PMC7272572_01
Multimodal imaging findings in a patient with posterior cortical atrophy at baseline and follow-up investigations. (Left) Positron emission tomography (PET) with F18-fluorodesoxyglucose (FDG-PET) reveals decreases in glucose metabolism: upper row in the patient (SUV standardized uptake value), second row compared to a healthy control cohort using NEUROSTAT/3D-SSP software (https://neurostat.neuro.utah.edu). Bottom rows show amyloid-beta accumulation in patient's individual F18-florbetaben PET scan compared to a healthy control cohort using Hermes BRASS software (Hermes Medical Solution, Stockholm, Sweden). (Right) Structural magnetic resonance imaging (MRI), T1 sequence, illustrating atrophy. Note that Capgras delusion was firstly evident between third and fourth follow-up. L, left; R, right.
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Figure 1 illustrates brain imaging findings. As illustrated in Figure 1 structural MRI indicated regional atrophy with slight increase in extent but without qualitative changes. Structural MRI (Figure 1) revealed more widespread atrophy compared with the previous MRIs, especially in temporoparietooccipital areas.
Quantifying dynamic structural imaging changes in single-subject voxel-based morphometry analysis. (Left) Top panel displays results of the voxel-based morphometry analysis showing, at each timepoint, the impairment in gray matter volume (GMV) in the patient compared to a normative elderly healthy control group. Bottom panel shows overlay of patient's atrophy across the four timepoints, clearly displaying disease progression over time. The same results are presented in Supplementary Video S3. (Right) Results of the regions-of-interest (ROI) analysis illustrating atrophy progression (GMV decline). The upper graph is related to the progression of the disease in the overall disease-specific pattern, i.e., regions affected at fourth follow-up. The middle and the bottom graphs show GMV changes in the clusters timely associated with the emergence of Capgras delusion, i.e., right posterior cingulate gyrus/precuneus, and middle frontal gyrus/frontal eye field (respectively, centered at MNI coordinates x, y, z 4, -32, 44 and 28, 0, 51). Significant results are shown at p < 0.05 family-wise error corrected (FWE) at cluster level (cluster forming threshold p < 0.005). Images are displayed in radiological convention: left of the figure displayed on the right of the image.
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Most specific changes during transition from the third to the fourth follow-up, i.e., the appearance of the Capgras delusion, are illustrated in yellow color in the left bottom panel in Figure 2 and in Supplementary Video S3. GMV values in the healthy control group were always higher in all of the three investigated regions. GMV values declined with each follow-up in all of the three ROIs (Figure 2, right panel).
Extracting functionally impaired brain networks by mapping atrophy to resting-state networks and functional co-activations. (Top) Graphical representation of the clusters of brain atrophy timely associated with the emergence of Capgras delusion, i.e., right posterior cingulate gyrus/precuneus, and middle frontal gyrus/frontal eye field. Coordinates of the maxima for each of the two clusters are reported in MNI space in the figure: x, y, z 4, -32, 44, and 28, 0, 52. (Middle) Results of the meta-analytic co-activation modeling (MACM) across >14,000 fMRI studies from the Neurosynth database (https://neurosynth.org/). Red blobs represent z-scores after correction for false discovery rate (FDR). (Bottom) Results of the seed-based resting-state functional connectivity analysis on an independent sample of N = 1,000 healthy controls generated with Neurosynth. Red blobs show Pearson's correlations with the seed, thresholded at r >= 0.2, uncorrected. Images are displayed in radiological convention. Left of the figure displayed on the right of the image.
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Most specific changes during transition from the third to the fourth follow-up, i.e., the appearance of the Capgras delusion, are illustrated in yellow color in the left bottom panel in Figure 2 and in Supplementary Video S3. Results from both MACM and seed-based resting-state functional connectivity were highly consistent for each seed (Figure 3).