Changes in Cortical Thickness in Patients With Early Parkinson's Disease at Different Hoehn and Yahr Stages.

Yuyuan Gao,Manli Guo,Biao Huang,Zhiheng Huang,Lijuan Wang,Kun Nie,Yuhu Zhang,Limin Wang,Jiehao Zhao,Mingjin Mei

doi:10.3389/fnhum.2018.00469

Abstract

Objectives: This study was designed to explore changes in cortical thickness in patients with early Parkinson’s disease (PD) at different Hoehn and Yahr (H-Y) stages and to demonstrate the association of abnormally altered brain regions with part III of the Unified Parkinson’s Disease Rating Scale (UPDRS-III).Materials and Methods: Sixty early PD patients and 29 age- and gender-matched healthy controls (HCs) were enrolled in this study. All PD patients underwent comprehensive clinical and neuropsychological evaluations and 3.0 T magnetic resonance scanning. Patients with H-Y stage ≤1.5 were included in the mild group, and all other patients were included in the moderate group. FreeSurfer software was used to calculate cortical thickness. We assessed the relationship between UPDRS-III and regional changes in cortical thinning, including the bilateral fusiform and the temporal lobe.Results: The average cortical thickness of the temporal pole, fusiform gyrus, insula of the left hemisphere and fusiform gyrus, isthmus cingulate cortex, inferior temporal gyrus, middle temporal cortex and posterior cingulate cortex of the right hemisphere exhibited significant decreasing trends in HCs group and PD groups (i.e., the mild group and moderate group). After controlling for the effects of age, gender, and disease duration, the UPDRS-III scores in patients with early PD were correlated with the cortical thickness of the left and right fusiform gyrus and the left temporal pole (p < 0.05).Conclusion: The average cortical thickness of specific brain regions reduced with increasing disease severity in early PD patients at different H-Y stages, and the UPDRS-III scores of early PD patients were correlated with cortical thickness of the bilateral fusiform gyrus and the left temporal pole.

Highlights

Parkinson’s disease is the second most common neurodegenerative disease, only to Alzheimer’s disease (AD), and is characterized by motor symptoms, such as bradykinesia, rest tremor and muscle rigidity, and non-motor symptoms (NMS), such as cognitive impairment, constipation, anxiety, depression, and sleep disorders
All Parkinson’s disease (PD) subjects included in this study met the following criteria: age ≥40 years, early stage PD (H-Y stage ≤2.5), and no severe depression or anxiety (HAMD ≤ 20 points and Hamilton Anxiety Scale (HAMA) ≤ 29 points)
Structural Magnetic Resonance Imaging (MRI) was acquired from 28 early PD patients in the mild group and 32 early PD patients in the moderate group (Figure 1)

Summary

Introduction

Parkinson’s disease is the second most common neurodegenerative disease, only to AD, and is characterized by motor symptoms, such as bradykinesia, rest tremor and muscle rigidity, and non-motor symptoms (NMS), such as cognitive impairment, constipation, anxiety, depression, and sleep disorders. The main pathological changes in PD are the loss of large quantities of dopaminergic neurons from the midbrain substantia nigra pars compacta and the formation of Lewy bodies by misfolded α-synuclein, resulting in basal ganglia dysfunction (Kalia and Lang, 2015). According to Braak’s staging system, the evolution of motor symptoms and NMS of PD can be well explained. The onset of motor symptoms is suggested to accompany the death of at least 50% of the dopaminergic neurons in the substantia nigra, corresponding to Braak stage III/IV. Patients at Braak stages I and II mainly exhibit NMS, such as orthostatic hypotension, olfactory dysfunction and rapid eye movement (REM) sleep abnormalities. Early identification of preclinical and early-stage PD patients may aid in the early management of PD

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