Suzanne Reeves

Age Effects on Diffusion Tensor Magnetic Resonance Imaging Tractography Measures of Frontal Cortex Connections in Schizophrenia

Diffusion tensor magnetic resonance imaging (DT‐MRI) has previously been used to investigate white matter tracts in schizophrenia, with inconsistent results. The aim of the study was to use a novel method for tract‐specific measurements of fronto‐temporal fasciculi in early‐onset schizophrenia. We hypothesized that by making tract‐specific measurements, clear diffusion abnormalities would be revealed in specific fasciculi in schizophrenia. Measurements of diffusion anisotropy and mean diffusivity were localized within fronto‐temporal fasciculi by forming 3‐D reconstructions of the cingulum, uncinate, superior longitudinal, and inferior fronto‐occipital fasciculi using diffusion tensor tractography. We were limited in our ability to test our hypothesis by the important and surprising finding that age affected DT‐MRI‐based measures in schizophrenia patients in a different way from comparison subjects, most notably in the left superior longitudinal fasciculus. The youngest schizophrenia patients that we studied had lower diffusion anisotropy than age‐matched comparison subjects, but this difference diminished with increasing age. The main conclusion of this study was that direct comparisons of absolute DT‐MRI‐based measures between individuals with schizophrenia and comparison subjects may be problematic and misleading because of underlying age‐related differences in brain maturation between groups. Hum Brain Mapp, 2005.

The dopaminergic basis of human behaviors: A review of molecular imaging studies.

This systematic review describes human molecular imaging studies which have investigated alterations in extracellular DA levels during performance of behavioral tasks. Whilst heterogeneity in experimental methods limits meta-analysis, we describe the advantages and limitations of different methodological approaches. Interpretation of experimental results may be limited by regional cerebral blood flow (rCBF) changes, head movement and choice of control conditions. We revisit our original study of striatal DA release during video-game playing [Koepp, M.J., Gunn, R.N., Lawrence, A.D., Cunningham, V.J., Dagher, A., Jones, T., Brooks, D.J., Bench, C.J., Grasby, P.M., 1998. Evidence for striatal dopamine release during a video game. Nature 393, 266-268] to illustrate the potentially confounding influences of head movement and alterations in rCBF. Changes in [(11)C]raclopride binding may be detected in extrastriatal as well as striatal brain regions-however we review evidence which suggests that extrastriatal changes may not be clearly interpreted in terms of DA release. Whilst several investigations have detected increases in striatal extracellular DA concentrations during task components such as motor learning and execution, reward-related processes, stress and cognitive performance, the presence of potentially biasing factors should be carefully considered (and, where possible, accounted for) when designing and interpreting future studies.

A Diffusion Tensor Magnetic Resonance Imaging Study of Frontal Cortex Connections in Very-Late-Onset Schizophrenia-Like Psychosis

OBJECTIVE Onset of psychosis after the age of 60 may be associated with structural abnormalities within cerebral white matter. The authors looked within white-matter tracts, which mediate connectivity of the frontal lobes, in psychotic patients for evidence of loss of fiber integrity consistent with degenerative damage. METHODS Fourteen patients with very-late-onset schizophrenia-like psychosis and an age-matched control group underwent diffusion tensor magnetic resonance imaging. Tract maps were constructed for each subject from the imaging data, and measurements of fractional anisotropy and mean diffusivity were made within the uncinate, superior longitudinal, and inferior occipito-frontal fasciculi, and the cingulum. RESULTS There were no significant differences in fractional anisotropy, a measure of the ordering of axons within fiber tracts, nor in mean diffusivity, an orientationally-averaged measure of the bulk diffusivity within each voxel, between patients and control subjects. CONCLUSION The lack of difference in fractional anisotropy and mean diffusivity measures between patients and controls argues against the presence of structural abnormalities within these tracts and the notion that a focal white-matter abnormality within the tracts investigated underpins the onset of psychosis.

