Large-scale resting state network correlates of cognitive impairment in Parkinson's disease and related dopaminergic deficits.

Cognitive impairment is a common non-motor feature of Parkinson’s disease (PD). The current study aimed to investigate resting state fMRI correlates of cognitive impairment in PD from a large-scale network perspective, and to assess the impact of dopamine deficiency on these networks. Thirty PD patients with resting state fMRI were included from the Parkinson’s Progression Marker Initiative (PPMI) database. Eighteen patients from this sample were also scanned with 123I-FP-CIT SPECT. A standardized neuropsychological battery was administered, evaluating verbal memory, visuospatial, and executive cognitive domains. Image preprocessing was performed using an SPM8-based workflow, obtaining time-series from 90 regions-of-interest (ROIs) defined from the AAL brain atlas. The Brain Connectivity Toolbox was used to extract nodal strength from all ROIs and modularity of the cognitive circuitry determined using the meta-analytical software Neurosynth. Brain-behavior covariance patterns between cognitive functions and nodal strength were estimated using Partial Least Squares. Extracted latent variable scores were correlated with performances in the three cognitive domains and striatal dopamine transporter binding ratios (SBR) using linear modeling. Finally, influence of nigrostriatal dopaminergic deficiency on modularity of the "cognitive network" was analyzed. Less severe executive impairment was associated with increased dorsal fronto-parietal cortical processing and inhibited subcortical and primary sensory involvement. This pattern was positively influenced by the relative preservation of nigrostriatal dopaminergic function. The pattern associated with better memory performance favored prefronto-limbic processing, and did not reveal associations with presynaptic striatal dopamine uptake. SBR ratios were negatively associated with modularity of the "cognitive network", suggesting integrative effects of the preserved nigrostriatal dopamine system on this circuitry.