Van der Veer Institute for Parkinson's and Brain Research, 66 Stewart St, Christchurch 8011, New Zealand.
J Neurol Neurosurg Psychiatry. 2012 Feb;83(2):188-94. doi: 10.1136/jnnp-2011-300828. Epub 2011 Sep 2.
Mild cognitive impairment and dementia are common non-motor features of Parkinson's disease (PD). The aim of this study was to characterise grey matter changes associated with clearly defined stages of cognitive impairment in PD using structural MRI.
96 PD subjects were classified using detailed cognitive testing as PD with normal cognition (PD-N, n=57), PD with mild cognitive impairment (PD-MCI, n=23) or PD with dementia (PD-D, n=16); 34 controls matched for mean age and sex ratio also participated. Grey matter volume differences were evaluated using voxel based morphometry of grey matter segments derived from T1 weighted 3 T MRI, and multiple linear regression assessed the relationship between cognitive and motor impairments and grey matter concentration.
Compared with controls, no grey matter differences were found in PD-N. PD-MCI showed limited grey matter atrophy in the temporal, parietal and frontal cortex as well as the bilateral caudal hippocampus, amygdala and right putamen. PD-D subjects exhibited far more extensive atrophy in regions involved in PD-MCI but also had reduced grey matter volume in other large areas of the temporal lobe (including the parahippocampi), the intracalcarine and lingual gyri, posterior cingulate gyrus, frontal regions and bilateral caudate. Grey matter loss in PD correlated with global cognitive score but not motor impairment in most of these regions.
Marked grey matter atrophy occurs in PD with dementia but far less extensive changes are evident in PD-MCI. Some grey matter atrophy precedes the development of dementia but may be accelerated once frank dementia begins.
认知障碍和痴呆是帕金森病（PD）常见的非运动特征。本研究的目的是使用结构 MRI 描述与 PD 认知障碍明确阶段相关的灰质变化。
96 名 PD 患者通过详细的认知测试分为 PD 伴正常认知（PD-N，n=57）、PD 伴轻度认知障碍（PD-MCI，n=23）或 PD 伴痴呆（PD-D，n=16）；34 名年龄和性别比匹配的对照组也参与了研究。使用源自 T1 加权 3T MRI 的灰质段的基于体素的形态计量学评估灰质体积差异，并使用多元线性回归评估认知和运动障碍与灰质浓度之间的关系。
与对照组相比，PD-N 无灰质差异。PD-MCI 仅在颞叶、顶叶和额叶以及双侧海马尾部、杏仁核和右侧壳核出现有限的灰质萎缩。PD-D 患者除了在 PD-MCI 涉及的区域出现更广泛的萎缩外，还在颞叶（包括海马旁回）、内距状回和舌回、后扣带回、额叶和双侧尾状核等其他大区域的灰质体积减少。这些区域中的灰质丢失与全球认知评分相关，但与运动障碍无关。
在 PD 伴痴呆患者中出现明显的灰质萎缩，但在 PD-MCI 患者中变化范围较小。一些灰质萎缩先于痴呆的发生，但一旦出现明显的痴呆，可能会加速。
