皮质下铁沉积模式可能预测丘脑底核深部脑刺激后的神经心理学结局：一项初步研究。
Subcortical Iron Accumulation Pattern May Predict Neuropsychological Outcomes After Subthalamic Nucleus Deep Brain Stimulation: A Pilot Study.
机构信息
Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA.
出版信息
J Parkinsons Dis. 2022;12(3):851-863. doi: 10.3233/JPD-212833.
BACKGROUND
: Neuropsychological outcomes after deep brain stimulation (DBS) are variable and may arise from the heterogeneous neuropathological processes in Parkinson’s disease (PD).
OBJECTIVE
: To explore if brain iron accumulation patterns and its region-specific alterations relate to neuropsychological outcomes post-DBS.
METHODS
: Thirty-two PD subjects were identified from our database with susceptibility MRI prior to bilateral subthalamic nucleus (STN) DBS between 2011–2016. Demographic (age, sex, education), clinical information (disease duration, neuropsychological scores), and R2* (susceptibility MRI measure reflecting iron) in 11 subcortical regions of interest were obtained. Neuropsychological outcomes were defined as changes in psychomotor speed, executive function, attention, memory, and depression by subtracting pre- and post-DBS scores. A penalized logistic analysis was used to identify the best pre-DBS clinical and R2* predictors for each neuropsychological domain. Pearson’s partial correlations explored R2* associations with neuropsychological outcomes.
RESULTS
: Combined clinical and MRI metrics were associated better with neuropsychological outcomes (R≥0.373, p-value≤0.008) than either alone. Adding R2* metrics increased prediction of executive function (R=0.455, p=0.008) and attention (R=0.182, p=0.018) outcomes over clinical metrics alone. Specifically, R2* in the substantia nigra, caudate, STN, and hippocampus improved prediction of executive function, and in the putamen for attention. Interestingly, higher caudate R2* correlated with better executive function (p=0.043), whereas higher putamen R2* associated with worsening attention (p=0.018).
CONCLUSIONS
: Brain iron accumulation patterns, captured by susceptibility MRI, may add value to clinical evaluation in predicting neuropsychological outcomes post-DBS in PD. Further studies are warranted to validate these findings and understand the region-specific relationships between iron and DBS outcomes.
背景
深部脑刺激（DBS）后的神经心理学结果是可变的，可能源于帕金森病（PD）中的异质性神经病理过程。
目的
探讨脑铁积累模式及其特定区域的改变是否与 DBS 后神经心理学结果相关。
方法
我们从 2011 年至 2016 年期间接受双侧丘脑底核（STN）DBS 的数据库中确定了 32 名 PD 患者。获取了人口统计学（年龄、性别、教育）、临床信息（疾病持续时间、神经心理学评分）和 11 个皮质下感兴趣区域的 R2*（磁化率 MRI 测量值，反映铁）。神经心理学结果通过减去 DBS 前后的评分来定义为运动速度、执行功能、注意力、记忆和抑郁的变化。使用惩罚性逻辑分析来确定每个神经心理学领域的最佳 DBS 前临床和 R2预测因子。Pearson 偏相关探索了 R2与神经心理学结果的关联。
结果
联合临床和 MRI 指标与神经心理学结果的相关性更好（R≥0.373，p 值≤0.008），而不是单独的指标。添加 R2指标可提高执行功能（R=0.455，p=0.008）和注意力（R=0.182，p=0.018）的预测效果，而不仅仅是临床指标。具体而言，黑质、尾状核、STN 和海马中的 R2可改善执行功能的预测，而壳核中的 R2可改善注意力的预测。有趣的是，更高的尾状核 R2与更好的执行功能相关（p=0.043），而更高的壳核 R2*与注意力恶化相关（p=0.018）。
结论
磁化率 MRI 捕获的脑铁积累模式可能为 DBS 后 PD 神经心理学结果的临床评估增加价值。需要进一步研究来验证这些发现，并了解铁与 DBS 结果之间的特定区域关系。
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