Wu Chenqing, Wu Haoting, Zhou Cheng, Guo Tao, Guan Xiaojun, Cao Zhengye, Wu Jingjing, Liu Xiaocao, Chen Jingwen, Wen Jiaqi, Qin Jianmei, Tan Sijia, Duanmu Xiaojie, Gu Luyan, Song Zhe, Zhang Baorong, Huang Peiyu, Xu Xiaojun, Zhang Minming
Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
CNS Neurosci Ther. 2024 Apr;30(4):e14540. doi: 10.1111/cns.14540. Epub 2023 Nov 23.
To explore the cortical structural reorganization in Parkinson's disease (PD) patients under chronic dopamine replacement therapy (DRT) in cross-sectional and longitudinal data and determine whether these changes were associated with clinical alterations.
A total of 61 DRT-treated, 60 untreated PD patients, and 61 normal controls (NC) were retrospectively included. Structural MRI scans and neuropsychological tests were conducted. Cortical thickness and volume were extracted based on FreeSurfer and were analyzed using general linear model to find statistically significant differences among three groups. Correlation analyses were performed among significant cortical areas, medication treatment (duration and dosage), and neuropsychological tests. Longitudinal cortical structural changes of patients who initiated DRT were analyzed using linear mixed-effect model.
Significant cortical atrophy was primarily observed in the prefrontal cortex in treated patients, including the cortical thickness of right pars opercularis and the volume of bilateral superior frontal cortex (SFC), left rostral anterior cingulate cortex (rACC), right lateral orbital frontal cortex, right pars orbitalis, and right rostral middle frontal cortex. A negative correlation was detected between the left SFC volume and levodopa equivalent dose (LED) (r = -0.316, p = 0.016), as well as the left rACC volume and medication duration (r = -0.329, p = 0.013). In the patient group, the left SFC volume was positively associated with digit span forward score (r = 0.335, p = 0.017). The left SFC volume reduction was longitudinally correlated with increased LED (standardized coefficient = -0.077, p = 0.001).
This finding provided insights into the influence of DRT on cortical structure and highlighted the importance of drug dose titration in DRT.
在横断面和纵向数据中探索帕金森病（PD）患者在慢性多巴胺替代疗法（DRT）下的皮质结构重组，并确定这些变化是否与临床改变相关。
回顾性纳入61例接受DRT治疗的患者、60例未治疗的PD患者和61例正常对照（NC）。进行了结构MRI扫描和神经心理学测试。基于FreeSurfer提取皮质厚度和体积，并使用一般线性模型进行分析，以发现三组之间的统计学显著差异。对显著的皮质区域、药物治疗（持续时间和剂量）和神经心理学测试进行相关性分析。使用线性混合效应模型分析开始DRT治疗的患者的纵向皮质结构变化。
在接受治疗的患者中，主要在前额叶皮质观察到显著的皮质萎缩，包括右侧 opercularis 部的皮质厚度以及双侧额上回（SFC）、左侧喙前扣带回皮质（rACC）、右侧外侧眶额皮质、右侧眶部和右侧喙中额皮质的体积。检测到左侧SFC体积与左旋多巴等效剂量（LED）之间存在负相关（r = -0.316，p = 0.016），以及左侧rACC体积与药物治疗持续时间之间存在负相关（r = -0.329，p = 0.013）。在患者组中，左侧SFC体积与顺背数字广度得分呈正相关（r = 0.335，p = 0.017）。左侧SFC体积减少与LED增加在纵向相关（标准化系数 = -0.077，p = 0.001）。
这一发现为DRT对皮质结构的影响提供了见解，并强调了DRT中药物剂量滴定的重要性。
