QEEG Signatures are Associated with Nonmotor Dysfunctions in Parkinson's Disease and Atypical Parkinsonism: An Integrative Analysis
Open accessAbstract
Parkinson's disease (PD) and atypical parkinsonism (AP), including progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), share similar nonmotor symptoms. Quantitative electroencephalography (QEEG) can be used to examine the nonmotor symptoms. This study aimed to characterize the patterns of QEEG and functional connectivity (FC) that differentiate PD from PSP or MSA, and explore the correlation between the differential QEEG indices and nonmotor dysfunctions in PD and AP. We enrolled 52 patients with PD, 31 with MSA, 22 with PSP, and 50 age-matched health controls to compare QEEG indices among specific brain regions. One-way analysis of variance was applied to assess QEEG indices between groups; Spearman's correlations were used to examine the relationship between QEEG indices and nonmotor symptoms scale (NMSS) and mini-mental state examination (MMSE). FCs using weighted phase lag index were compared between patients with PD and those with MSA/PSP. Patients with PSP revealed higher scores on the NMSS and lower MMSE scores than those with PD and MSA, with similar disease duration. The delta and theta powers revealed a significant increase in PSP, followed by PD and MSA. Patients with PD presented a significantly lower slow-to-fast ratio than those with PSP in the frontal region, while patients with PD presented significantly higher EEG-slowing indices than patients with MSA. The frontal slow-to-fast ratio showed a negative correlation with MMSE scores in patients with PD and PSP, and a positive correlation with NMSS in the perception and mood domain in patients with PSP but not in those with PD. Compared to PD, MSA presented enhanced FC in theta and delta bands in the posterior region, while PSP revealed decreased FC in the delta band within the frontal-temporal cortex. These findings suggest that QEEG might be a useful tool for evaluating the nonmotor dysfunctions in PD and AP. Our QEEG results suggested that with similar disease duration, the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by those with PD, and lastly in patients with MSA.
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TL;DR
This study compared QEEG spectral power and weighted phase lag index functional connectivity in Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, and healthy controls, finding distinct slowing and connectivity patterns associated with nonmotor dysfunction. QEEG indices differentiated PD from MSA/PSP and correlated with cognitive, mood, and anxiety measures.
Key findings
- In 52 PD, 31 MSA, 22 PSP, and 50 age/sex-matched controls, PSP showed higher NMSS and lower MMSE scores than PD and MSA with similar disease duration; delta and theta powers were increased in PSP, followed by PD and MSA (delta P=0.000; theta P=0.004).
- Global slow-to-fast ratio was higher in PSP than PD or MSA (P=0.000); frontal slow-to-fast ratio was lower in PD than PSP (P=0.003); PD had higher temporal and occipital slow-to-fast ratios and lower parietal/occipital alpha/theta ratios than MSA.
- Frontal slow-to-fast ratio negatively correlated with MMSE in PD (r=-0.308, p=0.026) and PSP (r=-0.451, P=0.035), and positively correlated with NMSS perception (r=0.465, P=0.029) and mood (r=0.434, P=0.043) domains in PSP; occipital alpha/theta ratio positively correlated with HAMA in MSA (r=0.396, P=0.027).
- ROC analysis showed occipital alpha/theta ratio AUC 0.799 for PD vs MSA and frontal slow-to-fast ratio AUC 0.717 for PD vs PSP; MSA had enhanced theta/delta functional connectivity in posterior regions, while PSP had decreased theta connectivity in frontal-temporal connections compared with PD.
Methods
- Retrospective enrollment of patients hospitalized at Zhujiang Hospital of Southern Medical University between 2017 and 2021; final diagnoses made by two neurologists; 52 PD, 31 MSA, 22 PSP, and 50 healthy controls; clinical assessment included MMSE, NMSS, HAMA, HAMD, UPDRS-III, H&Y stage, and LEDD.
- Resting EEG recorded for 20 min with 19 electrodes; QEEG analysis used FFT absolute spectral power for delta, theta, alpha, and beta bands, slow-to-fast ratio [(delta+theta)/(alpha+beta)], and alpha/theta ratio; functional connectivity used weighted phase lag index.
- Statistical analysis included ANOVA/Kruskal-Wallis with Bonferroni, Spearman correlations, logistic regression adjusted for confounders, and ROC analysis.
Limitations
- Stated: sample size was not sufficiently large and precluded certain subgroup analyses; diagnoses were based on clinical probable criteria and not verified by neuropathological examination; no detailed clinical subtypes were specified for PSP.
- Evident from the text: the study was single-center and retrospective, with cross-sectional correlations that cannot establish causality or longitudinal prediction; the authors also note only a small proportion of PD patients had tremor-dominant manifestations.
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- Findingown data
The global slow-to-fast ratio and frontal slow-to-fast ratio differences between PD and PSP were consistent after adjusting for age, LEDD, MMSE, UPDRS-III, NMSS, HAMA, HAMD, and H&Y stage.
“Logistic regression analyses were conducted to explore the association of the global slow-to-fast ratio (p=0.035) and frontal slow-to-fast ratio (p=0.036) between PD and PSP after adjusting for age, LEDD, MMSE, UPDRS-III, NMSS, HAMA, HMSD, and H&Y stage; the findings revealed that the differences were consistent (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Patients with PSP presented higher slow-to-fast ratio scores than those with MSA in almost all regions except for the central region.
“The patients with PSP presented higher scores than those with MSA in almost all regions except for the central region.”
Quote in the paperNot a substantial claim - Findingown data
Both patients with PD and PSP presented a significant difference in theta and delta ASP compared to those with MSA.
“Both patients with PD and PSP presented a significant difference in theta and delta ASP compared to those with MSA.”
Quote in the paperSubstantial claim - Findingown data
In the frontal region, patients with PD presented significantly lower slow-to-fast ratio values than those with PSP.
“In the frontal region, patients with PD presented significantly lower values than those with PSP (P=0.003).”
Quote in the paperSubstantial claim - Findingown data
The alpha/theta ratio in parietal and occipital regions between PD and MSA remained associated after adjusting for compounding factors.
“We explored the association of the alpha/theta ratio in parietal (P=0.029, Table 2) and occipital regions (P=0.001, Table 2) between PD and MSA adjusted for compounding factors and revealed the same results.”
Quote in the paperSubstantial claim
- Findingown data
Delta and theta powers were significantly higher in patients with PSP, followed by patients with PD and MSA, and HCs.
“Among the comparisons, the delta and theta powers were significantly higher in patients with PSP, followed by patients with PD and MSA, and HCs (Table 1).”
Quote in the paperSubstantial claim - Findingown data
There was no significant difference among the four groups in the alpha and beta bands in the regional distribution.
“However, there was no significant difference among the four groups in the alpha and beta bands in the regional distribution in a topographic map (Fig. 2).”
Quote in the paperNot a substantial claim - Findingown data
There was no significant difference in global alpha/theta ratios among the four groups.
“However, there was no significant difference among the four groups (P=0.050, Fig. 3D).”
Quote in the paperNot a substantial claim - Findingown data
Cardiovascular domain and HAMA scores were significantly higher in patients with MSA than in those with PD and PSP.
“Cardiovascular domain and HAMA scores were significantly higher in patients with MSA than in those with PD and PSP”
Quote in the paperNot a substantial claim - Findingown data
HAMD scores were significantly higher in patients with PSP than in those with PD and MSA.
