Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China; Department of Neurology, Jining No. 1 People's Hospital, Jining, 272000, China.
Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
Parkinsonism Relat Disord. 2022 Dec;105:96-102. doi: 10.1016/j.parkreldis.2022.11.012. Epub 2022 Nov 12.
The use of the anti-parkinsonian drug trihexyphenidyl (THP) to treat patients with Parkinson's disease (PD), particularly those with tremor-dominant PD (tdPD), has been well documented. Despite growing concerns about THP causing cognitive decline in tdPD patients, the underlying neural correlates remain unclear. Therefore, we investigated the effects of THP on prefrontal executive function and spontaneous neural activity in patients with tdPD by utilizing functional near-infrared spectroscopy (fNIRS).
We recruited 30 patients with tdPD, including 15 patients receiving THP and 15 patients not receiving THP. We performed comprehensive neuropsychological and clinical assessments to evaluate each patient's cognitive function, mental status, and clinical symptoms. We measured brain activation elicited from the verbal fluency task (VFT) and changes in amplitude of low-frequency fluctuations (ALFF) at rest to investigate executive function and spontaneous neural activity, respectively. In addition, we examined the relationship between altered activation during task and resting state and neuropsychological and clinical data.
Compared with tdPD patients not taking THP, tdPD patients taking THP showed no differences on neuropsychological tests. However, there was insufficient activity of the dorsolateral prefrontal cortex (DLPFC) during VFT and reduced ALFF values for the DLPFC, ventrolateral prefrontal cortex (VLPFC), and the orbitofrontal cortex (OFC) related to the frontoparietal network (FPN) at rest. Furthermore, ALFF values of the VLPFC were positively correlated with scores of multiple cognitive domain functions.
These findings suggest that THP treatment may lead to prefrontal dysfunction in tdPD patients, attenuating brain activation in executive function and cognition-related spontaneous neural activity.
抗帕金森病药物三己酚丁（THP）治疗帕金森病（PD）患者，尤其是震颤为主型 PD（tdPD）患者的疗效已得到充分证实。尽管越来越多的人担心 THP 会导致 tdPD 患者认知能力下降，但潜在的神经相关性尚不清楚。因此，我们通过功能近红外光谱（fNIRS）研究了 THP 对 tdPD 患者前额叶执行功能和自发神经活动的影响。
我们招募了 30 名 tdPD 患者，包括 15 名接受 THP 治疗的患者和 15 名未接受 THP 治疗的患者。我们对每位患者进行了全面的神经心理学和临床评估，以评估其认知功能、精神状态和临床症状。我们测量了言语流畅性任务（VFT）诱发的大脑激活和静息时低频波动幅度（ALFF）的变化，分别用于研究执行功能和自发神经活动。此外，我们还研究了任务和静息状态下改变的激活与神经心理学和临床数据之间的关系。
与未服用 THP 的 tdPD 患者相比，服用 THP 的 tdPD 患者在神经心理学测试中没有差异。然而，在 VFT 期间，背外侧前额叶皮层（DLPFC）的活动不足，静息时 DLPFC、腹外侧前额叶皮层（VLPFC）和眶额皮层（OFC）与额顶叶网络（FPN）相关的 ALFF 值降低。此外，VLPFC 的 ALFF 值与多个认知领域功能的评分呈正相关。
这些发现表明，THP 治疗可能导致 tdPD 患者前额叶功能障碍，减弱执行功能和认知相关自发神经活动的大脑激活。
