Disrupted Thalamo-Striato-Hypothalamic Function May Serve as a Good Biomarker for Parkinson Disease

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Scores on the SCOPA-AUT were highest in patients who were older and had longer duration of disease.
Scores on the SCOPA-AUT were highest in patients who were older and had longer duration of disease.

Study findings published in Neurology suggest that central deficits in neural circuits that regulate autonomic function accompany autonomic dysfunction symptoms in patients with Parkinson disease (PD), showing that these deficits may be important biomarkers in early PD.

Investigators evaluated resting state functional magnetic resonance imaging scans of patients with PD. Using the Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) questionnaire, investigators compared high (n=24) vs low (n=28) quartile patient scores. Each patient had a computed seed-based functional connectivity map, and investigators tested functional connectivity between the right and left hypothalamus as well as the other brain regions by using the seed-to-voxel strategy. Additionally, the investigators tested whether the association of hypothalamic functional connectivity and scores on the SCOPA-AUT were independent of age, cognitive function, disease duration, and motor dysfunction.

Scores on the SCOPA-AUT were highest in patients who were older (P =.0070) and had longer duration of disease (P =.0133) compared with patients with low scores. Associations between the right hypothalamus and the thalamo-striatal cluster and scores on the SCOPA-AUT were significant after adjustment for age, duration of disease, Movement Disorder Society Unified Parkinson's Disease Rating Scale, and Montreal Cognitive Assessment scores (P =.00059). Adjustment for these variables was associated with persistent significant associations between the left hypothalamus and the thalamo-striatal cluster and scores on the SCOPA-AUT (P =.000429).

The recruitment of patients with early PD may have resulted in the inclusion of patients with a false diagnosis.

The study investigators suggest the need for additional research “in imaging associations with autonomic dysfunction in PD…[which] should include objective quantification of autonomic function, various stages of disease, and longitudinal sequential evaluations.”

Reference

Dayan E, Sklerov M, Browner N. Disrupted hypothalamic functional connectivity in patients with PD and autonomic dysfunction. Neurology. 2018;90:e2051-e2058.

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