“the HAMD scores were significantly higher in patients with PSP than in those with PD and MSA.”
Quote in the paperNot a substantial claim - Findingown data
Patients with PD presented significantly lower parietal and occipital alpha/theta ratios than those with MSA.
“Patients with PD presented significantly lower parietal and occipital regions than those with MSA”
Quote in the paperSubstantial claim - Findingown data
The global slow-to-fast ratio was higher in patients with PSP than in either those with PD or MSA.
“The results revealed that the slow-to-fast ratio was higher in patients with PSP than in either those with PD or MSA (P=0.000, Fig. 3C).”
Quote in the paperSubstantial claim - Findingown data
In the temporal and occipital regions, patients with PD presented significantly higher slow-to-fast ratio scores than those with MSA.
“In the temporal and occipital regions, patients with PD presented significantly higher scores than those with MSA.”
Quote in the paperNot a substantial claim - Findingown data
The frontal slow-to-fast ratio showed a positive correlation with NMSS perception domain scores in patients with PSP (r=0.465, P=0.029).
“Meanwhile, a negative and positive correlation (r=-0.451, P=0.035, Fig. 4Aa) was found with MMSE and NMSS, respectively in the perception (r=0.465, P=0.029, Fig. 4Ab) and mood domain (r=0.434, P=0.043, Fig. 4Ac) in PSP.”
Quote in the paperSubstantial claim - Findingown data
Patients with PD presented significantly higher delta and theta ASP and slow-to-fast ratio in the temporal and occipital regions than those with MSA.
“Third, patients with PD presented significantly higher delta and theta ASP and slow-to-fast ratio in the temporal and occipital regions than those with MSA and a lower alpha/theta ratio in the parietal and occipital regions.”
Quote in the paperSubstantial claim - Findingown data
The frontal slow-to-fast ratio discriminated PD from PSP with an AUC of 0.717 (P=0.003), sensitivity 63.6%, specificity 73.1%, and cutoff 1.209.
“Comparing PD and PSP, the AUC for the global slow-to-fast ratio was 0.711 (P = 0.002), with a sensitivity of 68.2%, a specificity of 67.3%, and a cutoff of 1.178, and the AUC for the frontal slow-to-fast ratio was 0.717 (P = 0.003), with a sensitivity of 63.6%, a specificity of 73.1%, and a cutoff of 1.209 (Fig. 4Bb).”
Quote in the paperSubstantial claim - Findingown data
Patients with PSP showed significantly decreased EEG-FC in theta frequencies, mainly involving frontal-temporal connections, compared to patients with PD.
“Patients with PSP showed significantly decreased EEG-FC in theta frequencies, mainly involved in frontal-temporal connections than those with PD.”
Quote in the paperSubstantial claim - Findingown data
In patients with the same disease duration, PSP patients had lower MMSE scores than PD patients.
“First, in the same disease duration, patients with PSP revealed a lower MMSE score and higher UPDRS-III and NMSS scores than those with PD, suggesting severe motor and nonmotor functions in patients with PSP than those with PD.”
Quote in the paperSubstantial claim - Findingown data
Five significantly different functional connections in the theta band (P3-T3, T3-T4, O2-T5, F8-T5, T3-T5) were found between MSA and PD.
“Five significantly different functional connections (P3-T3, T3-T4, O2-T5, F8-T5, T3-T5, Fig. 5A) in the theta band and 6 connections (Fp1-F3, F3-P3, Fp1-T6, Fp1-Fz, T6-Cz, Cz-Pz, Fig. 5B) in the delta band were found.”
Quote in the paperSubstantial claim - Findingown data
Patients with MSA showed significantly enhanced EEG-FC in theta and delta frequencies, especially in posterior regions, compared to patients with PD.
“Patients with MSA showed significantly enhanced EEG-FC in theta and delta frequencies, especially in posterior regions than those with PD.”
Quote in the paperSubstantial claim - Findingown data
Seven significantly different functional connections in the delta band (Fp2-F3, Fp1-P4, F3-P4, F3-F7, O2-F7, F3-F7, F7-T3) were found between PSP and PD.
“Seven significantly different functional connections (Fp2-F3, Fp1-P4, F3-P4, F3-F7, O2-F7, F3-F7, F7-T3, Fig. 5C) in the delta band were found.”
Quote in the paperSubstantial claim - Findingown data
A significant correlation was found between the severity of nonmotor dysfunctions and QEEG indices in PD, MSA, and PSP.
“Fifth, a significant correlation was found between the severity of nonmotor dysfunctions and QEEG indices in PD, MSA, and PSP.”
Quote in the paperSubstantial claim - Findingown data
The occipital alpha/theta ratio showed a positive correlation with HAMA scores in patients with MSA (r=0.396, P=0.027).
“Meanwhile, the correlation between the occipital alpha/theta ratio and disease severity was examined, and a positive correlation with HAMA scores (r=0.396, P=0.027, Fig. 4Ad) was found in patients with MSA.”
Quote in the paperNot a substantial claim - Findingown data
Compared to PD, PSP patients had lower FC in the theta band.
“Sixth, compared to the FC in patients with PD, FC was lower in the theta band in patients with PSP and more enhanced in the theta and delta bands in patients with MSA; QEEG-related ROC analyses were applied to distinguish PD from MSA/PSP.”
Quote in the paperSubstantial claim - Findingown data
The delta and theta ASP were highest in patients with PSP, followed by those with PD and MSA.
“Second, the delta and theta ASP were highest in patients with PSP, followed by those with PD and MSA.”
Quote in the paperSubstantial claim - Findingown data
Patients with PD presented a lower alpha/theta ratio in the parietal and occipital regions than those with MSA.
“Third, patients with PD presented significantly higher delta and theta ASP and slow-to-fast ratio in the temporal and occipital regions than those with MSA and a lower alpha/theta ratio in the parietal and occipital regions.”
Quote in the paperSubstantial claim - Findingown data
The frontal slow-to-fast ratio showed a positive correlation with NMSS mood domain scores in patients with PSP (r=0.434, P=0.043).
“Meanwhile, a negative and positive correlation (r=-0.451, P=0.035, Fig. 4Aa) was found with MMSE and NMSS, respectively in the perception (r=0.465, P=0.029, Fig. 4Ab) and mood domain (r=0.434, P=0.043, Fig. 4Ac) in PSP.”
Quote in the paperSubstantial claim - Findingown data
Six significantly different functional connections in the delta band (Fp1-F3, F3-P3, Fp1-T6, Fp1-Fz, T6-Cz, Cz-Pz) were found between MSA and PD.
“Five significantly different functional connections (P3-T3, T3-T4, O2-T5, F8-T5, T3-T5, Fig. 5A) in the theta band and 6 connections (Fp1-F3, F3-P3, Fp1-T6, Fp1-Fz, T6-Cz, Cz-Pz, Fig. 5B) in the delta band were found.”
Quote in the paperSubstantial claim - Findingown data
The frontal slow-to-fast ratio showed a negative correlation with MMSE scores in patients with PD (r=-0.308, p=0.026).
“Correlation analysis of the frontal slow-to-fast ratio and severity of nonmotor dysfunctions revealed a negative correlation (r=-0.308, p=0.026, Fig. 4Aa) with MMSE in patients with PD.”
