Cognitive deficits in Machado-Joseph disease correlate with hypoperfusion of visual system areas.
Cognitive and olfactory impairments have previously been demonstrated in patients with spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD)-SCA3/MJD. We investigated changes in regional cerebral blood flow (rCBF) using single-photon emission computed tomography (SPECT) imaging in a cohort of Brazilian patients with SCA3/MJD. The aim of the present study was to evaluate the correlation among rCBF, cognitive deficits, and olfactory dysfunction in SCA3/MJD. Twenty-nine genetically confirmed SCA3/MJD patients and 25 control subjects were enrolled in the study. The severity of cerebellar symptoms was measured using the International Cooperative Ataxia Rating Scale and the Scale for the Assessment and Rating of Ataxia. Psychiatric symptoms were evaluated by the Hamilton Anxiety Scale and Beck Depression Inventory. The neuropsychological assessment consisted of Spatial Span, Symbol Search, Picture Completion, the Stroop Color Word Test, Trail Making Test (TMT), and Phonemic Verbal Fluency. Subjects were also submitted to odor identification evaluation using the 16-item Sniffin' Sticks. SPECT was performed using ethyl cysteine dimer labeled with technetium-99m. SCA3/MJD patients showed reduced brain perfusion in the cerebellum, temporal, limbic, and occipital lobes compared to control subjects (pFDR <0.001). A significant positive correlation was found between the Picture Completion test and perfusion of the left parahippocampal gyrus and basal ganglia in the patient group as well as a negative correlation between the TMT part A and bilateral thalamus perfusion. The visuospatial system is affected in patients with SCA3/MJD and may be responsible for the cognitive deficits seen in this disease.
Ataxia Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil. pbraganeto@hotmail.com
Pedro
P
Braga-Neto
Lívia Almeida
LA
Dutra
José Luiz
JL
Pedroso
André C
AC
Felício
Helena
H
Alessi
Ruth F
RF
Santos-Galduroz
Paulo Henrique F
PH
Bertolucci
Mário Luiz V
ML
Castiglioni
Rodrigo Affonseca
RA
Bressan
Griselda Esther Jara
GE
de Garrido
Orlando Graziani Povoas
OG
Barsottini
Andrea
A
Jackowski
D000328:Adult; D001007:Anxiety / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D017827:Machado-Joseph Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010477:Perfusion / Q000009:adverse effects; D015899:Tomography, Emission-Computed, Single-Photon; D014792:Visual Acuity