Journal
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Volume 91, Issue 4, Pages 418-425Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jnnp-2019-322042
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Funding
- Clinical Research Career Development Fellowship from the Wellcome Trust
- UCL
- Academy of Medical Sciences
- National Institute for Health Research University College London Hospitals Biomedical Research Centre
- Wellcome [203147/Z/16/Z]
- Medical Research Council [MR/N013867/1]
- GE healthcare [PO2580367614]
- Parkinson's UK [G-1606K-1213]
- Movement Disorders Society
- ESRC [ES/L009250/1]
- Cure Parkinson's Trust
- UCLH Biomedical Research Centre Grant [BRC302/NS/RW/101410]
- National Institute for Health Research
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Background Dementia is common in Parkinson's disease (PD) but measures that track cognitive change in PD are lacking. Brain tissue iron accumulates with age and co-localises with pathological proteins linked to PD dementia such as amyloid. We used quantitative susceptibility mapping (QSM) to detect changes related to cognitive change in PD. Methods We assessed 100 patients with early-stage to mid-stage PD, and 37 age-matched controls using the Montreal Cognitive Assessment (MoCA), a validated clinical algorithm for risk of cognitive decline in PD, measures of visuoperceptual function and the Movement Disorders Society Unified Parkinson's Disease Rating Scale part 3 (UPDRS-III). We investigated the association between these measures and QSM, an MRI technique sensitive to brain tissue iron content. Results We found QSM increases (consistent with higher brain tissue iron content) in PD compared with controls in prefrontal cortex and putamen (p<0.05 corrected for multiple comparisons). Whole brain regression analyses within the PD group identified QSM increases covarying: (1) with lower MoCA scores in the hippocampus and thalamus, (2) with poorer visual function and with higher dementia risk scores in parietal, frontal and medial occipital cortices, (3) with higher UPDRS-III scores in the putamen (all p<0.05 corrected for multiple comparisons). In contrast, atrophy, measured using voxel-based morphometry, showed no differences between groups, or in association with clinical measures. Conclusions Brain tissue iron, measured using QSM, can track cognitive involvement in PD. This may be useful to detect signs of early cognitive change to stratify groups for clinical trials and monitor disease progression.
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