Nucleus accumbens atrophy in Parkinson's disease (Mavridis' atrophy): 10 years later

Parkinson's disease (PD) is a common neurodegenerative disorder associated with gray matter atrophy. The human nucleus accumbens (NA) is a major part of the ventral striatum and modulator of the reward network of the brain. It plays an important role in several cognitive and emotional functions. In patients with PD, dysfunction of this nucleus is correlated not only with movement disorders but also with various neuropsychological deficits and psychiatric symptoms. The human NA suffers atrophy in PD, which is called Mavridis' atrophy (MA), a well established characteristic of PD that was first described 10 years ago. The purpose of this article is to review the current knowledge regarding the clinical significance of MA. We currently know that it begins in early-stage PD patients, precedes clinical phenotype, and is part of the degeneration of the dopaminergic nigrostriatal system in these patients. MA has several clinical consequences. It is, more specifically, associated with the expression (and severity) of specific neuropsychiatric PD symptoms, namely cognitive impairment, apathy, disinhibition, and impulsive behavior, while its association with motor symptoms remains unclear. MA was recently suggested as a marker of global dysfunction in the mesocorticolimbic network. With new research data, new questions about MA emerge and further research is obviously necessary in order to effectively apply MA, as an imaging finding, to clinical practice.