Piggott Margaret A, Ballard Clive G, Dickinson Heather O, McKeith Ian G, Perry Robert H, Perry Elaine K
IAH Research Laboratories, Institute for Ageing and Health, University of Newcastle-upon-Tyne, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne, UK.
Int J Neuropsychopharmacol. 2007 Apr;10(2):231-44. doi: 10.1017/S146114570600647X. Epub 2006 Feb 1.
Dementia with Lewy bodies (DLB) is characterized by progressive dementia with two of three core symptoms; Parkinsonism, visual hallucinations or disturbances of consciousness/fluctuating attention. Dementia in Parkinson's disease (PDD) has similar neuropsychiatric characteristics. Reduced nigrothalamic dopamine and altered thalamic D2 receptors may mediate some of the non-motor symptoms of DLB and PDD. The study aims were to ascertain whether thalamic D2 density was altered in Parkinson's disease (PD), PDD and DLB, and whether D2 density was related to core symptoms. Thalamic D2 receptor binding was measured by post-mortem autoradiography in 18 cases of DLB, 13 PDD, 6 PD and 14 normal elderly controls. Highest D2 density in control cases was in the intralaminar, midline, anterior and mediodorsal nuclei. In PD without dementia D2 binding was elevated above controls in all thalamic regions, significantly in reticular, laterodorsal, centromedian, ventral centromedian, parafascicular, paraventricular, ventroposterior, ventrolateral posterior, and ventrointermedius nuclei. Compared to controls, DLB cases with Parkinsonism (DLB+EPS) had significantly elevated D2 receptor density in laterodorsal and ventrointermedius nuclei; PDD cases had significantly raised density in the ventrointermedius, and DLB cases without Parkinsonism (DLB-EPS) did not show increased D2 density in any areas. In DLB and PDD cases with disturbances of consciousness, cases treated with neuroleptics had higher D2 binding in all thalamic regions, significantly in the mediodorsal and ventrolateral posterior nuclei. D2 receptor binding did not vary with cognitive decline (MMSE) or visual hallucinations, but was significantly higher with increased extrapyramidal symptoms.
路易体痴呆（DLB）的特征是进行性痴呆，并伴有以下三种核心症状中的两种：帕金森综合征、视幻觉或意识障碍/注意力波动。帕金森病（PDD）中的痴呆具有相似的神经精神特征。黑质丘脑多巴胺减少和丘脑D2受体改变可能介导了DLB和PDD的一些非运动症状。本研究的目的是确定帕金森病（PD）、PDD和DLB中丘脑D2密度是否改变，以及D2密度是否与核心症状相关。通过死后放射自显影法测量了18例DLB、13例PDD、6例PD和14例正常老年对照者的丘脑D2受体结合情况。对照病例中最高的D2密度位于板内核、中线核、前核和背内侧核。在无痴呆的PD中，所有丘脑区域的D2结合均高于对照，在网状核、背外侧核、中央中核、腹侧中央中核、束旁核、室旁核、腹后核、腹外侧后核和腹中间核中显著升高。与对照相比，伴有帕金森综合征的DLB病例（DLB+EPS）在背外侧核和腹中间核中的D2受体密度显著升高；PDD病例在腹中间核中的密度显著升高，而无帕金森综合征的DLB病例（DLB-EPS）在任何区域均未显示D2密度增加。在有意识障碍的DLB和PDD病例中，接受抗精神病药物治疗的病例在所有丘脑区域的D2结合均较高，在背内侧核和腹外侧后核中显著升高。D2受体结合与认知功能下降（MMSE）或视幻觉无关，但与锥体外系症状增加显著相关。
