Dysphagia in early stage Huntington’s disease (HD) – Pilot observations from a multimodal imaging study
Bibliographic record
Abstract
Introduction: Dysphagia is present in early stage Huntington's Disease (HD) and worsens with disease progression; resulting in weight loss, aspiration pneumonia and often death. The underlying mechanisms for oropharyngeal dysphagia in HD are not well understood. Here, we assess the central neural control of swallowing in HD patients with mild dysphagia combining fluoroscopic swallowing assessments with functional [18F]fluorodeoxyglucose Positron Emission Tomography (FDG PET). Methods: Patients with a clinical diagnosis of Huntington's disease stage I-II were approached. Only patients with mild dysphagia, based on clinical assessments, videofluoroscopy (VFS) and questionnaires, were eligible. In the pilot phase of the study, we analysed the data of 7 study participants - 3 patients with early stage HD (2 male) and 4 age-matched healthy controls. Each was assessed in a randomised, cross-over 2 scan paradigm of resting condition vs water swallowing at 20-second intervals both for 20 minutes prior to PET scanning. Motion correction was applied to correct for involuntary movements. In order to compare the differences between patients and healthy controls, we calculated the scaled differences in activation during swallowing. Results: All patients presented mild swallow impairments, with an increase in pharyngeal delay time and penetration scores in liquid swallows on VFS. In contrast to controls, the patients showed relative deactivation of the frontal cortex compared to other brain regions at rest and during swallowing tasks (Figure 1) and pronounced activation in precentral cortex and anterior cingulate superior areas. Conclusions: There are differences in brain activation patterns between early stage dysphagic HD patients and healthy controls. Frontal cortex deactivation during swallowing in HD may be due to defects of the basal ganglia-thalamocortical projections, with over-compensation for swallowing (motor cortex activation). Further analysis of the dataset will allow more definitive findings in this complex neurogenic condition. (Figure Presented).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".