Brain imaging and cognition in young narcoleptic patients.
The relationship between functional brain images and performances in narcoleptic patients and controls is a new field of investigation. We studied 71 young, type 1 narcoleptic patients and 20 sex- and age-matched control individuals using brain positron emission tomography (PET) images and neurocognitive testing. Clinical investigation was carried out using sleep-wake evaluation questionnaires; a sleep-wake study was conducted with actigraphy, polysomnography, multiple sleep latency test (MSLT), and blood tests (with human leukocyte antigen typing). The continuous performance test (CPT) and Wisconsin card sorting test (WCST) were administered on the same day as the PET study. PET data were analyzed using Statistical Parametric Mapping (version 8) software. Correlation of brain imaging and neurocognitive function was performed by Pearson's correlation. Statistical analyses (Student's t-test) were conducted with SPSS version-18. Seventy-one narcoleptic patients (mean age: 16.15 years, 41 boys (57.7%)) and 20 controls (mean age: 15.1 years, 12 boys (60%)) were studied. Results from the CPT and WCST showed significantly worse scores in narcoleptic patients than in controls (P < 0.05). Compared to controls, narcoleptic patients presented with hypometabolism in the right mid-frontal lobe and angular gyrus (P < 0.05) and significant hypermetabolism in the olfactory lobe, hippocampus, parahippocampus, amygdala, fusiform, left inferior parietal lobe, left superior temporal lobe, striatum, basal ganglia and thalamus, right hypothalamus, and pons (P < 0.05) in the PET study. Changes in brain metabolic activity in narcoleptic patients were positively correlated with results from the sleepiness scales and performance tests. Young, type 1 narcoleptic patients face a continuous cognitive handicap. Our imaging cognitive test protocol can be useful for investigating the effects of treatment trials in these patients.
Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan; Department of Clinical Psychology College of Medicine, FU JEN Catholic University, Taipei, Taiwan.
Yu-Shu
YS
Huang
Department of Nuclear Medicine, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan.
Feng-Yuan
FY
Liu
Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan.
Chin-Yang
CY
Lin
Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital and College of Medicine, Taoyuan, Taiwan.
Ing-Tsung
IT
Hsiao
Stanford University Sleep Medicine Division, Redwood City, CA, USA. Electronic address: cguil@stanford.edu.
Christian
C
Guilleminault
D000293:Adolescent; D001921:Brain / Q000378:metabolism*; D003071:Cognition; D005260:Female; D005625:Frontal Lobe / Q000378:metabolism; D006801:Humans; D008297:Male; D009290:Narcolepsy / Q000000981:diagnostic imaging* / Q000378:metabolism*; D009483:Neuropsychological Tests; D017286:Polysomnography; D049268:Positron-Emission Tomography / Q000379:methods; D012894:Sleep Stages / Q000502:physiology; D013702:Temporal Lobe / Q000378:metabolism
18-F FDG positron emission tomography; Brain image; Cognition; Hypermetabolism; Hypometabolism; Narcolepsy