Schumacher Julia, Ray Nicola J, Hamilton Calum A, Bergamino Maurizio, Donaghy Paul C, Firbank Michael, Watson Rosie, Roberts Gemma, Allan Louise, Barnett Nicola, O'Brien John T, Thomas Alan J, Taylor John-Paul
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK.
Department of Neurology, University Medical Center Rostock, Rostock, Germany.
Alzheimers Dement. 2023 Oct;19(10):4549-4563. doi: 10.1002/alz.13034. Epub 2023 Mar 15.
Degeneration of cortical cholinergic projections from the nucleus basalis of Meynert (NBM) is characteristic of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), whereas involvement of cholinergic projections from the pedunculopontine nucleus (PPN) to the thalamus is less clear.
We studied both cholinergic projection systems using a free water-corrected diffusion tensor imaging (DTI) model in the following cases: 46 AD, 48 DLB, 35 mild cognitive impairment (MCI) with AD, 38 MCI with Lewy bodies, and 71 controls.
Free water in the NBM-cortical pathway was increased in both dementia and MCI groups compared to controls and associated with cognition. Free water along the PPN-thalamus tract was increased only in DLB and related to visual hallucinations. Results were largely replicated in an independent cohort.
While NBM-cortical projections degenerate early in AD and DLB, the thalamic cholinergic input from the PPN appears to be more selectively affected in DLB and might associate with visual hallucinations.
Free water in the NBM-cortical cholinergic pathways is increased in AD and DLB. NBM-cortical pathway integrity is related to overall cognitive performance. Free water in the PPN-thalamus cholinergic pathway is only increased in DLB, not AD. PPN-thalamus pathway integrity might be related to visual hallucinations in DLB.
来自Meynert基底核（NBM）的皮质胆碱能投射纤维变性是路易体痴呆（DLB）和阿尔茨海默病（AD）的特征，而从脚桥核（PPN）到丘脑的胆碱能投射纤维受累情况尚不清楚。
我们在以下病例中使用自由水校正扩散张量成像（DTI）模型研究了这两种胆碱能投射系统：46例AD患者、48例DLB患者、35例伴有AD的轻度认知障碍（MCI）患者、38例伴有路易体的MCI患者以及71名对照者。
与对照组相比，痴呆组和MCI组中NBM - 皮质通路中的自由水均增加，且与认知相关。仅在DLB患者中，沿PPN - 丘脑束的自由水增加，且与视幻觉有关。结果在一个独立队列中得到了很大程度的重复。
虽然在AD和DLB中NBM - 皮质投射纤维早期就会发生变性，但来自PPN的丘脑胆碱能输入似乎在DLB中受到更具选择性的影响，并且可能与视幻觉有关。
AD和DLB中NBM - 皮质胆碱能通路中的自由水增加。NBM - 皮质通路的完整性与整体认知表现相关。PPN - 丘脑胆碱能通路中的自由水仅在DLB中增加，而在AD中未增加。PPN - 丘脑通路的完整性可能与DLB中的视幻觉有关。
