Cerebellar Volume and Disease Staging in Parkinson's Disease: An ENIGMA-PD Study.

Kerestes, Rebecca; Laansma, Max A; Owens-Walton, Conor; Perry, Andrew; van Heese, Eva M; Al-Bachari, Sarah; Anderson, Tim J; Assogna, Francesca; Aventurato, Ítalo K; van Balkom, Tim D; Berendse, Henk W; van den Berg, Kevin R E; Betts, Rebecca; Brioschi, Ricardo; Carr, Jonathan; Cendes, Fernando; Clark, Lyles R; Dalrymple-Alford, John C; Dirkx, Michiel F; Druzgal, Jason; ... (2023). Cerebellar Volume and Disease Staging in Parkinson's Disease: An ENIGMA-PD Study. Movement disorders, 38(12), pp. 2269-2281. Wiley 10.1002/mds.29611

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BACKGROUND

Increasing evidence points to a pathophysiological role for the cerebellum in Parkinson's disease (PD). However, regional cerebellar changes associated with motor and non-motor functioning remain to be elucidated.

OBJECTIVE

To quantify cross-sectional regional cerebellar lobule volumes using three dimensional T1-weighted anatomical brain magnetic resonance imaging from the global ENIGMA-PD working group.

METHODS

Cerebellar parcellation was performed using a deep learning-based approach from 2487 people with PD and 1212 age and sex-matched controls across 22 sites. Linear mixed effects models compared total and regional cerebellar volume in people with PD at each Hoehn and Yahr (HY) disease stage, to an age- and sex- matched control group. Associations with motor symptom severity and Montreal Cognitive Assessment scores were investigated.

RESULTS

Overall, people with PD had a regionally smaller posterior lobe (dmax  = -0.15). HY stage-specific analyses revealed a larger anterior lobule V bilaterally (dmax  = 0.28) in people with PD in HY stage 1 compared to controls. In contrast, smaller bilateral lobule VII volume in the posterior lobe was observed in HY stages 3, 4, and 5 (dmax  = -0.76), which was incrementally lower with higher disease stage. Within PD, cognitively impaired individuals had lower total cerebellar volume compared to cognitively normal individuals (d = -0.17).

CONCLUSIONS

We provide evidence of a dissociation between anterior "motor" lobe and posterior "non-motor" lobe cerebellar regions in PD. Whereas less severe stages of the disease are associated with larger motor lobe regions, more severe stages of the disease are marked by smaller non-motor regions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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