Atrophy of the cholinergic basal forebrain can detect presynaptic cholinergic loss in Parkinson's Disease

Objectives: Structural imaging of the cholinergic basal forebrain may provide a biomarker for cholinergic system integrity that can be used in motor and non-motor outcome studies in Parkinson's disease. However, no prior studies have validated these structural metrics with cholinergic nerve terminal in vivo imaging in Parkinson's disease. Here, we correlate cholinergic basal forebrain morphometry with the topography of vesicular acetylcholine transporter in a large Parkinson's sample. Methods: [18F]-Fluoroethoxybenzovesamicol vesicular acetylcholine transporter positron emission tomography was carried out in 101 non-demented people with Parkinson's (76.24% male, mean age 67.6 ± 7.72 years, disease duration 5.7 ± 4.4 years). Subregional cholinergic basal forebrain volumes were measured using magnetic resonance imaging morphometry. Relationships were assessed via volume-of-interest based correlation analysis. Results: Subregional volumes of the cholinergic basal forebrain predicted cholinergic nerve terminal loss, with most robust correlations occurring between the posterior cholinergic basal forebrain and temporofrontal, insula, cingulum, and hippocampal regions, and with modest correlations in parieto-occipital regions. Hippocampal correlations were not limited to the cholinergic basal forebrain subregion Ch1-2. Correlations were also observed in the striatum, thalamus, and brainstem. Interpretation: Cholinergic basal forebrain morphometry is a robust predictor of regional cerebral vesicular acetylcholine transporter bindings, especially in the anterior brain. The relative lack of correlation between parieto-occipital binding and basal forebrain volumes may reflect the presence of more diffuse synaptopathy in the posterior cortex due to etiologies that extend well beyond the cholinergic system. ANN NEUROL 2023;93:991–998

Cholinergic Denervation Patterns Across Cognitive Domains in Parkinson's Disease

BackgroundThe cholinergic system plays a key role in cognitive impairment in Parkinson’s disease (PD). Previous acetylcholinesterase positron emission tomography imaging studies found memory, attention, and executive function correlates of global cortical cholinergic losses. Vesicular acetylcholine transporter positron emission tomography allows for more accurate topographic assessment of not only cortical but also subcortical cholinergic changes.ObjectiveThe objectiveof this study was to investigate the topographic relationship between cognitive functioning and regional cholinergic innervation in patients with PD.MethodsA total of 86 nondemented patients with PD (mean ± SD age 67.8 ± 7.6 years, motor disease duration 5.8 ± 4.6 years), and 12 healthy control participants (age 67.8 ± 7.8 years) underwent cholinergic [18F]Fluoroethoxybenzovesamicol positron emission tomography imaging. Patients with PD underwent neuropsychological assessment. The z scores for each cognitive domain were determined using an age‐matched, gender‐matched, and educational level–matched control group. Correlations between domain‐specific cognitive functioning and cholinergic innervation were examined, controlling for motor impairments and levodopa equivalent dose. Additional correlational analyses were performed using a mask limited to PD versus normal aging binding differences to assess for disease‐specific versus normal aging effects.ResultsVoxel‐based whole‐brain analysis demonstrated partial overlapping topography across cognitive domains, with most robust correlations in the domains of memory, attention, and executive functioning (P < 0.01, corrected for multiple comparisons). The shared pattern included the cingulate cortex, insula/operculum, and (visual) thalamus.ConclusionOur results confirm and expand on previous observations of cholinergic system involvement in cognitive functioning in PD. The topographic overlap across domains may reflect a partially shared cholinergic functionality underlying cognitive functioning, representing a combination of disease‐specific and aging effects. © 2020 International Parkinson and Movement Disorder SocietyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167040/1/mds28360_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167040/2/mds28360.pd

Dopaminergic Nigrostriatal Connectivity in Early Parkinson Disease:In Vivo Neuroimaging Study of C-11-DTBZ PET Combined with Correlational Tractography

