Niels Okkels

Brain-first versus body-first Parkinson's disease: a multimodal imaging case-control study

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Brain-first versus body-first Parkinson's disease : a multimodal imaging case-control study. / Horsager, Jacob; Andersen, Katrine B.; Knudsen, Karoline; Skjaerbaek, Casper; Fedorova, Tatyana D.; Okkels, Niels; Schaeffer, Eva; Bonkat, Sarah K.; Geday, Jacob; Otto, Marit; Sommerauer, Michael; Danielsen, Erik H.; Bech, Einar; Kraft, Jonas; Munk, Ole L.; Hansen, Sandra D.; Pavese, Nicola; Goeder, Robert; Brooks, David J.; Berg, Daniela; Borghammer, Per.

I: Brain, Bind 143, 10.2020, s. 3077-3088.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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@article{eb72afc9f0574b53a619e7aee5145606,
title = "Brain-first versus body-first Parkinson's disease: a multimodal imaging case-control study",
abstract = "Parkinson's disease is characterized by the presence of abnormal, intraneuronal alpha-synuclein aggregates, which may propagate from cell-to-cell in a prion-like manner. However, it remains uncertain where the initial alpha-synuclein aggregates originate. We have hypothesized that Parkinson's disease comprises two subtypes. A brain-first (top-down) type, where a-synuclein pathology initially arises in the brain with secondary spreading to the peripheral autonomic nervous system; and a body-first (bottom-up) type, where the pathology originates in the enteric or peripheral autonomic nervous system and then spreads to the brain. We also hypothesized that isolated REM sleep behaviour disorder (iRBD) is a prodromal phenotype for the body-first type. Using multimodal imaging, we tested the hypothesis by quantifying neuronal dysfunction in structures corresponding to Braak stages I, II and III involvement in three distinct patient groups. We included 37 consecutive de novo patients with Parkinson's disease into this case-control PET study. Patients with Parkinson's disease were divided into 24 RBD-negative (PDRBD-) and 13 RBD-positive cases (PDRBD+) and a comparator group of 22 iRBD patients. We used C-11-donepezil PET/CT to assess cholinergic (parasympathetic) innervation, 123 I-metaiodobenzylguanidine (MIBG) scintigraphy to measure cardiac sympathetic innervation, neuromelanin-sensitive MRI to measure the integrity of locus coeruleus pigmented neurons, and F-18-dihydroxyphenylalanine (FDOPA) PET to assess putaminal dopamine storage capacity. Colon volume and transit times were assessed with CT scans and radiopaque markers. Imaging data from the three groups were interrogated with ANOVA and KruskalWallis tests corrected for multiple comparisons. The PDRBD- and PDRBD+ groups showed similar marked reductions in putaminal FDOPA-specific uptake, whereas two-thirds of iRBD patients had normal scans (P < 10(-13), ANOVA). When compared to the PDRBD-patients, the PDRBD+ and iRBD patients showed reduced mean MIBG heart:mediastinum ratios (P < 10(-5), ANOVA) and colon C-11-donepezil standard uptake values (P = 0.008, ANOVA). The PDRBD+ group trended towards a reduced mean MRI locus coeruleus: pons ratio compared to PDRBD- (P = 0.07, t-test). In comparison to the other groups, the PDRBD+ group also had enlarged colon volumes (P50.001, ANOVA) and delayed colonic transit times (P = 0.01, Kruskal-Wallis). The combined iRBD and PDRBD+ patient data were compatible with a body-first trajectory, characterized by initial loss of cardiac MIBG signal and C-11-colonic donepezil signal followed by loss of putaminal FDOPA uptake. In contrast, the PDRBD- data were compatible with a brain-first trajectory, characterized by primary loss of putaminal FDOPA uptake followed by a secondary loss of cardiac MIBG signal and C-11-donepezil signal. These findings support the existence of brain-first and body-first subtypes of Parkinson's disease.",
keywords = "PET, MRI, Parkinson's disease, REM sleep behaviour disorder, CARDIAC I-123-MIBG SCINTIGRAPHY, ALPHA-SYNUCLEIN PATHOLOGY, LEWY BODIES, DEMENTIA, ACETYLCHOLINESTERASE, QUESTIONNAIRE, DYSFUNCTION, RISK",
author = "Jacob Horsager and Andersen, {Katrine B.} and Karoline Knudsen and Casper Skjaerbaek and Fedorova, {Tatyana D.} and Niels Okkels and Eva Schaeffer and Bonkat, {Sarah K.} and Jacob Geday and Marit Otto and Michael Sommerauer and Danielsen, {Erik H.} and Einar Bech and Jonas Kraft and Munk, {Ole L.} and Hansen, {Sandra D.} and Nicola Pavese and Robert Goeder and Brooks, {David J.} and Daniela Berg and Per Borghammer",
year = "2020",
month = oct,
doi = "10.1093/brain/awaa238",
language = "English",
volume = "143",
pages = "3077--3088",
journal = "Brain",
issn = "0006-8950",
publisher = "Oxford University Press",