Quote in the paperSubstantial claim - Findingown data
In patients with the same disease duration, PSP patients had higher NMSS scores than PD patients.
“First, in the same disease duration, patients with PSP revealed a lower MMSE score and higher UPDRS-III and NMSS scores than those with PD, suggesting severe motor and nonmotor functions in patients with PSP than those with PD.”
Quote in the paperSubstantial claim - Findingown data
Patients with PD presented a significantly lower slow-to-fast ratio than those with PSP, especially in the frontal region.
“Fourth, patients with PD presented a significantly lower slow-to-fast ratio than those with PSP, especially in the frontal region.”
Quote in the paperSubstantial claim - Findingown data
In patients with the same disease duration, PSP patients had higher UPDRS-III scores than PD patients.
“First, in the same disease duration, patients with PSP revealed a lower MMSE score and higher UPDRS-III and NMSS scores than those with PD, suggesting severe motor and nonmotor functions in patients with PSP than those with PD.”
Quote in the paperNot a substantial claim - Findingown data
Compared to PD, MSA patients had enhanced FC in the theta and delta bands.
“Sixth, compared to the FC in patients with PD, FC was lower in the theta band in patients with PSP and more enhanced in the theta and delta bands in patients with MSA; QEEG-related ROC analyses were applied to distinguish PD from MSA/PSP.”
Quote in the paperSubstantial claim - Findingown data
The frontal slow-to-fast ratio showed a negative correlation with MMSE scores in patients with PSP (r=-0.451, P=0.035).
“Meanwhile, a negative and positive correlation (r=-0.451, P=0.035, Fig. 4Aa) was found with MMSE and NMSS, respectively in the perception (r=0.465, P=0.029, Fig. 4Ab) and mood domain (r=0.434, P=0.043, Fig. 4Ac) in PSP.”
Quote in the paperSubstantial claim - Findingown data
The global slow-to-fast ratio discriminated PD from PSP with an AUC of 0.711 (P=0.002), sensitivity 68.2%, specificity 67.3%, and cutoff 1.178.
“Comparing PD and PSP, the AUC for the global slow-to-fast ratio was 0.711 (P = 0.002), with a sensitivity of 68.2%, a specificity of 67.3%, and a cutoff of 1.178, and the AUC for the frontal slow-to-fast ratio was 0.717 (P = 0.003), with a sensitivity of 63.6%, a specificity of 73.1%, and a cutoff of 1.209 (Fig. 4Bb).”
Quote in the paperSubstantial claim - Findingown data
Global slow-to-fast ratio discriminated PD from PSP with AUC 0.711 (p=0.002).
“Global slow-to-fast ratio | 0.711 | 1.178 | 0.002** | 0.594-0.853 | 0.682 | 0.673”
Quote in the paperSubstantial claim - Findingown data
Patients with PD presented a lower slow-to-fast ratio and enhanced EEG-FC than those with PSP, especially in the frontal region.
“Patients with PD presented a lower slow-to-fast ratio and enhanced EEG-FC than those with PSP, especially in the frontal region”
Quote in the paperSubstantial claim - Findingown data
Delta spectral power discriminated PD from MSA with AUC 0.705 (p=0.002).
“Delta spectral power | 0.705 | 1.684 | 0.002** | 0.594-0.816 | 0.500 | 0.903”
Quote in the paperSubstantial claim - Findingown data
In the present EEG-FC analysis, significant alterations in EEG-FC were found between PD and MSA/PSP.
“In the present EEG-FC analysis, significant alterations in EEG-FC were found between PD and MSA/PSP.”
Quote in the paperSubstantial claim - Findingown data
Parietal alpha/theta ratio discriminated PD from MSA with AUC 0.722 (p=0.001).
“Parietal alpha/theta ratio | 0.722 | 0.978 | 0.001** | 0.608-0.835 | 0.677 | 0.745”
Quote in the paperSubstantial claim - Findingown data
Temporal slow-to-fast ratio discriminated PD from MSA with AUC 0.717 (p=0.001).
“Temporal slow-to-fast ratio | 0.717 | 1.128 | 0.001** | 0.604-0.829 | 0.654 | 0.710”
Quote in the paperSubstantial claim - Findingown data
The occipital alpha/theta ratio had a positive association with anxiety severity in MSA.
“The occipital alpha/theta ratio had a positive association with anxiety severity in MSA.”
Quote in the paperSubstantial claim - Findingown data
Patients with MSA show significantly enhanced functional connectivity in theta frequency, especially in posterior regions.
“Patients with MSA show significantly enhanced functional connectivity in theta frequency, especially in posterior regions.”
Quote in the paperSubstantial claim - Findingown data
Patients with MSA show significantly enhanced functional connectivity in delta frequency, mainly in posterior regions.
“Patients with MSA show significantly enhanced functional connectivity in delta frequency, mainly in posterior regions.”
Quote in the paperSubstantial claim - Findingown data
Occipital slow-to-fast ratio discriminated PD from MSA with AUC 0.686 (p=0.005).
“Occipital slow-to-fast ratio | 0.686 | 1.121 | 0.005** | 0.567-0.805 | 0.615 | 0.710”
Quote in the paperNot a substantial claim - Findingown data
Occipital alpha/theta ratio discriminated PD from MSA with AUC 0.799 (p=0.000).
“Occipital alpha/theta ratio | 0.799 | 0.989 | 0.000*** | 0.701-0.898 | 0.774 | 0.804”
Quote in the paperSubstantial claim - Findingown data
Theta spectral power discriminated PD from MSA with AUC 0.684 (p=0.005).
“Theta spectral power | 0.684 | 1.654 | 0.005** | 0.568-0.800 | 0.538 | 0.774”
Quote in the paperSubstantial claim - Findingown data
Compared to PD, PSP revealed decreased EEG-FC in theta bands, mainly within the frontal-temporal cortex.
“Compared to PD, PSP revealed decreased EEG-FC in theta bands, mainly within the frontal-temporal cortex (Fig. 5C)”
Quote in the paperSubstantial claim - Findingown data
Patients with PD presented a lower frontal slow-to-fast ratio than those with PSP after adjusting for confounding factors.
“while patients with PD presented a lower frontal slow-to-fast ratio than those with PSP (Fig. 3E) after adjusting for confounding factors.”
Quote in the paperSubstantial claim - Findingown data
Patients with PSP show significantly decreased functional connectivity in theta frequency, mainly in frontal-temporal connections, compared with patients with PD.
“The patients with PSP show significantly decreased functional connectivity in theta frequency, which is mainly involved in frontal-temporal connections, compared with the patients with PD.”
Quote in the paperSubstantial claim - Findingown data
The occipital alpha/theta ratio showed a significant correlation with HAMA scores in MSA.
“Interestingly, we also found that the occipital alpha/theta ratio showed a significant correlation with HAMA scores in MSA”
Quote in the paperSubstantial claim - Findingown data
QEEG indices were independent factors differentiating PD from MSA and PSP.
“We found that QEEG indices were independent factors differentiating PD from MSA and PSP (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Patients with PD revealed significantly higher EEG slowing than those with MSA in almost all brain regions.