Previous histopathologic and animal studies have shown axonal impairment and loss of connectivity of the nigrostriatal pathway in Parkinson disease (PD). However, there are conflicting reports from in vivo human studies. C-11-dihydrotetrabenazine (C-11-DTBZ) is a vesicular monoamine type 2 transporter PET ligand that allows assessment of nigrostriatal presynaptic dopaminergic terminal integrity. Correlational tractography based on diffusion MRI can incorporate ligand-specific information provided by C-11-DTBZ PET into the fiber-tracking process. The purpose of this study was to assess the in vivo association between the integrity of the nigrostriatal tract (defined by correlational tractography) and the degree of striatal dopaminergic denervation based on C-11-DTBZ PET. Methods: The study involved 30 subjects with mild to moderate PD (23 men and 7 women; mean age, 66 +/- 6.2 y; disease duration, 6.4 +/- 4.0 y; Hoehn and Yahr stage, 2.1 +/- 0.6; Movement Disorder Society [MDS]-revised Unified Parkinson Disease Rating Scale [UPDRS] [I-III] total score, 43.4 +/- 17.8) and 30 control subjects (18 men and 12 women; mean age, 62 +/- 10.3 y). C-11-DTBZ PET was performed using standard synthesis and acquisition protocols. Correlational tractography was performed to assess quantitative anisotropy (QA; a measure of tract integrity) of white matter fibers correlating with information derived from striatal C-11-DTBZ data using the DS! Studio toolbox. Scans were realigned according to least and most clinically affected cerebral hemispheres. Results: Nigrostriatal tracts were identified in both hemispheres of PD patients. Higher mean QA values along the identified tracts were significantly associated with higher striatal C-11-DTBZ distribution volume ratios (least affected: r = 0.57, P = 0.001; most affected: r = 0.44, P = 0.02). Lower mean QA values of the identified tract in the LA hemisphere associated with increased severity of bradykinesia sub-score derived from MDS-UPDRS part III (r = 0.42; P = 0.02). Cross-validation revealed the generalizability of these results. Conclusion: These findings suggest that impaired integrity of dopaminergic nigrostriatal nerve terminals is associated with nigrostriatal axonal dysfunction in mild to moderate PD. Assessment of nigrostriatal tract integrity may be suitable as a biomarker of earlyor even prodromal-stage PD

No Dopamine Agonist Modulation of Brain [F-18]FEOBV Binding in Parkinson's Disease

The[F-18]fluoroethoxybenzovesamicol ([F-18]-FEOBV) positron emission tomography (PET) ligand targets the vesicular acetylcholine transporter. Recent [F-18]FEOBV PET rodent studies suggest that regional brain [F-18]FEOBV binding may be modulated by dopamine D2-like receptor agents. We examined associations of regional brain [F-18]FEOBV PET binding in Parkinson's disease (PD) subjects without versus with dopamine D2-like receptor agonist drug treatment. PD subjects (n = 108; 84 males, 24 females; mean age 68.0 +/- 7.6 [SD] years), mean disease duration of 6.0 +/- 4.0 years, and mean Movement Disorder Society-revised Unified PD Rating Scale III 35.5 +/- 14.2 completed [F-18]FEOBV brain PET imaging. Thirty-eight subjects were taking dopamine D2-like agonists. Vesicular monoamine transporter type 2 [C-11]dihydrotetrabenazine (DTBZ) PET was available in a subset of 54 patients. Subjects on dopamine D2-like agonists were younger, had a longer duration of disease, and were taking a higher levodopa equivalent dose (LED) compared to subjects not taking dopamine agonists. A group comparison between subjects with versus without dopamine D2-like agonist use did not yield significant differences in cortical, striatal, thalamic, or cerebellar gray matter [F-18]FEOBV binding. Confounder analysis using age, duration of disease, LED, and striatal [C-11]DTBZ binding also failed to show significant regional [F-18]FEOBV binding differences between these two groups. Chronic D2-like dopamine agonist use in PD subjects is not associated with significant alterations of regional brain [F-18]FEOBV binding

Cholinergic system changes of falls and freezing of gait in Parkinson’s disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149240/1/ana25430_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149240/2/ana25430.pd

Topography of Cholinergic Changes in Dementia With Lewy Bodies and Key Neural Network Hubs

