Biomedical subjects

Jesús Pujol

Publications and source records attributed to Jesús Pujol.

12 recordsLinked to original sources

PubMed2004

Age-related metabolic changes in the upper brainstem tegmentum by MR spectroscopy.

Several neurodegenerative disorders have a profound metabolic and structural impact on the brainstem. MR spectroscopy provides metabolic information non-invasively and has the potential to characterize the changes associated with normal aging and differentiate them from neurodegenerative alterations. The present work was aimed at studying the upper brainstem tegmentum at the midbrain and pontine levels in 57 adult normal volunteers, aged 23-79 years, with long-echo time proton MR spectroscopy to evaluate possible regional differences and the effect of age. Higher ratios of N-acetyl aspartate (NAA)/total creatine (Cr) and choline-containing compounds (Cho)/Cr were observed in the pons compared to the midbrain, resulting from higher net NAA and Cho content. In the midbrain, there was a linear decline of NAA and Cho with age in subjects over 50, most probably related to neuronal tissue loss. In the pons, such an aging effect was not observed, with subjects over 50 showing higher Cr and Cho than the under-50 subjects. Our findings provided evidence of regional differences and suggest different effects of age on the two studied brainstem segments, hitherto undescribed.

Adult↗

PubMed2004

Mapping structural brain alterations in obsessive-compulsive disorder.

BACKGROUND: Recent technical developments have made it feasible to comprehensively assess brain anatomy in psychiatric populations. OBJECTIVE: To describe the structural brain alterations detected in the magnetic resonance images of a large series of patients with obsessive-compulsive disorder (OCD) using imaging procedures that allow the evaluation of volume changes throughout the brain. DESIGN: Case-control study. SETTING: Referral OCD unit in a tertiary hospital. PARTICIPANTS: A consecutive sample of 72 outpatients with OCD and 72 age- and sex-matched control subjects. INTERVENTIONS: Three-dimensional sequences were obtained in all participants. A statistical parametric mapping approach was used to delineate possible anatomical alterations in the entire brain. To preserve volumetric information, voxel values were modulated by the Jacobian determinants (volume change measurement) derived from spatial normalization. MAIN OUTCOME MEASURES: Voxelwise brain volumes. RESULTS: The brains of patients with OCD showed reduced gray matter volume in the medial frontal gyrus, the medial orbitofrontal cortex, and the left insulo-opercular region. A relative increase in gray matter volume was observed bilaterally in the ventral part of the putamen and in the anterior cerebellum. All these brain alterations were abnormally correlated in patients with OCD, and age statistically significantly contributed to the relative enlargement observed in the striatal areas. Disease severity, the nature of symptoms, and comorbidities were not related to the changes described. Nevertheless, patients with prominent aggressive obsessions and checking compulsions showed reduced amygdala volume in the right hemisphere. CONCLUSIONS: The pattern of anatomical features depicted by this voxelwise approach is consistent with data from functional studies. The reported anatomical maps identified the specific parts of the frontostriatal system that were altered in patients with OCD and detected changes in anatomically connected distant regions. These data further define the structural brain alterations in OCD and may contribute to constraining the prevailing biological models of this psychiatric process.

Adolescent↗

PubMed2004

Delayed myelination in children with developmental delay detected by volumetric MRI.

Delayed acquisition of developmental motor and cognitive milestones is a common clinical expression of many etiological processes. Imaging exams of developmentally delayed children often show no structural brain alterations despite suspicion of brain maturation delay. MRI studies increasingly suggest that white matter myelination finely reflects the progression in functional brain maturation. In this volumetric MRI study, we sought to evaluate whether developmental delay in children with normal conventional MRI exams is associated with reduced myelinated white matter. A total of 100 children (mean age, 4.4 years) with developmental delay and 50 normally developing age-matched control children underwent 3-D MRI to measure the volume of myelinated white matter. Patients showed a significant reduction in the relative content of myelinated white matter (accounting for 19.8% of brain volume in patients and 21.4% in control subjects, P = 0.005). The observed difference was equivalent to a 3.2-year myelination delay. Although the whole hemispheres were invariably symmetrical, the volume of myelinated white matter was asymmetrical in 30% of patients and 10% of control subjects (P = 0.006). We conclude that volumetric assessment of white matter may reveal a reduction in brain myelination beyond early childhood in developmentally delayed children showing normal brain appearance. This finding further emphasizes the view of white matter myelination as an indicator of functional brain maturation.

