Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Mol Psychiatry. 2018 Feb;23(2):459-466. doi: 10.1038/mp.2017.18. Epub 2017 Mar 7.
This study assessed brain structural and functional alterations in patients with Parkinson's disease and impulsive-compulsive behaviours (PD-ICB) compared with controls and PD no-ICB cases. Eighty-five PD patients (35 PD-ICB) and 50 controls were recruited. All subjects underwent three-dimensional T1-weighted, diffusion tensor (DT), and resting state functional magnetic resonance imaging (RS fMRI). We assessed cortical thickness with surface-based morphometry, subcortical volumes using FIRST, DT MRI metrics using region of interest and tractography approaches, and RS fMRI using a model free approach. Compared with controls, both PD groups showed a pattern of brain structural alterations in the basal ganglia (more evident in PD no-ICB patients), sensorimotor and associative systems. Compared with PD no-ICB, PD-ICB cases showed left precentral and superior frontal cortical thinning, and motor and extramotor white matter tract damage. Compared with controls, all patients had an increased functional connectivity within the visual network. Additionally, PD no-ICB showed increased functional connectivity of bilateral precentral and postcentral gyri within the sensorimotor network compared with controls and PD-ICB. Severity and duration of PD-ICB modulated the functional connectivity between sensorimotor, visual and cognitive networks. Relative to PD no-ICB, PD-ICB patients were characterised by a more severe involvement of frontal, meso-limbic and motor circuits. These data suggest ICB in PD as the result of a disconnection between sensorimotor, associative and cognitive networks with increasing motor impairment, psychiatric symptoms, and ICB duration. These findings may have important implications in understanding the neural substrates underlying ICB in PD.
这项研究评估了帕金森病伴冲动-强迫行为（PD-ICB）患者与对照组和 PD 无 ICB 患者相比的大脑结构和功能改变。招募了 85 名 PD 患者（35 名 PD-ICB）和 50 名对照者。所有受试者均接受了三维 T1 加权、弥散张量（DT）和静息状态功能磁共振成像（RS fMRI）检查。我们使用基于表面的形态测量学评估皮质厚度，使用 FIRST 评估皮质下体积，使用基于感兴趣区和轨迹的方法评估 DT MRI 指标，使用无模型方法评估 RS fMRI。与对照组相比，两组 PD 患者均表现出基底节（在 PD 无 ICB 患者中更为明显）、感觉运动和联合系统的脑结构改变模式。与 PD 无 ICB 相比，PD-ICB 患者表现出左中央前回和额上回皮质变薄，以及运动和非运动白质束损伤。与对照组相比，所有患者的视觉网络内功能连接均增加。此外，与对照组和 PD-ICB 相比，PD 无 ICB 患者的感觉运动网络内双侧中央前回和中央后回的功能连接增加。PD-ICB 的严重程度和持续时间调节了感觉运动、视觉和认知网络之间的功能连接。与 PD 无 ICB 相比，PD-ICB 患者的额、中边缘和运动回路的受累更为严重。这些数据表明，PD 中的 ICB 是感觉运动、联想和认知网络之间的脱节的结果，随着运动障碍、精神症状和 ICB 持续时间的增加，这种脱节越来越严重。这些发现可能对理解 PD 中 ICB 的神经基础具有重要意义。
