehn‐Yahr and UPDRS‐III (Unified Parkinson's Disease Rating Scale) staging (Zhang et al., 2015). Furthermore, DKI was found to be effective in differentiating PD and detecting microstructural changes in both subcortical (basal ganglia) and cortical regions and in the white matter (Ito et al., 2015; Kamagata et al., 2017; Minsterova et al., 2020; Surova et al., 2018; Zhang et al., 2015). Despite these promising results, there are still no studies aiming to identify PD‐related alterations in the high‐risk population at the pre‐motor stage.…”

Stereotactic Surgery of Parkinson’s Disease with Magnetic Resonance Imaging under Three‐Dimensional Mark Point Positioning Algorithm

“…At present, there is no cure for PD, and the main treatment method is a combination of drugs and surgery. Stereotactic surgery is a method for the treatment of PD [ 10 ]. With the rapid development of imaging and neuroelectrophysiology, the use of brain stereotaxic technology to treat PD has become an important treatment method.…”