Hamada Tomoya, Higashiyama Yuichi, Saito Asami, Morihara Keisuke, Landin-Romero Ramon, Okamoto Mitsuo, Kimura Katsuo, Miyaji Yousuke, Joki Hideto, Kishida Hitaru, Doi Hiroshi, Ueda Naohisa, Takeuchi Hideyuki, Tanaka Fumiaki
Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
Department of Speech-Language-Hearing Therapy, Japan Welfare Education College, Shinjuku-ku, Tokyo, Japan.
J Parkinsons Dis. 2021;11(4):2005-2016. doi: 10.3233/JPD-202473.
Mild cognitive impairment (MCI) in Parkinson's disease (PD) is considered a risk factor for PD with dementia (PDD). Verbal fluency tasks are widely used to assess executive function in PDD. However, in cases of PD with MCI (PD-MCI), the relative diagnostic accuracy of different qualitative verbal fluency measures and their related neural mechanisms remain unknown.
This study aimed to investigate the relative diagnostic accuracy of qualitative (clustering and switching) verbal fluency strategies and their correlates with functional imaging in PD-MCI.
Forty-five patients with PD (26 with MCI and 19 without MCI) and 25 healthy controls underwent comprehensive neurocognitive testing and resting-state functional magnetic resonance imaging. MCI in patients with PD was diagnosed according to established clinical criteria. The diagnostic accuracy of verbal fluency measures was determined via receiver operating characteristic analysis. Changes in brain functional connectivity between groups and across clinical measures were assessed using seed-to-voxel analyses.
Patients with PD-MCI generated fewer words and switched less frequently in semantic and phonemic fluency tasks compared to other groups. Switching in semantic fluency showed high diagnostic accuracy for PD-MCI and was associated with reduced functional connectivity in the salience network.
Our results indicate that reduced switching in semantic fluency tasks is a sensitive and specific marker for PD-MCI. Qualitative verbal fluency deficits and salience network dysfunction represent early clinical changes observed in PD-MCI.
帕金森病（PD）中的轻度认知障碍（MCI）被认为是帕金森病痴呆（PDD）的一个风险因素。言语流畅性任务被广泛用于评估PDD中的执行功能。然而，在帕金森病合并MCI（PD-MCI）的病例中，不同定性言语流畅性测量方法的相对诊断准确性及其相关神经机制仍不清楚。
本研究旨在调查定性（聚类和转换）言语流畅性策略在PD-MCI中的相对诊断准确性及其与功能成像的相关性。
45例帕金森病患者（26例合并MCI，19例未合并MCI）和25名健康对照者接受了全面的神经认知测试和静息态功能磁共振成像检查。帕金森病患者的MCI根据既定的临床标准进行诊断。通过受试者工作特征分析确定言语流畅性测量方法的诊断准确性。使用种子点到体素分析评估组间和临床测量指标之间脑功能连接的变化。
与其他组相比，PD-MCI患者在语义和音素流畅性任务中生成的单词较少，转换频率较低。语义流畅性任务中的转换对PD-MCI具有较高的诊断准确性，并且与突显网络中功能连接的减少有关。
我们的结果表明，语义流畅性任务中转换减少是PD-MCI的一个敏感且特异的标志物。定性言语流畅性缺陷和突显网络功能障碍代表了在PD-MCI中观察到的早期临床变化。
