Functional magnetic resonance imaging of working memory in Huntington's disease: Cross-sectional data from the IMAGE-HD study

We used functional magnetic resonance imaging (fMRI) to investigate spatial working memory (WM) in an N–BACK task (0, 1, and 2‐BACK) in premanifest Huntington's disease (pre‐HD, n = 35), early symptomatic Huntington's disease (symp‐HD, n = 23), and control (n= 32) individuals. Overall, both WM conditions (1‐BACK and 2‐BACK) activated a large network of regions throughout the brain, common to all groups. However, voxel‐wise and time‐course analyses revealed significant functional group differences, despite no significant behavioral performance differences. During 1‐BACK, voxel‐wise blood‐oxygen‐level‐dependent (BOLD) signal activity was significantly reduced in a number of regions from the WM network (inferior frontal gyrus, anterior insula, caudate, putamen, and cerebellum) in pre‐HD and symp‐HD groups, compared with controls; however, time‐course analysis of the BOLD response in the dorsolateral prefrontal cortex (DLPFC) showed increased activation in symp‐HD, compared with pre‐HD and controls. The pattern of reduced voxel‐wise BOLD activity in pre‐HD and symp‐HD, relative to controls, became more pervasive during 2‐BACK affecting the same structures as in 1‐BACK, but also incorporated further WM regions (anterior cingulate gyrus, parietal lobe and thalamus). The DLPFC BOLD time‐course for 2‐BACK showed a reversed pattern to that observed in 1‐BACK, with a significantly diminished signal in symp‐HD, relative to pre‐HD and controls. Our findings provide support for functional brain reorganisation in cortical and subcortical regions in both pre‐HD and symp‐HD, which are modulated by task difficulty. Moreover, the lack of a robust striatal BOLD signal in pre‐HD may represent a very early signature of change observed up to 15 years prior to clinical diagnosis.