Department of Neurology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; Graduate School of Frontier Biosciences, Osaka University, Suita 565-0871, Japan.
Department of Neurology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan.
Neuroimage Clin. 2023;37:103307. doi: 10.1016/j.nicl.2022.103307. Epub 2022 Dec 28.
Impulsive compulsive behaviors (ICBs) often disturb patients with Parkinson's Disease (PD), of which impulse control disorder (ICD) and dopamine dysregulation syndrome (DDS) are two major subsets. The nucleus accumbens (NAcc) is involved in ICB; however, it remains unclear how the NAcc affects cortical function and defines the different behavioral characteristics of ICD and DDS.
To identify the cortico-striatal network primarily involved in ICB and the differences in these networks between patients with ICD and DDS using structural and resting-state functional magnetic resonance imaging.
Patients with PD were recruited using data from a previous cohort study and divided into those with ICB (ICB group) and without ICB (non-ICB group) using the Japanese version of the Questionnaire for Impulsive Compulsive Disorders in Parkinson's Disease (J-QUIP). From these two groups, we extracted 37 pairs matched for age, sex, disease duration, and levodopa equivalent daily dose of dopamine agonists. Patients with ICB were further classified as having ICD or DDS based on the J-QUIP subscore. General linear models were used to compare gray matter volume and functional connectivity (FC) of the NAcc, caudate, and putamen between the ICB and non-ICB groups and between patients with ICD and those with DDS.
We found no significant differences in gray matter volumebetween the ICB and non-ICB groups or between patients with ICD and those with DDS. Compared with the non-ICB group, the FC of the right NAcc in the ICB group was lower in the bilateral ventromedial prefrontal cortex and higher in the left middle occipital gyrus. Furthermore, patients with DDS showed higher FC between the right putamen and left superior temporal gyrus and higher FC between the left caudate and bilateral middle occipital gyrus than patients with ICD. In contrast, patients with ICD exhibited higher FC between the left NAcc and the right posterior cingulate cortex than patients with DDS.
The functionally altered network between the right NAcc and ventromedial prefrontal cortex was associated with ICB in PD. In addition, the surrounding cortico-striatal networks may differentiate the behavioral characteristics of patients with ICD and those with DDS.
冲动强迫行为（ICBs）常困扰帕金森病（PD）患者，其中冲动控制障碍（ICD）和多巴胺失调综合征（DDS）是两个主要亚型。伏隔核（NAcc）参与 ICB；然而，NAcc 如何影响皮质功能并定义 ICD 和 DDS 的不同行为特征仍不清楚。
使用结构和静息状态功能磁共振成像来识别主要参与 ICB 的皮质纹状体网络，以及这些网络在 ICD 和 DDS 患者之间的差异。
利用先前队列研究的数据招募 PD 患者，并使用帕金森病冲动强迫障碍问卷（J-QUIP）的日文版将患者分为有 ICB（ICB 组）和无 ICB（非 ICB 组）。从这两个组中，我们提取了 37 对年龄、性别、疾病持续时间和多巴胺激动剂等效日剂量匹配的患者。根据 J-QUIP 子评分，ICB 患者进一步分为 ICD 或 DDS。使用一般线性模型比较 ICB 和非 ICB 组以及 ICD 和 DDS 患者之间 NAcc、尾状核和壳核的灰质体积和功能连接（FC）。
我们发现 ICB 和非 ICB 组或 ICD 和 DDS 患者之间的灰质体积没有显著差异。与非 ICB 组相比，ICB 组右侧 NAcc 的 FC 在双侧腹内侧前额叶皮质较低，而左侧中枕叶较高。此外，与 ICD 患者相比，DDS 患者的右侧壳核与左侧颞上回之间的 FC 较高，左侧尾状核与双侧中枕叶之间的 FC 较高。相比之下，与 DDS 患者相比，ICD 患者的左侧 NAcc 与右侧后扣带回之间的 FC 较高。
PD 中右侧 NAcc 和腹内侧前额叶皮质之间功能改变的网络与 ICB 相关。此外，周围的皮质纹状体网络可能区分 ICD 和 DDS 患者的行为特征。
