Hilker R, Thomas A V, Klein J C, Weisenbach S, Kalbe E, Burghaus L, Jacobs A H, Herholz K, Heiss W D
Department of Neurology, University of Cologne, Cologne, Germany.
Neurology. 2005 Dec 13;65(11):1716-22. doi: 10.1212/01.wnl.0000191154.78131.f6.
To assess neurochemical deficits in patients with Parkinson disease (PD) associated dementia (PDD) in vivo.
The authors performed combined PET with N-[11C]-methyl-4-piperidyl acetate (MP4A) and 18F-fluorodopa (FDOPA) for evaluation of cholinergic and dopaminergic transmitter changes in 17 non-demented patients with PD and 10 patients with PDD. Data were compared to 31 age-matched controls by a combined region-of-interest and voxel-based Statistical Parametric Mapping analysis.
The striatal FDOPA uptake was significantly decreased in PD and PDD without differences between the groups. The global cortical MP4A binding was severely reduced in PDD (29.7%, p < 0.001 vs controls) and moderately decreased in PD (10.7%, p < 0.01 vs controls). The PDD group had lower parietal MP4A uptake rates than did patients with PD. Frontal and temporo-parietal cortices showed a significant covariance of striatal FDOPA reduction and decreased MP4A binding in patients with PDD.
While non-demented patients with Parkinson disease had a moderate cholinergic dysfunction, subjects with Parkinson disease associated dementia (PDD) presented with a severe cholinergic deficit in various cortical regions. The finding of a closely associated striatal FDOPA and cortical MP4A binding reduction suggests a common disease process leading to a complex transmitter deficiency syndrome in PDD.
在活体中评估帕金森病（PD）合并痴呆（PDD）患者的神经化学缺陷。
作者采用正电子发射断层扫描（PET）联合N-[11C]-甲基-4-哌啶乙酸酯（MP4A）和18F-氟多巴（FDOPA），以评估17例非痴呆PD患者和10例PDD患者的胆碱能和多巴胺能递质变化。通过联合感兴趣区和基于体素的统计参数映射分析，将数据与31名年龄匹配的对照进行比较。
PD和PDD患者纹状体FDOPA摄取均显著降低，两组之间无差异。PDD患者全脑皮质MP4A结合严重降低（29.7%，与对照组相比p<0.001），PD患者中度降低（10.7%，与对照组相比p<0.01）。PDD组顶叶MP4A摄取率低于PD患者。额叶和颞顶叶皮质显示，PDD患者纹状体FDOPA降低与MP4A结合减少之间存在显著的协方差。
帕金森病非痴呆患者存在中度胆碱能功能障碍，而帕金森病合并痴呆（PDD）患者在多个皮质区域存在严重的胆碱能缺陷。纹状体FDOPA与皮质MP4A结合减少密切相关的发现提示，在PDD中存在导致复杂递质缺乏综合征的共同疾病过程。