“Here, we found that patients with PD revealed significantly higher EEG slowing than those with MSA in almost all brain regions (Fig. 3)”
Quote in the paperSubstantial claim - Findingown data
Frontal slow-to-fast ratio discriminated PD from PSP with AUC 0.717 (p=0.003).
“Frontal slow-to-fast ratio | 0.717 | 1.209 | 0.003** | 0.584-0.850 | 0.636 | 0.731”
Quote in the paperSubstantial claim - Premisecitation
Only one study in literature, related to PSP, demonstrated that EEG-slowing was found in six patients with PSP mainly in the frontal region compared to six healthy control participants.
“However, only one study in literature, related to PSP, demonstrated that EEG-slowing was found in six patients with PSP mainly in the frontal region compared to six healthy control participants [53], which was consistent with our results.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [53] Montplaisir J, Petit D, Décary A, Masson H, Bédard MA, Panisset M, et al. (1997). Sleep and quantitative EEG in patients with progressive supranuclear palsy. Neurology, 49:999-1003. source
Not checked in the free run.
- Interpretationcitation
QEEG is a valuable tool to assess the electrophysiological changes related to cognitive impairment or dementia.
“Other studies and our results suggest that QEEG is a valuable tool to assess the electrophysiological changes related to cognitive impairment or dementia [47].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [47] Schjønning Nielsen M, Simonsen AH, Siersma V, Engedal K, Jelic V, Andersen BB, et al. (2018). Quantitative Electroencephalography Analyzed by Statistical Pattern Recognition as a Diagnostic and Prognostic Tool in Mild Cognitive Impairment: Results from a Nordic Multicenter Cohort Study. Dement Geriatr Cogn Dis Extra, 8:426-438. source
Not checked in the free run.
- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
- Interpretationown data
QEEG might be a useful tool for evaluating the nonmotor dysfunctions in PD and AP.
“These findings suggest that QEEG might be a useful tool for evaluating the nonmotor dysfunctions in PD and AP.”
Quote in the paperSubstantial claim - Premisecitation
Abnormalities in delta or theta band power are related to cognitive deficits in patients with PD.
“while abnormalities in delta or theta band power are related to cognitive deficits in patients with PD [29].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] Guner D, Tiftikcioglu BI, Tuncay N, Zorlu Y (2017). Contribution of Quantitative EEG to the Diagnosis of Early Cognitive Impairment in Patients With Idiopathic Parkinson's Disease. Clin EEG Neurosci, 48:348-354. source
Not checked in the free run.
- Interpretationown data
QEEG could be a novel tool to understand the mechanism of Parkinsonism disorders.
“This study indicated that QEEG could be a novel tool to understand the mechanism of Parkinsonism disorders.”
Quote in the paperNot a substantial claim- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
- Interpretationown data
QEEG could be used as a potential indicator to evaluate the severity of anxiety in MSA.
“strongly implying that QEEG could be used as a potential indicator to evaluate the severity of anxiety in MSA.”
Quote in the paperSubstantial claim - Interpretationown data
QEEG could be a promising noninvasive tool to understand the pathogenesis of nonmotor dysfunctions in Parkinsonian disorders.
“QEEG could be a promising noninvasive tool to understand the pathogenesis of nonmotor dysfunctions in Parkinsonian disorders.”
Quote in the paperNot a substantial claim- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
- Interpretationown data
Cholinergic deficits and synaptic dysfunction in PSP/PD are more serious than those in MSA with similar disease duration.
“This finding strongly implies that cholinergic deficits and synaptic dysfunction in PSP/PD are more serious than those in MSA with similar disease duration.”
Quote in the paperSubstantial claim - Premisecitation
PET-CT imaging showed lower glucose metabolism in the frontal lobe of patients with PSP than those with PD at the early stage.
“Meanwhile, PET-CT imaging also showed lower glucose metabolism in the frontal lobe of patients with PSP than those with PD at the early stage [64, 65], which indirectly further verifies our findings.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [64] Lee YE, Williams DR, Anderson JF (2016). Frontal deficits differentiate progressive supranuclear palsy from Parkinson's disease. J Neuropsychol, 10:1-14. source
Not checked in the free run.
- cites [65] Zhao P, Zhang B, Gao S, Li X (2020). Clinical, MRI and 18F-FDG-PET/CT analysis of progressive supranuclear palsy. J Clin Neurosci, 80:318-323. source
Not checked in the free run.
- Premisecitation
Patients with MSA showed bilateral hypometabolism in the basal ganglia through PET-CT examination.
“Moreover, patients with MSA showed bilateral hypometabolism in the basal ganglia through positron emission tomography-computed tomography (PET-CT) [63] examination.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [63] Zhao P, Zhang B, Gao S, Li X (2020). Clinical features, MRI, and 18F-FDG-PET in differential diagnosis of Parkinson disease from multiple system atrophy. Brain Behav, 10:e01827. source
Not checked in the free run.
- Interpretationown data
The decreased EEG-FC and slow-to-fast ratio in the frontal lobe may be promising markers for distinguishing PSP from PD.
“Based on the current results, the decreased EEG-FC and slow-to-fast ratio in the frontal lobe may be promising markers for distinguishing PSP from PD.”
Quote in the paperSubstantial claim - Interpretationown data
QEEG has potential diagnostic value in differentiating PD from PSP.
“Our results suggested that QEEG has potential diagnostic value in differentiating PD from PSP (Fig. 4B).”
Quote in the paperSubstantial claim- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
- Premisecitation
Patients with PDD show reduced EEG-FC in delta band frequency compared to those with PD without dementia.
“Moreover, several studies have revealed that patients with PDD show reduced EEG-FC in delta band frequency compared to those with PD without dementia [61].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bertrand JA, McIntosh AR, Postuma RB, Kovacevic N, Latreille V, Panisset M, et al. (2016). Brain Connectivity Alterations Are Associated with the Development of Dementia in Parkinson's Disease. Brain Connect, 6:216-224. source
Not checked in the free run.
- May combine two claims. 28
- Classified as probably not a substantial claim. 30
May combine two claims.
Findingown dataPatients with PSP have higher NMSS scores in the attention/memory and perception domains and lower MMSE scores than patients with PD and MSA.
“Clinical characteristics, such as UPDRS-III and H&Y stage and NMSS scores, in the attention/memory and perception domains, were significantly higher, and MMSE scores were lower in patients with PSP than in those with MSA and PD.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataBoth delta and theta powers could independently distinguish between PD and MSA after adjusting for age, LEDD, MMSE, UPDRS-III, NMSS, HAMA, HAMD, and H&Y stage.
“The results showed that both delta (p = 0.001) and theta powers (p = 0.002) could independently distinguish between PD and MSA (Table 2).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPatients with PD revealed significantly higher EEG-slowing and lower EEG-FC than those with MSA.
“and patients with PD revealed significantly higher EEG-slowing and lower EEG-FC than those with MSA.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe frontal slow-to-fast ratio showed significant positive correlations with cognition in PD and PSP, and with mood/apathy in PSP.
“We observed that the frontal slow-to-fast ratio showed significant positive correlations with cognition in PD and PSP, and with mood/apathy in PSP.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationAlterations in brain FC may precede structural damage and might be a key marker in detecting changes in brain plasticity over short periods in some neurodegenerative diseases.
