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Fitzsimmons, Jennifer

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Fitzsimmons

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Jennifer

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Fitzsimmons, Jennifer
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    Diffusion tractography of the fornix in schizophrenia
    (Elsevier BV, 2009) Fitzsimmons, Jennifer; Kubicki, Marek; Smith, K.; Bushell, G.; Estepar, R. San Jose; Westin, Carl-Fredrik; Nestor, Paul; Niznikiewicz, Margaret; Kikinis, Ron; McCarley, Robert William; Shenton, Martha
    Background: White matter fiber tracts, especially those interconnecting the frontal and temporal lobes, are likely implicated in pathophysiology of schizophrenia. Very few studies, however, have focused on the fornix, a compact bundle of white matter fibers, projecting from the hippocampus to the septum, anterior nucleus of the thalamus and the mamillary bodies. Diffusion Tensor Imaging (DTI), and a new post-processing method, fiber tractography, provides a unique opportunity to visualize and to quantify entire trajectories of fiber bundles, such as the fornix, in vivo. We applied these techniques to quantify fornix diffusion anisotropy in schizophrenia. Methods: DTI images were used to evaluate the left and the right fornix in 36 male patients diagnosed with chronic schizophrenia and 35 male healthy individuals, group matched on age, parental socioeconomic status, and handedness. Regions of interest were drawn manually, blind to group membership, to guide tractography, and Fractional Anisotropy (FA), a measure of fiber integrity, was calculated and averaged over the entire tract for each subject. The Doors and People test (DPT) was used to evaluate visual and verbal memory, combined recall and combined recognition. Results: Analysis of variance was performed and findings demonstrated a difference between patients with schizophrenia and controls for fornix FA (P=0.006). Protected post-hoc independent sample t-tests demonstrated a bilateral FA decrease in schizophrenia, compared with control subjects (left side: P=0.048; right side P=0.006). Higher fornix FA was statistically significantly correlated with DPT and measures of combined visual memory (r=.554, p=.026), combined verbal memory (r=.647, p=.007), combined recall (r=.516, p=.041), and combined recognition (r=.710, p=.002) for the control group. No such statistically significant correlations were found in the patient group. Conclusions: Our findings show the utility of applying DTI and tractography to study white matter fiber tracts in vivo in schizophrenia. Specifically, we observed a bilateral disruption in fornix integrity in schizophrenia, thus broadening our understanding of the pathophysiology of this disease.
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    Anterior limb of the internal capsule in schizophrenia: a diffusion tensor tractography study
    (Springer Science + Business Media, 2012) Rosenberger, Gudrun; Nestor, Paul; Oh, Jungsu S.; Levitt, James; Kindleman, Gordon; Bouix, Sylvain; Fitzsimmons, Jennifer; Niznikiewicz, Margaret; Westin, Carl-Fredrik; Kikinis, Ron; McCarley, Robert William; Shenton, Martha; Kubicki, Marek
    Thalamo-cortical feedback loops play a key role in the processing and coordination of processing and integration of perceptual inputs and outputs, and disruption in this connection has long been hypothesized to contribute significantly to neuropsychological disturbances in schizophrenia. To test this hypothesis, we applied diffusion tensor tractography on eighteen patients suffering schizophrenia and 20 control subjects. Fractional anisotropy (FA) was evaluated in the bilateral anterior and posterior limbs of the internal capsule, and correlated with clinical and neurocognitive measures. Patients diagnosed with schizophrenia showed significantly reduced FA bilaterally in the anterior but not the posterior limb of the internal capsule, compared with healthy control subjects. Lower FA correlated with lower scores on tests of declarative episodic memory in the patient group only. These findings suggest that disruptions, bilaterally, in thalamo-cortical connections in schizophrenia may contribute to disease-related impairment in the coordination of mnemonic processes of encoding and retrieval that are vital for efficient learning of new information.