A magnetic resonance imaging study of patients with Parkinson’s disease with mild cognitive impairment and dementia using voxel-based morphometry

Background: Dementia is common in Parkinson’s disease, but the underlying brain pathology is not yet fully understood. Aim: To examine the changes in the brain of patients with Parkinson’s disease with mild cognitive impairment (MCI) and dementia, using structural magnetic resonance imaging. Methods: Using voxel-based morphometry, the grey matter atrophy on brain images of patients with Parkinson’s disease and dementia (PDD; n = 16) and Parkinson’s disease without dementia (PDND; n = 20), and healthy elderly subjects (n = 20) was studied. In the PDND group, 12 subjects had normal cognitive status and 8 had MCI. Standardised rating scales for motor, cognitive and psychiatric symptoms were used. Results: Widespread areas of cortical atrophy were found in patients with PDD compared with normal controls (in both temporal and frontal lobes and in the left parietal lobe). Grey matter reductions were found in frontal, parietal, limbic and temporal lobes in patients with PDD compared with those with PDND. In patients with PDND with MCI, areas of reduced grey matter in the left frontal and both temporal lobes were found. Conclusion: These findings show that dementia in Parkinson’s disease is associated with structural neocortical changes in the brain, and that cognitive impairment in patients with PDND may be associated with structural changes in the brain. Further studies with larger groups of patients are needed to confirm these findings.

[1]  T Wentzel-Larsen,et al.  Performance on the dementia rating scale in Parkinson’s disease with dementia and dementia with Lewy bodies: comparison with progressive supranuclear palsy and Alzheimer’s disease , 2003, Journal of neurology, neurosurgery, and psychiatry.

[2]  T. Robbins,et al.  The cognitive ability of an incident cohort of Parkinson's patients in the UK. The CamPaIGN study. , 2004, Brain : a journal of neurology.

[3]  S. Fahn Unified Parkinson's Disease Rating Scale , 1987 .

[4]  D. Salmon,et al.  Cognitive profiles of individual patients with Parkinson's disease and dementia: Comparison with dementia with lewy bodies and Alzheimer's disease , 2006, Movement disorders : official journal of the Movement Disorder Society.

[5]  E. Dupont,et al.  Clinical diagnosis of Parkinson's disease. Proposal of diagnostic subgroups classified at different levels of confidence , 1994, Acta neurologica Scandinavica.

[6]  K. Hugdahl,et al.  Subtypes of mild cognitive impairment in parkinson's disease: Progression to dementia , 2006, Movement disorders : official journal of the Movement Disorder Society.

[7]  Karl J. Friston,et al.  Voxel-Based Morphometry—The Methods , 2000, NeuroImage.

[8]  G. Borasio,et al.  Palliative therapy in the terminal stage of neurological disease , 1997, Journal of Neurology.

[9]  Jane S. Paulsen,et al.  Neuropsychiatric assessment of patients with hyperkinetic and hypokinetic movement disorders. , 1998, Archives of neurology.

[10]  A. Benton,et al.  Visuospatial judgment. A clinical test. , 1978, Archives of neurology.

[11]  K. Jellinger,et al.  Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. , 1996, Neurology.

[12]  O. J. Greve,et al.  Visual rating of white matter hyperintensities in Parkinson's disease , 2006, Movement disorders : official journal of the Movement Disorder Society.

[13]  C. Summerfield,et al.  Dementia in Parkinson disease: a proton magnetic resonance spectroscopy study. , 2002, Archives of neurology.

[14]  C. Summerfield,et al.  Longitudinal evaluation of cerebral morphological changes in Parkinson's disease with and without dementia , 2005, Journal of Neurology.

[15]  D. Aarsland,et al.  Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. , 2003, Archives of neurology.

[16]  J L Lancaster,et al.  Automated Talairach Atlas labels for functional brain mapping , 2000, Human brain mapping.

[17]  Bernard Pillon,et al.  Cognitive deficits in Parkinson’s disease , 1996, Journal of Neurology.

[18]  G. Frisoni,et al.  A voxel based morphometry study on mild cognitive impairment , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[19]  R. Hu Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) , 2003 .