“Alterations in the brain FC may precede structural damage and might be a key marker in detecting changes in brain plasticity over short periods in some neurodegenerative diseases [30-32].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [30] Dauwan M, Linszen MMJ, Lemstra AW, Scheltens P, Stam CJ, Sommer IE (2018). EEG-based neurophysiological indicators of hallucinations in Alzheimer's disease: Comparison with dementia with Lewy bodies. Neurobiol Aging, 67:75-83. source
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- cites [31] Pelaez Suarez AA, Berrillo Batista S, Pedroso Ibanez I, Casabona Fernandez E, Fuentes Campos M, Chacon LM (2021). EEG-Derived Functional Connectivity Patterns Associated with Mild Cognitive Impairment in Parkinson's Disease. Behav Sci (Basel), 11. source
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- cites [32] Attaluri S, Arora M, Madhu LN, Kodali M, Shuai B, Melissari L, et al. (2022). Oral Nano-Curcumin in a Model of Chronic Gulf War Illness Alleviates Brain Dysfunction with Modulation of Oxidative Stress, Mitochondrial Function, Neuroinflammation, Neurogenesis, and Gene Expression. Aging Dis, 13:583-613.
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May combine two claims.
PremisecitationPatients with PSP showed a higher rate of cognitive, behavioral, and urinary dysfunctions, while those with MSA had higher prevalence of urinary dysfunction, sleep/fatigue symptoms, and mood disorders than patients with PD.
“Patients with PSP showed a higher rate of cognitive, behavioral, and urinary dysfunctions, while those with MSA had higher prevalence of urinary dysfunction, sleep/fatigue symptoms, and mood disorders than patients with PD [18, 19].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [18] Zhang L, Cao B, Ou R, Wei QQ, Zhao B, Yang J, et al. (2017). Non-motor symptoms and the quality of life in multiple system atrophy with different subtypes. Parkinsonism Relat Disord, 35:63-68. source
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- cites [19] Lee CN, Kim M, Lee HM, Jang JW, Lee SM, Kwon DY, et al. (2013). The interrelationship between non-motor symptoms in Atypical Parkinsonism. J Neurol Sci, 327:15-21. source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThis study was approved by the Ethics Committee of Zhujiang Hospital of Southern Medical University (NO: 2021-KY-110-02) and complied with ethical standards.
“This study was approved by the Ethics Committee of Zhujiang Hospital of Southern Medical University (NO: 2021-KY-110-02) and complied with the ethical standards of the 1975 Declaration of Helsinki and the 1999 National Institutes of Health Policy and Guidelines for Human Subjects conduct.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataLogistic regressions were applied to confirm whether QEEG indices could be differential factors between PD and PSP/MSA after adjusting for sex, age, LEDD, MMSE, UPDRS-III, NMSS, HAMA, and HAMD scores.
“Logistic regressions were applied to confirm whether QEEG indices could be differential factors between PD and PSP/MSA after adjusting for sex, age, LEDD, MMSE, UPDRS-III, NMSS, HAMA, and HAMD scores.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPSP is characterized by the deposition of four repeat tau inclusions in the caudate, midbrain, thalamus, and frontal cortex.
“PSP is characterized by the deposition of four repeat tau inclusions in the caudate, midbrain, thalamus, and frontal cortex [33].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Filippi M, Sarasso E, Agosta F (2019). Resting-state Functional MRI in Parkinsonian Syndromes. Mov Disord Clin Pract, 6:104-117. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCholinergic degeneration may be an important indicator for early cognitive impairment in PD.
“Neuropathological evidence suggests that cholinergic degeneration may be an important indicator for early cognitive impairment in PD [48-50].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [48] McKinley JW, Shi Z, Kawikova I, Hur M, Bamford IJ, Sudarsana Devi SP, et al. (2019). Dopamine Deficiency Reduces Striatal Cholinergic Interneuron Function in Models of Parkinson's Disease. Neuron, 103:1056-1072 e1056. source
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- cites [49] Huntington TE, Srinivasan R (2021). Adeno-Associated Virus Expression of α-Synuclein as a Tool to Model Parkinson's Disease: Current Understanding and Knowledge Gaps. Aging Dis, 12:1120-1137. source
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- cites [50] Tian H, Hu Z, Wang C (2022). The Therapeutic Potential of tRNA-derived Small RNAs in Neurodegenerative Disorders. Aging Dis, 13:389-401.
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPSP is associated with a widespread cholinergic deficit resulting from a loss of cholinergic neurons, and with an obvious cholinergic deficiency in the cerebral cortex.
“Meanwhile, PSP is associated with a widespread cholinergic deficit resulting from a loss of cholinergic neurons, and with an obvious cholinergic deficiency in the cerebral cortex [52].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [52] Javoy-Agid F (1994). Cholinergic and peptidergic systems in PSP. J Neural Transm Suppl, 42:205-218. source
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Study design and conductcitationThe final diagnosis of PD, MSA, and PSP was determined by two neurologists according to updated clinical guidelines.
“The final diagnosis of PD, MSA, and PSP was determined by two neurologists according to the updated clinical guidelines[37-40].”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [37] Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, et al. (1996). Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology, 47:1-9. source
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- cites [38] Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, et al. (2008). Second consensus statement on the diagnosis of multiple system atrophy. Neurology, 71:670-676. source
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- cites [39] Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. (2015). MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord, 30:1591-1601. source
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- cites [40] Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, et al. (2017). Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord, 32:853-864.
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Study design and conductnone givenASP was logarithmically transformed to achieve homogeneity of variance for normally distributed data.
“ASP was logarithmically transformed to achieve homogeneity of variance for normally distributed data.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBeta power changes are associated with the severity of motor function, such as dyskinesias and freezing gait, in patients with PD.
“Studies have revealed that beta power changes are associated with the severity of motor function, such as dyskinesias and freezing gait [28]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Quynh Tran L, Ardi Handojoseno AM, Gilat M, Nghia N, Rifai C, Tran Y, et al. (2016). Detection of gait initiation failure in Parkinson's disease patients using EEG signals. Annu Int Conf IEEE Eng Med Biol Soc, 2016:1599-1602.
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe complex interaction between cholinergic and other transmitter systems participates in the pathophysiological mechanism of brain electricity slowing and cognitive decline in neurodegenerative diseases.
“Studies have shown that the complex interaction between cholinergic and other transmitter systems participates in the pathophysiological mechanism of brain electricity slowing and cognitive decline in neurodegenerative diseases [42-46].”
Quote in the paperNot a substantial claim0 of 5 sources checked- cites [42] Kuhl DE, Minoshima S, Fessler JA, Frey KA, Foster NL, Ficaro EP, et al. (1996). In vivo mapping of cholinergic terminals in normal aging, Alzheimer's disease, and Parkinson's disease. Ann Neurol, 40:399-410. source
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- cites [43] Bohnen NI, Kaufer DI, Hendrickson R, Ivanco LS, Lopresti BJ, Constantine GM, et al. (2006). Cognitive correlates of cortical cholinergic denervation in Parkinson's disease and parkinsonian dementia. J Neurol, 253:242-247. source
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- cites [44] Garcia-Serrano AM, Mohr AA, Philippe J, Skoug C, Spégel P, Duarte JMN (2022). Cognitive Impairment and Metabolite Profile Alterations in the Hippocampus and Cortex of Male and Female Mice Exposed to a Fat and Sugar-Rich Diet are Normalized by Diet Reversal. Aging Dis, 13:267-283. source
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- cites [45] Liu N, Tang J, Xue Y, Mok V, Zhang M, Ren X, et al. (2022). EP3 Receptor Deficiency Improves Vascular Remodeling and Cognitive Impairment in Cerebral Small Vessel Disease. Aging Dis, 13:313-328. source
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- cites [46] Wang Y, Huang C, Guo Q, Chu H (2022). Aquaporin-4 and Cognitive Disorders. Aging Dis, 13:61-72. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationQEEG could reflect the amount of phosphorylated α-synuclein in the cortex of patients with PD.
