Abstract
Objective: To estimate alterations in neurometabolic profile of patients with early stage Parkinson's disease (PD) by using a short echo-time whole brain magnetic resonance spectroscopic imaging (wbMRSI) as possible biomarker for early diagnosis and monitoring of PD.Methods: 20 PD patients in early stage (H&Y ≤ 2) without evidence of severe other diseases and 20 age and sex matched healthy controls underwent wbMRSI. In each subject brain regional concentrations of metabolites N-acetyl-aspartate (NAA), choline (Cho), total creatine (tCr), glutamine (Gln), glutamate (Glu), and myo-inositol (mIns) were obtained in atlas-defined lobar structures including subcortical basal ganglia structures (the left and right frontal lobes, temporal lobes, parietal lobes, occipital lobes, and the cerebellum) and compared between patients and matched healthy controls. Clinical characteristics of the PD patients were correlated with spectroscopic findings.Results: In comparison to controls the PD patients revealed altered lobar metabolite levels in all brain lobes contralateral to dominantly affected body side, i.e., decreases of temporal NAA, Cho, and tCr, parietal NAA and tCr, and frontal as well as occipital NAA. The frontal NAA correlated negatively with the MDS-UPDRS II (R = 22120.585, p = 0.008), MDS-UPDRS IV (R = −0.458, p = 0.048) and total MDS-UPDRS scores (R = −0.679, p = 0.001).Conclusion: In early PD stages metabolic alterations are evident in all contralateral brain lobes demonstrating that the neurodegenerative process affects not only local areas by dopaminergic denervation, but also the functional network within different brain regions. The wbMRSI-detectable brain metabolic alterations reveal the potential to serve as biomarkers for early PD.
Highlights
Parkinson’s disease (PD) is characterized by symptoms of rigidity, bradykinesia, tremor, and postural instability
All the early PD subjects revealed good cognitive functions measured by the DemTect with a mean score of
Corresponding to the fact that the basal ganglia, which has been reported to be involved in PD pathological processes in previous Magnetic resonance spectroscopy (MRS) studies [22, 23, 31,32,33,34,35,36], are located in the temporal and frontal lobar atlas regions used in this study, we found that most metabolic changes occurred in temporal lobe, while the frontal NAA changes correlated significantly to Movement Disorder Society (MDS)-UPDRS score describing clinical symptoms
Summary
Parkinson’s disease (PD) is characterized by symptoms of rigidity, bradykinesia, tremor, and postural instability. Due to methodical limitations of commonly used MRS techniques that suffered from limited spatial coverage, most studies reported PD-related metabolic changes in one or a few small brain structures. These results may not necessarily reflect the metabolic status within whole brain. Considering that human brain functions as organized networks with interactions between different multiple brain regions [10, 12], information about PD-related metabolic alterations within the whole brain with high spatial resolution may help to better characterize PD and understand the underlying pathologic mechanisms. As a first part of the project we aimed to obtain an overview about altered neurometabolic profile in early PD by exploring metabolic changes in eight brain lobes and cerebellum that composed the whole brain, with the results being reported in the following
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