[20]  Richard Camicioli,et al.  Parkinson's disease is associated with hippocampal atrophy , 2003, Movement disorders : official journal of the Movement Disorder Society.

[21]  C. Marsden,et al.  Recent Developments in Parkinson's Disease , 1986 .

[22]  D. Aarsland,et al.  Risk of dementia in Parkinson’s disease: A community-based, prospective study , 2001 .

[23]  T. Riise,et al.  The epidemiology of Parkinson's disease in the county of Rogaland, Norway , 1995, Movement disorders : official journal of the Movement Disorder Society.

[24]  Alan C. Evans,et al.  Cerebral atrophy and its relation to cognitive impairment in Parkinson disease , 2005, Neurology.

[25]  Karl J. Friston,et al.  Detecting Activations in PET and fMRI: Levels of Inference and Power , 1996, NeuroImage.

[26]  J. Morris,et al.  Current concepts in mild cognitive impairment. , 2001, Archives of neurology.

[27]  H. Soininen,et al.  Hippocampus and entorhinal cortex in mild cognitive impairment and early AD , 2004, Neurobiology of Aging.

[28]  Karl J. Friston,et al.  A Voxel-Based Morphometric Study of Ageing in 465 Normal Adult Human Brains , 2001, NeuroImage.

[29]  I. McKeith,et al.  Brain atrophy rates in Parkinson's disease with and without dementia using serial magnetic resonance imaging , 2005, Movement disorders : official journal of the Movement Disorder Society.

[30]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[31]  J. Baron,et al.  Mapping gray matter loss with voxel-based morphometry in mild cognitive impairment , 2002, Neuroreport.

[32]  F. Huppert,et al.  CAMDEX: A Standardised Instrument for the Diagnosis of Mental Disorder in the Elderly with Special Reference to the Early Detection of Dementia , 1986, British Journal of Psychiatry.

[33]  I. McKeith,et al.  Temporal lobe atrophy on MRI in Parkinson disease with dementia , 2005, Neurology.

[34]  D. Aarsland,et al.  Cognitive Predictors of Dementia in Parkinson’s Disease: A Community-Based, 4-Year Longitudinal Study , 2005, Journal of geriatric psychiatry and neurology.

[35]  K. Marder,et al.  Memory and executive function impairment predict dementia in Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[36]  I. McKeith,et al.  Cerebral atrophy in Parkinson's disease with and without dementia: a comparison with Alzheimer's disease, dementia with Lewy bodies and controls. , 2004, Brain : a journal of neurology.

[37]  Paul J. Laurienti,et al.  An automated method for neuroanatomic and cytoarchitectonic atlas-based interrogation of fMRI data sets , 2003, NeuroImage.

[38]  M. Yamada,et al.  [Dementia rating scale]. , 1997, Nihon rinsho. Japanese journal of clinical medicine.

[39]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[40]  C. Summerfield,et al.  Amygdalar and hippocampal MRI volumetric reductions in Parkinson's disease with dementia , 2005, Movement disorders : official journal of the Movement Disorder Society.

[41]  D. Aarsland,et al.  Neuropathology of dementia in Parkinson's disease: A prospective, community‐based study , 2005, Annals of neurology.

[42]  C. Summerfield,et al.  Structural brain changes in Parkinson disease with dementia: a voxel-based morphometry study. , 2005, Archives of neurology.

[43]  J. Cummings,et al.  The occurrence of depression in Parkinson's disease. A community-based study. , 1996, Archives of neurology.

[44]  J. Talairach,et al.  Co-Planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System: An Approach to Cerebral Imaging , 1988 .

[45]  M. Emre Dementia associated with Parkinson's disease , 2003, The Lancet Neurology.

[46]  S. Robinson,et al.  The present state of people who survived the holocaust as children , 1994, Acta psychiatrica Scandinavica.

[47]  A. Bonnet,et al.  [The Unified Parkinson's Disease Rating Scale]. , 2000, Revue neurologique.

[48]  Joseph A Maldjian,et al.  Precentral gyrus discrepancy in electronic versions of the Talairach atlas , 2004, NeuroImage.