Background and purpose
Reduced facial expression of emotions is a very frequent symptom of Parkinson's disease (PD) and has been considered part of the motor features of the disease. However, the ...neural correlates of hypomimia and the relationship between hypomimia and other non‐motor symptoms of PD are poorly understood.
Methods
The clinical and structural brain correlates of hypomimia were studied. For this purpose, cross‐sectional data from the COPPADIS study database were used. Age, disease duration, levodopa equivalent daily dose, Unified Parkinson's Disease Rating Scale part III (UPDRS‐III), severity of apathy and depression and global cognitive status were collected. At the imaging level, analyses based on gray matter volume and cortical thickness were used.
Results
After controlling for multiple confounding variables such as age or disease duration, the severity of hypomimia was shown to be indissociable from the UPDRS‐III speech and bradykinesia items and was significantly related to the severity of apathy (β = 0.595; p < 0.0001). At the level of neural correlates, hypomimia was related to motor regions brodmann area 8 (BA 8) and to multiple fronto‐temporo‐parietal regions involved in the decoding, recognition and production of facial expression of emotions.
Conclusion
Reduced facial expressivity in PD is related to the severity of symptoms of apathy and is mediated by the dysfunction of brain systems involved in motor control and in the recognition, integration and expression of emotions. Therefore, hypomimia in PD may be conceptualized not exclusively as a motor symptom but as a consequence of a multidimensional deficit leading to a symptom where motor and non‐motor aspects converge.
Hypomimia in Parkinson’s disease (PD) is related to the severity of symptoms of apathy and is mediated by the dysfunction of brain systems involved in motor control and in the recognition, integration and expression of emotions. Hypomimia in PD may be conceptualized not exclusively as a motor symptom but as a consequence of a multidimensional deficit where motor and non‐motor aspects converge.
We aimed to assess associations between multimodal neuroimaging measures of cholinergic basal forebrain (CBF) integrity and cognition in Parkinson's disease (PD) without dementia.
The study included ...a total of 180 non-demented PD patients and 45 healthy controls, who underwent structural MRI acquisitions and standardized neurocognitive assessment through the PD-Cognitive Rating Scale (PD-CRS) within the multicentric COPPADIS-2015 study. A subset of 73 patients also had Diffusion Tensor Imaging (DTI) acquisitions. Volumetric and microstructural (mean diffusivity, MD) indices of CBF degeneration were automatically extracted using a stereotactic CBF atlas. For comparison, we also assessed multimodal indices of hippocampal degeneration. Associations between imaging measures and cognitive performance were assessed using linear models.
Compared to controls, CBF volume was not significantly reduced in PD patients as a group. However, across PD patients lower CBF volume was significantly associated with lower global cognition (PD-CRStotal: r = 0.37, p < 0.001), and this association remained significant after controlling for several potential confounding variables (p = 0.004). Analysis of individual item scores showed that this association spanned executive and memory domains. No analogue cognition associations were observed for CBF MD. In covariate-controlled models, hippocampal volume was not associated with cognition in PD, but there was a significant association for hippocampal MD (p = 0.02).
Early cognitive deficits in PD without dementia are more closely related to structural MRI measures of CBF degeneration than hippocampal degeneration. In our multicentric imaging acquisitions, DTI-based diffusion measures in the CBF were inferior to standard volumetric assessments for capturing cognition-relevant changes in non-demented PD.
•Multimodal MRI study of cognitive deficits in nondemented Parkinson's disease (PD).•Cognitive deficits in PD relate to lower cholinergic basal forebrain (CBF) volume.•Hippocampal volume not associated with cognitive deficits.•DTI diffusion measures more sensitive than volume in hippocampus but not in CBF.•Implications for the development of imaging biomarkers of cognitive decline in PD.
Blood homocysteine appears to be increased in Parkinson's disease (PD) and may play a role in the development and progression of this disorder. However, the specific contribution of abnormal ...homocysteine levels to cortical degeneration in PD remains elusive.
To characterize the cortical structural correlates of homocysteine levels in PD.
From the COPPADIS cohort, we identified a subset of PD patients and healthy controls (HC) with available homocysteine and imaging data. Surface-based vertex-wise multiple regression analyses were performed to investigate the cortical macrostructural (cortical thinning) and microstructural (increased intracortical diffusivity) correlates of homocysteine levels in this sample.
