Dysautonomia is associated with structural and functional alterations in Parkinson disease

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Abstract

Objective

To investigate whether the presence of autonomic dysfunction is associated with white matter and functional connectivities and the level of cognitive performance in patients with de novo Parkinson disease (PD).

Methods

Seventy-five patients with de novo PD underwent a comprehensive autonomic function test and were classified into 2 groups according to the Composite Autonomic Severity Score (CASS; 30 with moderate to severe autonomic dysfunction [CASS 4–10, PD-AUT+] and 45 without significant autonomic dysfunction [CASS 0–3, PD-AUT−]). Network-based statistics and a graph theoretical analysis were performed to assess the interregional white matter connectivity using diffusion tensor imaging. We also performed analyses of resting-state functional connectivity and compared cognitive performance between the 2 groups.

Results

There were no significant differences in demographic characteristics and vascular risk factors between the PD-AUT+ and PD-AUT− groups. The PD-AUT+ group showed poorer cognitive performance on frontal/executive function than the PD-AUT− group. The PD-AUT+ group exhibited severely disrupted white matter connectivity in both fronto-subcortical and posterior cortical regions, which was well correlated with the severity of autonomic dysfunction assessed by the CASS. In addition, functional connectivity within the executive control network and dorsal attention network negatively correlated with the CASS.

Conclusions

Our results suggest that autonomic dysfunction is associated with disrupted white matter and functional brain connectivity as well as cognitive impairment in de novo patients with PD.

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Functionally linked resting-state networks reflect the underlying structural connectivity architecture of the human brain.

Martijn P. van den Heuvel, René C.W. Mandl, René S Kahn … (2009)

During rest, multiple cortical brain regions are functionally linked forming resting-state networks. This high level of functional connectivity within resting-state networks suggests the existence of direct neuroanatomical connections between these functionally linked brain regions to facilitate the ongoing interregional neuronal communication. White matter tracts are the structural highways of our brain, enabling information to travel quickly from one brain region to another region. In this study, we examined both the functional and structural connections of the human brain in a group of 26 healthy subjects, combining 3 Tesla resting-state functional magnetic resonance imaging time-series with diffusion tensor imaging scans. Nine consistently found functionally linked resting-state networks were retrieved from the resting-state data. The diffusion tensor imaging scans were used to reconstruct the white matter pathways between the functionally linked brain areas of these resting-state networks. Our results show that well-known anatomical white matter tracts interconnect at least eight of the nine commonly found resting-state networks, including the default mode network, the core network, primary motor and visual network, and two lateralized parietal-frontal networks. Our results suggest that the functionally linked resting-state networks reflect the underlying structural connectivity architecture of the human brain.

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Seoul Neuropsychological Screening Battery-Dementia Version (SNSB-D): A Useful Tool for Assessing and Monitoring Cognitive Impairments in Dementia Patients

Hyun-Jung Ahn, Juhee Chin, Aram Park … (2010)

The Seoul Neuropsychological Screening Battery (SNSB) is one of the standardized neuropsychological test batteries widely used in Korea. However, it may be a bit too lengthy for patients with decreased attention span; and it does not provide the score of global cognitive function (GCF), which is useful for monitoring patients longitudinally. We sought to validate a dementia version of SNSB (SNSB-D) that was shorter than the original SNSB and contained only scorable tests with a GCF score of 300. We administered SNSB-D to patients with mild cognitive impairment (MCI) (n=43) and Alzheimer's disease (AD) (n=93), and normal controls (NC) (n=77). MCI and AD groups had GCF scores significantly different from NC group, and GCF scores were able to distinguish patients with Clinical Dementia Rating of 0.5 and 1. Test-retest reliability was high, with a correlation coefficient of 0.918 for AD, 0.999 for MCI, and 0.960 for NC. The GCF score significantly correlated with the Mini-Mental State Examination (MMSE). Through ROC-curve analysis, GCF scores were found to yield more accurate diagnoses than the MMSE. The SNSB-D is a valid, reliable tool for assessing the overall cognitive function, and can be used to monitor cognitive changes in patients with dementia.