Prefrontal activity in Huntington's disease reflects cognitive and neuropsychiatric disturbances: The IMAGE-HD study

• Published in: Experimental neurology Vol. 239; pp. 218 - 228
• Main Authors: Gray, M.A., Egan, G.F., Ando, A., Churchyard, A., Chua, P., Stout, J.C., Georgiou-Karistianis, N.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.01.2013; Elsevier
• Subjects: Adult; Attention; Biological and medical sciences; Cognition - physiology; Data Interpretation, Statistical; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disease Progression; DLPFC; Executive function; Executive Function - physiology; Female; fMRI; Gyrus Cinguli; Humans; Huntington Disease - genetics; Huntington Disease - pathology; Huntington Disease - psychology; Huntington's disease; Image Processing, Computer-Assisted; Longitudinal Studies; Magnetic Resonance Imaging; Male; Medical sciences; Mental Disorders - etiology; Mental Disorders - pathology; Middle Aged; Neostriatum - physiopathology; Neurology; Neuropsychological Tests; Oxygen - blood; Prefrontal Cortex - pathology; Psychomotor Performance - physiology; Reaction Time - physiology; Set shifting; fMRI; Executive function; DLPFC; Huntington's disease; Set shifting; Attention; Nervous system diseases; Cognitive disorder; Huntington disease; Nuclear magnetic resonance imaging; Genetic disease; Cerebral disorder; Central nervous system disease; Degenerative disease; Extrapyramidal syndrome
• ISSN: 0014-4886; 1090-2430
• DOI: 10.1016/j.expneurol.2012.10.020

Functional integrity of prefrontal cortico-striatal circuits underlying executive functioning may be compromised by basal ganglia degeneration during Huntington's disease (HD). This study investigated challenged inhibitory attentional control with a shifting response-set (SRS) task whilst assessing neural response via functional magnetic resonance imaging (fMRI) in 35 healthy controls, 35 matched pre-symptomatic (pre-HD) and 30 symptomatic (symp-HD) participants. A ≥70% performance accuracy threshold allowed confident identification of neural activity associated with SRS performance in a sub-set of 33 healthy controls, 32 pre-HD and 20 symp-HD participants. SRS activated dorsolateral prefrontal and dorsal anterior cingulate cortices, premotor, parietal, and basal ganglia regions and deactivated subgenual anterior cingulate cortex. Symp-HD participants showed greater prefrontal functional responses relative to controls and pre-HD, including larger activations and larger deactivations in response to cognitive challenge, consistent with compensatory neural recruitment. We then investigated associations between prefrontal BOLD responses, SRS performance accuracy and neuropsychiatric disturbance in all participants, including those below SRS performance accuracy threshold. We observed that reduced prefrontal responsivity in symp-HD was associated with reduced accuracy in SRS performance, and with increased neuropsychiatric disturbance within domains including executive dysfunction, pathological impulses, disinhibition, and depression. These findings demonstrate prefrontal response during inhibitory attentional control usefully characterises cognitive and neuropsychiatric status in symp-HD. The functional integrity of compensatory prefrontal responses may provide a useful marker for treatments which aim to sustain cognitive function and delay executive and neuropsychiatric disturbance. ► Symp-HD displayed increased compensatory BOLD responses whilst shifting response set. ► Symp-HD prefrontal BOLD responses reflected cognitive and neuropsychiatric function. ► Shifting response set in symp-HD is informative of generalised cognitive disturbance.