Borchert Robin J, Rittman Timothy, Rae Charlotte L, Passamonti Luca, Jones Simon P, Vatansever Deniz, Vázquez Rodríguez Patricia, Ye Zheng, Nombela Cristina, Hughes Laura E, Robbins Trevor W, Rowe James B
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.
Brain Commun. 2019;1(1):fcz013. doi: 10.1093/braincomms/fcz013. Epub 2019 Sep 6.
Parkinson's disease has multiple detrimental effects on motor and cognitive systems in the brain. In contrast to motor deficits, cognitive impairments in Parkinson's disease are usually not ameliorated, and can even be worsened, by dopaminergic treatments. Recent evidence has shown potential benefits from restoring other neurotransmitter deficits, including noradrenergic and serotonergic transmission. Here, we study global and regional brain network organization using task-free imaging (also known as resting-state), which minimizes performance confounds and the bias towards predetermined networks. Thirty-three patients with idiopathic Parkinson's disease were studied three times in a double-blinded, placebo-controlled counter-balanced crossover design, following placebo, 40 mg oral atomoxetine (selective noradrenaline reuptake inhibitor) or 30 mg oral citalopram (selective serotonin reuptake inhibitor). Neuropsychological assessments were performed outside the scanner. Seventy-six controls were scanned without medication to provide normative data for comparison to the patient cohort. Graph theoretical analysis of task-free brain connectivity, with a random 500-node parcellation, was used to measure the effect of disease in placebo-treated state (versus unmedicated controls) and pharmacological intervention (drug versus placebo). Relative to controls, patients on placebo had executive impairments (reduced fluency and inhibitory control), which was reflected in dysfunctional network dynamics in terms of reduced clustering coefficient, hub degree and hub centrality. In patients, atomoxetine improved fluency in proportion to plasma concentration ( = 0.006, = 0.24), and improved response inhibition in proportion to increased hub Eigen centrality ( = 0.044, = 0.14). Citalopram did not improve fluency or inhibitory control, but its influence on network integration and efficiency depended on disease severity: clustering ( = 0.01, = 0.22), modularity ( = 0.043, = 0.14) and path length ( = 0.006, = 0.25) increased in patients with milder forms of Parkinson's disease, but decreased in patients with more advanced disease (Unified Parkinson's Disease Rating Scale motor subscale part III > 30). This study supports the use of task-free imaging of brain networks in translational pharmacology of neurodegenerative disorders. We propose that hub connectivity contributes to cognitive performance in Parkinson's disease, and that noradrenergic treatment strategies can partially restore the neural systems supporting executive function.
帕金森病对大脑的运动和认知系统有多种有害影响。与运动功能障碍不同,帕金森病的认知障碍通常不会因多巴胺能治疗而改善,甚至可能恶化。最近的证据表明,恢复其他神经递质缺乏(包括去甲肾上腺素能和5-羟色胺能传递)可能有益。在这里,我们使用无任务成像(也称为静息状态)研究全脑和区域脑网络组织,这种成像可将行为干扰和对预定网络的偏差降至最低。在双盲、安慰剂对照、平衡交叉设计中,对33例特发性帕金森病患者进行了三次研究,分别给予安慰剂、40mg口服托莫西汀(选择性去甲肾上腺素再摄取抑制剂)或30mg口服西酞普兰(选择性5-羟色胺再摄取抑制剂)。在扫描器外进行神经心理学评估。对76名未用药的对照者进行扫描,以提供规范数据,用于与患者队列进行比较。使用随机500节点分割的无任务脑连接性的图论分析来测量疾病在安慰剂治疗状态(与未用药对照相比)和药物干预(药物与安慰剂相比)中的作用。与对照组相比,服用安慰剂的患者存在执行功能障碍(流畅性和抑制控制能力下降),这在网络动力学功能障碍中有所体现,表现为聚类系数、枢纽度和枢纽中心性降低。在患者中,托莫西汀改善流畅性的程度与血浆浓度成正比(=0.006,=0.24),改善反应抑制的程度与枢纽特征中心性增加成正比(=0.044,=0.14)。西酞普兰没有改善流畅性或抑制控制能力,但其对网络整合和效率的影响取决于疾病严重程度:在帕金森病较轻形式的患者中,聚类(=0.01,=0.22)、模块性(=0.043,=0.14)和路径长度(=0.006,=0.25)增加,但在疾病更严重的患者中(统一帕金森病评定量表运动子量表第三部分>30)则降低。本研究支持在神经退行性疾病的转化药理学中使用脑网络的无任务成像。我们提出,枢纽连接性有助于帕金森病的认知表现,而去甲肾上腺素能治疗策略可以部分恢复支持执行功能的神经系统。