Linortner Patricia, McDaniel Colin, Shahid Marian, Levine Taylor F, Tian Lu, Cholerton Brenna, Poston Kathleen L
Department of Neurology and Neurological Sciences Stanford University Palo Alto California USA.
Psychological & Brain Sciences Washington University St. Louis Missouri USA.
Mov Disord Clin Pract. 2020 Apr 30;7(6):629-638. doi: 10.1002/mdc3.12956. eCollection 2020 Aug.
People with Parkinson's disease (PD) can develop multidomain cognitive impairments; however, it is unclear whether different pathologies underlie domain-specific cognitive dysfunction.
We investigated the contribution of vascular copathology severity and location, as measured by MRI white matter hyperintensities (WMHs), to domain-specific cognitive impairment in PD.
We studied 85 PD (66.6 ± 9.2 years) and 18 control (65.9 ± 6.6) participants. Using the Fazekas scale for rating the severity of WMH, we subdivided PD into 14 PDWMH and 71 PDWMH. Participants underwent global, executive, visuospatial, episodic memory, and language testing. We performed nonparametric permutation testing to create WMH probability maps based on PD-WMH group and cognitive test performance.
The PDWMH group showed worse global and executive cognitive performance than the PDWMH group. On individual tests, the PDWMH group showed worse Montreal Cognitive Assessment (MoCA), Stroop, Symbol Digit Modalities Test (SDMT), and Digit Span scores. WMH probability maps showed that in the PDWMH group, worse Stroop was associated with lesions centered around the corticospinal tract (CST), forceps major, inferior-fronto-occipital fasciculus, and superior longitudinal fasciculus; worse SDMT with lesions around the CST, forceps major, and posterior corona radiata; worse Digit Span with lesions around the posterior corona radiata; and worse MoCA with lesions around the CST.
We found that WMH severity was associated with PD executive dysfunction, including worse attention, working memory, and processing speed. Disruption of key white matter tracts in proximity to vascular lesions could contribute to these specific cognitive impairments. Early treatment of vascular disease might mitigate some executive dysfunction in a subset of patients with PD.
帕金森病（PD）患者可出现多领域认知障碍；然而，尚不清楚不同的病理改变是否是特定领域认知功能障碍的基础。
我们研究了通过MRI白质高信号（WMH）测量的血管共病严重程度和位置对PD患者特定领域认知障碍的影响。
我们研究了85名PD患者（66.6±9.2岁）和18名对照者（65.9±6.6岁）。使用Fazekas量表对WMH严重程度进行评分，我们将PD患者分为14名PD-WMH患者和71名非PD-WMH患者。参与者接受了整体、执行、视觉空间、情景记忆和语言测试。我们进行了非参数置换测试，以根据PD-WMH组和认知测试表现创建WMH概率图。
PD-WMH组的整体和执行认知表现比非PD-WMH组更差。在个体测试中，PD-WMH组的蒙特利尔认知评估（MoCA）、Stroop测试、符号数字模式测试（SDMT）和数字广度得分更差。WMH概率图显示，在PD-WMH组中，较差的Stroop测试成绩与皮质脊髓束（CST）、胼胝体、额枕下束和上纵束周围的病变有关；较差的SDMT成绩与CST、胼胝体和放射冠后部周围的病变有关；较差的数字广度成绩与放射冠后部周围的病变有关；较差的MoCA成绩与CST周围的病变有关。
我们发现WMH严重程度与PD执行功能障碍有关，包括注意力、工作记忆和处理速度较差。血管病变附近关键白质束的破坏可能导致这些特定的认知障碍。早期治疗血管疾病可能会减轻一部分PD患者的执行功能障碍。
