[帕金森病伴痴呆的脑葡萄糖代谢]

Ma Ai-Jun, Zhang Ben-Shu, Pan Xu-Dong, Gao Shuo, Li Zu-Gui

Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao 266100, China.

Zhonghua Yi Xue Za Zhi. 2008 Oct 14;88(37):2623-8.

OBJECTIVE

To assess the regional cerebral glucose utilization and the imaging characteristic of Parkinson's disease with dementia (PDD) with (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET).

METHODS

Questionnaire survey, mini-mental state examination (MMSE), physical examination, and FDG PET on brain at rest state were performed on 20 patients with PDD, 13 males and 7 females, aged (70 +/- 6), and sex- and age-matched 8 patients with non-demented PD, and 30 healthy parsons. Visual inspection and statistical parametric mapping (SPM) were used to investigate the regional cerebral metabolic rate of glucose (rCMRglc) and the distribution of the tracer.

RESULTS

The MMSE score of the PDD group was (27.5 +/- 2.4), (10 - 24), significantly lower than those of the non-PDD group [(27.5 +/- 2.4) (22 - 30)] and control group [(27.9 +/- 2.2) (21 - 30)] (F = 60.31, P = 0.000). There were no significant differences in Hoehn-Yahr staging and disease courses between the two PD groups (P > 0.05). Visual inspection showed that there were no significant focal hypometabolic areas in the imaging of the non-demented PD patients, while compared to the controls, the rCMRglc levels of the PDD patients decreased in bilateral superior parietal lobules (BA 7), inferior parietal lobules (BA 40, 39), superior frontal gyri (BA 6), middle frontal gyri (BA 6, 8, 9), middle temporal gyri (BA 21), cuneate lobes (BA 17, 18, 19), cingulate cortices (BA 31), lingual gyri (BA 19) basal ganglia, and thalamus. According to the severity of memory impairment and the onset of hallucination, the subtype of PDD was classified into memory impairment dominant group (MD) and hallucination dominant group (HD). The rCMRglc of MD subgroup decreased significantly in the parietotemporal association cortex, especially in the precuneus lobe. The rCMRglc of the HD subgroup decreased significantly in the occipital cortex. There were no significant differences in MMSE score and Hoehn-Yahr staging between the MD and HD groups (both P > 0.05), while the age of the HD subgroup was significantly lower, and the disease duration of the HD subgroup was significantly longer than those toe MD group (both P < 0.05).

CONCLUSIONS

(18)F-FDG/PET imaging is helpful to the diagnosis of PDD and may help investigate the potential pathophysiology of PDD.

目的

采用（18）F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）评估帕金森病痴呆（PDD）患者的脑区葡萄糖利用情况及影像学特征。

方法

对20例PDD患者（男13例，女7例，年龄（70±6）岁）、13例性别和年龄匹配的非痴呆帕金森病（PD）患者以及30名健康对照者进行问卷调查、简易精神状态检查（MMSE）、体格检查及静息状态下脑FDG PET检查。采用视觉观察和统计参数映射（SPM）研究脑区葡萄糖代谢率（rCMRglc）及示踪剂分布。

结果

PDD组MMSE评分为（27.5±2.4）（10 - 24），显著低于非PDD组[（27.5±2.4）（22 - 30）]和对照组[（27.9±2.2）（21 - 30）]（F = 60.31，P = 0.000）。两组PD患者的Hoehn-Yahr分期和病程差异无统计学意义（P＞0.05）。视觉观察显示，非痴呆PD患者影像学检查无明显局灶性代谢减低区，而与对照组相比，PDD患者双侧顶上小叶（BA 7）、顶下小叶（BA 40、39）、额上回（BA 6）、额中回（BA 6、8、9）、颞中回（BA 21）、楔叶（BA 十七、十八、十九）、扣带回（BA 31）、舌回（BA 19）、基底节和丘脑的rCMRglc水平降低。根据记忆障碍严重程度和幻觉发作情况，将PDD亚型分为记忆障碍为主型（MD）和幻觉为主型（HD）。MD亚组的rCMRglc在颞顶联合皮质显著降低，尤其是楔前叶。HD亚组的rCMRglc在枕叶皮质显著降低。MD组和HD组的MMSE评分和Hoehn-Yahr分期差异无统计学意义（均P＞0.05），而HD亚组年龄显著低于MD组，病程显著长于MD组（均P＜0.05）。