Distinct atrophy of septal nuclei in Parkinson's disease

Parkinson's disease (PD) mainly affects basal ganglia including septal nuclei. Septal nuclei have extensive cholinergic connections with thalamus and brain stem nuclei. We hypothesized that the degeneration of septal nuclei has an impact on dopaminergic (motor) and non-dopaminergic (cognitive) symptoms in PD.

Clinical and MRI data of 80 patients with Parkinson's disease and 20 healthy controls (HC) with a structural magnetic resonance imaging (MRI) were selected from their first visit from PPMI database. Septal nuclei were manually segmented from T1W images according to previously established anatomical criteria. In addition, subcortical structures such as thalamus, amygdala, hippocampus, caudate, putamen, pallidum and accumbens were automatically segmented.

Volume of septal nuclei in the patients with PD was decreased in comparison with controls. These changes were independent of volume changes in other subcortical grey structure in PD. In addition, we found a correlation between motor components of unified Parkinson's disease rating scale (UPDRS) and volume of septal nuclei in PD. Other clinical measures such as olfactory test, upper extremity function (mobility) performance, total UPDRS, lower extremity function (mobility) performance, and cognitive function were significantly more in PD group than in control. No correction was found between cognitive function and volume of septal nuclei.

We concluded that septal nuclei is distinctly affected in PD and is strongly associated with motor impairment. This may be a modulatory effect of cholinergic system on dopaminergic and glutamergic system. It is suggested that volume of septal nuclei may be a useful biomarker in PD diagnosis and monitoring.