Objectives: The authors investigated the topography of cholinergic vulnerability in patients with dementia with Lewy bodies (DLB) using positron emission tomography (PET) imaging with the vesicular acetylcholine transporter (VAChT) [F-18]- fluoroethoxybenzovesamicol ([F-18]- FEOBV) radioligand. Methods: Five elderly participants with DLB (mean age, 77.8 years [SD=4.2]) and 21 elderly healthy control subjects (mean age, 73.62 years [SD=8.37]) underwent clinical assessment and [F-18]-FEOBV PET. Results: Compared with the healthy control group, reduced VAChT binding in patients with DLB demonstrated non-diffuse regionally distinct and prominent reductions in bilateral opercula and anterior cingulate to mid-cingulate cortices, bilateral insula, right (more than left) lateral geniculate nuclei, pulvinar, right proximal optic radiation, bilateral anterior and superior thalami, and posterior hippocampal fimbria and fornices. Conclusions: The topography of cholinergic vulnerability in DLB comprises key neural hubs involved in tonic alertness (cingulo-opercular), saliency (insula), visual attention (visual thalamus), and spatial navigation (fimbria/fornix) networks. The distinct denervation pattern suggests an important cholinergic role in specific clinical disease-defining features, such as cognitive fluctuations, visuoperceptual abnormalities causing visual hallucinations, visuospatial changes, and loss of balance caused by DLB

Cerebral topography of vesicular cholinergic transporter changes in neurologically intact adults:A [18F]FEOBV PET study

Acetylcholine plays a major role in brain cognitive and motor functions with regional cholinergic terminal loss common in several neurodegenerative disorders. We describe age-related declines of regional cholinergic neuron terminal density in vivo using the positron emission tomography (PET) ligand [18F](-)5-Fluoroethoxybenzovesamicol ([18F] FEOBV), a vesamicol analogue selectively binding to the vesicular acetylcholine transporter (VAChT). A total of 42 subjects without clinical evidence of neurologic disease (mean 50.55 [range 20-80] years, 24 Male/18 Female) underwent [18F]FEOBV brain PET imaging. We used SPM based voxel-wise statistical analysis to perform whole brain voxel-based parametric analysis (family-wise error corrected, FWE) and to also extract the most significant clusters of regions correlating with aging with gender as nuisance variable. Age-related VAChT binding reductions were found in primary sensorimotor cortex, visual cortex, caudate nucleus, anterior to mid-cingulum, bilateral insula, para-hippocampus, hippocampus, anterior temporal lobes/amygdala, dorsomedial thalamus, metathalamus, and cerebellum (gender and FWE-corrected, P &lt; 0.05). These findings show a specific topographic pattern of regional vulnerability of cholinergic nerve terminals across multiple cholinergic systems accompanying aging.</p

Altered cholinergic innervation in De Novo Parkinson's disease with and without cognitive impairment

BACKGROUND: Altered cholinergic innervation plays a putative role in cognitive impairment in Parkinson's disease (PD) at least in advanced stages. Identification of the relationship between cognitive impairment and cholinergic innervation early in the disease will provide better insight into disease prognosis and possible early intervention. OBJECTIVE: The aim was to assess regional cholinergic innervation status in de novo patients with PD, with and without cognitive impairment. METHODS: Fifty-seven newly diagnosed, treatment-naive, PD patients (32 men, mean age 64.6 ± 8.2 years) and 10 healthy controls (5 men, mean age 54.6 ± 6.0 years) were included. All participants underwent cholinergic [18 F]fluoroethoxybenzovesamicol positron emission tomography and detailed neuropsychological assessment. PD patients were classified as either cognitively normal (PD-NC) or mild cognitive impairment (PD-MCI). Whole brain voxel-based group comparisons were performed. RESULTS: Results show bidirectional cholinergic innervation changes in PD. Both PD-NC and PD-MCI groups showed significant cortical cholinergic denervation compared to controls (P < 0.05, false discovery rate corrected), primarily in the posterior cortical regions. Higher-than-normal binding was most prominent in PD-NC in both cortical and subcortical regions, including the cerebellum, cingulate cortex, putamen, gyrus rectus, hippocampus, and amygdala. CONCLUSION: Altered cholinergic innervation is already present in de novo patients with PD. Posterior cortical cholinergic losses were present in all patients independent of cognitive status. Higher-than-normal binding in cerebellar, frontal, and subcortical regions in cognitively intact patients may reflect compensatory cholinergic upregulation in early-stage PD. Limited or failing cholinergic upregulation may play an important role in early, clinically evident cognitive impairment in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Cholinergic Upregulation in Dorsomedial Thalamus prior to Conversion to Freezing of Gait in Parkinson’s Disease

