Lin Yu-Fan, Fuh Jong-Ling, Yang Albert C
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Neuroimage Rep. 2025 Mar 1;5(1):100246. doi: 10.1016/j.ynirp.2025.100246. eCollection 2025 Mar.
Parkinson's disease (PD) is a clinical neurodegenerative disorder. The Unified Parkinson's Disease Rating Scale (UPDRS) has been used as a standard measure of the PD symptom profile, and magnetic resonance (MR) imaging is widely used for identifying the critical brain regions involved in PD progression.
The present study aimed to (1) identify PD subtypes based on the motor dysfunction profile in the MDS-UPDRS and (2) find the differences in gray matter volumes of brain regions, and (3) compare non-motor features between the subtypes to explore their distinct clinical profiles.
In total, 299 patients with PD and 173 healthy participants from the Parkinson's Progression Markers Initiative were included. A software package, Generalized Association Plots, was used to cluster the motor dysfunction profile in the MDS-UPDRS. Regression models and the Artificial Intelligence Platform as a Service were used to quantify the differences in gray matter volume of brain regions between subtypes.
We identified three PD subtypes-resting tremor, intermediate, and akinetic-rigid-using motor symptom clustering. MRI analysis revealed significant differences in brain regions, including the posterior cingulate gyrus, lenticular nucleus, olfactory cortex, and cerebellum. Non-motor features, such as cognitive decline and autonomic dysfunctions, varied across subtypes, highlighting distinct systemic profiles. Akinetic-rigid patients exhibited the most severe impairments, while tremor-dominant patients showed milder non-motor symptoms.
Three PD subtypes of motor dysfunction were identified. Structural brain imaging revealed subtype-specific differences not only in cingulum and putamen regions, but also in the olfactory cortex, parahippocampal gyrus, and cerebellum, correlating with motor symptoms. Non-motor features varied by subtype, with increasing severity from tremor-dominant to akinetic-rigid.
帕金森病（PD）是一种临床神经退行性疾病。统一帕金森病评定量表（UPDRS）一直被用作衡量PD症状特征的标准指标，而磁共振（MR）成像广泛用于识别参与PD进展的关键脑区。
本研究旨在（1）基于MDS-UPDRS中的运动功能障碍特征识别PD亚型，（2）找出脑区灰质体积的差异，以及（3）比较各亚型之间的非运动特征，以探索它们不同的临床特征。
总共纳入了帕金森病进展标志物倡议项目中的299例PD患者和173名健康参与者。使用一个名为广义关联图的软件包对MDS-UPDRS中的运动功能障碍特征进行聚类。使用回归模型和人工智能平台即服务来量化各亚型之间脑区灰质体积的差异。
我们通过运动症状聚类识别出三种PD亚型——静止性震颤型、中间型和运动不能-强直型。MRI分析显示脑区存在显著差异，包括后扣带回、豆状核、嗅觉皮层和小脑。认知衰退和自主神经功能障碍等非运动特征在各亚型中有所不同，突出了不同的系统特征。运动不能-强直型患者表现出最严重的损伤，而震颤为主型患者的非运动症状较轻。
识别出了三种运动功能障碍的PD亚型。脑结构成像显示，不仅在扣带和壳核区域，而且在嗅觉皮层、海马旁回和小脑中存在亚型特异性差异，这些差异与运动症状相关。非运动特征因亚型而异，从震颤为主型到运动不能-强直型严重程度逐渐增加。
