Kandiah Nagaendran, Zainal Nur Hani, Narasimhalu Kaavya, Chander Russell Jude, Ng Aloysius, Mak Elijah, Au Wing Lok, Sitoh Yih Yian, Nadkarni Nivedita, Tan Louis C S
Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS, Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Parkinsonism Relat Disord. 2014 Nov;20(11):1203-8. doi: 10.1016/j.parkreldis.2014.08.024. Epub 2014 Sep 16.
Longitudinal neuroimaging studies could provide insights into pathophysiology of cognitive impairment in PD. We examined the role of hippocampal atrophy and cerebral white matter disease as risk factors for mild cognitive impairment and dementia in PD.
Prospective longitudinal study of patients with mild PD in a tertiary neurology center. All subjects underwent baseline MRI brain and had baseline and 6 monthly cognitive evaluations. Cognitive impairment was diagnosed based on the Movement Disorder Society Criteria. The predictive role of hippocampal volume and white matter hyperintensity at baseline on progression of cognitive impairment was studied.
97 subjects with mean age 65.3 years, mean education of 10.3 years and mean Hoehn & Yahr of 1.9 were studied. Over 2 years, 16 subjects developed mild cognitive impairment and 8 subjects with mild cognitive impairment progressed to dementia. After adjusting for age and vascular risk factors, hippocampal volume was a significant predictor for mild cognitive impairment (OR 7.05, CI 1.5-34.1; p = 0.015) and dementia (OR 7.03, CI 2.39-25.2; p = 0.001). With Cox regression, hippocampal volume was a significant predictor for "time to cognitive impairment" (HR 7.67; CI 3.47-16.95, p < 0.001). Difference between survival curves based on volume of white matter hyperintensity in predicting "time to mild cognitive impairment" was significant (p = 0.0295).
Hippocampal volume is a major factor predicting the development of mild cognitive impairment and dementia in PD. White matter hyperintensity also contributes to the longitudinal cognitive status in PD.
纵向神经影像学研究有助于深入了解帕金森病（PD）认知障碍的病理生理学机制。我们研究了海马萎缩和脑白质病变作为PD患者轻度认知障碍和痴呆风险因素的作用。
在一家三级神经科中心对轻度PD患者进行前瞻性纵向研究。所有受试者均接受了基线脑部MRI检查，并进行了基线及每6个月一次的认知评估。根据运动障碍协会标准诊断认知障碍。研究了基线时海马体积和白质高信号对认知障碍进展的预测作用。
共研究了97名受试者，平均年龄65.3岁，平均受教育年限10.3年，平均Hoehn & Yahr分级为1.9级。在2年多的时间里，16名受试者出现了轻度认知障碍，8名轻度认知障碍患者进展为痴呆。在调整年龄和血管危险因素后，海马体积是轻度认知障碍（比值比7.05，可信区间1.5 - 34.1；p = 0.015）和痴呆（比值比7.03，可信区间2.39 - 25.2；p = 0.001）的显著预测因素。通过Cox回归分析，海马体积是“至认知障碍时间”的显著预测因素（风险比7.67；可信区间3.47 - 16.95，p < 0.001）。基于白质高信号体积预测“至轻度认知障碍时间”的生存曲线差异具有显著性（p = 0.0295）。
海马体积是预测PD患者轻度认知障碍和痴呆发生的主要因素。白质高信号也对PD患者的纵向认知状态有影响。
