Neurodegeneration Imaging Group, University of Exeter Medical School, London, United Kingdom.
Neurodegeneration Imaging Group, University of Exeter Medical School, London, United Kingdom.
Handb Clin Neurol. 2021;179:189-205. doi: 10.1016/B978-0-12-819975-6.00010-8.
Cognitive impairment affects approximately 20%-50% of patients with Parkinson's disease (PD), with a higher prevalence as the disease advances. The nucleus basalis of Meynert (NBM) provides the majority of cholinergic innervations to the cerebral cortex. Dysfunction of the cholinergic system and degeneration of the NBM have been implicated in the pathophysiology of cognitive impairment in neurodegenerative disorders including PD. Several studies have aimed to identify risk factors associated with cognitive decline in order to construct models to predict future cognitive impairment in PD. Given the link between cholinergic dysfunction and the pathogenesis of cognitive decline in PD, a number of studies have focused on the role of the NBM underlying cognitive performance. Recently, microstructural alterations within the NBM, detected using diffusion tensor imaging, have been identified as a strong predictor for the development of cognitive impairment in patients with PD. These microstructural changes in NBM have been shown to precede structural gray matter volumetric loss and may present with an early marker to predict cognitive decline in patients with PD. Longitudinal studies are warranted to provide insights into the potential utility of cholinergic positron emission tomography imaging to predict the development of cognitive impairment in PD and other neurodegenerative disorders. Provided the urgent need for disease modifying therapies aiming to slow and ultimately halt the progression of cognitive impairment, neuromodulation of NBM, and treatments targeting the cholinergic system may hold a promising potential. In this review, we discuss the link between NBM pathology and clinical symptomatology of cognitive impairment in PD with a focus on the use of in vivo imaging techniques and potential therapeutic interventions.
认知障碍影响大约 20%-50%的帕金森病 (PD) 患者，随着疾病的进展，患病率更高。基底核梅内尔特核 (NBM) 为大脑皮层提供了大部分胆碱能神经支配。胆碱能系统功能障碍和 NBM 退化与神经退行性疾病（包括 PD）认知障碍的发病机制有关。多项研究旨在确定与认知下降相关的危险因素，以便构建预测 PD 患者未来认知障碍的模型。鉴于胆碱能功能障碍与 PD 认知下降的发病机制之间的联系，许多研究都集中在 NBM 对认知表现的作用上。最近，使用弥散张量成像检测到的 NBM 内的微观结构改变已被确定为 PD 患者认知障碍发展的强有力预测因子。NBM 中的这些微观结构变化先于结构灰质体积损失，可能作为预测 PD 患者认知下降的早期标志物。需要进行纵向研究，以深入了解胆碱能正电子发射断层扫描成像在预测 PD 和其他神经退行性疾病认知障碍发展方面的潜在效用。鉴于迫切需要针对疾病修饰疗法以减缓并最终阻止认知障碍的进展，NBM 的神经调节以及针对胆碱能系统的治疗方法可能具有很大的潜力。在这篇综述中，我们讨论了 NBM 病理学与 PD 认知障碍的临床症状之间的联系，重点讨论了体内成像技术的应用和潜在的治疗干预措施。
