Magazine article Clinical Psychiatry News

Changes in Brain May Herald Dementia in PD: A Decrease in the Volume of the Hippocampus Could Predict Which Patients Will Progress to Dementia

Magazine article Clinical Psychiatry News

Changes in Brain May Herald Dementia in PD: A Decrease in the Volume of the Hippocampus Could Predict Which Patients Will Progress to Dementia

Article excerpt

MIAMI BEACH -- Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorova, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

"What is important from a practical point of view is that atrophy of hippocampus probably predicts a switch to dementia," said Dr. Rektorova, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521-4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorova provided some additional perspective on the extent of volume changes. "Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease."

Using voxel-based morphometry, other researchers have reported gray matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791-800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify "the malignant form" of MCI that will progress to dementia, said Dr. Rektorova, who had no relevant disclosures.

"Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?" Dr. Rektorova asked. It is possible, she said, based on the promising results of multiple studies using [.sup.18]F-fluorodeoxyglucose (FDG) positron emission tomography or functional MRI. …

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