Yuan Xiaorong, Yu Qiaowen, Liu Yanyan, Chen Jinge, Gao Jie, Liu Yujia, Song Ruxi, Zhang Yingzhi, Hou Zhongyu
Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Medical Imaging, Shandong Provincial Hospital, Jinan, Shandong, China.
Front Neurosci. 2024 Aug 1;18:1439443. doi: 10.3389/fnins.2024.1439443. eCollection 2024.
The advent of new clinical subtyping systems for Parkinson's disease (PD) has led to the classification of patients into distinct groups: mild motor predominant (PD-MMP), intermediate (PD-IM), and diffuse malignant (PD-DM). Our goal was to evaluate the efficacy of diffusion tensor imaging (DTI) in the early diagnosis, assessment of clinical progression, and prediction of prognosis of these PD subtypes. Additionally, we attempted to understand the pathological mechanisms behind white matter damage using single-photon emission computed tomography (SPECT) and cerebrospinal fluid (CSF) analyses.
We classified 135 de novo PD patients based on new clinical criteria and followed them up after 1 year, along with 45 healthy controls (HCs). We utilized tract-based spatial statistics to assess the microstructural changes of white matter at baseline and employed multiple linear regression to examine the associations between DTI metrics and clinical data at baseline and after follow-up.
Compared to HCs, patients with the PD-DM subtype demonstrated reduced fractional anisotropy (FA), increased axial diffusivity (AD), and elevated radial diffusivity (RD) at baseline. The FA and RD values correlated with the severity of motor symptoms, with RD also linked to cognitive performance. Changes in FA over time were found to be in sync with changes in motor scores and global composite outcome measures. Furthermore, baseline AD values and their rate of change were related to alterations in semantic verbal fluency. We also discovered the relationship between FA values and the levels of α-synuclein and β-amyloid. Reduced dopamine transporter uptake in the left putamen correlated with RD values in superficial white matter, motor symptoms, and autonomic dysfunction at baseline as well as cognitive impairments after 1 year.
The PD-DM subtype is characterized by severe clinical symptoms and a faster progression when compared to the other subtypes. DTI, a well-established technique, facilitates the early identification of white matter damage, elucidates the pathophysiological mechanisms of disease progression, and predicts cognitively related outcomes. The results of SPECT and CSF analyses can be used to explain the specific pattern of white matter damage in patients with the PD-DM subtype.
帕金森病（PD）新临床亚型分类系统的出现，使得患者被分为不同组别：轻度运动为主型（PD-MMP）、中间型（PD-IM）和弥漫恶性型（PD-DM）。我们的目标是评估弥散张量成像（DTI）在这些PD亚型的早期诊断、临床进展评估及预后预测中的效能。此外，我们试图通过单光子发射计算机断层扫描（SPECT）和脑脊液（CSF）分析来了解白质损伤背后的病理机制。
我们根据新的临床标准对135例初发PD患者进行分类，并在1年后对其进行随访，同时纳入45名健康对照者（HCs）。我们利用基于纤维束的空间统计学方法评估基线时白质的微观结构变化，并采用多元线性回归分析来研究DTI指标与基线及随访后临床数据之间的关联。
与HCs相比，PD-DM亚型患者在基线时表现出分数各向异性（FA）降低、轴向扩散率（AD）增加和径向扩散率（RD）升高。FA和RD值与运动症状严重程度相关，RD还与认知表现有关。发现FA随时间的变化与运动评分和整体综合结局指标的变化同步。此外，基线AD值及其变化率与语义言语流畅性的改变有关。我们还发现了FA值与α-突触核蛋白和β-淀粉样蛋白水平之间的关系。左侧壳核多巴胺转运体摄取减少与基线时浅表白质的RD值、运动症状和自主神经功能障碍以及1年后的认知障碍相关。
与其他亚型相比，PD-DM亚型具有严重的临床症状和更快的进展速度。DTI作为一种成熟的技术，有助于早期识别白质损伤，阐明疾病进展的病理生理机制，并预测与认知相关的结局。SPECT和CSF分析结果可用于解释PD-DM亚型患者白质损伤的特定模式。
