Boonstra Jackson Tyler, Michielse Stijn, Temel Yasin, Hoogland Govert, Jahanshahi Ali
Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS) Maastricht University Medical Center Maastricht The Netherlands.
Mov Disord Clin Pract. 2020 Nov 6;8(2):175-192. doi: 10.1002/mdc3.13107. eCollection 2021 Feb.
The neuroanatomical substrates of Parkinson's disease (PD) with tremor-dominance (TD) and those with non-tremor dominance (nTD), postural instability and gait difficulty (PIGD), and akinetic-rigid (AR) are not fully differentiated. A better understanding of symptom specific pathoanatomical markers of PD subtypes may result in earlier diagnosis and more tailored treatment. Here, we aim to give an overview of the neuroimaging literature that compared PD motor subtypes.
A systematic literature review on neuroimaging studies of PD subtypes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms submitted to the PubMed database included: "Parkinson's disease", "MRI" and "motor subtypes" (TD, nTD, PIGD, AR). The results are first discussed from macro to micro level of organization (i.e., (1) structural; (2) functional; and (3) molecular) and then by applied imaging methodology.
Several neuroimaging methods including diffusion imaging and positron emission tomography (PET) distinguish specific PD motor subtypes well, although findings are mixed. Furthermore, our review demonstrates that nTD-PD patients have more severe neuroalterations compared to TD-PD patients. More specifically, nTD-PD patients have deficits within striato-thalamo-cortical (STC) circuitry and other thalamocortical projections related to cognitive and sensorimotor function, while TD-PD patients tend to have greater cerebello-thalamo-cortical (CTC) circuitry dysfunction.
Based on the literature, STC and CTC circuitry deficits seem to be the key features of PD and the subtypes. Future research should make greater use of multimodal neuroimaging and techniques that have higher sensitivity in delineating subcortical structures involved in motor diseases.
震颤为主型（TD）、非震颤为主型（nTD）、姿势不稳和步态障碍型（PIGD）以及运动不能-强直型（AR）帕金森病（PD）的神经解剖学基础尚未完全区分。更好地了解PD亚型的症状特异性病理解剖学标志物可能会实现更早的诊断和更具针对性的治疗。在此，我们旨在对比较PD运动亚型的神经影像学文献进行综述。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对PD亚型的神经影像学研究进行了系统的文献综述。提交至PubMed数据库的检索词包括：“帕金森病”、“MRI”和“运动亚型”（TD、nTD、PIGD、AR）。结果首先从组织的宏观到微观层面进行讨论（即，（1）结构；（2）功能；以及（3）分子），然后按应用的成像方法进行讨论。
包括扩散成像和正电子发射断层扫描（PET）在内的几种神经影像学方法能够很好地区分特定的PD运动亚型，尽管研究结果不一。此外，我们的综述表明，与TD-PD患者相比，nTD-PD患者的神经改变更为严重。更具体地说，nTD-PD患者在与认知和感觉运动功能相关的纹状体-丘脑-皮质（STC）回路及其他丘脑皮质投射中存在缺陷，而TD-PD患者往往存在更严重的小脑-丘脑-皮质（CTC）回路功能障碍。
基于文献，STC和CTC回路缺陷似乎是PD及其亚型的关键特征。未来的研究应更多地使用多模态神经影像学以及在描绘运动疾病相关皮质下结构方面具有更高灵敏度的技术。
