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帕金森病中的抑郁、焦虑和冷漠:神经影像学研究的见解

Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies.

作者信息

Wen M-C, Chan L L, Tan L C S, Tan E K

机构信息

Department of Research, National Neuroscience Institute, Singapore, Singapore.

Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.

出版信息

Eur J Neurol. 2016 Jun;23(6):1001-19. doi: 10.1111/ene.13002.

Abstract

Depression, anxiety and apathy are common mood disturbances in Parkinson's disease (PD) but their pathophysiology is unclear. Advanced neuroimaging has been increasingly used to unravel neural substrates linked to these disturbances. A systematic review is provided of neuroimaging findings in depression, anxiety and apathy in PD. A PubMed, MEDLINE and EMBASE search of peer-reviewed original research articles on these mood disturbances in PD identified 38 studies on depression, eight on anxiety and 14 on apathy in PD. Most of the imaging studies used either position emission tomography or single-photon emission computed tomography techniques. These studies generally suggest increased neural activity in the prefrontal regions and decreased functional connectivity between the prefrontal-limbic networks in depressed patients. Functional imaging studies revealed an inverse correlation between dopaminergic density in the caudate and putamen with the severity of anxiety in PD. There was no consistent correlation between dopaminergic density of thalamus and anxiety. Studies demonstrated both positive and inverse correlations between apathy and metabolism or activity in the striatum, amygdalar, prefrontal, temporal and parietal regions. The clinical variability of study subjects and differences in image pre-processing and analytical strategies may contribute to discrepant findings in these studies. Both nigrostriatal and extra-nigrostriatal pathways (in particular the frontal region and its connecting areas) are affected in mood disorders in PD. Identifying the relative contributions of these neural pathways in PD patients with overlapping motor and mood symptoms could provide new pathophysiological clues for the development of better therapeutic targets for affected patients.

摘要

抑郁、焦虑和冷漠是帕金森病(PD)常见的情绪障碍,但其病理生理学尚不清楚。先进的神经影像学越来越多地用于揭示与这些障碍相关的神经基质。本文对PD患者抑郁、焦虑和冷漠的神经影像学研究结果进行了系统综述。通过对PubMed、MEDLINE和EMBASE数据库进行检索,查找关于PD患者这些情绪障碍的同行评审原始研究文章,共识别出38项关于PD患者抑郁的研究、8项关于焦虑的研究以及14项关于冷漠的研究。大多数影像学研究采用正电子发射断层扫描或单光子发射计算机断层扫描技术。这些研究普遍表明,抑郁症患者前额叶区域神经活动增加,前额叶-边缘网络之间的功能连接减少。功能成像研究显示,尾状核和壳核中多巴胺能密度与PD患者焦虑严重程度呈负相关。丘脑多巴胺能密度与焦虑之间没有一致的相关性。研究表明,冷漠与纹状体、杏仁核、前额叶、颞叶和顶叶区域的代谢或活动之间存在正相关和负相关。研究对象的临床变异性以及图像预处理和分析策略的差异可能导致这些研究结果存在差异。黑质纹状体和黑质纹状体以外的通路(特别是额叶区域及其连接区域)在PD患者的情绪障碍中均受到影响。确定这些神经通路在具有重叠运动和情绪症状的PD患者中的相对作用,可为开发更好的治疗靶点提供新的病理生理学线索,以造福受影响的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89e0/5084819/de79a2f89216/ENE-23-1001-g001.jpg

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