The Differential Diagnosis and Prognosis of Idiopathic and Atypical Parkinson Disease by Using Diffusion MRI
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Observational [Patient Registry]

Summary: 
      The hypothesis is that the differential extent of microstructural damages in the affected
      brain regions can be specific to the disease of interest and could reflect the clinical
      severity. Therefore, we propose that the whole brain parcellation of diffusion MRI can be
      used to improve the diagnosis and prediction of clinical outcomes in Parkinson's Disease.

        1. A regression model between clinical severity and two-year clinical outcomes and
           diffusion properties from multiple parcellated regions will be developed.

        2. Blind validation will be performed.
    

Detailed description: 
      Parkinson's disease (PD) is a common progressive neurodegenerative disorder characterized by
      resting tremor, bradykinesia, restricted mobility, and postural instability. Early diagnosis
      of PD would be paramount for further treatment and prognosis. The most common
      neurodegenerative parkinsonian syndrome is known as Parkinson's disease (PD) or idiopathic
      Parkinson syndrome, if it occurs sporadically (not familial) and its lead clinical symptom is
      a movement disorder after brainstem-predominant α-synuclein deposition. To distinguish them
      from Parkinson's disease, other sporadic entities have been named atypical parkinsonian
      syndromes or atypical parkinsonism. The present review article describes current standards
      for the diagnosis and treatment of the most important disease entities in this latter group:
      dementia with Lewy bodies (DLB), multiple system atrophy (MSA), progressive supranuclear
      palsy (PSP), and corticobasal degeneration (CBD).

      PD is diagnosed mainly by neurologists, based on clinical symptoms. However, there are no
      objective criteria available for their diagnosis. Although magnetic resonance imaging (MRI)
      is often employed in conjunction with clinical judgment, the images are mostly used to
      eliminate other diseases, rather than to confirm the diagnosis. Other imaging methods, such
      as Positron Emission Tomography or Computed Tomography, may help in the diagnosis of PD but
      have harmful effects on the human body. MRI image of patients with Parkinson's disease is
      usually normal. Previous studies have also indicated that brain-related areas, such as the
      atrophy of basal ganglia, are not observed until a period of disease progression. However,
      the shrinkage of brain tissue cannot be used as a criterion for the diagnosis of Parkinson's
      disease, because many other diseases are accompanied by atrophy of brain tissue as well.
      Furthermore, because human brain cells cannot regenerate, It is too late to diagnose or treat
      when a large number of nerve cells are apoptotic. Since we expect the function of the
      diseased cells to change first, therefore, if you can detect changes in the patient's brain
      microenvironment, it is possible to achieve early detection of Parkinson's disease. Magnetic
      resonance imaging can detect functional images and display functional changes, thus providing
      an opportunity to detect abnormalities and diagnose diseases early. One of the key
      technologies in the measurement of functional images is diffusion magnetic resonance imaging.

      Diffusion MRI has been widely utilized to investigate the patterns of neural connectivity.
      Mean diffusivity (MD) and the directionality (fractional anisotropy (FA)) have been studied
      in epilepsy, multiple sclerosis, and noticeably in Parkinson's Disease. Owing to their
      paramount pathogenetic role in Parkinson's disease, the basal ganglia in general and the
      substantia nigra pars compacta, in particular, have been the subject of intense MRI
      investigation.

      The plan uses standard anatomic labeling (AAL) to perform whole-brain diffusion MRI to obtain
      diffusion data for the whole brain parcellation. We will use statistical methods to identify
      the areas affected by each PD's subtype, we will also identify areas that are likely to be
      related to the severity of the disease, and then combine these areas for linear regression
      analysis. We anticipate that diffusion magnetic resonance imaging can be used as a
      differential diagnosis, as well as to define areas of high correlation with clinical
      severity, and to be used for accurate disease prediction and future development, and to
      provide physicians and patients with clinically important information.

      The program uses diffusion magnetic resonance imaging to assess clinical status and prognosis
      for Parkinson's disease. Our research goal is

        1. Establish objective and clear imaging diagnostic criteria of diffusion MRI for
           idiopathic and atypical Parkinson's disease.

        2. Establish objective and clear clinical severity and the prognosis prediction mode of
           diffusion MRI for idiopathic and atypical Parkinson's disease.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All subjects should meet the following criteria:

          1. Between 50-80 years old

          2. Right-handed

          3. Able to understand study requirements and give informed consent

          4. Agree to return for follow-up checks

          5. Able to suspend intake of medication for at least 12 hours
      
Keywords: Magnetic Resonance Imaging; Neurodegeneration disease; Cognitive impairment; Diagnosis; Prognosis