Centro de Investigacion Biomedica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.
Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau, Barcelona, Spain.
Eur J Neurol. 2022 Dec;29(12):3720-3727. doi: 10.1111/ene.15513. Epub 2022 Jul 30.
Reduced facial expression of emotions is a very frequent symptom of Parkinson's disease (PD) and has been considered part of the motor features of the disease. However, the neural correlates of hypomimia and the relationship between hypomimia and other non-motor symptoms of PD are poorly understood.
The clinical and structural brain correlates of hypomimia were studied. For this purpose, cross-sectional data from the COPPADIS study database were used. Age, disease duration, levodopa equivalent daily dose, Unified Parkinson's Disease Rating Scale part III (UPDRS-III), severity of apathy and depression and global cognitive status were collected. At the imaging level, analyses based on gray matter volume and cortical thickness were used.
After controlling for multiple confounding variables such as age or disease duration, the severity of hypomimia was shown to be indissociable from the UPDRS-III speech and bradykinesia items and was significantly related to the severity of apathy (β = 0.595; p < 0.0001). At the level of neural correlates, hypomimia was related to motor regions brodmann area 8 (BA 8) and to multiple fronto-temporo-parietal regions involved in the decoding, recognition and production of facial expression of emotions.
Reduced facial expressivity in PD is related to the severity of symptoms of apathy and is mediated by the dysfunction of brain systems involved in motor control and in the recognition, integration and expression of emotions. Therefore, hypomimia in PD may be conceptualized not exclusively as a motor symptom but as a consequence of a multidimensional deficit leading to a symptom where motor and non-motor aspects converge.
表情减少是帕金森病（PD）非常常见的症状，被认为是该疾病运动特征的一部分。然而，低表情的神经相关性以及低表情与 PD 的其他非运动症状之间的关系尚未得到很好的理解。
研究了低表情的临床和结构脑相关性。为此，使用了 COPPADIS 研究数据库的横断面数据。收集了年龄、疾病持续时间、左旋多巴等效日剂量、帕金森病评定量表第三部分（UPDRS-III）、淡漠和抑郁严重程度以及整体认知状态。在影像学水平上，使用基于灰质体积和皮质厚度的分析。
在控制了年龄或疾病持续时间等多个混杂变量后，低表情的严重程度与 UPDRS-III 的言语和运动徐缓项目不可分割，并且与淡漠的严重程度显著相关（β=0.595；p<0.0001）。在神经相关性方面，低表情与运动区域布罗德曼区 8（BA 8）以及多个额颞顶叶区域相关，这些区域参与了情绪的解码、识别和表达。
PD 中表情减少与淡漠症状的严重程度有关，并且是由涉及运动控制以及情绪的识别、整合和表达的大脑系统功能障碍介导的。因此，PD 中的低表情可能不仅仅被概念化为运动症状，而是由于导致运动和非运动方面汇聚的多维缺陷而导致的症状。