“A study revealed that QEEG could reflect the amount of phosphorylated α-synuclein in the cortex of patients with PD [27].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] Caviness JN, Lue LF, Hentz JG, Schmitz CT, Adler CH, Shill HA, et al. (2016). Cortical phosphorylated alpha-Synuclein levels correlate with brain wave spectra in Parkinson's disease. Mov Disord, 31:1012-1019. source
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May combine two claims.
Study design and conductown dataIn total, 205 patients with Parkinsonian symptoms were retrospectively reviewed, and after exclusions, 52 patients with PD, 31 with MSA, 22 with PSP, and 50 HC participants were enrolled.
“In total, 205 patients with Parkinsonian symptoms were retrospectively reviewed. Twenty-nine patients with uncertain diagnoses of probable MSA with cerebellar ataxia (MSA-C), DLB, and CBD were excluded, and 71 patients were ultimately excluded due to excessive artifacts or meeting the exclusion criteria. Consequently, only 52 patients with PD, 31 with MSA, and 22 with PSP and 50 HC participants”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataWith similar disease duration, the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by those with PD, and lastly in patients with MSA.
“Our QEEG results suggested that with similar disease duration, the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by those with PD, and lastly in patients with MSA.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe wPLI is a good candidate parameter for revealing synchronized data among connectivity analyses of EEG and magneto-encephalogram signals.
“In conclusion, among the connectivity analyses of EEG and magneto-encephalogram signals, the wPLI is a good candidate parameter for revealing synchronized data [36].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [36] Vinck M, Oostenveld R, van Wingerden M, Battaglia F, Pennartz CM (2011). An improved index of phase-synchronization for electrophysiological data in the presence of volume-conduction, noise and sample-size bias. Neuroimage, 55:1548-1565. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationQEEG features provide a valuable variable in distinguishing various etiological dementias, such as DLB, PDD, and AD.
“Several studies[23-26] have suggested that QEEG features provide a valuable variable in distinguishing various etiological dementias, such as dementia with Lewy bodies (DLB), PD with dementia (PDD), and Alzheimer’s disease (AD).”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [23] Stylianou M, Murphy N, Peraza LR, Graziadio S, Cromarty R, Killen A, et al. (2018). Quantitative electroencephalography as a marker of cognitive fluctuations in dementia with Lewy bodies and an aid to differential diagnosis. Clin Neurophysiol, 129:1209-1220. source
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- cites [24] van der Zande JJ, Gouw AA, van Steenoven I, van de Beek M, Scheltens P, Stam CJ, et al. (2020). Diagnostic and prognostic value of EEG in prodromal dementia with Lewy bodies. Neurology, 95:e662-e670. source
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- cites [25] Botchway BO, Okoye FC, Chen Y, Arthur WE, Fang M (2022). Alzheimer Disease: Recent Updates on Apolipoprotein E and Gut Microbiome Mediation of Oxidative Stress, and Prospective Interventional Agents. Aging Dis, 13:87-102. source
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- cites [26] Decourt B, D'Souza GX, Shi J, Ritter A, Suazo J, Sabbagh MN (2022). The Cause of Alzheimer's Disease: The Theory of Multipathology Convergence to Chronic Neuronal Stress. Aging Dis, 13:37-60. source
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Classified as probably not a substantial claim.
PremisecitationNonmotor symptoms may vary in PD and AP.
“Previous studies [16, 17] indicated that nonmotor symptoms may vary in PD and AP.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [16] Hendricks RM, Khasawneh MT (2021). A Systematic Review of Parkinson's Disease Cluster Analysis Research. Aging Dis, 12:1567-1586. source
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- cites [17] Leggio L, Paternò G, Vivarelli S, Falzone GG, Giachino C, Marchetti B, et al. (2021). Extracellular Vesicles as Novel Diagnostic and Prognostic Biomarkers for Parkinson's Disease. Aging Dis, 12:1494-1515. source
Not checked in the free run.
May combine two claims.
Interpretationown dataPSP patients have more severe motor and nonmotor functions than PD patients.
“First, in the same disease duration, patients with PSP revealed a lower MMSE score and higher UPDRS-III and NMSS scores than those with PD, suggesting severe motor and nonmotor functions in patients with PSP than those with PD.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe differences in sex, age, and duration were not significant among groups.
“The differences in sex, age, and duration were not significant.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataThe false discovery rate (FDR) measurement was used to address multiple testing and perform graph theory analysis.
“The false discovery rate (FDR) measurement provided by the network-based statistic connectome MATLAB package and HERMES toolbox was used to address the problems of multiple testing and perform graph theory analysis.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIn a QEEG study, EEG slowing is frequently reported in patients with PD, and delta and theta global absolute powers were found in patients with PDD.
“In a QEEG study, EEG slowing is frequently reported in patients with PD, and delta and theta global absolute powers were found in patients with PDD [51].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] Fonseca LC, Tedrus GM, Carvas PN, Machado EC (2013). Comparison of quantitative EEG between patients with Alzheimer's disease and those with Parkinson's disease dementia. Clin Neurophysiol, 124:1970-1974. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAn EEG study with transgenic mice demonstrated a close correlation between neuronal accumulation of α-synuclein and slowing of brain oscillations and changes in network excitability.
“An EEG study with transgenic mice demonstrated a close correlation between neuronal accumulation of α-synuclein and slowing of brain oscillations and changes in network excitability [22, 41].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [22] Colom-Cadena M, Spires-Jones T, Zetterberg H, Blennow K, Caggiano A, DeKosky ST, et al. (2020). The clinical promise of biomarkers of synapse damage or loss in Alzheimer's disease. Alzheimers Res Ther, 12:21. source
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- cites [41] Morris M, Sanchez PE, Verret L, Beagle AJ, Guo W, Dubal D, et al. (2015). Network dysfunction in α-synuclein transgenic mice and human Lewy body dementia. Ann Clin Transl Neurol, 2:1012-1028. source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenPairwise comparisons were conducted by Student's t-test, and FDR-corrected P < 0.05 was considered statistically significant.
“Pairwise comparisons were conducted by Student’s t-test, and FDR-corrected P < 0.05 was considered statistically significant.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll participants signed an informed consent form.
“All participants signed an informed consent form.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationQEEG could demonstrate increased theta power in patients with depression, and increased alpha power or decreased theta/delta power in patients with anxiety.