}

RIS

TY - JOUR

T1 - Brain-first versus body-first Parkinson's disease

T2 - a multimodal imaging case-control study

AU - Horsager, Jacob

AU - Andersen, Katrine B.

AU - Knudsen, Karoline

AU - Skjaerbaek, Casper

AU - Fedorova, Tatyana D.

AU - Okkels, Niels

AU - Schaeffer, Eva

AU - Bonkat, Sarah K.

AU - Geday, Jacob

AU - Otto, Marit

AU - Sommerauer, Michael

AU - Danielsen, Erik H.

AU - Bech, Einar

AU - Kraft, Jonas

AU - Munk, Ole L.

AU - Hansen, Sandra D.

AU - Pavese, Nicola

AU - Goeder, Robert

AU - Brooks, David J.

AU - Berg, Daniela

AU - Borghammer, Per

PY - 2020/10

Y1 - 2020/10

N2 - Parkinson's disease is characterized by the presence of abnormal, intraneuronal alpha-synuclein aggregates, which may propagate from cell-to-cell in a prion-like manner. However, it remains uncertain where the initial alpha-synuclein aggregates originate. We have hypothesized that Parkinson's disease comprises two subtypes. A brain-first (top-down) type, where a-synuclein pathology initially arises in the brain with secondary spreading to the peripheral autonomic nervous system; and a body-first (bottom-up) type, where the pathology originates in the enteric or peripheral autonomic nervous system and then spreads to the brain. We also hypothesized that isolated REM sleep behaviour disorder (iRBD) is a prodromal phenotype for the body-first type. Using multimodal imaging, we tested the hypothesis by quantifying neuronal dysfunction in structures corresponding to Braak stages I, II and III involvement in three distinct patient groups. We included 37 consecutive de novo patients with Parkinson's disease into this case-control PET study. Patients with Parkinson's disease were divided into 24 RBD-negative (PDRBD-) and 13 RBD-positive cases (PDRBD+) and a comparator group of 22 iRBD patients. We used C-11-donepezil PET/CT to assess cholinergic (parasympathetic) innervation, 123 I-metaiodobenzylguanidine (MIBG) scintigraphy to measure cardiac sympathetic innervation, neuromelanin-sensitive MRI to measure the integrity of locus coeruleus pigmented neurons, and F-18-dihydroxyphenylalanine (FDOPA) PET to assess putaminal dopamine storage capacity. Colon volume and transit times were assessed with CT scans and radiopaque markers. Imaging data from the three groups were interrogated with ANOVA and KruskalWallis tests corrected for multiple comparisons. The PDRBD- and PDRBD+ groups showed similar marked reductions in putaminal FDOPA-specific uptake, whereas two-thirds of iRBD patients had normal scans (P < 10(-13), ANOVA). When compared to the PDRBD-patients, the PDRBD+ and iRBD patients showed reduced mean MIBG heart:mediastinum ratios (P < 10(-5), ANOVA) and colon C-11-donepezil standard uptake values (P = 0.008, ANOVA). The PDRBD+ group trended towards a reduced mean MRI locus coeruleus: pons ratio compared to PDRBD- (P = 0.07, t-test). In comparison to the other groups, the PDRBD+ group also had enlarged colon volumes (P50.001, ANOVA) and delayed colonic transit times (P = 0.01, Kruskal-Wallis). The combined iRBD and PDRBD+ patient data were compatible with a body-first trajectory, characterized by initial loss of cardiac MIBG signal and C-11-colonic donepezil signal followed by loss of putaminal FDOPA uptake. In contrast, the PDRBD- data were compatible with a brain-first trajectory, characterized by primary loss of putaminal FDOPA uptake followed by a secondary loss of cardiac MIBG signal and C-11-donepezil signal. These findings support the existence of brain-first and body-first subtypes of Parkinson's disease.

