A comparative analysis of cognitive profiles and white-matter alterations using voxel-based diffusion tensor imaging between patients with Parkinson's disease dementia and dementia with Lewy bodies

Lee, Ji E.; Park, Hae Jeong; Park, Bo Suk; Song, Sook Keun; Sohn, Young H.; Lee, Jong Doo; Lee, Phil Hyu

doi:10.1136/jnnp.2009.184747

Cited by 95 publications

(66 citation statements)

References 36 publications

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“…Differences among these diseases are gradually being elucidated and they may form part of a continuous spectrum of Lewy body disease. The study 44 comparing PDD and LBD found generally similar regions of reduced FA in both diseases, with more severe white matter abnormalities in LBD. It is possible that in such studies, patients may have a degree of overlap with another dementia pathology, especially Alzheimer disease, which could diminish the differences detected between the 2 diseases.…”

Section: Resultsmentioning

confidence: 71%

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Diffusion tensor imaging in parkinsonian syndromes

2013

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Objectives: We performed a systematic review to assess alterations in measures of diffusion tensor imaging (DTI) in parkinsonian syndromes, exploring the potential role of DTI in diagnosis and as a candidate biomarker. Methods:We searched EMBASE and Medline databases for DTI studies comparing parkinsonian syndromes or related dementias with controls or another defined parkinsonian syndrome. Key details for each study regarding participants, imaging methods, and results were extracted. Estimates were pooled, where appropriate, by random-effects meta-analysis. Results:Of 333 results, we identified 43 studies suitable for inclusion (958 patients, 764 controls). DTI measures detected alterations in all parkinsonian syndromes, with distribution varying differentially with disease type. Nine studies were included in a meta-analysis of the substantia nigra in Parkinson disease. A notable effect size was found for lowered fractional anisotropy in the substantia nigra for patients with Parkinson disease vs controls (20.639, 95% confidence interval 20.860 to 20.417, p , 0.0001).Conclusion: DTI may be a promising biomarker in parkinsonian syndromes and have a future role in differential diagnosis. Larger cohort studies are required to investigate some encouraging preliminary findings. Given the complexity of the parkinsonian syndromes, it is likely that any potential DTI biomarker would be used in combination with other relevant biomarkers. Differences in natural history and therapy options make early and accurate diagnosis of parkinsonian syndromes important. 1 Emission tomography (SPECT or PET) has a role but it can be expensive, with limited availability, and requires radioactive tracers. 2 There is particular interest in the potential of advanced structural MRI techniques to differentiate among parkinsonian syndromes and to offer candidate biomarkers, facilitating early or premanifest diagnosis and monitoring of disease progression.Diffusion tensor imaging (DTI) is an MRI technique assessing the orientation and integrity of white matter tracts in vivo by measuring the diffusion of water molecules in neural fibers 3 and it also shows promise for studying gray matter areas. It estimates both the degree of directionality using anisotropy (frequently fractional anisotropy [FA]) and the overall movement of molecules (mean diffusivity [MD]; trace; apparent diffusion coefficient [ADC]). These measurements can either be extracted locally in predefined regions using region of interest (ROI) analysis or tractography or, alternatively, globally using voxel-based analysis (VBA) or tract-based spatial statistics (TBSS). Disruptions to microstructural tissue integrity, such as those found in the neurodegeneration of parkinsonian syndromes can be associated with alterations in anisotropy and diffusivity measures. 3 We therefore performed a systematic review of the literature to assess

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Section: Resultsmentioning

confidence: 71%

“…PDD and LBD were compared in 1 identified study. 44 Using VBA, statistically significant differences, although reported with uncorrected p values with a cluster size of .50 mm 3 , were in the temporooccipital and posterior cingular areas.…”

Section: Resultsmentioning

confidence: 91%

Diffusion tensor imaging in parkinsonian syndromes

2013

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“…11 Previous DTI studies using ROI methods have found reductions of FA in the precuneus occipital areas and ILF in DLB. 3,5,7 SPECT studies have also revealed precuneal and occipital hypoperfusion, 22 and PET studies have revealed occipital hypometabolism, 23 without associated structural gray matter loss of sufficient magnitude to explain this. 24 Therefore, it is possible that the functional imaging changes reflect damage to the microstructural white matter connections, supporting the notion that DLB is a disease predominantly caused by neuronal synaptic dysfunction rather than loss.…”

Section: Subject Demographicsmentioning

confidence: 99%

“…2 Previous studies investigating the DTI changes in DLB have used conventional region of interest (ROI) or voxel-based morphometry (VBM) methods. [3][4][5][6][7][8] Some studies found widespread FA changes in comparison with healthy controls, 3,7 whereas others have found very little change. 5,6 The most consistent finding has been of reduced FA in the region of the inferior longitudinal fasciculus (ILF), 3,6 -8 and FA reductions have also been reported to occur in the posterior cingulate and precuneal areas.…”