A total of 137 PD patients and 43 HC were included. Homocysteine levels were increased in the PD group (t = −2.2, p = 0.03), correlating in turn with cognitive performance (r = −0.2, p = 0.03). Homocysteine in PD was also associated with frontal cortical thinning and, in a subset of patients with available DTI data, with microstructural damage in frontal and posterior-cortical regions (p < 0.05 Monte-Carlo corrected).
Homocysteine in PD appears to be associated with cognitive performance and structural damage in the cerebral cortex. These findings not only reinforce the presence and importance of cortical degeneration in PD, but also suggest that homocysteine plays a role among the multiple pathological processes thought to be involved in its development.
•Parkinson's disease (PD) patients appear to show increased homocysteine levels.•Homocysteine correlated in turn with cognitive performance in our PD sample.•Homocysteine was also associated with cortical macro- and microstructural alterations.•This metabolic marker may play a role in cortical degeneration in the PD population.
Background
Detection of suicidal ideation (SI) is key for trying to prevent suicide. The aim of this study was to analyze the frequency of SI and related factors in Spanish people with Parkinson's ...Disease (PwPD) and to compare them with a control group.
Methods
PD patients and controls recruited from the Spanish cohort COPPADIS from January 2016 to November 2017 were included. Two visits were conducted: V0 (baseline); V2 (2‐year ± 1 month follow‐up). SI was defined as a score ≥1 on item nine of the Beck Depression Inventory‐II (BDI‐II). Regression analyses were conducted to identify factors related to SI.
Results
At baseline, 693 PwPD (60.2% males; 62.59 ± 8.91 years old) and 207 controls (49.8% males; 60.99 ± 8.32 years old) were included. No differences between PwPD and controls were detected in SI frequency at either V0 (5.1% 35/693 vs. 4.3% 9/207; p = 0.421) or at V2 (5.1% 26/508 vs. 4.8% 6/125; p = 0.549). Major depression (MD) and a worse quality of life were associated with SI at both visits in PwPD: V0 (MD, OR = 5.63; p = 0.003; PDQ‐39, OR = 1.06; p = 0.021); V2 (MD, OR = 4.75; p = 0.027; EUROHIS‐QOL8, OR = 0.22; p = 0.006). A greater increase in the BDI‐II total score from V0 to V2 was the only factor predicting SI at V2 (OR = 1.21; p = 0.002) along with an increase in the total number of non‐antiparkinsonian drugs (OR = 1.39; p = 0.041).
Conclusion
The frequency of SI (5%) in PwPD was similar to in controls. Depression, a worse quality of life, and a greater comorbidity were related to SI.
Key points
This study detected suicidal ideation in about 5% of people with Parkinson's disease (PwPD) and was not more frequent than in controls.
Independent factors associated with suicidal ideation were major depression, a worse quality of life, and an increase in mood impairment or comorbidity over time.
These findings suggest the importance of detecting depressive symptoms in PwPD and evaluation for suicide thoughts, especially in those PwPD with major depression.
Background
Although depression is known to be frequent in Parkinson's disease (PD), it is unclear how mood can change and/or impact on patient's quality of life (QoL) over time. Our aim was to ...analyze the frequency of depression, mood related factors and the contribution of mood to a patient's QoL perception in regard to disease duration.
Methods
PD patients recruited from the COPPADIS cohort from January 2016 to November 2017 were included in this cross‐sectional study. Three groups were defined: <5 years (Group A); from 5 to <10 years (Group B); ≥10 years (Group C). Analysis with well‐planned linear regression models was conducted to determine how different factors contribute to mood (Beck Depression Inventory‐II BDI‐II as dependent variable), to health‐related QoL (39‐item Parkinson's Disease Questionnaire PDQ‐39SI as dependent variable) and to global QoL (European Health Interview Survey – Quality of Life Eight‐Item Index EUROHIS‐QOL8 as dependent variable).
Results
Six hundred and sixty‐three PD patients (62.6 ± 8.9 years old, 59.6% males) were included: Group A, 50.1% (n = 332); Group B, 33.3% (n = 221) and Group C, 16.6% (n = 110). There were no differences between the three groups in terms of the frequency of depressive symptoms nor the frequency of depression type (major vs. minor vs. subthreshold) (p = 0.729). However, the unique percent variance of PDQ‐39SI and EUROHIS‐QOL8 explained by BDI‐II total score was 2 (23.7%) and threefold (26.9%), respectively, in Group C compared to the other two groups. EUROHIS‐QOL8 total score provided the highest unique contribution to mood (16.8%).
Conclusions
Although depression‐type frequency does not appear to change over time in PD; the contribution of mood on QoL perception is greater in patients with longer disease duration.
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