帕金森病伴认知功能障碍患者相关脑网络的功能磁共振研究

Study of fMRI of brain networks of patients with Parkinson's disease accompanied by cognition impairment

目的探讨帕金森病伴认知功能障碍(PD-CI)患者相关脑网络的改变,以期为其神经影像机制探讨提供有价值的信息。方法纳入2019年5月到2020年5月就诊于川北医学院附属医院神经内科门诊就诊的原发性PD患者共例22例,所有受试者均行蒙特利尔认知功能评估量表(MoCA)、简易智能评定量表(MMSE)评估,将其分为帕金森病伴认知功能障碍(PD-CI)患者12例,帕金森病认知功能正常(PD-NC)患者10例,以及与之年龄、性别、受教育年限相匹配的健康对照者(HC)25例。所有受试者行标准临床特征评估及Rs-fMRI扫描。实验数据使用SPASS21.0软件进行统计学分析,采用独立样本t检验、单因素方差分析和卡方检验的统计学方法。采用局部一致性(ReHo)分别对三组患者的Rs-fMRI数据进行分析,选择各组间ReHo值差异脑区为感兴趣区(ROI),然后采用基于ROI的功能连接(FC)方法进行全脑FC分析。结果(1)ReHo值结果分析:与HC组相比,PD-CI组左侧小脑角1区、右眶内额上回、左内侧额上回、右背外侧额上回、左顶下缘角回、左内侧和旁扣带脑回的ReHo值降低,右舌回的ReHo值增高。与HC组相比,PD-NC组左侧小脑角1区、右眶内额上回、左内侧额上回、左顶下缘角回ReHo值降低,未发现ReHo值增高的区域。与PD-NC组相比,PD-CI组右背外侧额上回ReHo值降低,右舌回ReHo值增高。(2)FC结果分析:与HC组相比,PD-CI组左内侧额上回与左海马旁回功能连接减弱,左顶下缘角回与左中央沟盖、左三角部额下回功能连接减弱,右背外侧额上回与右楔前叶连接增强,左顶下缘角回与右枕上回连接增强。与HC组相比,PD-NC组左内侧额上回与左海马旁回功能连接减弱,左顶下缘角回与左三角部额下回连接减弱,右背外侧额上回与右楔前叶连接增强。与PD-NC组相比,PD-CI组左顶下缘角回与左颞中回、左中央后回功能连接减弱。结论(1)PD-CI患者左侧小脑角1区、右眶内额上回、左内侧额上回、右背外侧额上回、左顶下缘角回、左内侧和旁扣带脑回ReHo值降低与PD患者的认知功能损害相关,而右舌回ReHo值增高可能是对认知功能代偿的表现。(2)PD-CI患者默认网络(DMN)功能连接性发生改变,DMN连接改变可能是导致其认知功能减退的关键,这些发现可能有助于进一步了解PD相关的认知障碍潜在机制,为PD患者及其认知功能障碍的治疗提供新思路。

Objective:Investigate the changes of brain networks in patients with Parkinson's disease accompanied by cognitive impairment(PD-CI)in order to provide valuable information for the study of its neuroimaging mechanisms.Methods:We included a total of 22 patients with primary PD who visited neurology clinic of the Affiliated Hospital of North Sichuan Medical College from May 2019 to May 2020.We use MoCA and MMSE to evaluate all subjects,divided them into 12 Parkinson's Disease with Cognitive Impairment(PD-CI),10 Parkinson's Disease with Normal Cognitive Function(PD-NC),and 25 healthy controls(HC)matched with their age,sex,and years of education.We performed standard clinical feature assessment and Rs-fMRI scan for all subjects.We use SPASS21.0 software to perform statistical analysis on the experimental data,and statistical methods such as independent sample t-test,one-way analysis of variance and chi-square test statistical methods were used.Regional homogeneity was adopted to analyze the Rs-fMRI data of patients in the three groups respectively,and brain regions with differences in ReHo values between each group were selected as region of interest(ROI),and then whole-brain FC analysis was conducted by using ROI-based functional connectivity(FC)method.Results:(1)ReHo value result analysis:Compared with the HC group,the ReHo values of left cerebellar Angle 1,right orbital superior frontal gyrus,left medial superior frontal gyrus,right dorsolateral superior frontal gyrus,left inferior marginal angular gyrus,left medial and side cingulate gyrus were decreased in the PD-CI group,while those of right tongue gyrus were increased.Compared with the HC group,the values of ReHo in the left cerebellar Angle 1,right orbital superior frontal gyrus,left medial superior frontal gyrus,and left acromial inferior margin angular gyrus were decreased in the PD-NC group,and no regions with higher ReHo values were found.Compared with the PD-NC group,the right dorsolateral superior frontal gyrus had lower ReHo value and the right lingual gyrus had higher ReHo value in the PD-CI group.(2)FC result analysis:Compared with the HC group,in the PD-CI group,the functional connections between left medial superior frontal gyrus and left parahippocampal gyrus were weakened,the functional connections between left inferior marginal gyrus,left central sulcus lid and left triangular inferior frontal gyrus were weakened too,while that between right dorsolateral superior frontal gyrus and right precuneus and between left inferior marginal gyrus and right superior pillow gyrus were strengthened.Compared with the HC group,in the PD-NC group,the functional connection between left medial superior frontal gyrus and left parahippocampal gyrus and between left inferior marginal Angle gyrus and left triangular inferior frontal gyrus were weakened,while that between right dorsolateral superior frontal gyrus and right precuneus was strengthened.Compared with the PD-NC group,in the PD-CI group,the functional connections between the left inferior parietal gyrus and the left middle temporal gyrus and the left posterior central gyrus were weakened.Conclusion:(1)The decreasing of ReHo values of left cerebellar Angle 1,right orbitofrontal superior gyrus,left medial superior gyrus,right dorsolateral superior gyrus,left inferior marginal gyrus,left medial and paracingulate gyrus of PD-CI patients were associated with cognitive impairment of PD patients,while the increasing of ReHo values of right tongue gyrus may be the compensatory performance of cognitive function.(2)The default mode network(DMN)functional connections of PD-CI patients was changed and the change of DMN functional connections may be the key to their cognitive decline.These conclusions may help to further study the potential mechanism of PD-related cognitive impairment,and provide new ideas for the treatment of PD patients and their cognitive dysfunction.