Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Brain. 2024 Oct 3;147(10):3370-3378. doi: 10.1093/brain/awae186.
Visual hallucinations can increase the burden of disease for both patients with Parkinson's disease and their caregivers. Multiple neurotransmitters have been implicated in the neuropathology of visual hallucinations, which provide targets for treatment and prevention. In this study, we assessed the association between cholinergic denervation and visual hallucinations in Parkinson's disease in vivo, using PET imaging of the cholinergic system. A total of 38 patients with Parkinson's disease participated in this study. A group of 10 healthy subjects, matched for age, sex and education, was included for comparison. None of the participants used cholinergic drugs. Thirteen patients who had experienced visual hallucinations in the past month (VH+) were compared with 20 patients who had never experienced visual hallucinations in their lives (VH-). Cholinergic system integrity was assessed with PET imaging using 18F-fluoroethoxybenzovesamicol as the tracer. We assessed the differences in tracer uptake between groups by cluster-based analysis and by analysis of predefined regions of interest consisting of the ventral visual stream, the dorsal attentional network, the ventral attentional network and the lateral geniculate nucleus and mediodorsal nucleus of the thalamus. The Parkinson's disease group (n = 38) showed an extensive pattern of decreased tracer uptake throughout the brain compared with the controls (n = 10). Within the Parkinson's disease group, the VH+ group (n = 13) showed a cluster of decreased tracer uptake compared with the VH- group (n = 20), which covered most of the left ventral visual stream and extended towards superior temporal areas. These results were mirrored in the regions of interest-based analysis, in which the VH+ group showed the strongest deficits in the left inferior temporal gyrus and the left superior temporal gyrus compared with the VH- group. Visual hallucinations in Parkinson's disease are associated with a marked cholinergic deficiency in the left ventral visual stream and the left superior temporal lobe, in addition to an extensive global cholinergic denervation in the general Parkinson's disease population.
视觉幻觉会增加帕金森病患者及其照顾者的疾病负担。多种神经递质与视觉幻觉的神经病理学有关，为治疗和预防提供了靶点。在这项研究中，我们使用胆碱能系统的 PET 成像评估了帕金森病患者体内胆碱能神经支配与视觉幻觉之间的关联。共有 38 名帕金森病患者参与了这项研究。为了进行比较，我们纳入了一组 10 名年龄、性别和教育程度相匹配的健康对照者。所有参与者均未使用胆碱能药物。我们比较了过去一个月经历过视觉幻觉的 13 名患者（VH+）和一生中从未经历过视觉幻觉的 20 名患者（VH-）。使用 18F-氟乙氧基苯并伏安昔洛尔作为示踪剂，通过 PET 成像评估胆碱能系统的完整性。我们通过基于聚类的分析和通过分析包括腹侧视觉流、背侧注意网络、腹侧注意网络以及外侧膝状体和丘脑的中背核的预定义感兴趣区域，评估了各组之间示踪剂摄取的差异。与对照组（n=10）相比，帕金森病组（n=38）整个大脑的示踪剂摄取明显减少。在帕金森病组中，与 VH-组（n=20）相比，VH+组（n=13）表现出一个示踪剂摄取减少的簇，该簇覆盖了大部分左侧腹侧视觉流，并向颞上区延伸。基于感兴趣区域的分析也得到了类似的结果，在该分析中，与 VH-组相比，VH+组在左侧颞下回和左侧颞上回的表现出最强的缺陷。除了在一般帕金森病患者中广泛存在的胆碱能神经支配缺失外，帕金森病患者的视觉幻觉与左侧腹侧视觉流和左侧颞上叶的明显胆碱能缺乏有关。
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