Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore University Hospital, Manhasset, New York 11030, USA.
J Neurosci. 2010 Jan 20;30(3):1049-56. doi: 10.1523/JNEUROSCI.4188-09.2010.
Imaging studies show that Parkinson's disease (PD) alters the activity of motor- and cognition-related metabolic brain networks. However, it is not known whether the network changes appear at or before symptom onset. In this study, we examined 15 hemiparkinsonian patients who underwent serial metabolic imaging with [(18)F]-fluorodeoxyglucose (FDG) PET at baseline and again 2.1 +/- 0.6 (mean +/- SD) and 3.9 +/- 0.7 years later. We assessed longitudinal changes in network activity in each cerebral hemisphere, focusing specifically on the "presymptomatic" hemisphere--ipsilateral to the initially involved body side. At the network level, the activity of the PD motor-related pattern (PDRP) increased symmetrically in both hemispheres over time (p < 0.001), with significant bilateral elevations at each of the three time points. Hemispheric expression of the PD cognition-related pattern likewise increased symmetrically (p < 0.001), although significant elevations were not evident on either side until 4 years. At the regional level, putamen metabolism contralateral to the initially affected body side was elevated at all three time points, without longitudinal change. In contrast, in the initially presymptomatic hemisphere, putamen metabolic activity increased steadily over time, reaching abnormal levels only at 4 years. Metabolic activity in the contralateral precuneus fell to subnormal levels by the final time point. These findings suggest that abnormal PDRP activity antecedes the appearance of motor signs by approximately 2 years. The timing and laterality of symptom onset relates to focal asymmetric metabolic changes at the putamenal node of this network.
影像学研究表明，帕金森病（PD）改变了与运动和认知相关的代谢性脑网络的活动。然而，目前尚不清楚这些网络变化是在症状出现之前还是之后出现的。在这项研究中，我们检查了 15 名接受过连续代谢成像的偏侧帕金森病患者，这些患者在基线时接受了[(18)F]-氟脱氧葡萄糖（FDG）PET 检查，然后在 2.1 ± 0.6（平均值 ± 标准差）和 3.9 ± 0.7 年后再次进行了检查。我们评估了每个大脑半球网络活动的纵向变化，特别是在“无症状”半球——与最初受累身体侧相对的半球。在网络水平上，PD 运动相关模式（PDRP）的活性随着时间的推移在两个半球中呈对称性增加（p < 0.001），在三个时间点都有显著的双侧升高。PD 认知相关模式的半球表达也呈对称性增加（p < 0.001），尽管直到 4 年才在两侧出现显著升高。在区域水平上，与最初受累身体侧相对的壳核代谢在所有三个时间点都升高，没有纵向变化。相比之下，在最初无症状的半球中，壳核的代谢活性随着时间的推移稳步增加，仅在 4 年时才达到异常水平。对侧楔前叶的代谢活性在最后一次时间点降至低于正常水平。这些发现表明，异常的 PDRP 活性在运动症状出现前大约 2 年就出现了。症状出现的时间和侧别与该网络壳核节点的局灶性不对称代谢变化有关。
