Neurodegeneration
How does brain structure change in early Parkinson's disease?
Open access · cc by · source: Europe PMC
Newly diagnosed Parkinson's patients with mild cognitive impairment show rapid, widespread thinning of the brain's outer layer over 18 months compared to those with normal cognition.
How this study connects
Role on claims
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At the onset of newly diagnosed Parkinson's disease, patients who present with mild cognitive impairment exhibit structural alterations in subcortical reward regions, specifically showing reduced volume in the nucleus accumbens compared to patients with normal cognition.
Evidence for the claim as stated.
In newly diagnosed Parkinson's disease, patients with mild cognitive impairment show accelerated, widespread cortical thinning in frontal, temporal, parietal, and occipital regions over 18 months compared to patients with normal cognition.
Evidence for the claim as stated.
Degeneration of subcortical grey matter structures, such as the caudate, hippocampus, and the nucleus basalis of Meynert, is closely linked to and can predict the onset of cognitive impairment in patients with Parkinson's disease.
Evidence for the claim as stated.
High-resolution MRI tracking can detect rapid, progressive longitudinal grey matter thinning and subcortical volume loss over a period as short as 18 months in newly diagnosed clinical populations.
Evidence for the claim as stated.
Discoveries this paper informs or conflicts with
- In newly diagnosed Parkinson's, the cortex was already thinner in those with cognitive impairment
This paper informs this development.
Study at a glance
- Design
- Cohort — 18-month VBM follow-up of newly diagnosed PD (PD-MCI vs PD-NC) vs healthy controls
- N
- N=146 · 108 PD with baseline and follow-up (40 PD-MCI, 68 PD-NC) and 38 controls with both scans; 128 PD enrolled
- Population
- Newly diagnosed Parkinson's disease patients from North East England clinics and healthy controls
- Outcome
- Baseline and 18-month grey-matter change, including PD-MCI vs cognitively normal PD
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How does brain structure change in early Parkinson's disease?
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108 patients with Parkinson's disease participated
Only subjects ( n = 108) with baseline and follow-up assessments were included in this study.
38 healthy controls were included
This resulted in a final sample size of 38 healthy controls with both baseline and follow-up scans.
Key findings
At the start of the study, patients with mild cognitive impairment already had notable brain thinning in frontal, parietal, and occipital regions, alongside smaller volumes in the hippocampus and nucleus accumbens. Over 18 months, these patients experienced accelerated thinning in the frontal and temporal lobes, as well as rapid shrinkage of the caudate and hippocampus. Meanwhile, patients with normal cognition at baseline did not show early differences compared to healthy controls, but they still developed significant thinning in frontal regions over 18 months.
Methodology
The researchers tracked grey matter changes in 108 newly diagnosed Parkinson's disease patients and 38 healthy controls over an 18-month period. Using high-resolution 3 T MRI scans, they measured cortical thickness and subcortical brain volumes at baseline and follow-up. The Parkinson's group was classified into 68 patients with normal cognition and 40 with mild cognitive impairment based on scoring 1.5 standard deviations below average on cognitive tests.
Limitations
While the study shows clear structural differences over 18 months, it cannot prove that cortical thinning directly causes cognitive decline, as the relationships are correlational. Additionally, because the participants were evaluated while taking their normal dopaminergic medications, the potential masking effects of these drugs on cognitive scores and brain activity cannot be completely ruled out. The study is also limited by having only a single test to assess visuospatial function, which may have restricted its ability to fully capture this specific cognitive domain.
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