Background and Aim: The mechanisms underlying Freezing of Gait (FOG) in Parkinson’s Disease (PD) are poorly understood, making it a challenging symptom to treat. Previous work identified morphological alterations in the Thalamus and Caudate nuclei as predictive of conversion to FOG, however the neurochemical changes involved in these adaptations were unexplored. In this study, we used [¹⁸F]fluoroethoxybenzovesamicol (FEOBV) radiotracer PET imaging to investigate the cholinergic activity in the Dorsomedial Thalamus and Head of the Caudate in relationship to the onset of FOG in PD. Methods: Eighty-two participants (11 Healthy Controls, 71 PD – 51 Non-Freezers & 20 Freezers) underwent FEOBV PET and structural MR imaging as well as behavioral assessments at the University Hospital, Ann Arbor, MI. These participants were re-tested two years later and conversion to FOG was determined. Standardized uptake value maps for FEOBV were generated and high resolution T1-weighted scans underwent Voxel-Based Morphometry, implemented in FSL’s (Oxford, UK) tool FIRST. Previously identified masks of the Dorsomedial Thalamus and Caudate Head were used to extract mean FEOBV and local shape values bilaterally which were analyzed in IBM SPSSS version 23 (Armonk, NY). Results: Six out of the fifty-one (11.7%) Non-Freezers converted to FOG during the study (CONV). Baseline analysis revealed that CONV tended to show higher FEOBV values across groups in the right Dorsomedial Thalamus (Group effect: F3,75 = 2.268, P = 0.087), particularly with respect to the baseline Freezers (post-hoc Tukey P=0.068). Interestingly, FEOBV values in the Dorsomedial Thalamus were positively associated with local shape values (Right: r = 0.448, P < 0.001; Left: r = 0.25, P = 0.026) while in the Caudate head they showed an inverse relationship (Right: r = -0.207, P = 0.067; Left: r = -0.229, P = 0.043). Behavioral analyses showed that at baseline, Thalamus FEOBV values were associated with better performance on multiple cognitive tests [MMSE, MOCA and Parkinson’s Disease Cognitive Rating Scale (r – 0.3 – 0.4, Ps < 0.012)], while change in Right Thalamus FEOBV values over two years were related to greater improvements in Parkinson’s Disease Cognitive Rating Scale (r = 0.31, P = 0.039). Conclusions: This study provides a link between cholinergic neuronal activity and subcortical morphological adaptations as well as converging evidence implicating the Dorsomedial Thalamus as an important player in conversion to FOG. The compensatory upregulation seen in the cholinergic neurons in the Dorsomedial Thalamus prior to the onset of FOG seems to be positive and, subject to further investigation, may provide an interesting target for clinical studies.status: publishe

Cholinergic Denervation Patterns Across Cognitive Domains in Parkinson's Disease

BACKGROUND: The cholinergic system plays a key role in cognitive impairment in Parkinson's disease (PD). Previous acetylcholinesterase positron emission tomography imaging studies found memory, attention, and executive function correlates of global cortical cholinergic losses. Vesicular acetylcholine transporter positron emission tomography allows for more accurate topographic assessment of not only cortical but also subcortical cholinergic changes.OBJECTIVE: The objectiveof this study was to investigate the topographic relationship between cognitive functioning and regional cholinergic innervation in patients with PD.METHODS: A total of 86 nondemented patients with PD (mean ± SD age 67.8 ± 7.6 years, motor disease duration 5.8 ± 4.6 years), and 12 healthy control participants (age 67.8 ± 7.8 years) underwent cholinergic [18 F]Fluoroethoxybenzovesamicol positron emission tomography imaging. Patients with PD underwent neuropsychological assessment. The z scores for each cognitive domain were determined using an age-matched, gender-matched, and educational level-matched control group. Correlations between domain-specific cognitive functioning and cholinergic innervation were examined, controlling for motor impairments and levodopa equivalent dose. Additional correlational analyses were performed using a mask limited to PD versus normal aging binding differences to assess for disease-specific versus normal aging effects.RESULTS: Voxel-based whole-brain analysis demonstrated partial overlapping topography across cognitive domains, with most robust correlations in the domains of memory, attention, and executive functioning (P &lt; 0.01, corrected for multiple comparisons). The shared pattern included the cingulate cortex, insula/operculum, and (visual) thalamus.CONCLUSION: Our results confirm and expand on previous observations of cholinergic system involvement in cognitive functioning in PD. The topographic overlap across domains may reflect a partially shared cholinergic functionality underlying cognitive functioning, representing a combination of disease-specific and aging effects. © 2020 International Parkinson and Movement Disorder Society.</p