Increased striatal dopamine (D2/D3) receptor availability and delusions in Alzheimer disease

Objective: Dysfunction within corticostriatal dopaminergic neurocircuitry has been implicated in neuropsychiatric symptoms associated with Alzheimer disease (AD). This study aimed to test the hypothesis that the symptom domains delusions and apathy would be associated with striatal dopamine (D2) receptor function in AD. Methods: In vivo dopamine (D2/D3) receptor availability was determined with [11C]raclopride (RAC) PET in 23 patients with mild and moderate probable AD. Behavioral symptoms were measured using the Neuropsychiatric Inventory and the Apathy Inventory. Imaging data were analyzed using a region-of-interest approach. The potential confounding effects of age, sex, and disease stage were explored using a linear mixed model. Correlational and independent samples comparisons were used to examine the relationship between behavioral and binding potential (BPND) measures. Results: Mean [11C]RAC BPND was higher in patients with delusions (n = 7; 5 men) than in patients without delusions (n = 16; 6 men) (p = 0.006). When women were excluded from the analysis, [11C]RAC BPND was higher in men with delusions than in men without delusions (p = 0.05). Apathy measures showed no association with [11C]RAC BPND. Conclusions: Striatal dopamine (D2/D3) receptor availability is increased in Alzheimer disease patients with delusions, to an extent comparable to that observed in drug-naive patients with schizophrenia. Whether this represents up-regulation of dopamine (D2) or possibly dopamine (D3) receptors and how this relates to responsivity of the striatal dopaminergic system merit further exploration. AD = Alzheimer disease; AI = Apathy Inventory; AST = associative striatum; BPND = binding potential; CAMCOG = Cambridge Cognitive Examination; DA = dopamine; LS = limbic striatum; MMSE = Mini-Mental State Examination; MRC = Medical Research Council; non-AC = non–attenuated corrected; NPI = Neuropsychiatric Inventory; RAC = raclopride; ROI = region of interest; SMST = sensorimotor striatum.

Dopamine release in the human striatum: motor and cognitive tasks revisited

Striatal dopamine (DA) release has been shown during behavioural tasks, but the relative contribution of motor, reward, and cognitive components is unclear. Dopamine release was quantified using [11C]-raclopride in two studies using a triple-scan approach, comprising active task, motor control, and rest. In the first, bolus radiotracer was delivered during a sequential motor learning paradigm; in the second, a spatial planning task, bolus plus constant infusion was applied. [11C]-raclopride binding potentials (BPNDs) in striatal functional subdivisions were compared across conditions. [11C]-raclopride BPND was significantly reduced in active task compared with rest in both the sensorimotor and associative striatum in both studies, because of differences between rest and motor control conditions. In both regions, the motor control BPND fell between the rest and active task in the planning study, but the difference between motor control and active task conditions was not significant. No such changes were observed in the limbic striatum. Using rigorous methodology, this study validates earlier evidence that striatal DA release occurs during behavioural challenges. Increased DA release during movement was reliably detected in the sensorimotor and associative striatum, supporting use of the functional subdivision model in humans. No additional DA release was observed specific to the cognitive component of either task.

Striatal dopamine (D2) receptor availability predicts socially desirable responding.

Research in non-human primates has implicated striatal dopamine (D2) receptor function in the expression of social dominance--a fundamental component of social extraversion. We predicted that trait extraversion - indexed by the revised Eysenck Personality Questionnaire (EPQ-R) - would correlate with striatal DA (D2) receptor measures - indexed by [(11)C]-Raclopride binding potential (BP) - in 28 healthy post-menopausal females (mean age=75 years; range=58-91 years). Region of interest (ROI) and voxel-based statistical parametric mapping (SPM) analyses were performed, using a reference tissue model for [(11)C]-Raclopride. ROI analysis showed moderately significant negative correlations between extraversion and BP measures in the left caudate and between psychoticism scores and BP in the right putamen. Unexpectedly, scores on the Lie scale, a measure of socially desirable responding, were significantly and negatively correlated with BP measures in the putamen and survived Bonferroni correction on the right side. After controlling for the potential confounding of self-report bias in high Lie scorers, only the correlation between Lie scores and BP measures in the right putamen remained significant. Voxel-based analysis showed only Lie scores to be significantly and negatively correlated with BP measures in the right putamen. We explored this association further by applying an ROI-based approach to data on a previously scanned sample of young adults (n=13) and found a similar pattern of association, which achieved trend level significance in the right putamen. Although unanticipated, the relationship observed between BP measures in the right putamen and Lie scores is consistent with dopaminergic involvement in socially rewarding behaviour. How this relates to dopaminergic tone will need to be further explored.

Origins of delusions in Alzheimer's disease.

