快速眼动睡眠行为障碍认知缺陷的皮质和皮质下灰质基础。
Cortical and subcortical gray matter bases of cognitive deficits in REM sleep behavior disorder.
机构信息
From the Centre for Advanced Research in Sleep Medicine (S.R., R.B.P., J.M., D.G.M., M.G., P.-A.B., J.C., J.-F.G.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (S.R., D.G.M., M.G., P.-A.B., J.-F.G.), Université du Québec à Montréal; Department of Neurology (R.B.P.), Montreal General Hospital; Departments of Psychiatry (J.M.), Psychology (F.E., J.C., S.J.), and Radiology, Radio-Oncology, and Nuclear Medicine (O.M.), Université de Montréal; Research Centre (F.E., J.C., O.M., S.J., J.-F.G.), Institut universitaire de gériatrie de Montréal; Departments of Clinical Neurosciences and Radiology (O.M.), and Hotchkiss Brain Institute, University of Calgary, Canada; Université de Strasbourg and CNRS (F.B.), ICube UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, Strasbourg; and Saint François Day Hospital, Department of Geriatrics (F.B.), and Memory Resources and Research Centre (CM2R), Departments of Geriatrics and Neurology (F.B.), Hôpitaux Universitaires de Strasbourg, France.
出版信息
Neurology. 2018 May 15;90(20):e1759-e1770. doi: 10.1212/WNL.0000000000005523. Epub 2018 Apr 18.
OBJECTIVE
To investigate cortical and subcortical gray matter abnormalities underlying cognitive impairment in patients with REM sleep behavior disorder (RBD) with or without mild cognitive impairment (MCI).
METHODS
Fifty-two patients with RBD, including 17 patients with MCI, were recruited and compared to 41 controls. All participants underwent extensive clinical assessments, neuropsychological examination, and 3-tesla MRI acquisition of T1 anatomical images. Vertex-based cortical analyses of volume, thickness, and surface area were performed to investigate cortical abnormalities between groups, whereas vertex-based shape analysis was performed to investigate subcortical structure surfaces. Correlations were performed to investigate associations between cortical and subcortical metrics, cognitive domains, and other markers of neurodegeneration (color discrimination, olfaction, and autonomic measures).
RESULTS
Patients with MCI had cortical thinning in the frontal, cingulate, temporal, and occipital cortices, and abnormal surface contraction in the lenticular nucleus and thalamus. Patients without MCI had cortical thinning restricted to the frontal cortex. Lower patient performance in cognitive domains was associated with cortical and subcortical abnormalities. Moreover, impaired performance on olfaction, color discrimination, and autonomic measures was associated with thinning in the occipital lobe.
CONCLUSIONS
Cortical and subcortical gray matter abnormalities are associated with cognitive status in patients with RBD, with more extensive patterns in patients with MCI. Our results highlight the importance of distinguishing between subgroups of patients with RBD according to cognitive status in order to better understand the neurodegenerative process in this population.
目的
研究 REM 睡眠行为障碍（RBD）伴或不伴轻度认知障碍（MCI）患者认知障碍的皮质和皮质下灰质异常。
方法
招募了 52 名 RBD 患者，包括 17 名 MCI 患者，并与 41 名对照进行比较。所有参与者均接受了广泛的临床评估、神经心理学检查和 3 特斯拉 MRI 的 T1 解剖图像采集。进行基于顶点的皮质体积、厚度和表面积分析，以研究组间皮质异常，而进行基于顶点的形状分析，以研究皮质下结构表面。进行相关性分析，以研究皮质和皮质下指标与认知域以及其他神经退行性变标志物（颜色辨别、嗅觉和自主测量）之间的关联。
结果
MCI 患者的额叶、扣带回、颞叶和枕叶皮质变薄，以及豆状核和丘脑表面异常收缩。无 MCI 的患者仅出现额叶皮质变薄。认知域中患者表现下降与皮质和皮质下异常有关。此外，嗅觉、颜色辨别和自主测量受损与枕叶变薄有关。
结论
皮质和皮质下灰质异常与 RBD 患者的认知状态有关，MCI 患者的异常模式更为广泛。我们的结果强调了根据认知状态区分 RBD 患者亚组的重要性，以便更好地理解该人群的神经退行性过程。
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