Age Distribution↗

PubMed2003

Quantitative signal intensity measures on magnetic resonance imaging in attention-deficit hyperactivity disorder.

OBJECTIVE: The aim of this study was to investigate possible abnormalities of cerebral myelination in subjects with attention-deficit hyperactivity disorder (ADHD). BACKGROUND: Anatomic and functional neuroimaging studies of subjects with ADHD demonstrated a right frontostriatal deficit and abnormal cerebral asymmetries. Some also reported white matter abnormalities, such as smaller white matter volumes in the right anterior-superior frontal region, and the smaller bilateral retrocallosal region. Smaller volumes in specific areas of the corpus callosum have also been reported. We hypothesized that white matter signal intensities may also show differences indicating abnormal cerebral myelination. METHOD: We analyzed T2-weighted magnetic resonance images of 11 adolescents with ADHD and 20 controls. Regions of interest were set in both the white and gray matter in frontal and parieto-occipital associative regions. RESULTS: The ADHD group showed a higher signal intensity ratio, probably reflecting a higher degree of myelination. Significant interhemispheric differences emerged only in the posterior region in the ADHD group. CONCLUSIONS: The higher degree of myelination in the right frontal region of ADHD may be due to a compensatory mechanism for the right frontostriatal dysfunction.

Adolescent↗

PubMed2003

Beneficial effect of donepezil on sensorimotor function after stroke.

Pharmacotherapy of poststroke sensorimotor deficits is currently used alone or combined with physiotherapy to promote recovery of mobility problems. This case study examined the effectiveness of donepezil hydrochloride (HCl) administered to a stroke patient with chronic, dense, left sensorimotor deficit. The patient received donepezil HCl (5 mg daily for 4 wk, followed by 10 mg daily for 12 wk) but no physiotherapy. Baseline and posttreatment evaluations were performed with the Fugl-Meyer scale and the Rivermead Mobility Index. One month after starting donepezil HCl (10 mg/day), sensorimotor function improved dramatically in the hemiplegic lower limb and shoulder. It was concluded that donepezil HCl may be an effective treatment for improving sensorimotor function in chronic stroke patients. Randomized controlled trials are required to support these preliminary findings.

Cholinesterase Inhibitors↗

PubMed2003

Enlargement of brain cerebrospinal fluid spaces as a predictor of poor clinical outcome in melancholia.

BACKGROUND: A number of recent neuroimaging findings in depression have provided new insight into the biological substratum of depressive illness. The question now is what particular relevance the structural brain alteration described may have within the clinical context of depressive patients. We investigated a possible relationship between brain cerebrospinal fluid (CSF) space changes and patient prognosis in melancholic depression. METHOD: Fifty-five patients who met DSM-IV criteria for major depressive disorder with melancholic features were examined with 3-dimensional magnetic resonance imaging, and CSF volumes were measured for global brain CSF and for lateral ventricles and left and right sylvian fissure regions. Clinical outcome was prospectively assessed during a 6-month standardized antidepressive treatment period (Phase I) and in a 2-year follow-up (Phase II) of recovered patients. The outcome measurements were total days to symptom remission (Phase I) and to eventual symptom relapse or recurrence (Phase II). The study took place from July 1998 to Dec. 2001. RESULTS: Phase I: Enlargement of CSF spaces in the left sylvian fissure region predicted poor treatment response. Volume measurements from this region accounted for 35% of remission time variance. Median time to full clinical remission was 82 days in patients with severe changes, 51 days in the case of mild-to-moderate CSF enlargement, and 35 days in patients with no left sylvian fissure region alterations. Phase II: Severe enlargement of global cortical CSF spaces was associated with increased risk of depression relapse or recurrence. Patients with severe cortical CSF changes showed a 7.8-fold excess risk of depression relapse/recurrence compared with patients with no cortical CSF space alteration. CONCLUSION: Our data suggest that MRI-detected CSF space enlargement may be an important neuroimaging marker for poor prognosis in melancholic depression.

Adult↗

PubMed2002

CSF spaces of the Sylvian fissure region in severe melancholic depression.

