Abstract
Depression and apathy can both be present in patients with Parkinson's disease (PD) while e. g., essential tremor (ET) patients mostly only report depressive symptoms. In PD, depression has been linked with brainstem raphe (BR) signal alterations in transcranial sonography (TCS) but apathy has not been evaluated in such terms as a putative biomarker. Furthermore, the BR has only been investigated using a singular axial TCS examination plane, although coronal TCS examination allows a much more accurate evaluation of the craniocaudal formation of serotonergic raphe structures in the midbrain area. The objective of this study was to investigate the value of coronal TCS examination for the detection of BR signal alterations and clinically correlate it to apathy in patients with PD, ET and healthy controls (HC). We prospectively included PD patients (n = 31), ET patients (n = 16), and HC (n = 16). All were examined by TCS in the axial and coronal plane with focus on BR signal alterations. LARS and BDI-II scores were conducted to assess apathic and depressive symptoms in the study population. In a detailed analysis we found that the correlation of coronal and axial TCS alterations of BR was very high (rho = 0.950, p < 0.001). BR signal alterations were more frequent in PD patients than in ET patients and HC, while it was not different between ET patients and HC. In the PD patient group, BDI-II and LARS scores were negatively correlated to BR signal changes in TCS in a significant manner (BDI-II and axial BR: p = 0.019; BDI-II and coronal BR: p = 0.011; LARS and axial BR: p = 0.017; LARS and coronal BR: p = 0.023). Together in this brainstem ultrasound study we find a significant association of BR signal alterations with clinically evident apathy and depression in patients with PD. Therefore, TCS might enable the identification of a subgroup of PD patients which are at higher risk to suffer from or to develop depression or apathy.
Highlights
Transcranial sonography (TCS) is increasingly applied for the differential diagnosis of Parkinson’s disease (PD) patients
That brainstem raphe (BR) signal alterations detected by axial transcranial sonography (TCS) examination plane appear more frequently in PD patients compared to essential tremor (ET) patients and healthy controls (HC)
Concerning the coronal TCS examination plane, we could confirm a higher prevalence of BR signal alterations in PD patients compared to ET patients and HC
Summary
Transcranial sonography (TCS) is increasingly applied for the differential diagnosis of Parkinson’s disease (PD) patients. Depression and apathy frequently appear in PD patients and can represent early non-motor symptoms [2,3,4]. Several studies have shown that many PD patients are affected by depression, even in the prodromal state of disease [5]. Apathy has been described to appear independently from depression [6] and can severely impact quality of life [7]. Brainstem raphe (BR) alterations in TCS have been associated with depressed PD patients [8, 9] but were not observed in patients with essential tremor (ET). BR signal alterations have never been examined in relation to apathy and, have only been evaluated using a singular axial TCS plane in spite of an additional coronal examination [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
