IRCCS Neuromed Institute, Pozzilli, IS, Italy.
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
J Neurol. 2018 Jan;265(1):52-62. doi: 10.1007/s00415-017-8654-1. Epub 2017 Nov 11.
Freezing of gait (FOG) is a disabling disorder that often affects Parkinson's disease (PD) patients in advanced stages of the disease. To study structural gray matter (GM) and white matter (WM) changes in PD patients with and without FOG, twenty-one PD patients with FOG (PD-FOG), 16 PD patients without FOG (PD-nFOG) and 19 healthy subjects (HS) underwent a standardized MRI protocol. For the gray matter evaluation, cortical volume (CV), cortical thickness (CTh), and surface area (SA) were analyzed using the FreeSurfer pipeline. For the white matter evaluation, DTI images were analyzed using tracts constrained by underlying anatomy (TRACULA) toolbox in FreeSurfer. PD-FOG patients exhibited lower CTh than HS in the mesial surface of both cerebral hemispheres, including the superior frontal gyrus, paracentral lobule, posterior cingulate cortex, precuneus and pericalcarine cortex, and in the right dorsolateral prefrontal cortex. Moreover, significant WM changes were observed in PD-FOG patients in comparison with HS in the superior longitudinal fasciculus, uncinate fasciculus, cingulum cingulate gyrus and inferior longitudinal fasciculus (prevalently in the right hemisphere) and in the frontal radiations of the corpus callosum. DTI abnormalities in specific WM bundles correlated significantly with cognitive measures. The damage of multiple cortical areas involved in high-level gait control together with WM disruption between motor, cognitive and limbic structures may represent the anatomical correlate of FOG.
冻结步态(FOG)是一种使人致残的疾病,常影响处于疾病晚期的帕金森病(PD)患者。为了研究有和无 FOG 的 PD 患者的结构灰质(GM)和白质(WM)变化,21 名有 FOG 的 PD 患者(PD-FOG)、16 名无 FOG 的 PD 患者(PD-nFOG)和 19 名健康受试者(HS)接受了标准化的 MRI 方案。对于灰质评估,使用 FreeSurfer 管道分析皮质体积(CV)、皮质厚度(CTh)和表面积(SA)。对于白质评估,使用 FreeSurfer 中的基于解剖结构的束追踪(TRACULA)工具箱分析 DTI 图像。PD-FOG 患者的内侧脑半球(包括额上回、旁中央小叶、后扣带回、楔前叶和距状皮层)和右侧背外侧前额叶的 CTh 低于 HS。此外,与 HS 相比,PD-FOG 患者的 WM 变化明显,在胼胝体上纵束、钩束、扣带束和下纵束(主要在右侧)和胼胝体额辐射中。DTI 异常在特定的 WM 束中与认知测量显著相关。涉及高级步态控制的多个皮质区域的损伤以及运动、认知和边缘结构之间的 WM 中断可能代表 FOG 的解剖学相关性。
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