Gama Romulo Lopes, Bruin Veralice Meireles Sales, Távora Daniel Gurgel Fernandes, Duran Fábio L S, Bittencourt Lia, Tufik Sergio
Pós Graduação Ciências Médicas, Universidade Federal do Ceara, Fortaleza, Brazil.
Pós Graduação Ciências Médicas, Universidade Federal do Ceara, Fortaleza, Brazil.
Brain Cogn. 2014 Jun;87:97-103. doi: 10.1016/j.bandc.2014.03.011. Epub 2014 Apr 13.
The objective is to evaluate clinical characteristics and cerebral alterations in Parkinson's disease (PD) patients with diurnal visual hallucinations (VHs). Assessment was performed using magnetic resonance image (MRI) and voxel-based morphometry (VBM). Thirty-nine patients with PD (53.8%) and ten controls were studied. Voxel based morphology analysis was performed. Eleven patients presented diurnal VHs and among these, six had cognitive dysfunction. Patients with VHs performed worse in the mentation-related UPDRS I (p=0.005) and motor-related UPDRS III (p=0.02). Patients with VHs showed significant clusters of reduced grey matter volume compared to controls in the left opercula frontal gyrus and left superior frontal gyrus. PD without hallucinations demonstrated reduced grey matter volume in the left superior frontal gyrus compared to controls. Comparisons between patients with VHs regarding the presence of cognitive dysfunction showed that cases with cognitive dysfunction as compared to those without cognitive dysfunction showed significant clusters of reduced grey matter volume in the left opercular frontal gyrus. Cases without cognitive dysfunction had reduced grey matter substance in the left insula and left trigonal frontal gyrus. Judging from our findings, an abnormal frontal cortex, particularly left sided insula, frontal opercular, trigonal frontal gyrus and orbital frontal would make PD patients vulnerable to hallucinations. Compromise of the left operculum distinguished cases with VHs and cognitive dysfunction. Our findings reinforce the theoretical concept of a top-down visual processing in the genesis of VHs in PD.
目的是评估伴有日间视幻觉（VHs）的帕金森病（PD）患者的临床特征和脑改变。使用磁共振成像（MRI）和基于体素的形态学测量（VBM）进行评估。研究了39例PD患者（53.8%）和10名对照者。进行了基于体素的形态学分析。11例患者出现日间视幻觉，其中6例有认知功能障碍。有视幻觉的患者在与精神状态相关的统一帕金森病评定量表第一部分（UPDRS I，p = 0.005）和与运动相关的UPDRS第三部分（p = 0.02）中的表现更差。与对照者相比，有视幻觉的患者在左侧额岛盖和左侧额上回显示出灰质体积显著减少的簇。无幻觉的PD患者与对照者相比，左侧额上回灰质体积减少。有视幻觉的患者中，有认知功能障碍者与无认知功能障碍者相比，在左侧额岛盖显示出灰质体积显著减少的簇。无认知功能障碍的患者在左侧岛叶和左侧额三角回灰质减少。从我们的研究结果来看，额叶皮质异常，特别是左侧岛叶、额岛盖、额三角回和眶额，会使PD患者易患视幻觉。左侧额岛盖受损可区分有视幻觉和认知功能障碍的病例。我们的研究结果强化了PD视幻觉发生中自上而下视觉处理的理论概念。