“QEEG could demonstrate the increased theta power in patients with depression, and the increased alpha power or decreased theta/delta power in patients with anxiety[54].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54] Moon SY, Choi YB, Jung HK, Lee YI, Choi SH (2018). Increased Frontal Gamma and Posterior Delta Powers as Potential Neurophysiological Correlates Differentiating Posttraumatic Stress Disorder from Anxiety Disorders. Psychiatry Investig, 15:1087-1093. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe volume of the striatum and brainstem was significantly reduced in MSA.
“Previous neuroimaging findings showed that the volume of the striatum and brainstem was significantly reduced in MSA [62].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [62] Brenneis C, Seppi K, Schocke MF, Müller J, Luginger E, Bösch S, et al. (2003). Voxel-based morphometry detects cortical atrophy in the Parkinson variant of multiple system atrophy. Mov Disord, 18:1132-1138. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataOnly a small proportion of patients with PD presented tremor-dominant manifestations.
“In our study, only a small proportion of patients with PD presented tremor-dominant manifestations.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe sample size was not sufficiently large, and the relatively small sample size precluded certain subgroup analyses.
“First, the sample size was not sufficiently large, and the relatively small sample size precluded certain subgroup analyses.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by PD and then MSA.
“Since the disease durations for the three Parkinsonism cases in our study were very similar (Table 1), the QEEG indicators (Figs. 2, 3) and FC network data (Fig. 5) indicated that the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by PD and then MSA.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataPatients with PSP experience worse cognitive dysfunction and cortical degeneration than PD.
“further implying that patients with PSP experience worse cognitive dysfunction and cortical degeneration, which was verified by MMSE scores between PD and PSP (Table 1).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningQEEG indices could contribute to a better understanding of the underlying neurophysiology of nonmotor dysfunctions in PD and PSP/MSA.
“QEEG indices could contribute to a better understanding of the underlying neurophysiology of nonmotor dysfunctions in PD and PSP/MSA.”
Quote in the paperNot a substantial claim- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAmong all indicators for EEG-slowing, the alpha/theta ratio is more sensitive in the early stage of Parkinsonism.
“It has been documented that, among all indicators for EEG-slowing, the alpha/theta ratio is more sensitive in the early stage of Parkinsonism [56].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Massa F, Meli R, Grazzini M, Fama F, De Carli F, Filippi L, et al. (2020). Utility of quantitative EEG in early Lewy body disease. Parkinsonism Relat Disord, 75:70-75. source
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Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenNo detailed clinical subtypes were specified for PSP.
“Third, no detailed clinical subtypes were specified for PSP.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationCompared with healthy people, patients with PD without cognitive impairment showed decreased EEG-FC in the alpha and theta frequencies, while those with PD with mild cognitive impairment showed decreased EEG-FC in alpha in posterior distribution, and delta frequency with a generalized distribution.
“Compared with healthy people, patients with PD without cognitive impairment showed a decrease EEG-FC in the alpha and theta frequencies, while those with PD with mild cognitive impairment showed decreased EEG-FC in alpha in posterior distribution, and delta frequency with a generalized distribution [60].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [60] Peláez Suárez AA, Berrillo Batista S, Pedroso Ibáñez I, Casabona Fernández E, Fuentes Campos M, Chacón LM (2021). EEG-Derived Functional Connectivity Patterns Associated with Mild Cognitive Impairment in Parkinson's Disease. Behav Sci (Basel), 11. source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationNeurodegenerative diseases are usually characterized by a significant reduction in network connectivity, and cortical EEG-FC reflects the intensity of information flow among involved cortical regions.
“Neurodegenerative diseases are usually characterized by a significant reduction in network connectivity, and cortical EEG-FC reflects the intensity of information flow among involved cortical regions [57-59].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [57] Vecchio F, Miraglia F, Marra C, Quaranta D, Vita MG, Bramanti P, et al. (2014). Human brain networks in cognitive decline: a graph theoretical analysis of cortical connectivity from EEG data. J Alzheimers Dis, 41:113-127. source
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- cites [58] Cai M, Dang G, Su X, Zhu L, Shi X, Che S, et al. (2021). Identifying Mild Cognitive Impairment in Parkinson's Disease With Electroencephalogram Functional Connectivity. Front Aging Neurosci, 13:701499. source
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- cites [59] Peng W, Zhou R, Sun ZF, Long JW, Gong YQ (2022). Novel Insights into the Roles and Mechanisms of GLP-1 Receptor Agonists against Aging-Related Diseases. Aging Dis, 13:468-490.
Not checked in the free run.
May combine two claims.
Interpretationown dataThe EEG features identified in this study are important indicators for cognition in PD and PSP, mood and apathy in PSP, and anxiety in patients with MSA.
“Based on our data (Fig. 4), we propose that the EEG features identified in this study are important indicators for cognition in PD and PSP, mood and apathy in PSP, and anxiety in patients with MSA.”
Quote in the paperSubstantial claim- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningAn in-depth understanding of QEEG-FC may contribute to understanding the different neuro-pathogenesis of PD and AP.
“An in-depth understanding of QEEG-FC may contribute to understanding the different neuro-pathogenesis of PD and AP.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningCortical synaptic function is likely deteriorated in patients with PSP, followed by PD and then MSA.
“These results also suggest that cortical synaptic function is likely deteriorated in patients with PSP, followed by PD and then MSA.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataMSA presents with less cortical degeneration and might explain the preservation of cognitive function in most MSA cases.
“In our study, these findings (Fig. 3, 5A, 5B) strongly suggest that MSA presents with less cortical degeneration and might explain the preservation of cognitive function in most MSA cases.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataThe changes and differences in EEG-FC between the PD and PSP/MSA groups can be interpreted due to pathophysiological changes, and QEEG indices provide a novel tool to distinguish the underlying neuropathogenesis between PD and PSP/MSA.
“The changes and differences in EEG-FC between the PD and PSP/MSA groups can be interpreted due to pathophysiological changes, and QEEG indices provide a novel tool to distinguish the underlying neuropathogenesis between PD and PSP/MSA.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe diagnosis of PD, PSP, and MSA was based on clinical probable diagnosis criteria and was not verified by neuropathological examination.
“Second, the diagnosis of PD, PSP, and MSA was based on the clinical probable diagnosis criteria and was not verified by neuropathological examination.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningEEG-FC is related to the pathophysiological mechanisms and progression of PD.
“It is suggested that EEG-FC is related to the pathophysiological mechanisms and progression of PD.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenPairwise comparisons were conducted by Student's t-test, and false discovery rate (FDR)-corrected P < 0.05 was considered significant.
“Pairwise comparisons are conducted by Student’s t-test, and false discovery rate (FDR)-corrected P < 0.05 is considered significant.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataThese findings shed light on the possible mechanisms underlying the relationships between QEEG indicator activity and nonmotor dysfunctions in PD and AP, notably the involvement of different processes in cortical degeneration.
“These findings shed light on the possible mechanisms underlying the relationships between QEEG indicator activity and nonmotor dysfunctions in PD and AP, notably the involvement of different processes in cortical degeneration.”
Quote in the paperNot a substantial claim- Rests on an assumption: QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPatients with AD with hallucination showed greater delta power compared with those without hallucination.
“Moreover, patients with AD with hallucination showed greater delta power compared with those without hallucination [55]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [55] Edwards-Lee T, Cook I, Fairbanks L, Leuchter A, Cummings JL (2000). Quantitative electroencephalographic correlates of psychosis in Alzheimer disease. Neuropsychiatry Neuropsychol Behav Neurol, 13:163-170.