The Sylvian fissure region gathers lateral frontotemporal cortices and subcortical structures that are frequently disturbed in patients with mood disorders. We have investigated possible CSF space changes in this brain region in severe melancholic depression. Fifty-seven patients and 37 control subjects received three-dimensional MRI. CSF volumes were obtained for cerebral CSF, lateral ventricles, and both Sylvian fissure regions. As a group, patients showed a significant CSF space enlargement that was prominent around the Sylvian fissure, particularly in the left hemisphere. Likewise, evident leftward asymmetry was more frequent in the patient group (patients 31.6%, controls 2.7%). The combination of CSF space enlargement and the pattern of Sylvian CSF asymmetry predicted the patient condition with 62.2% specificity and 82.5% sensitivity. We conclude that, in the context of a broad severity spectrum of imaging alterations in severe melancholic depression, asymmetrical CSF space enlargement may be evident in the Sylvian fissure region.

Aged↗

PubMed2002

Anatomical variability of the anterior cingulate gyrus and basic dimensions of human personality.

This study focused on investigating a possible relationship between interindividual variability in the morphology of the cingulate gyrus and behavioral styles. Using magnetic resonance images obtained from 100 healthy young volunteers (50 women and 50 men), we measured the surface area of the anterior cingulate gyrus and related it to the scores on the Temperament and Character Inventory. Anatomical data revealed that hemispheric asymmetry in the anterior cingulate gyrus surface area was very common (83% of cases) and that a prominent right anterior cingulate was more frequent in women than in men. In the correlational analysis, surface measurements of the right anterior cingulate gyrus accounted for a 24% score variance in Harm Avoidance. Both women and men with larger right anterior cingulate described themselves as experiencing greater worry about possible problems, fearfulness in the face of uncertainty, shyness with strangers, and fatigability. Furthermore, women reported overall higher scores in Harm Avoidance than men; these gender differences were largely explained by gender differences in the right anterior cingulate area in a covariate analysis. Our observations suggest that a large right anterior cingulate is related to a temperamental disposition to fear and anticipatory worry in both genders and that a higher prevalence of these traits in women may be coupled with a greater expansion of this brain region.

Adult↗

PubMed2002

Fibrinogen and the amount of leukoaraiosis in patients with symptomatic small-vessel disease.

UNLABELLED: We investigated whether there is a direct correlation between plasma fibrinogen levels and the amount of leukoaraiosis (LA) in patients with symptomatic small-vessel disease. The study included 28 patients: 12 with a first-ever lacunar infarction (LI) and 16 with Binswanger's disease (BD). The mean age was 71 years (SD 8.6), and 21 were men. For each patient, we recorded demographic data, vascular risk factors and the results of blood chemistry analysis including fibrinogen (g/l), hematocrit (decimal fraction) and total serum proteins (g/l). A cerebral MR scan was performed in each patient and an LA score was obtained by an investigator blind to clinical data, using a semiquantified scale in six areas of each cerebral hemisphere (0-4 points in each area, total scoring range 0-48 points). RESULTS: The mean (SD) for the LA score was 18.9 (10.7) and for plasma fibrinogen 3.97 (1.1). Pearson's and Spearman's correlation coefficients between fibrinogen and LA score were 0.43 (p = 0.02) and 0.49 (p = 0.007), respectively. Multiple-regression analysis between groups (LI or BD) and fibrinogen versus LA score showed the strongest association for the BD group (p = 0.014) and a direct relation with fibrinogen (p = 0.018). No statistically significant association was found between LA score and age, sex, any vascular risk factor, hematocrit or total serum protein. CONCLUSION: There is a significant correlation between plasma fibrinogen levels and the amount of LA in patients with symptomatic cerebral small-vessel disease. This result suggests that fibrinogen may be involved in the pathophysiology of LA in these patients.

Aged↗

PubMed2002

The lateral asymmetry of the human brain studied by volumetric magnetic resonance imaging.

