Does attentional dysfunction and thalamic atrophy predict decline in dementia with Lewy bodies?
Parkinsonism and Related Disorders
Elsevier for World Federation of Neurology Research Group on Parkinsonism and Related Disorders
© 2017 Elsevier Ltd. All rights reserved.
Reason for embargo
Under embargo until 9 October 2018 in compliance with publisher policy
INTRODUCTION: To evaluate the clinical characteristics of DLB subjects who died within 1 year of assessment compared to those who survived and investigate their patterns of in vivo regional thalamic atrophy using structural MRI. METHODS: Seventy subjects (35 DLB, 35 aged controls) underwent 3 T T1-weighted MR scanning as well as clinical and cognitive assessments, including a computerised assessment of attention. All subjects were contacted after 12 months for reassessment. For both hemispheres, using FSL FIRST, the thalamus was automatically segmented followed by inter-subject vertex-wise analyses involving group comparisons and behavioural correlates. RESULTS: There was significant bilateral atrophy in the ventral-dorsal and pulvinar regions in DLB relative to controls (pcorrected < 0.05). The DLB group was then re-categorised based on 12-month mortality data: DLB-a (n = 26) and DLB-d (n = 9) (a = alive, d = death within 12 months of study assessment). Compared to controls, significant attentional dysfunction and bilateral atrophy of the pulvinar, ventral and dorsal nuclei were observed in DLB-d (pcorrected < 0.05), whereas in DLB-a, atrophy was far less extensive. CONCLUSIONS: Distinct patterns of thalamic atrophy occur in DLB that may relate to the attentional dysfunction and cognitive fluctuations that characterise this disorder. Relative to controls, the extent of attentional impairment and pattern of thalamic degeneration differ in those patients who died within 12 months of assessment, despite having an otherwise similar level of dementia severity. These findings may provide insight into the neurobiological changes underpinning important clinical characteristics and disease heterogeneity.
The study was funded by the Sir Jules Thorn Charitable Trust [grant ref: 05/JTA] and supported by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre in Ageing and Chronic Disease and Biomedical Research Unit in Lewy Body Dementia based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. Dr Watson is supported by the Yulgilbar Alzheimer's Research Program. Professor Wesnes owns Wesnes Cognition Ltd which provides internet based cognitive testing facilities to worldwide clinical trials. Professor O'Brien is supported by the Cambridge Biomedical Research Centre.
This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record
Vol. 45, pp. 69 - 74
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