Research over the past two decades supports a shared aetiology for delusions in Alzheimers disease (AD) and schizophrenia. Functional networks involved in salience attribution and belief evaluation have been implicated in the two conditions, and striatal D2/3 receptors are increased to a comparable extent. Executive/frontal deficits are common to both disorders and predict emergent symptoms. Putative risk genes for schizophrenia, which may modify the AD process, have been more strongly implicated in delusions than those directly linked with late-onset AD. Phenotypic correlates of delusions in AD may be dependent upon delusional subtype. Persecutory delusions occur early in the disease and are associated with neurochemical and neuropathological changes in frontostriatal circuits. In contrast, misidentification delusions are associated with greater global cognitive deficits and advanced limbic pathology. It is unclear whether the two subtypes are phenomenologically and biologically distinct or are part of a continuum, in which misidentification delusions manifest increasingly as the pathological process extends. This has treatment implications, particularly if they are found to have discrete chemical and/or pathological markers.

Midlife Neuroticism and the age of onset of Alzheimer's disease

BACKGROUND There may be important public health implications of increasing our knowledge of factors associated with age of dementia onset. The pre-morbid personality domain of Neuroticism constituted an interesting and theoretically plausible, yet uninvestigated, candidate for such an association. We aimed to examine whether midlife Neuroticism was associated with earlier age of onset of Alzheimers disease (AD). METHOD This was a case-comparison study of 213 patients with probable AD. Detailed clinical information was collected for all patients including age of onset of dementia symptoms. One or two knowledgeable informants rated each patients midlife personality retrospectively using the Neuroticism, Extraversion, Openness Five-Factor Inventory (NEO-FFI) questionnaire. The relationship between midlife Neuroticism and age of dementia onset was evaluated using both correlational analysis and backward linear regression analysis. RESULTS Midlife Neuroticism predicted younger age of dementia onset in females but not in males. The association found in females was independent of pre-morbid history of affective disorder. CONCLUSIONS This finding and its potential mechanism warrant further investigation.

Truth, lies or self-deception? Striatal D(2/3) receptor availability predicts individual differences in social conformity.

Previous positron emission tomography (PET) studies have consistently shown a negative association between striatal D(2/3) receptor availability and socially desirable responding (SDR). However, as SDR is a complex personality trait, the functional significance of this relationship is unclear. The aim of the present study was to determine whether the relationship between D(2/3) receptor availability and SDR reflects a tendency to present oneself positively to others, consistent with social conformity (impression management, IM), or the tendency to view ones own behavior positively (self-deceptive enhancement, SDE). Striatal D(2/3) receptor availability was assessed in 23 healthy volunteers using [(11)C]raclopride PET. SDR was assessed using the Lie scale of the revised Eysenck Personality Questionnaire, and IM and SDE were measured using the Paulhus Deception Scales. Analysis of personality variables revealed a positive relationship between Lie and log IM (r=0.64, p=0.01) but not Lie and SDE (r=-0.36, ns). Consistent with previous findings, Lie was negatively associated with D(2/3) receptor availability in the sensorimotor striatum (r=- 0.55, p=0.05), and a similar trend-level relationship was observed for log IM (r=-0.54 p=0.06) but not SDE (r=0.23, ns). Whilst these associations are modest, results suggest that striatal D(2/3) receptor availability may be particularly associated with social conformity, rather than self-deception.

Establishing Test–Retest Reliability of an Adapted [18F]Fallypride Imaging Protocol in Older People

[ 18 F]fallyprlde is a high-affinity dopamine D2/3 receptor tracer with the ability to reliably quantify D2/3 receptor sites in both striatal and corticolimbic regions. The translational potential of [ 18 F]fallypride imaging is, however, limited by the lengthy scanning sessions (60–80 minutes duration over a total of 3–4 hours) required by current protocols. The aims of our study were to adapt [ 18 F]fallypride imaging for use in clinical populations with neurological and neuropsychiatric disorders, by reducing the duration of individual scanning sessions;and to establish the reproducibility and reliability of our adapted protocol in healthy older people. Eight participants (five male and three female;mean age = 75.87 ± 4.39 years) were scanned twice, 4–6 weeks apart. [ 18 F]fallypride binding potential was determined from image data collected during three sampling times: 0-30;60-90;and 210–240 minutes post injection. High reproducibility and reliability (test-retest variability <8%;intraclass correlation coefficient >0.8) were observed in all but the prefrontal regions, and remained so when sampling times were reduced to 20 minutes (0-20;70-90;220-240 minutes). The adapted protocol is feasible for use across neuropsychiatric disorders in which dopamine has been implicated and is sufficiently sensitive to detect within-subject changes between 2.7% and 5.5% in striatal and limbic regions.