De Micco Rosa, Piramide Noemi, Di Nardo Federica, Siciliano Mattia, Cirillo Mario, Russo Antonio, Silvestro Marcello, Tedeschi Gioacchino, Esposito Fabrizio, Tessitore Alessandro
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Neuropsychology Laboratory, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
J Neural Transm (Vienna). 2023 Jan;130(1):43-51. doi: 10.1007/s00702-022-02565-7. Epub 2022 Dec 6.
Epidemiological studies have shown that Parkinson's disease (PD) patients with probable REM sleep behavior disorder (pRBD) present an increased risk of worse cognitive progression over the disease course. The aim of this study was to investigate, using resting-state functional MRI (RS-fMRI), the functional connectivity (FC) changes associated with the presence of pRBD in a cohort of newly diagnosed, drug-naive and cognitively unimpaired PD patients compared to healthy controls (HC). Fifty-six drug-naïve patients (25 PD-pRBD and 31 PD-pRBD) and 23 HC underwent both RS-fMRI and clinical assessment. Single-subject and group-level independent component analysis was used to analyze intra- and inter-network FC differences within the major large-scale neurocognitive networks, namely the default mode (DMN), frontoparietal (FPN), salience (SN) and executive-control (ECN) networks. Widespread FC changes were found within the most relevant neurocognitive networks in PD patients compared to HC. Moreover, PD-pRBD patients showed abnormal intrinsic FC within the DMN, ECN and SN compared to PD-pRBD. Finally, PD-pRBD patients showed functional decoupling between left and right FPN. In the present study, we revealed that FC changes within the most relevant neurocognitive networks are already detectable in early drug-naïve PD patients, even in the absence of clinical overt cognitive impairment. These changes are even more evident in PD patients with RBD, potentially leading to profound impairment in cognitive processing and cognitive/behavioral integration, as well as to fronto-striatal maladaptive compensatory mechanisms.
流行病学研究表明,患有可能的快速眼动睡眠行为障碍(pRBD)的帕金森病(PD)患者在疾病过程中出现认知功能恶化进展的风险增加。本研究的目的是使用静息态功能磁共振成像(RS-fMRI),调查一组新诊断、未用药且认知未受损的PD患者与健康对照(HC)相比,与pRBD存在相关的功能连接(FC)变化。56名未用药患者(25名PD-pRBD患者和31名非PD-pRBD患者)和23名HC接受了RS-fMRI和临床评估。采用单受试者和组水平独立成分分析来分析主要大规模神经认知网络内的网络内和网络间FC差异,即默认模式(DMN)、额顶叶(FPN)、突显(SN)和执行控制(ECN)网络。与HC相比,在PD患者最相关的神经认知网络中发现了广泛的FC变化。此外,与非PD-pRBD患者相比,PD-pRBD患者在DMN、ECN和SN内显示出异常的内在FC。最后,PD-pRBD患者在左右FPN之间表现出功能解耦。在本研究中,我们发现即使在没有明显临床认知障碍的情况下,在早期未用药的PD患者中已经可以检测到最相关神经认知网络内的FC变化。这些变化在患有RBD的PD患者中更为明显,可能导致认知加工和认知/行为整合的严重受损,以及额纹状体适应不良的代偿机制。