Kim Heeyoung, Oh Minyoung, Oh Jungsu S, Moon Hyojeong, Chung Sun Ju, Lee Chong Sik, Kim Jae Seung
Department of Nuclear Medicine, Kosin University Gospel Hospital, University of Kosin College of Medicine, Busan.
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
Nucl Med Commun. 2019 Dec;40(12):1216-1223. doi: 10.1097/MNM.0000000000001098.
Cognitive impairment is a common non-motor feature of Parkinson's disease (PD). However, the underlying pathophysiology of cognitive decline is unclear. We investigated the association of striatal dopamine transporter (DAT) loss with cognitive function and cerebral cortical metabolism in PD.
Twenty-eight patients (63.1 ± 7.1 yrs, M:F = 15:13) with advanced stage of PD were enrolled, including 15 (53.6%) diagnosed with mild cognitive impairment (MCI). All patients underwent FP-CIT PET/CT, neuropsychological tests, and FDG PET/CT within a 2-week interval. We calculated the specific to non-specific binding ratio on FP-CIT PET images in 12 striatal subregional VOIs, using one occipital VOI template as a reference. Age-adjusted normalized specific to non-specific binding ratios (%BRs) of striatal subregions were compared in two groups: PD with MCI versus PD (without cognitive impairment).
There were no statistical differences in age, age at onset, disease duration, motor symptoms, or level of education between the two groups. The PD with MCI had lower %BRs in all striatal subregions (P < 0.05) except the posterior putamen, compared with the PD. Striatal DAT availability correlated with frontal/executive function (r = 0.567, P = 0.003) and visuospatial function (r = 0.614, P = 0.001) but not with memory function. Dopamine transporter binding of striatal subregions also correlated with posterior cortical metabolism.
This study suggest that DAT loss in the striatum, except in the posterior putamen, is associated with cognitive dysfunction, specifically frontal/executive function and visuospatial function in PD subjects.
认知障碍是帕金森病（PD）常见的非运动特征。然而，认知功能下降的潜在病理生理学尚不清楚。我们研究了纹状体多巴胺转运体（DAT）缺失与PD患者认知功能及大脑皮质代谢之间的关联。
纳入28例晚期PD患者（年龄63.1±7.1岁，男∶女 = 15∶13），其中15例（53.6%）被诊断为轻度认知障碍（MCI）。所有患者在2周内依次接受氟哌啶醇丁醚（FP-CIT）PET/CT、神经心理学测试及氟脱氧葡萄糖（FDG）PET/CT检查。我们以一个枕叶感兴趣区（VOI）模板为参照，计算12个纹状体亚区VOI在FP-CIT PET图像上的特异性与非特异性结合率。比较两组患者（PD合并MCI组与PD组[无认知障碍]）经年龄校正后的纹状体亚区标准化特异性与非特异性结合率（%BRs）。
两组患者在年龄、发病年龄、病程、运动症状或教育程度方面无统计学差异。与PD组相比，PD合并MCI组除壳核后部外，所有纹状体亚区的%BRs均较低（P < 0.05）。纹状体DAT可用性与额叶/执行功能（r = 0.567，P = 0.003）及视觉空间功能（r = 0.614，P = 0.001）相关，但与记忆功能无关。纹状体亚区的多巴胺转运体结合也与皮质后部代谢相关。
本研究提示，纹状体中除壳核后部外的DAT缺失与认知功能障碍相关，尤其是与PD患者的额叶/执行功能及视觉空间功能有关。