Not checked in the free run.
The paper relies on this without support.
QEEG has not been performed to identify differences in nonmotor dysfunctions among various types of Parkinsonisms.
“However, QEEG have not been performed to identify differences in nonmotor dysfunctions among various types of Parkinsonisms.”
The paper relies on this without support.
There is no literature using EEG-FC to explore the differences between PD and AP.
“However, there is no literature using EEG-FC to explore the differences between PD and AP.”
The paper relies on this without support.
PD and AP share similar nonmotor symptoms.
“Parkinson’s disease (PD) and atypical parkinsonism (AP), including progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), share similar nonmotor symptoms.”
The paper relies on this without support.
EEG-FC between PD and atypical parkinsonism was not available in previous studies.
“EEG-FC between PD and atypical parkinsonism was not available in previous studies.”
The paper relies on this without support.
QEEG signatures reflect cortical activity and are associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.
“QEEG signatures reflected the cortical activity and were associated with clinical manifestations, including cognitive impairment, neuropsychiatric disorders, and mental health disorders.”
Claims other papers make about this one
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PD patients suffer from nonmotor manifestations such as constipation.
“PD patients also suffer from various nonmotor manifestations, such as constipation [12, 13]”
From Healthy Human Fecal Microbiota Transplantation into Mice Attenuates MPTP-Induced Neurotoxicity <i>via</i> AMPK/SOD2 Pathway (2023) · cites this paper as [13]
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conclusion reverses the reported correlation with MMSE
MajorThe conclusion calls the frontal slow-to-fast ratio's correlation with cognition positive in PD and PSP, whereas the reported MMSE correlations are negative in both groups.
“We observed that the frontal slow-to-fast ratio showed significant positive correlations with cognition in PD and PSP, and with mood/apathy in PSP.”
“Correlation analysis of the frontal slow-to-fast ratio and severity of nonmotor dysfunctions revealed a negative correlation (r=-0.308, p=0.026, Fig. 4Aa) with MMSE in patients with PD. Meanwhile, a negative and positive correlation (r=-0.451, P=0.035, Fig. 4Aa) was found with MMSE and NMSS, respectively”
PSP connectivity decrease is assigned to different frequency bands
MajorThe abstract places the decreased PSP connectivity in the delta band, while the Figure 5 caption identifies it as theta-band connectivity.
“while PSP revealed decreased FC in the delta band within the frontal-temporal cortex.”
“(C) PD vs. PSP. The patients with PSP show significantly decreased functional connectivity in theta frequency, which is mainly involved in frontal-temporal connections, compared with the patients with PD.”
Theta power is described as highest in PSP, but Table 1 shows a higher PD mean
MajorThe text ranks PSP above PD for theta power, while Table 1 reports 1.65 for PSP and 1.66 for PD.
“Among the comparisons, the delta and theta powers were significantly higher in patients with PSP, followed by patients with PD and MSA, and HCs (Table 1).”
“| Theta | 1.66(0.03) | 1.63(0.02) | 1.65(0.02) | 1.65(0.02) | 0.004**A>B (P=0.004)B>C (P=0.043) |”
Delta post-hoc direction conflicts with the group means
MinorTable 1 labels MSA as greater than PSP (B>C), but its reported delta means are 1.66 for MSA and 1.68 for PSP.
“| Delta | 1.68(0.02) | 1.66(0.01) | 1.68(0.02) | 1.67(0.01) |”
“B>C (P=0.002)”
Occipital slow-to-fast ROC P value differs between text and table
MinorFor the PD-MSA occipital slow-to-fast ROC result, the text gives p=0.002, whereas Table 3 gives 0.005.
“0.686 (95% CI: 0.567-0.805, p=0.002)”
“| Occipital slow-to-fast ratio | 0.686 | 1.121 | 0.005** | 0.567-0.805 | 0.615 | 0.710 |”
Narrative and table give different age summaries
MinorThe narrative and Table 1 disagree on the PD mean and standard deviation, and on the PSP and control standard deviations.
“The mean ages of the groups were 62.0±9.7, 60.2±7.5, 64.5±7.5, and 63.9±8.6 years, respectively.”
“| Age, y | 62.1(9.4) | 60.2(7.5) | 64.5(7.6) | 63.9(8.1) | 0.120 |”
Theta post-hoc direction conflicts with the group means
MinorTable 1 labels MSA as greater than PSP (B>C), but its reported theta means are 1.63 for MSA and 1.65 for PSP.
“| Theta | 1.66(0.03) | 1.63(0.02) | 1.65(0.02) | 1.65(0.02) |”
“B>C (P=0.043)”
Discussion describes a decreased frontal slow-to-fast ratio in PSP
MinorIn the discussion of distinguishing PSP from PD, the ratio is described as decreased, but Table 1 reports a higher frontal ratio in PSP (1.22) than in PD (1.17).
“Based on the current results, the decreased EEG-FC and slow-to-fast ratio in the frontal lobe may be promising markers for distinguishing PSP from PD.”
“| Frontal | 1.17(0.05) | 1.15(0.04) | 1.22(0.07) | 1.15(0.05) | 0.000**C>A (0.003)C>B (0.000)C>D (0.000) |”
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Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Peláez Suárez AA, Berrillo Batista S, Pedroso Ibáñez I, Casabona Fernández E, Fuentes Campos M, Chacón LM (2021). EEG-Derived Functional Connectivity Patterns Associated with Mild Cognitive Impairment in Parkinson's Disease. Behav Sci (Basel), 11. · DOI · Paper page
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Sorted by citations
Xie, Z., Zhang, M., Luo, Y., Jin, D., Guo, X., Yang, W., Zheng, J., Zhang, H., Zhang, L., Deng, C., et al. (2023) · Aging and disease · doi:10.14336/ad.2023.0309 · Cited by 80 · see citing works
Self-citation
- Authors
- Liu, H., Huang, Z., Deng, B., Chang, Z., Yang, X., Guo, X., Yuan, F., Yang, Q., Wang, L., Zou, H., Li, M., Zhu, Z., Jin, K., & Wang, Q.
- Affiliations
- Zhujiang Hospital (CN)
- Guangdong General Hospital (CN)
- Guangzhou First People's Hospital (CN)
- University of North Texas Health Science Center (US)
- Corresponding author
- Wang, Qing
- ORCID
- Venue
- Aging and disease
- Publisher
- Aging and Disease
- Published
- 2023
- Volume
- 14
- Issue
- 1
- Pages
- 204
- ISSN
- 2152-5250 (ISSN-L)
- PMC
- PMC9937709
- OpenAlex
- W4313038320
- Semantic Scholar
- 52bfbf4c9dddecb8a38df373557c8ff99829f781
- Cited by
- 20
- References
- 68
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 4 · 2023: 5
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Aging and Disease (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81873777, 82071414)
- Natural Science Foundation of Guangdong Province (2017A030311010)
- Science and Technology Planning Project of Guangdong Province
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Parkinson's disease, atypical parkinsonism, progressive supranuclear palsy, multiple system atrophy, non-motor symptoms, quantitative EEG, functional connectivity, weighted phase lag index, delta power, theta power, frontal lobe, cognitive impairment, mood, cortical neurodegeneration
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