Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany.
Psychol Med. 2023 Mar;53(4):1244-1253. doi: 10.1017/S0033291721002725. Epub 2021 Sep 23.
Impaired self-awareness of cognitive deficits (ISAcog) has rarely been investigated in Parkinson's disease (PD). ISAcog is associated with poorer long-term outcome in other diseases. This study examines ISAcog in PD with and without mild cognitive impairment (PD-MCI), compared to healthy controls, and its clinical-behavioral and neuroimaging correlates.
We examined 63 PD patients and 30 age- and education-matched healthy controls. Cognitive state was examined following the Movement Disorder Society Level II criteria. ISAcog was determined by subtracting -scores (based on controls' scores) of objective tests and subjective questionnaires. Neural correlates were assessed by structural magnetic resonance imaging (MRI) and 2-[fluorine-18]fluoro-2-deoxy-d-glucose-positron emission tomography (FDG-PET) in 47 patients (43 with MRI) and 11 controls. We analyzed whole-brain glucose metabolism and cortical thickness in regions where FDG-uptake correlated with ISAcog.
PD-MCI patients ( = 23) showed significantly more ISAcog than controls and patients without MCI ( = 40). When all patients who underwent FDG-PET were examined, metabolism in the bilateral superior medial frontal gyrus, anterior and midcingulate cortex negatively correlated with ISAcog (FWE-corrected p < 0.001). In PD-MCI, ISAcog was related to decreased metabolism in the right superior temporal lobe and insula ( = 13; FWE-corrected = 0.023) as well as the midcingulate cortex (FWE-corrected = 0.002). Cortical thickness was not associated with ISAcog in these regions. No significant correlations were found between ISAcog and glucose metabolism in controls and patients without MCI.
Similar to Alzheimer's disease, the cingulate cortex seems to be relevant in ISAcog in PD. In PD-MCI patients, ISAcog might result from a disrupted network that regulates awareness of cognition and error processes.
在帕金森病（PD）中，对认知缺陷的自我意识受损（ISAcog）的研究很少。在其他疾病中，ISAcog 与较差的长期预后相关。本研究比较了 PD 伴轻度认知障碍（PD-MCI）患者与健康对照组的 ISAcog，并探讨了其临床行为和神经影像学相关性。
我们检查了 63 名 PD 患者和 30 名年龄和教育程度匹配的健康对照组。根据运动障碍协会 II 级标准评估认知状态。ISAcog 通过减去客观测试和主观问卷的 -分数（基于对照组的分数）来确定。在 47 名患者（43 名有 MRI）和 11 名对照中，通过结构磁共振成像（MRI）和 2-[氟-18]氟-2-脱氧-d-葡萄糖正电子发射断层扫描（FDG-PET）评估神经影像学相关性。我们分析了与 ISAcog 相关的 FDG 摄取的大脑皮质各区域的葡萄糖代谢和皮质厚度。
PD-MCI 患者（n=23）与对照组和无 MCI 的患者（n=40）相比，ISAcog 显著更高。当检查所有接受 FDG-PET 的患者时，双侧额上内侧回、前扣带回和中扣带回皮质的代谢与 ISAcog 呈负相关（FWE 校正 p<0.001）。在 PD-MCI 中，ISAcog 与右侧颞上回和岛叶（n=13；FWE 校正 = 0.023）以及中扣带回皮质（FWE 校正 = 0.002）的代谢减少有关。在这些区域，皮质厚度与 ISAcog 无显著相关性。在对照组和无 MCI 的患者中，ISAcog 与葡萄糖代谢无显著相关性。
与阿尔茨海默病类似，扣带回皮质在 PD 中的 ISAcog 中似乎具有相关性。在 PD-MCI 患者中，ISAcog 可能是由于调节认知和错误处理意识的网络受损所致。