Improvements in in vivo imaging methods have boosted research on brain asymmetry aimed at further establishing putative anatomical substrates for brain functional lateralization and particularly to explain left-hemisphere specialization for language. We analyzed volume asymmetries for major anatomical divisions of the lateral (perisylvian) brain region and their relative white matter content. A total of 100 healthy right-handed subjects were examined with 3D magnetic resonance imaging (MRI). The insular plane was used to limit the lateral brain, and the sylvian fissure and central sulcus to define frontal, parietal, temporal, and temporo-parieto-occipital regions. Results revealed a frontal region showing similar volumes in both hemispheres, a parietal region and a temporal region both larger in the left hemisphere, and a temporo-parieto-occipital region with predominantly right-sided asymmetry. Volume measurements of the parietal, temporal, and temporo-parieto-occipital regions complemented each other and accounted for 58% of planum temporale area variations. All study regions showed significant asymmetry for relative white matter content (percentage of white matter relative to region volume). White matter asymmetry, however, was particularly relevant for the frontal and temporal regions showing a highly frequent left-sided pattern (frontal region, 90%; temporal region, 91% of subjects). Leftward asymmetry in these two regions occurred in both genders, although hemisphere differences were significantly larger in men. Results from this MRI volume analysis of structural asymmetries in the lateral brain region complement data obtained by other methods and suggest a high occurrence of leftward asymmetry for relative white matter content in language-related regions.

Adult↗

PubMed2002

Brainstem proton magnetic resonance spectroscopy in idopathic REM sleep behavior disorder.

STUDY OBJECTIVES: Rapid-eye-movement (REM) sleep behavior disorder (RBD) is thought to result from a dysfunction of the brainstem structures that regulate physiologic REM sleep muscle atonia. Proton magnetic resonance spectroscopy (1H-MRS) is a noninvasive method that allows detection of in vivo neuronal dysfunction in localized brain areas. The aim of our study was to investigate whether 1H-MRS can detect brainstem abnormalities in patients with idiopathic RBD. DESIGN: 1H-MRS centered on the midbrain and the pontine tegmentum was acquired in 15 patients with idiopathic RBD and 15 control subjects matched for age and sex. SETTING: University hospital sleep laboratory center. PARTICIPANTS: Fifteen untreated patients with chronic RBD diagnosed by history and video-polysomnography, normal neurologic examination, and normal cranial MRI. Fifteen healthy controls with no sleep complaints and normal polysomnography and brain MRI. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The metabolic peaks detectable with 1H-MRS, N-acetylaspartate (NAA), creatine-phosphocreatine (Cr), choline-containing compounds (Cho) and myoinositol (mI), and the ratios of NAA, Cho and ml to Cr were evaluated both in the midbrain and pontine tegmentum. No significant differences in N-acetylaspartate/creatine, choline/creatine and myoinosito/creatine ratios were found between patients and controls. CONCLUSIONS: The results do not suggest that marked mesopontine neuronal loss or 1H-MRS detectable metabolic disturbances occur in idiopathic RBD.

Aged↗

PubMedDate not supplied

Alexithymia correlates with the size of the right anterior cingulate.

OBJECTIVE: The authors investigated a possible relationship between interindividual variability in anterior cingulate gyrus (ACG) morphology and alexithymia. MATERIALS AND METHODS: Magnetic resonance images were obtained in 100 healthy university graduates (51 female, 49 male; mean age 25.6 y). Surface area measurements of the ACG were performed on reformatted sagittal views in both hemispheres. The Toronto Alexithymia Scale (TAS-20) and the Temperament and Character Inventory (TCI) were administered. RESULTS: Right ACG surface area significantly correlated with TAS-20 total score in men (r = 0.37; p = 0.009) and in women (r = 0.30; p = 0.034). After controlling for three TCI subscales (harm avoidance, self-directedness, and self-transcendency), the correlation between TAS-20 total and right ACG became nonsignificant in women, but was only slightly reduced (r = 0.32; p = 0.032) in men. A linear regression model with right ACG as a dependent variable revealed brain volume, TCI-harm avoidance and TAS 20 total score as significant predictors in the total sample (explained proportion of total variation (EPTV) 37%). In men, beside brain volume, only TAS-20 total score showed a highly significant contribution (EPTV 41%), whereas in women only TCI-harm avoidance was a significant predictor (EPTV 36%). CONCLUSIONS: The authors' findings indicate that there is a significant positive relation between the size of the right ACG and alexithymia as measured with the TAS in healthy subjects. This applies especially for men whereas in women ACG size is more associated with the subscale harm avoidance of the TCI. Our findings also suggest a partial lateralization of human emotion processing, especially negative emotion.

Adult↗