Kuroha Yasuko, Takahashi Tetsuya, Arai Yuki, Yoshino Mihoko, Kasuga Kensaku, Hasegawa Arika, Matsubara Nae, Koike Ryoko, Ikeuchi Takeshi
Department of Neurology, NHO Nishiniigata Chuo Hospital.
Certified Clinical Psychologist, NHO Nishiniigata Chuo Hospital.
Rinsho Shinkeigaku. 2024 Sep 26;64(9):623-631. doi: 10.5692/clinicalneurol.cn-001968. Epub 2024 Aug 28.
This study aimed to clarify associations of clinical and neuropsychological features and change in regional cerebral blood flow (rCBF) on I-IMP-SPECT in patients with Parkinson's disease (PD) who developed dementia. Sixty-one PD patients (mean age, 65.9 ± 8.6 years; mean disease duration, 11.0 ± 11.0 years) were recruited and followed-up for two years. Clinical and neuropsychological characteristics, and rCBF from SPECT were compared between PD patients who developed dementia (PDD+) and those who remained undemented (PDD-). Thirty-eight PD patients (62.3%) were diagnosed with PD-MCI at baseline. During follow-up, 22 PD patients (36%) developed dementia (PDD+). Univariate logistic regression models showed that Hoehn and Yahr scale 4 (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.35-30.75]), visual hallucination (OR 5.95; 95%CI 1.67-25.4]), and PD-MCI (OR 6.47; 95%CI 1.57-39.63]) represented a significant risk factor for PDD+. Among neuropsychological parameters, WAIS (Wechsler Adult Intelligence Scale)-III block design (OR 6.55; 95%CI 1.66-29.84), letter number sequencing (OR 7.01; 95%CI 1.65-36.64), digit-symbol coding (OR 3.90; 95%CI 1.13-14.2), Wechsler Memory Scale, revised (WMS-R) visual paired associates II (delayed recall) (OR 4.68; 95%CI 1.36-17.36), Logical memory I (immediate recall) (OR 8.30; 95%CI 1.37-90.89), Logical memory II (delayed recall) (OR 6.61; 95%CI 1.35-44.33), Visual reproduction I (immediate recall) (OR 7.67; 95%CI 2.11-31.40), and Visual reproduction II (delayed recall) (OR 5.64; 95%CI 1.62-21.47) were significant risk factors. Decreased rCBF assessed using the general linear model (two-sample t-test) by SPM8 was observed in the left precuneus (0, -66, 16), right cuneus (6, -76, 30), and left angular gyrus (-46, -74, 32) in PDD+ compared with PDD- patients. Collectively, we have here shown that clinical and neuropsychological characteristics as well as changes to rCBF in PD patients who converted to PDD+. These features should be carefully monitored to detect the development of dementia in PD patients.
本研究旨在阐明帕金森病（PD）合并痴呆患者的临床和神经心理学特征与I-IMP-SPECT检查中脑血流区域（rCBF）变化之间的关联。招募了61例PD患者（平均年龄65.9±8.6岁；平均病程11.0±11.0年），并进行了为期两年的随访。比较了发生痴呆的PD患者（PDD+）和未发生痴呆的患者（PDD-）的临床和神经心理学特征以及SPECT检查中的rCBF。38例PD患者（62.3%）在基线时被诊断为PD-MCI。随访期间，22例PD患者（36%）发生痴呆（PDD+）。单因素逻辑回归模型显示，Hoehn和Yahr分级4级（比值比[OR]5.85；95%置信区间[CI]1.35-30.75）、视幻觉（OR 5.95；95%CI 1.67-25.4）和PD-MCI（OR 6.47；95%CI 1.57-39.63）是PDD+的显著危险因素。在神经心理学参数中，韦氏成人智力量表（WAIS）-III积木设计（OR 6.55；95%CI 1.66-29.84）、字母数字排序（OR 7.01；95%CI 1.65-36.64）、数字符号编码（OR 3.90；95%CI 1.13-14.2）、修订版韦氏记忆量表（WMS-R）视觉配对联想II（延迟回忆）（OR 4.68；95%CI 1.36-17.36）、逻辑记忆I（即时回忆）（OR 8.30；95%CI 1.37-90.89）、逻辑记忆II（延迟回忆）（OR 6.61；95%CI 1.35-44.33）、视觉再现I（即时回忆）（OR 7.67；95%CI 2.11-31.40）和视觉再现II（延迟回忆）（OR 5.64；95%CI 1.62-21.47）是显著危险因素。与PDD-患者相比，PDD+患者使用SPM8通过一般线性模型（双样本t检验）评估的rCBF在左侧楔前叶（0，-66，16）、右侧楔叶（6，-76，30）和左侧角回（-46，-74，32）降低。总体而言，我们在此表明了PD患者转变为PDD+时的临床和神经心理学特征以及rCBF的变化。应仔细监测这些特征，以检测PD患者痴呆的发生。