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confidence: 99%

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Characterizing dementia with Lewy bodies by means of diffusion tensor imaging

et al. 2012

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Objective: To investigate patterns of in vivo white matter tract change using diffusion tensor imaging (DTI), we conducted a cross-sectional study of dementia with Lewy bodies (DLB) in comparison with Alzheimer disease (AD) and normal aging. Methods:The study included 106 subjects (35 with DLB, 36 with AD, and 35 elderly controls) who underwent clinical and neuropsychological assessment and diffusion tensor MRI. We used tract-based spatial statistics to investigate patterns of reduced fractional anisotropy (FA) and increased mean diffusivity (MD) across the entire white matter tract skeleton and also investigated correlations with clinical features. Results:Areas of reduced FA in subjects with DLB vs controls were found primarily in parietooccipital white matter tracts; in AD, the changes were much more diffuse. DLB was also associated with reduced FA in the pons and left thalamus, in comparison with AD. The pattern of MD increase was diffuse in AD and DLB. We found an association between DTI parameters and impaired episodic memory, letter fluency, and severity of motor parkinsonism in DLB. Conclusions:Despite a similar level of dementia severity, patterns of DTI changes in AD and DLB differed significantly. The selective involvement of the visual association areas and subcortical structures and the significant clinical correlations highlight the potential importance of white matter tract change in the pathogenesis of DLB. DTI may be a useful technique to investigate early and possible preclinical changes in DLB and warrants further investigation. Neurology Dementia with Lewy bodies (DLB) is a common form of neurodegenerative dementia in older people, second to Alzheimer disease (AD). The separation between AD and DLB clinically remains a challenge. We therefore need to establish in vivo biomarkers that can distinguish the differing pathologies and their contribution to the clinical features of the conditions. Diffusion tensor imaging (DTI) utilizes the anisotropic nature of diffusion in neuronal white matter tracts.1 With neuronal degeneration, the mean diffusivity (MD) increases with the loss of structural barriers that normally restrict diffusion, and diffusion becomes less directionally oriented, which is associated with a reduction in fractional anisotropy (FA). 2Previous studies investigating the DTI changes in DLB have used conventional region of interest (ROI) or voxel-based morphometry (VBM) methods.3-8 Some studies found widespread FA changes in comparison with healthy controls, 3,7 whereas others have found very little

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Structural connectivity networks in Alzheimer’s disease and Lewy body disease

et al. 2021

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Objective We evaluated disruption of the white matter (WM) network related with Alzheimer's disease (AD) and Lewy body disease (LBD), which includes Parkinson's disease and dementia with Lewy bodies. Methods We consecutively recruited 37 controls and 77 patients with AD‐related cognitive impairment (ADCI) and/or LBD‐related cognitive impairment (LBCI). Diagnoses of ADCI and LBCI were supported by amyloid PET and dopamine transporter PET, respectively. There were 22 patients with ADCI, 19 patients with LBCI, and 36 patients with mixed ADCI/LBCI. We investigated the relationship between ADCI, LBCI, graph theory‐based network measures on diffusion tensor images, and cognitive dysfunction using general linear models after controlling for age, sex, education, deep WM hyperintensities (WMH), periventricular WMH, and intracranial volume. Results LBCI, especially mixed with ADCI, was associated with increased normalized path length and decreased normalized global efficiency. LBCI was related to the decreased nodal degree of left caudate, which was further associated with broad cognitive dysfunction. Decreased left caudate nodal degree was associated with decreased fractional anisotropy (FA) in the brain regions vulnerable to LBD. Compared with the control group, the LBCI group had an increased betweenness centrality in the occipital nodes, which was associated with decreased FA in the WM adjacent to the striatum and visuospatial dysfunction. Conclusion Concomitant ADCI and LBCI are associated with the accentuation of LBCI‐related WM network disruption centered in the left caudate nucleus. The increase of occipital betweenness centrality could be a characteristic biologic change associated with visuospatial dysfunction in LBCI.

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A comparative analysis of cognitive profiles and white-matter alterations using voxel-based diffusion tensor imaging between patients with Parkinson's disease dementia and dementia with Lewy bodies

Cited by 95 publications

References 36 publications

Diffusion tensor imaging in parkinsonian syndromes

Diffusion tensor imaging in parkinsonian syndromes

Characterizing dementia with Lewy bodies by means of diffusion tensor imaging

Structural connectivity networks in Alzheimer’s disease and Lewy body disease

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