AB - Parkinson's disease is characterized by the presence of abnormal, intraneuronal alpha-synuclein aggregates, which may propagate from cell-to-cell in a prion-like manner. However, it remains uncertain where the initial alpha-synuclein aggregates originate. We have hypothesized that Parkinson's disease comprises two subtypes. A brain-first (top-down) type, where a-synuclein pathology initially arises in the brain with secondary spreading to the peripheral autonomic nervous system; and a body-first (bottom-up) type, where the pathology originates in the enteric or peripheral autonomic nervous system and then spreads to the brain. We also hypothesized that isolated REM sleep behaviour disorder (iRBD) is a prodromal phenotype for the body-first type. Using multimodal imaging, we tested the hypothesis by quantifying neuronal dysfunction in structures corresponding to Braak stages I, II and III involvement in three distinct patient groups. We included 37 consecutive de novo patients with Parkinson's disease into this case-control PET study. Patients with Parkinson's disease were divided into 24 RBD-negative (PDRBD-) and 13 RBD-positive cases (PDRBD+) and a comparator group of 22 iRBD patients. We used C-11-donepezil PET/CT to assess cholinergic (parasympathetic) innervation, 123 I-metaiodobenzylguanidine (MIBG) scintigraphy to measure cardiac sympathetic innervation, neuromelanin-sensitive MRI to measure the integrity of locus coeruleus pigmented neurons, and F-18-dihydroxyphenylalanine (FDOPA) PET to assess putaminal dopamine storage capacity. Colon volume and transit times were assessed with CT scans and radiopaque markers. Imaging data from the three groups were interrogated with ANOVA and KruskalWallis tests corrected for multiple comparisons. The PDRBD- and PDRBD+ groups showed similar marked reductions in putaminal FDOPA-specific uptake, whereas two-thirds of iRBD patients had normal scans (P < 10(-13), ANOVA). When compared to the PDRBD-patients, the PDRBD+ and iRBD patients showed reduced mean MIBG heart:mediastinum ratios (P < 10(-5), ANOVA) and colon C-11-donepezil standard uptake values (P = 0.008, ANOVA). The PDRBD+ group trended towards a reduced mean MRI locus coeruleus: pons ratio compared to PDRBD- (P = 0.07, t-test). In comparison to the other groups, the PDRBD+ group also had enlarged colon volumes (P50.001, ANOVA) and delayed colonic transit times (P = 0.01, Kruskal-Wallis). The combined iRBD and PDRBD+ patient data were compatible with a body-first trajectory, characterized by initial loss of cardiac MIBG signal and C-11-colonic donepezil signal followed by loss of putaminal FDOPA uptake. In contrast, the PDRBD- data were compatible with a brain-first trajectory, characterized by primary loss of putaminal FDOPA uptake followed by a secondary loss of cardiac MIBG signal and C-11-donepezil signal. These findings support the existence of brain-first and body-first subtypes of Parkinson's disease.

KW - PET

KW - MRI

KW - Parkinson's disease

KW - REM sleep behaviour disorder

KW - CARDIAC I-123-MIBG SCINTIGRAPHY

KW - ALPHA-SYNUCLEIN PATHOLOGY

KW - LEWY BODIES

KW - DEMENTIA

KW - ACETYLCHOLINESTERASE

KW - QUESTIONNAIRE

KW - DYSFUNCTION

KW - RISK

U2 - 10.1093/brain/awaa238

DO - 10.1093/brain/awaa238

M3 - Journal article

C2 - 32830221

VL - 143

SP - 3077

EP - 3088

JO - Brain

JF - Brain

SN - 0006-8950

ER -