Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People's Hospital, Yancheng, China.
CNS Neurosci Ther. 2024 Jul;30(7):e14867. doi: 10.1111/cns.14867.
Parkinson's disease (PD) is increasingly recognized for its non-motor symptoms, among which emotional disturbances and sleep disorders frequently co-occur. The commonality of neuroanatomical underpinnings for these symptoms is not fully understood. This study is intended to investigate the differences in gray matter volume (GMV) between PD patients with anxiety (A-PD) and those without anxiety (NA-PD). Additionally, it seeks to uncover the interplay between GMV variations and the manifestations of anxiety and sleep quality.
A total of 37 A-PD patients, 43 NA-PD patients, and 36 healthy controls (HCs) were recruited, all of whom underwent voxel-based morphometry (VBM) analysis. Group differences in GMV were assessed using analysis of covariance (ANCOVA). Partial correlation between GMV, anxiety symptom, and sleep quality were analyzed. Mediation analysis explored the mediating role of the volume of GMV-distinct brain regions on the relationship between sleep quality and anxiety within the PD patient cohort.
A-PD patients showed significantly lower GMV in the fusiform gyrus (FG) and right inferior temporal gyrus (ITG) compared to HCs and NA-PD patients. GMV in these regions correlated negatively with Hamilton Anxiety Rating Scale (HAMA) scores (right ITG: r = -0.690, p < 0.001; left FG: r = -0.509, p < 0.001; right FG: r = -0.576, p < 0.001) and positively with sleep quality in PD patients (right ITG: r = 0.592, p < 0.001; left FG: r = 0.356, p = 0.001; right FG: r = 0.470, p < 0.001). Mediation analysis revealed that GMV in the FG and right ITG mediated the relationship between sleep quality and anxiety symptoms, with substantial effect sizes accounted for by the right ITG (25.74%) and FG (left: 11.90%, right: 15.59%).
This study has shed further light on the relationship between sleep disturbances and anxiety symptoms in PD patients. Given the pivotal roles of the FG and the ITG in facial recognition and the recognition of emotion-related facial expressions, our findings indicate that compromised sleep quality, under the pathological conditions of PD, may exacerbate the reduction in GMV within these regions, impairing the recognition of emotional facial expressions and thereby intensifying anxiety symptoms.
帕金森病（PD）的非运动症状日益受到关注，其中情绪障碍和睡眠障碍常同时发生。这些症状的神经解剖学基础的共同性尚未完全了解。本研究旨在探讨伴焦虑（A-PD）和不伴焦虑（NA-PD）的 PD 患者之间灰质体积（GMV）的差异，并揭示 GMV 变化与焦虑和睡眠质量表现之间的相互作用。
共纳入 37 例 A-PD 患者、43 例 NA-PD 患者和 36 例健康对照者（HCs），所有患者均接受基于体素的形态学（VBM）分析。采用协方差分析（ANCOVA）评估 GMV 组间差异。采用偏相关分析 GMV 与焦虑症状和睡眠质量之间的关系。中介分析探索了 PD 患者中 GMV 特定脑区体积在睡眠质量和焦虑之间关系中的中介作用。
与 HCs 和 NA-PD 患者相比，A-PD 患者的梭状回（FG）和右侧颞下回（ITG）的 GMV 明显降低。这些区域的 GMV 与汉密尔顿焦虑量表（HAMA）评分呈负相关（右侧 ITG：r=-0.690，p<0.001；左侧 FG：r=-0.509，p<0.001；右侧 FG：r=-0.576，p<0.001），与 PD 患者的睡眠质量呈正相关（右侧 ITG：r=0.592，p<0.001；左侧 FG：r=0.356，p=0.001；右侧 FG：r=0.470，p<0.001）。中介分析显示，FG 和右侧 ITG 的 GMV 介导了睡眠质量和焦虑症状之间的关系，其中右侧 ITG（25.74%）和 FG（左侧：11.90%，右侧：15.59%）的效应量较大。
本研究进一步阐明了 PD 患者睡眠障碍与焦虑症状之间的关系。鉴于 FG 和 ITG 在面部识别和情绪相关面部表情识别中的关键作用，我们的发现表明，在 PD 病理条件下，睡眠质量下降可能会加剧这些区域 GMV 的减少，损害对情绪面部表情的识别，从而加剧焦虑症状。
