From the Department of Neurology (D.H.H., E.M.J.F., K.T.E.O.D., H.W.B.) and Department of Anatomy and Neurosciences (D.H.H., W.D.J.v.d.B., M.M.S.), Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1108, Postbus 7057, 1007 MB Amsterdam, the Netherlands.
Radiology. 2017 Dec;285(3):896-903. doi: 10.1148/radiol.2017170438. Epub 2017 Sep 27.
Purpose To gain more insight into the pathophysiological mechanisms of visual hallucinations (VHs) in patients with Parkinson disease (PD) by analyzing whole-brain resting-state functional connectivity in PD patients with VH (hereafter, referred to as PD + VH patients) and without VH (hereafter, referred to as PD - VH patients) and control participants. Materials and Methods For this retrospective study, 15 PD + VH patients, 40 PD - VH patients, and 15 control participants from a prospective cohort study were included, which was approved by the local ethics board and written informed consent was obtained from all participants. Functional connectivity was calculated between 47 regions of interests, of which whole-brain and region-specific means were compared by using a general linear model with false discovery rate control for multiple comparisons. Results Whole-brain mean functional connectivity was significantly lower in PD patients compared with control participants, with regional decreases involving paracentral and occipital regions in both PD + VH and PD - VH patients (mean whole-brain functional connectivity in PD + VH vs PD - VH, 0.12 ± 0.01 [standard deviation] vs 0.14 ± 0.03, respectively; control participants, 0.15 ± 0.04; P < .05, corrected). In PD + VH patients, nine additional frontal, temporal, occipital, and striatal regions showed decreased functional connectivity compared with control participants (mean of these nine regions in PD + VH, PD - VH, and control participants: 0.12 ± 0.02, 0.14 ± 0.03, and 0.16 ± 0.04, respectively; P < .05, corrected). Resting-state functional connectivity was unrelated to motor performance (r = 0.182; P = .184) and related to cognitive deficits such as attention and perception (ρ, -0.555 and -0.558, respectively; P < .05). Conclusion The findings show a PD-related effect on resting-state functional connectivity of posterior and paracentral brain regions, whereas the presence of VH is associated with a more global loss of connectivity, related to attention and perception. These findings suggest that the pathophysiological mechanisms of VH in PD may include a global loss of network efficiency, which could drive disturbed attentional and visual processing. RSNA, 2017 Online supplemental material is available for this article.
目的 通过分析帕金森病（PD）患者伴（PD + VH）和不伴（PD - VH）视觉幻觉（VH）患者与对照组的全脑静息状态功能连接，深入了解 PD 患者 VH 的病理生理机制。
材料与方法 本回顾性研究纳入了一项前瞻性队列研究中的 15 例 PD + VH 患者、40 例 PD - VH 患者和 15 例对照组参与者，该研究已获得当地伦理委员会的批准，并获得了所有参与者的书面知情同意书。使用基于虚假发现率控制的多比较的一般线性模型比较了 47 个感兴趣区域之间的功能连接，比较了全脑和区域特定均值。
结果 与对照组相比，PD 患者的全脑平均功能连接显著降低，PD + VH 和 PD - VH 患者的双侧旁中央和枕叶区域均存在区域性降低（PD + VH 与 PD - VH 相比，PD + VH 患者的全脑平均功能连接为 0.12 ± 0.01 [标准差] 与 0.14 ± 0.03 相比，对照组为 0.15 ± 0.04；P <.05，校正）。与对照组相比，PD + VH 患者还存在 9 个额外的额、颞、枕和纹状体区域的功能连接降低（PD + VH 患者的这 9 个区域的平均值：0.12 ± 0.02、0.14 ± 0.03 和 0.16 ± 0.04，分别；P <.05，校正）。静息状态功能连接与运动表现无关（r = 0.182；P =.184），但与注意力和感知等认知缺陷相关（ρ，-0.555 和 -0.558，分别；P <.05）。
结论 这些发现表明，PD 与后颅和旁中央脑区静息状态功能连接有关，而 VH 的存在与更广泛的连接丧失有关，与注意力和感知有关。这些发现表明，PD 患者 VH 的病理生理机制可能包括网络效率的整体丧失，这可能导致注意力和视觉处理的紊乱。RSNA，2017 在线补充材料可在本文中获得。
