Weil, R;
Zarkali, A;
McColgan, P;
Leyland, L;
Lees, A;
Rees, G;
(2020)
Fibre-specific white matter reductions in Parkinson’s hallucinations and visual dysfunction.
Neurology
, 94
(14)
e1525-e1538.
10.1212/WNL.0000000000009014.
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Abstract
Objective: To investigate the microstructural and macrostructural white matter changes that accompany visual hallucinations and low visual performance in Parkinson’s disease, a risk factor for Parkinson’s dementia. Methods: We performed fixel-based analysis, a novel technique that provides metrics of specific fibre-bundle populations within a voxel (or fixel). Diffusion MRI data was acquired from patients with Parkinson’s disease (n=105, of which 34 low visual performers and 19 hallucinators) and age-matched controls (n=35). We used whole brain fixel-based analysis to compare micro-structural differences in fibre density (FD), macro-structural differences in fibre bundle cross-section (FC) and the combined fibre density and cross-section metric (FDC) across all white matter fixels. We then performed a tract of interest analysis comparing the most sensitive FDC metric across 11 tracts within the visual system. Results: Patients with Parkinson’s disease hallucinations exhibited macrostructural changes (reduced FC) within the splenium of the corpus callosum and the left posterior thalamic radiation compared to patients without hallucinations. Whilst there were no significant changes in FD, we found large reductions in the combined FDC metric in Parkinson’s hallucinators within the splenium (>50% reduction compared to non-hallucinators). Patients with Parkinson’s disease and low visual performance showed widespread microstructural and macrostructural changes within the genu and splenium of the corpus callosum, bilateral posterior thalamic radiations and the left inferior fronto-occipital fasciculus. Conclusions: We demonstrate specific white matter tract degeneration affecting posterior thalamic tracts in patients with Parkinson’s disease with hallucinations and low visual performance, providing direct mechanistic support for attentional models of visual hallucinations.
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