Petrou M, Davatzikos C, Hsieh M, Foerster B R, Albin R L, Kotagal V, Müller M L, Koeppe R A, Herman W H, Frey K A, Bohnen N I
Department of Radiology, University of Michigan, Ann Arbor, Michigan; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Radiol. 2016 May;23(5):577-81. doi: 10.1016/j.acra.2015.07.014. Epub 2016 Feb 10.
Parkinson disease (PD) is a progressive neurodegenerative disorder affecting motor and cognitive functions. Prior studies showed that patients with PD and diabetes (DM) demonstrate worse clinical outcomes compared to nondiabetic subjects with PD. Our study aimed at defining the relationship between DM, gray matter volume, and cognition in patients with PD.
This study included 36 subjects with PD (12 with DM, 24 without DM, mean age = 66). Subjects underwent high-resolution T1-weighted brain magnetic resonance imaging, [(11)C]dihydrotetrabenazine positron emission tomography imaging to quantify nigrostriatal dopaminergic denervation, clinical, and cognitive assessments. Magnetic resonance images were postprocessed to determine total and lobar cortical gray matter volumes. Cognitive testing scores were converted to z-scores for specific cognitive domains and a composite global cognitive z-score based on normative data computed. Analysis of covariance, accounting for effects of age, gender, intracranial volume, and striatal [(11)C]dihydrotetrabenazine binding, was used to test the relationship between DM and gray matter volumes.
Impact of DM on total gray matter volume was significant (P = 0.02). Post hoc analyses of lobar cortical gray matter volumes revealed that DM was more selectively associated with lower gray matter volumes in the frontal regions (P = 0.01). Cognitive post hoc analyses showed that interaction of total gray matter volume and DM status was significantly associated with composite (P = 0.007), executive (P = 0.02), and visuospatial domain cognitive z-scores (P = 0.005). These associations were also significant for the frontal cortical gray matter.
DM may exacerbate brain atrophy and cognitive functions in PD with greater vulnerability in the frontal lobes. Given the high prevalence of DM in the elderly, delineating its effects on patient outcomes in the PD population is of importance.
帕金森病（PD）是一种影响运动和认知功能的进行性神经退行性疾病。先前的研究表明，与非糖尿病的帕金森病患者相比，患有帕金森病和糖尿病（DM）的患者临床预后更差。我们的研究旨在确定帕金森病患者中糖尿病、灰质体积和认知之间的关系。
本研究纳入了36名帕金森病患者（12名患有糖尿病，24名未患糖尿病，平均年龄 = 66岁）。受试者接受了高分辨率T1加权脑磁共振成像、[(11)C]二氢四苯嗪正电子发射断层扫描成像以量化黑质纹状体多巴胺能去神经支配、临床和认知评估。对磁共振图像进行后处理以确定全脑和脑叶皮质灰质体积。根据计算出的标准数据，将认知测试分数转换为特定认知领域的z分数和综合整体认知z分数。采用协方差分析，考虑年龄、性别、颅内体积和纹状体[(11)C]二氢四苯嗪结合的影响，来检验糖尿病与灰质体积之间的关系。
糖尿病对全脑灰质体积的影响显著（P = 0.02）。对脑叶皮质灰质体积的事后分析显示，糖尿病更选择性地与额叶灰质体积降低相关（P = 0.01）。认知事后分析表明，全脑灰质体积与糖尿病状态的相互作用与综合（P = 0.007）、执行（P = 0.02）和视觉空间领域认知z分数（P = 0.005）显著相关。这些关联在额叶皮质灰质中也很显著。
糖尿病可能会加剧帕金森病患者的脑萎缩和认知功能衰退，额叶的易损性更大。鉴于老年人中糖尿病的高患病率，明确其对帕金森病患者预后的影响具有重要意义。
