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. 2022 Sep 13:14:975390.
doi: 10.3389/fnagi.2022.975390. eCollection 2022.

Iron deposition heterogeneity in extrapyramidal system assessed by quantitative susceptibility mapping in Parkinson's disease patients with type 2 diabetes mellitus

Wanyao Li  1 , Bingbing Gao  1 , Wei Du  1 , Yuhan Jiang  1 , Jing Yang  1 , Rui Hu  1 , Yangyingqiu Liu  1 , Na Liu  1 , Yukun Zhang  1 , Qingwei Song  1 , Yanwei Miao  1
Affiliations

Iron deposition heterogeneity in extrapyramidal system assessed by quantitative susceptibility mapping in Parkinson's disease patients with type 2 diabetes mellitus

Wanyao Li et al. Front Aging Neurosci. .

Abstract

Purpose: Excessive brain iron depositions were found in both patients with Parkinson's disease (PD) and those with type 2 diabetes mellitus (T2DM). The present study aimed to explore iron deposition and heterogeneity in the extrapyramidal system in PD patients with T2DM using quantitative susceptibility mapping (QSM) and further to reveal the effect of T2DM on the changes in brain iron in patients with PD.

Materials and methods: A total of 38 PD patients with T2DM (PDDM), 30 PD patients without T2DM (PDND), and 20 asymptomatic control subjects (CSs) were recruited for this study. All subjects underwent multiple MRI sequences involving enhanced gradient echo T2 star weighted angiography (ESWAN). The magnetic sensitivity values (MSV) and volume of the whole nuclei (MSVW, VW) and high iron region (MSVRII, VRII) were measured on the bilateral caudate nucleus (CN), the putamen (PUT), the globus pallidus (GP), the substantia nigra (SN), the red nucleus (RN) and the dentate nucleus (DN). Clinical and laboratory data were recorded, especially for the Hoehn and Yahr (H-Y) stage, the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Hamilton Depression Rating Scale (HAMD), and the Hamilton Anxiety Rating Scale (HAMA). All QSM data were compared between PDDM and PDND groups and correlated with clinical and laboratory data.

Results: Compared to the PDND group, the VRII/VW of the left CN was significantly increased in the PDDM group. Significantly higher MSVW and MSVRII were also found in the PDDM group, including bilateral SN of MSVW, right PUT, and bilateral CN, GP, and SN of MSVRII. The H-Y stage of the PDDM group was significantly higher than that of the PDND group. The MSVRII of bilateral RN of the PDDM group was positively correlated with the HAMA scores. HDL, DBP, and SBP levels were associated with MSVRII of right CN in the PDDM group.

Conclusion: T2DM could aggravate the disease severity and anxiety in patients with PD. The iron distribution of deep gray matter nuclei in PD patients with T2DM was significantly heterogeneous, which was related to blood pressure and blood lipids.

Keywords: Parkinson’s disease; heterogeneity; iron; magnetic sensitivity value; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
A 61-year-old female of PDDM group. Regions of interest selected on susceptibility maps. (A) Green-caudate nucleus; orange-putamen; blue-globus pallidus; (B) Red-substantia nigra; yellow-red nucleus; (C) purple-dentate nucleus. Panels (D–F) were based on the MSV threshold, the purple regions were the obtained high iron content region of the corresponding nuclei. (D) Right caudate nucleus; (E) right globus pallidus; (F) right putamen.
FIGURE 2
FIGURE 2
Comparisons of MSVw and MSVRII of gray matter nucleus in brain between PDDM and PDND group. The results in the figures showed that iron deposition in the PDDM group was greater than that in the PDND group in most nuclei except for the R-DN. For MSVw, there were significant differences in the R-SN and L-SN (A); For MSVRII, there were significant differences in the R-CN, L-CN, R-PUT, R-GP, L-GP, R-SN, and L-SN (B). *P < 0.05. MSVW, MSV of the whole nuclei; MSVRII, MSV of the high iron region; PDDM, PD with T2DM; PDND, PD without 20 T2DM; R, right; L, left; CN, caudate nucleus; PUT, putamen; GP, globus pallidus; SN, substantia nigra; RN, red nucleus; DN, dentate nucleus.
FIGURE 3
FIGURE 3
Comparisons of VRII/VW of gray matter nucleus in brain between PDDM group and PDND group. The results in the figure showed that VRII/VW in the PDDM group were greater than that in the PDND group in most nuclei. There was significant differences in the L-CN. *P < 0.05. VW, volume of the whole nuclei; VRII, volume of the high iron region; PDDM, PD with T2DM; PDND, PD without T2DM; R, right; L, left; CN, caudate nucleus; PUT, putamen; GP, globus pallidus; SN, substantia nigra; RN, red nucleus; DN, dentate nucleus.
FIGURE 4
FIGURE 4
Correlation of MSVRII and HAMA scores in PDDM Group. Positive correlation between MSVRII of R-RN, L-CN and HAMA score in PDDM group. MSVRII, MSV of the high iron region; PDDM, PD with T2DM; R-CN, right-caudate nucleus; L-CN, left-caudate nucleus; HAMA, Hamilton anxiety scale.
FIGURE 5
FIGURE 5
The results of multiple linear regression. (A) SBP level (B = 0.409, β = 0.488, R2 = 0.227, P = 0.021) was positively correlated with MSVRII of R-CN in PDDM group. (B) DBP level (B = -0.634, β = -0.482, R2 = 0.227, P = 0.023) was negatively correlated with MSVRII of R-CN in PDDM group. (C) HDL level (B = -17.835, β = -0.458, R2 = 0.227, P = 0.023) was negatively correlated with MSVRII of R-CN in PDDM patients. MSVRII, MSV of the high iron region; PDDM, PD with T2DM; R-CN, right caudate nucleus; SBP, systolic pressure; DBP, diastolic pressure; HDL, high-density lipoprotein.
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