Menka Jha1, Ketan Jhunjhunwala1, Bagepally B Sankara2, Jitender Saini3, J Keshav Kumar4, Ravi Yadav1, Pramod Kumar Pal5. 1. Departments of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India. 2. Regional Occupational Health Centre (Southern), NIOH, ICMR, Bangalore, Karnataka, India. 3. Neuroimaging & Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India. 4. Clinical Psychology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India. 5. Departments of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India. Electronic address: pal.pramod@rediffmail.com.
Abstract
BACKGROUND: Neuropsychological evaluation with advanced neuroimaging may be a useful tool to determine the anatomical substrates that play crucial role in freezing of gait (FOG) in patients with Parkinson's Disease (PD). OBJECTIVES: To compare the cognitive profile and gray matter (GM) changes (using Voxel Based Morphometry - VBM) between patients with PD with and without FOG (FOG+ve and FOG-ve). METHODS: Seventeen FOG+ve (M:F = 11:6) and 21 FOG-ve (M:F = 11:10) were evaluated clinically and with a structured neuropsychological battery. All patients underwent 3 T MRI. In order to determine areas of GM atrophy, T1W volumetric MRI data of the two groups were compared using VBM and Statistical Parametric Mapping 8. RESULTS: The mean age of FOG+ve and FOG-ve patients were 56.9 ± 6.6 and 47.4 ± 9.1 years respectively. There was no significant difference in the duration (6.0 ± 4.9 vs 5.2 ± 3.5 years, p < 0.05) and stage of PD (Hoehn & Yahr stage: 1.96 ± 0.53 vs 1.78 ± 0.37) between the two groups. Compared to the FOG-ve group, the FOG+ve group had (i) significant impairment in memory, attention, executive and visuospatial functions on neuropsychological tests, and (ii) significant GM atrophy in the right cerebellum (pyramis, declive), left cerebrum (Brodmann area (BA) 21 and 22) and right cerebrum (BA 10 and 6) on VBM analysis. CONCLUSIONS: The FOG+ve group showed widespread involvement of cognition localizing to frontal, temporal (especially left) and parietal areas. VBM analysis showed significant GM atrophy in FOG+ve group in left temporal, right frontal areas (coinciding with that observed in neuropsychological tests) and significant involvement of right cerebellum.
BACKGROUND: Neuropsychological evaluation with advanced neuroimaging may be a useful tool to determine the anatomical substrates that play crucial role in freezing of gait (FOG) in patients with Parkinson's Disease (PD). OBJECTIVES: To compare the cognitive profile and gray matter (GM) changes (using Voxel Based Morphometry - VBM) between patients with PD with and without FOG (FOG+ve and FOG-ve). METHODS: Seventeen FOG+ve (M:F = 11:6) and 21 FOG-ve (M:F = 11:10) were evaluated clinically and with a structured neuropsychological battery. All patients underwent 3 T MRI. In order to determine areas of GM atrophy, T1W volumetric MRI data of the two groups were compared using VBM and Statistical Parametric Mapping 8. RESULTS: The mean age of FOG+ve and FOG-ve patients were 56.9 ± 6.6 and 47.4 ± 9.1 years respectively. There was no significant difference in the duration (6.0 ± 4.9 vs 5.2 ± 3.5 years, p < 0.05) and stage of PD (Hoehn & Yahr stage: 1.96 ± 0.53 vs 1.78 ± 0.37) between the two groups. Compared to the FOG-ve group, the FOG+ve group had (i) significant impairment in memory, attention, executive and visuospatial functions on neuropsychological tests, and (ii) significant GM atrophy in the right cerebellum (pyramis, declive), left cerebrum (Brodmann area (BA) 21 and 22) and right cerebrum (BA 10 and 6) on VBM analysis. CONCLUSIONS: The FOG+ve group showed widespread involvement of cognition localizing to frontal, temporal (especially left) and parietal areas. VBM analysis showed significant GM atrophy in FOG+ve group in left temporal, right frontal areas (coinciding with that observed in neuropsychological tests) and significant involvement of right cerebellum.
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Authors: Shweta Prasad; Abhishek Lenka; Albert Stezin; Rajini M Naduthota; Menka Jha; Ravi Yadav; Pramod Kumar Pal Journal: Ann Indian Acad Neurol Date: 2018 Oct-Dec Impact factor: 1.383