Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Mov Disord. 2023 Jan;38(1):4-15. doi: 10.1002/mds.29248. Epub 2022 Oct 17.
Studies on dementia with Lewy bodies (DLB) have mainly focused on the degeneration of distinct cortical and subcortical regions related to the deposition of Lewy bodies. In view of the proposed trans-synaptic spread of the α-synuclein pathology, investigating the disease only in this segregated fashion would be detrimental to our understanding of its progression. In this systematic review, we summarize findings on structural and functional brain connectivity in DLB, as connectivity measures may offer better insights on how the brain is affected by the spread of the pathology. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched Web of Science, PubMed, and SCOPUS for relevant articles published up to November 1, 2021. Of 1215 identified records, we selected and systematically reviewed 53 articles that compared connectivity features between patients with DLB and healthy controls. Structural and functional magnetic resonance imaging, positron emission tomography, single-positron emission computer tomography, and electroencephalography assessments of patients revealed widespread abnormalities within and across brain networks in DLB. Frontoparietal, default mode, and visual networks and their connections to other brain regions featured the most consistent disruptions, which were also associated with core clinical features and cognitive impairments. Furthermore, graph theoretical measures revealed disease-related decreases in local and global network efficiency. This systematic review shows that structural and functional connectivity characteristics in DLB may be particularly valuable at early stages, before overt brain atrophy can be observed. This knowledge may help improve the diagnosis and prognosis in DLB as well as pinpoint targets for future disease-modifying treatments. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
关于路易体痴呆（DLB）的研究主要集中在与路易体沉积相关的特定皮质和皮质下区域的变性上。鉴于α-突触核蛋白病理学的拟突触传递扩散，仅以这种隔离的方式研究该疾病将不利于我们对其进展的理解。在本系统评价中，我们总结了 DLB 结构和功能脑连接的研究结果，因为连接测量可能提供更好的见解，了解大脑如何受到病理学传播的影响。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，我们在 Web of Science、PubMed 和 SCOPUS 中搜索了截至 2021 年 11 月 1 日发表的相关文章。在 1215 条确定的记录中，我们选择并系统地回顾了 53 篇比较 DLB 患者和健康对照组连接特征的文章。对患者进行结构和功能磁共振成像、正电子发射断层扫描、单正电子发射计算机断层扫描和脑电图评估显示，DLB 患者的大脑网络内和跨网络存在广泛的异常。额顶叶、默认模式和视觉网络及其与其他大脑区域的连接特征最一致，这些异常也与核心临床特征和认知障碍相关。此外，图论测量显示与疾病相关的局部和全局网络效率降低。本系统评价表明，DLB 的结构和功能连接特征在早期阶段（在明显的脑萎缩之前）可能特别有价值。这一知识可能有助于改善 DLB 的诊断和预后，并确定未来疾病修饰治疗的靶点。
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