Mild cognitive dysfunction in hereditary spastic paraplegia 4 disease related to fluorodesoxyglucose cerebral positron emission tomography.

Fiche publication

Date publication

octobre 2025

Journal

Brain communications

Auteurs

Membres identifiés du Cancéropôle Est :
Dr BONNET Céline , Pr VERGER Antoine

Tous les auteurs :
Miroglio R, Hocquel A, Ravel JM, Clément G, Puisieux S, Meyer M, Lavigne L, Dillier C, Liao L, Schmitt E, Hopes L, Michaud M, Pittion-Vouyovitch S, Lambert L, Guillaud-Bataille M, Banneau G, Bossenmeyer-Pourié C, Bonnet C, Verger A, Renaud M

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/41180955

Résumé

Autosomal dominant spastic paraplegia type 4 (SPG4, gene) is commonly described as a pure phenotype, with progressive spastic weakness of the lower limbs. Some cognitive disorders have been reported but remain difficult to characterize. Brain flurodesoxyglucose (18F-FDG) PET is a sensitive biomarker of glycolytic metabolism and shows loss of neuronal activity. Our objective was to describe the cognitive impairment of SPG4 patients, supported by brain 18F-FDG PET, to characterize the cognitive pattern and its localization. Twenty subjects from the Grand Est region, with a pathogenic variant in the gene, were included. Each patient had to undergo a neuropsychological assessment, a brain 18F-FDG PET scan, and a SPATAX-EuroSpa clinical assessment, including the Spastic Paraplegia Rating Scale (SPRS). Brain 18F-FDG PET was analyzed semiquantitatively after comparison with age and sex-matched control subjects. The study population was 65% (13/20) female, with an average age of 50 years (19-75 years). The median SPRS was 15/52 (12-45). Forty-six percent (7/15) of patients had a deficient Montreal Cognitive Assessment (MoCA) score (score <26) without any severe impairment (score <10). Assessments with a pathological score of <1.65 standard deviations or at the 5th percentile included verbal episodic memory in 16-item Free and Cued Recall Test (16-FCRT; 63%, 10/16), facial emotion recognition (56%, 9/16), and executive functions (Trail Making Test A and B; 47%, 7/15; the Stroop; 47%, 7/15; digit span of Weschler Adult Intelligence Scale 4; 38%, 6/16). Compared with those of control subjects, 18-FDG PET images of the brains of SPG4 subjects revealed frontotemporal and precuneus hypometabolism, principally in the prefrontal cortex, which was mainly mesial ( voxel value <0.001, corrected for the size of the familywise error (FWE) cluster, = 1464). Frontal hypometabolism was correlated with age at onset ( = -0.475, = 0.046) and the time to perform the Trail Making Test B test ( = -0.597, = 0.019). Here, we describe a mild cognitive disorder clinically in SPG4 patients, associated with an hypometabolism on 18F-FDG PET imaging, which mainly corresponded to frontotemporal localization. Mild cognitive dysfunction should be screened in SPG4, as it can have a significant impact on socioprofessional life. Brain 18F-FDG PET, combined with neuropsychological assessment appears to be a good screening and follow-up examination for cognitive disorders.