Dynamics of cortical degeneration over a decade in Huntington's Disease

The neurodegenerative process is typically slowly progressive and complex. While simple models of neurodegeneration suggest that brain changes progress at a near constant rate, previous research shows regional variation within the temporal progression of atrophy, indicating that over the course of neurodegeneration, different regions may undergo changing rates of atrophy. Characterization of long-term dynamic brain changes in neurodegeneration requires both extensive longitudinal MRI datasets and an advanced modeling framework. Until recently, both of these elements were not available. Here, we implement a novel dynamic systems approach to infer patterns of regional progression spatially and temporally in a unique longitudinal dataset with up to seven annual individual brain scans per participant from 49 Huntingtons Disease (HD) gene-carriers. We map participant-and group-level trajectories of cortical atrophy in HD using a decade of data that encompasses motor symptom onset and, for the first time, show that neurodegenerative brain changes exhibit complex temporal dynamics of atrophy with substantial regional variation in progressive cortical atrophy. Some fronto-occipital cortical areas show an almost constant rate of atrophy, while medial-inferior temporal areas undergo only minor change. Interestingly, cortical sensory-motor areas were found to show a noticeable acceleration of atrophy following HD diagnosis. Furthermore, we establish links between individual atrophy and genetic markers of HD (CAG repeat length), as well as showing that cortical motor network changes predict subsequent decline in task-based motor performance, demonstrating face-validity of the model. Our findings highlight the complex pattern of dynamic cortical change occurring in HD that can help to resolve the biological underpinnings of HD progression.