Abstract
Background and PurposeAccurate diagnosis of Atypical Parkinsonian Syndromes (APS) is important due to differences in prognosis and management, but remains a challenge in the clinical setting. The purpose of our meta-analysis was to identify characteristic patterns of gray matter atrophy in Corticobasal Degeneration (CBD), Progressive Supranuclear Palsy (PSP), Multisystem-Atrophy Parkinsonian type (MSA-P), and Idiopathic Parkinson's Disease (IPD).Materials and MethodsWhole-brain meta-analysis was performed on 39 published voxel-based morphometry (VBM) articles (consisting of 404 IPD, 87 MSA-P, 165 CBD, and 176 PSP subjects) using the modified Anatomic Likelihood Estimation method. Based on these results, contrast analyses were then utilized to determine areas of atrophy shared by as well as unique to each disorder.ResultsCBD was characterized by asymmetric gray matter atrophy in multiple cortical regions, while the thalamus-midbrain and insula were predominantly involved in PSP. The striatum and superior cerebellum were affected in MSA-P, while IPD demonstrated an anterior cerebral pattern. Although there was a mild overlap among PSP, CBD, and MSA-P, significant regions of atrophy unique to each disorder were identified, including (1) the superior parietal lobule in CBD (2) putamen in MSA-P (3) insula and medial dorsal nucleus in PSP.ConclusionOur results suggest that there are characteristic patterns of atrophy in APS. Guided by these findings, future studies on the individual subject level may lead to the development of robust imaging biomarkers.
Highlights
A multitude of movement disorders have been described in the neurological literature
Internet searches were performed of the PubMed Database for voxel-based morphometry (VBM) studies of Atypical Parkinsonian Syndromes (APS)
Our search yielded 39 APS papers, which are detailed in Anatomic likelihood estimation
Summary
A multitude of movement disorders have been described in the neurological literature. Atypical Parkinsonism syndromes (APS) constitute a subset known to resemble Idiopathic Parkinson’s Disease (IPD) on a clinical basis: multi-system atrophy (MSA), progressive supranuclear palsy, (PSP) and corticobasal degeneration (CBD) (Stamelou et al 2013). Distinguishing these disorders from IPD, and from each other, is important given differences in prognosis and potential therapies, as well as the growing elderly population (Horwitz and Rowe 2011). Future studies on the individual subject level may lead to the development of robust imaging biomarkers
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