Jannik Prasuhn1,2,3, Michelle Prasuhn4,5, Anja Fellbrich1, Robert Strautz1,2,6, Felicitas Lemmer1,2, Shalida Dreischmeier1,2, Meike Kasten2,3,6, Thomas F Münte1,3,7, Henrike Hanssen1,2,3, Marcus Heldmann1,3,7, Norbert Brüggemann8,2,3. 1. Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. 2. Institute of Neurogenetics, University of Lübeck, Lübeck, Germany. 3. Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany. 4. Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. 5. Laboratory for Angiogenesis and Ocular Cell Transplantation, University of Lübeck, Lübeck, Germany. 6. Department of Psychiatry, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. 7. Institute of Psychology II, University of Lübeck, Lübeck, Germany. 8. Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany norbert.brueggemann@neuro.uni-luebeck.de.
Abstract
OBJECTIVE: To investigate the contribution of substantia nigra (SN) and locus coeruleus (LC) pathology to clinical signs and symptoms in Parkinson's disease (PD) by applying neuromelanin-weighted imaging. METHODS: Forty-seven patients with PD and 53 matched controls underwent motor assessment, a neuropsychological test battery and neuromelanin-weighted MRI. Patients with PD have been enrolled after fulfilling the criteria for 'clinically established PD' as defined by the Movement Disorders Society Clinical Diagnostic Criteria. Two independent raters identified SN and LC and calculated the contrast-to-noise ratio (CNR). RESULTS: The intra-rater reliability demonstrated a good reliability between raters with an intraclass correlation coefficient of .88 (p<.001) and an inter-rater reliability of .80 (p<.001). Both, SN and LC CNRs were lower in patients with PD (p≤.001) compared to controls. The CNR of SN but not of LC was strongly correlated with disease duration (p≤.001). Neuromelanin pathology of the pars compacta-containing dorso-lateral SN correlated with MDS-UPDRS I, II and III but not cognitive functions. In contrast, neuromelanin pathology of LC was associated with cognitive functions in all tested domains but not with motor impairment or activities of daily living. No such associations were present in controls. CONCLUSIONS: Neuromelanin imaging of the SN and LC is well-suited to map neurodegeneration in PD. Neuromelanin pathology of the SN correlates with motor dysfunction whereas LC pathology is related to cognitive impairment. Neuromelanin-weighted imaging of the LC could thus serve as an imaging marker of executive and other cognitive dysfunctions in PD. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that neuromelanin-weighted imaging was associated with the severity of various signs and symptoms in patients with PD.
OBJECTIVE: To investigate the contribution of substantia nigra (SN) and locus coeruleus (LC) pathology to clinical signs and symptoms in Parkinson's disease (PD) by applying neuromelanin-weighted imaging. METHODS: Forty-seven patients with PD and 53 matched controls underwent motor assessment, a neuropsychological test battery and neuromelanin-weighted MRI. Patients with PD have been enrolled after fulfilling the criteria for 'clinically established PD' as defined by the Movement Disorders Society Clinical Diagnostic Criteria. Two independent raters identified SN and LC and calculated the contrast-to-noise ratio (CNR). RESULTS: The intra-rater reliability demonstrated a good reliability between raters with an intraclass correlation coefficient of .88 (p<.001) and an inter-rater reliability of .80 (p<.001). Both, SN and LC CNRs were lower in patients with PD (p≤.001) compared to controls. The CNR of SN but not of LC was strongly correlated with disease duration (p≤.001). Neuromelanin pathology of the pars compacta-containing dorso-lateral SN correlated with MDS-UPDRS I, II and III but not cognitive functions. In contrast, neuromelanin pathology of LC was associated with cognitive functions in all tested domains but not with motor impairment or activities of daily living. No such associations were present in controls. CONCLUSIONS: Neuromelanin imaging of the SN and LC is well-suited to map neurodegeneration in PD. Neuromelanin pathology of the SN correlates with motor dysfunction whereas LC pathology is related to cognitive impairment. Neuromelanin-weighted imaging of the LC could thus serve as an imaging marker of executive and other cognitive dysfunctions in PD. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that neuromelanin-weighted imaging was associated with the severity of various signs and symptoms in patients with PD.
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