Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.
School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands.
Cortex. 2020 Feb;123:1-11. doi: 10.1016/j.cortex.2019.09.015. Epub 2019 Oct 24.
Cognitive impairment is common in Parkinson's disease (PD), yet with large heterogeneity in the range and course of deficits. In a cross-sectional study, 124 PD patients underwent extensive clinical and neuropsychological assessment as well as a 3T MRI scan of the brain. Our aim was to identify differences in grey matter volume and thickness, as well as cortical folding, across different cognitive profiles as defined through a data-driven exploratory cluster analysis of neuropsychological data. The identified cognitive groups ranged from cognitively intact patients to patients with severe deficits in all cognitive domains, whilst showing comparable levels of motor disability and disease duration. Each group was compared to the cognitively intact PD group using voxel- and vertex-based morphometry. Results revealed widespread age-related grey matter abnormalities associated with progressive worsening of cognitive functions in mild PD. When adjusted for age, significant differences were only seen between cognitively intact and severely affected PD patients and these were restricted to the right posterior cingulate and the right precuneus. Reduced cortical thickness was seen in the right inferior temporal gyrus and reduced folding in the right temporal region. As these differences were not associated with age, we assume that they are associated with underlying pathology of the cognitive decline. Given the limited involvement of grey matter differences, and the absence of differences in vascular changes across the groups, we hypothesize a more important role for white matter tract changes in cognitive decline in PD.
认知障碍在帕金森病（PD）中很常见，但缺陷的范围和病程存在很大的异质性。在一项横断面研究中，124 名 PD 患者接受了广泛的临床和神经心理学评估以及 3T MRI 脑部扫描。我们的目的是通过对神经心理学数据进行数据驱动的探索性聚类分析，确定不同认知特征之间的灰质体积和厚度差异，以及皮质折叠差异。确定的认知组从认知正常的患者到所有认知领域严重受损的患者不等，同时表现出相似的运动障碍和疾病持续时间。使用基于体素和基于顶点的形态计量学将每个组与认知正常的 PD 组进行比较。结果显示，与认知正常的 PD 患者相比，与认知相关的灰质异常与轻度 PD 患者认知功能的逐渐恶化有关，这与年龄有关。在调整年龄后，仅在认知正常和严重受影响的 PD 患者之间观察到显著差异，这些差异仅限于右侧后扣带回和右侧楔前叶。在右侧颞下回观察到皮质厚度降低，在右侧颞区观察到折叠减少。由于这些差异与年龄无关，我们假设它们与认知下降的潜在病理学有关。鉴于灰质差异的有限参与，以及各组之间血管变化的差异不存在，我们假设在 PD 中，白质束变化在认知下降中起着更重要的作用。
