Hippocampal Metabolic Alterations in Amyotrophic Lateral Sclerosis: A Magnetic Resonance Spectroscopy Study

• Published in: Life (Basel, Switzerland) Vol. 13; no. 2; p. 571
• Main Authors: Christidi, Foteini, Argyropoulos, Georgios D, Karavasilis, Efstratios, Velonakis, Georgios, Zouvelou, Vasiliki, Kourtesis, Panagiotis, Pantoleon, Varvara, Tan, Ee Ling, Daponte, Ariadne, Aristeidou, Stavroula, Xirou, Sofia, Ferentinos, Panagiotis, Evdokimidis, Ioannis, Rentzos, Michail, Seimenis, Ioannis, Bede, Peter
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-02-2023; MDPI
• Subjects: Amyotrophic lateral sclerosis; Biomarkers; Care and treatment; Cognition; Cognition & reasoning; Cognitive ability; Dementia; Diagnosis; Diffusion; Diffusivity; Evaluation; grey matter; Hippocampus; Image resolution; Magnetic resonance imaging; Magnetic resonance spectroscopy; Medical imaging; Memory; Metabolism; Metabolites; Neuroimaging; Neuropsychology; Nuclear magnetic resonance spectroscopy; Spectroscopic analysis; Spectroscopy; Spectrum analysis; Structure-function relationships; Substantia grisea; Tensors; Greece; white matter; tractography; memory; hippocampus; grey matter; magnetic resonance spectroscopy; perforant pathway; amyotrophic lateral sclerosis; metabolites
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life13020571

Magnetic resonance spectroscopy (MRS) in amyotrophic lateral sclerosis (ALS) has been overwhelmingly applied to motor regions to date and our understanding of frontotemporal metabolic signatures is relatively limited. The association between metabolic alterations and cognitive performance in also poorly characterised.
In a multimodal, prospective pilot study, the structural, metabolic, and diffusivity profile of the hippocampus was systematically evaluated in patients with ALS. Patients underwent careful clinical and neurocognitive assessments. All patients were non-demented and exhibited normal memory performance. 1H-MRS spectra of the right and left hippocampi were acquired at 3.0T to determine the concentration of a panel of metabolites. The imaging protocol also included high-resolution T1-weighted structural imaging for subsequent hippocampal grey matter (GM) analyses and diffusion tensor imaging (DTI) for the tractographic evaluation of the integrity of the hippocampal perforant pathway zone (PPZ).
ALS patients exhibited higher hippocampal tNAA, tNAA/tCr and tCho bilaterally, despite the absence of volumetric and PPZ diffusivity differences between the two groups. Furthermore, superior memory performance was associated with higher hippocampal tNAA/tCr bilaterally. Both longer symptom duration and greater functional disability correlated with higher tCho levels.
Hippocampal 1H-MRS may not only contribute to a better academic understanding of extra-motor disease burden in ALS, but given its sensitive correlations with validated clinical metrics, it may serve as practical biomarker for future clinical and clinical trial applications. Neuroimaging protocols in ALS should incorporate MRS in addition to standard structural, functional, and diffusion sequences.