Yoon Ji Hye, Ahn Yisuh, Kim Sook Hui, Chin Juhee, Park Seongbeom, Na Duk L
Department of Speech Pathology and Audiology, Audiology and Speech Pathology Research Institute, College of Natural Sciences, Hallym University, Chuncheon, Republic of Korea.
The BOM Neuropsychology Center and Cognitive Rehabilitation Research Institute, Seoul, Republic of Korea.
Eur Neurol. 2017;78(1-2):93-104. doi: 10.1159/000479023. Epub 2017 Jul 24.
BACKGROUND/AIMS: Early detection and intervention may alter the disease course of subcortical vascular cognitive impairment (SVCI). Patients with SVCI have white matter ischemia that disrupts connections between the cortex and subcortical gray matter and therefore manifest various symptoms such as motor disturbances and behavioral/cognitive dysfunction. Reduced vocal loudness, or hypophonia, is one of the common motor symptoms of SVCI, but few studies have systematically investigated it in this patient population. The main purpose of this investigation was to identify neural pathways underlying hypophonia in patients with SVCI.
Eighty-eight patients with SVCI and 21 normal controls performed phonation tasks. Diffusion tensor imaging data from 73 patients were utilized to measure white matter changes associated with hypophonia.
Correlational analyses between white matter fractional anisotropy values and the decibel level of the "sustained phonation" task identified the left midbrain cerebral peduncle (corticobulbar tract), external capsule, corona radiata/internal capsule, and bilateral frontal white matter as possible neural correlates for hypophonia.
Our results support the notion that hypophonia in SVCI patients might be caused by the impairment of the pyramidal and extrapyramidal systems. This study provides a unique contribution towards understanding the neuropathology of hypophonic features in this population.
背景/目的：早期检测和干预可能会改变皮质下血管性认知障碍（SVCI）的疾病进程。SVCI患者存在白质缺血，这会破坏皮质与皮质下灰质之间的联系，从而表现出各种症状，如运动障碍和行为/认知功能障碍。声音响度降低，即发声障碍，是SVCI常见的运动症状之一，但很少有研究对该患者群体进行系统研究。本研究的主要目的是确定SVCI患者发声障碍的神经通路。
88例SVCI患者和21名正常对照者进行发声任务。利用73例患者的扩散张量成像数据测量与发声障碍相关的白质变化。
白质分数各向异性值与“持续发声”任务的分贝水平之间的相关性分析确定，左中脑大脑脚（皮质延髓束）、外囊、放射冠/内囊以及双侧额叶白质可能是发声障碍的神经关联因素。
我们的结果支持这样一种观点，即SVCI患者的发声障碍可能是由锥体系统和锥体外系受损引起的。本研究为理解该人群发声障碍特征的神经病理学做出了独特贡献。
