Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
J Neurol Sci. 2021 Nov 15;430:120032. doi: 10.1016/j.jns.2021.120032. Epub 2021 Oct 18.
According to epidemiological studies, Parkinson's disease (PD) patients with probable REM sleep behavior disorder (pRBD) are more prone to develop impulse control disorders (ICDs), which is shown to be present in drug-naïve PD patients, and vice versa.
To investigate white-matter integrity differences, with and without comorbid pRBD and ICDs.
149 de-novo PD patients and 30 age- and gender-matched controls from the Parkinson's Progression Markers Initiative were studied. PD subjects were categorized into four groups with and without these comorbidities. We investigated the white matter integrity differences between these groups.
PDs with only ICDs manifested greater fractional anisotropy (FA) and lower mean diffusivity (MD) in ipsilateral cerebellar connections when compared to controls and to Parkinson's with both comorbid disorders. In contrast, significantly lower FA and higher MD in the ipsilateral fornix-stria-terminalis was observed in PDs with only pRBD compared to controls and to PDs without either comorbid disorder. Also, PDs with only pRBD manifested greater FA in contralateral putamen when compared to controls.
Our results suggest the presence of an underlying neural network in PDs with ICDs, particularly involving cerebellar connections, which makes the subjects susceptible to pRBD. Lower white-matter integrity in the fornix of PDs with only pRBD suggests a neuropathological pathway specific to sleep behavior disorder, independent of impulse control disorders. Greater white-matter integrity observed in PDs without comorbid ICDs, regardless of their comorbid pRBD status, might reflect compensatory mechanisms. Targeted therapies for this particular neuropathology may help prevent these comorbidities.
根据流行病学研究，有 REM 睡眠行为障碍（pRBD）可能的帕金森病（PD）患者更容易出现冲动控制障碍（ICD），这在未经药物治疗的 PD 患者中已经显现出来，反之亦然。
研究合并或不合并 pRBD 和 ICD 的 PD 患者的白质完整性差异。
研究了来自帕金森病进展标志物倡议的 149 名初发 PD 患者和 30 名年龄和性别匹配的对照者。将 PD 患者分为有或无这些合并症的四组。我们研究了这些组之间白质完整性的差异。
与对照组和同时合并两种疾病的 PD 患者相比，仅患有 ICD 的 PD 患者表现出同侧小脑连接的各向异性分数（FA）更高和平均扩散系数（MD）更低。相反，与对照组和无任何合并症的 PD 患者相比，仅患有 pRBD 的 PD 患者的同侧穹窿-终纹状体的 FA 更低，MD 更高。此外，与对照组相比，仅患有 pRBD 的 PD 患者的对侧壳核表现出更大的 FA。
我们的结果表明，存在一种潜在的神经网络，特别是涉及小脑连接的网络，使患者易患 pRBD。仅患有 pRBD 的 PD 患者的穹窿完整性较低，提示存在一种与冲动控制障碍无关的特定于睡眠行为障碍的神经病理学途径。无合并 ICD 的 PD 患者的白质完整性更高，无论其合并 pRBD 状态如何，可能反映了代偿机制。针对这种特定神经病理学的靶向治疗可能有助于预防这些合并症。
