Abstract
ObjectiveParkinson's disease (PD), Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are neurodegenerative diseases that can be difficult to distinguish clinically. The objective of the current study was to use surface-based analysis techniques to assess cortical thickness, surface area and grey matter volume to identify unique morphological patterns of cortical atrophy in PD, MSA and PSP and to relate these patterns of change to disease duration and clinical features.MethodsHigh resolution 3D T1-weighted MRI volumes were acquired from 14 PD patients, 18 MSA, 14 PSP and 19 healthy control participants. Cortical thickness, surface area and volume analyses were carried out using the automated surface-based analysis package FreeSurfer (version 5.1.0). Measures of disease severity and duration were assessed for correlation with cortical morphometric changes in each clinical group.ResultsResults show that in PSP, widespread cortical thinning and volume loss occurs within the frontal lobe, particularly the superior frontal gyrus. In addition, PSP patients also displayed increased surface area in the pericalcarine. In comparison, PD and MSA did not display significant changes in cortical morphology.ConclusionThese results demonstrate that patients with clinically established PSP exhibit distinct patterns of cortical atrophy, particularly affecting the frontal lobe. These results could be used in the future to develop a useful clinical application of MRI to distinguish PSP patients from PD and MSA patients.
Highlights
Cortical Measures in Parkinson’s Plus Syndromes. These results demonstrate that patients with clinically established Progressive Supranuclear Palsy (PSP) exhibit distinct patterns of cortical atrophy, affecting the frontal lobe
These results could be used in the future to develop a useful clinical application of magnetic resonance imaging (MRI) to distinguish PSP patients from Parkinson’s disease (PD) and Multiple System Atrophy (MSA) patients
Post hoc t-tests showed that the PSP group is significantly older than the MSA and healthy controls (HC) groups
Summary
Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP) and Parkinson’s disease (PD) are pathologically distinct neurodegenerative diseases [1] that can be clinically indistinguishable, in the early stages.[2, 3] The majority of MSA and PSP cases are characterised by relentless disease progression and carry a shortened life expectancy from onset of symptoms, whereas PD is not associated with a substantial reduction in life expectancy.[2, 4, 5] It is possible that these neurodegenerative diseases possess unique morphological signatures, detection of sensitive and specific biomarkers may prove useful in improving early diagnosis.Neurodegenerative disorders are often associated with structural changes in the brain and magnetic resonance imaging (MRI) holds the potential to detect subtle variations in the volume and shape of subcortical regions, as well as cortical morphometric changes such as cortical volume, thickness, area and folding pattern, allowing the identification of objective diagnostic markers. Voxelbased morphometry (VBM) is a neuroimaging analysis technique allowing whole brain voxel-based investigation of focal changes in brain anatomy.[6] Studies exploring regional brain volume differences in Parkinsonian syndromes have revealed that the pathology of this disease is not confined to subcortical regions but may include atrophy of the cerebral cortex, in particular the frontal cortex.[7,8,9,10] This frontal atrophy is especially prominent in PSP, often with a distinct pattern of superior frontal atrophy.[8] Despite several studies indicating the involvement of the cortex, the brain pathology underlying motor and nonmotor symptoms in parkinsonian syndromes is incompletely defined and inferences are currently limited by the use of grey matter volume measurement
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