Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies.
Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies.
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DOI：
10.1111/ene.13002
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发表时间：
2016-06
影响因子：
5.1
通讯作者：
Tan EK
中科院分区：
文献类型：
--
作者：
Wen MC;Chan LL;Tan LC;Tan EK
抑郁、焦虑和冷漠是帕金森病（PD）常见的情绪障碍，但其病理生理机制尚不清楚。先进的神经影像学已越来越多地用于解开与这些干扰相关的神经基质。本文对帕金森病中抑郁、焦虑和冷漠的神经影像学表现进行了系统回顾。PubMed、MEDLINE和EMBASE检索了关于PD中这些情绪障碍的同行评审原始研究文章，确定了38项关于抑郁的研究，8项关于焦虑的研究和14项关于PD中冷漠的研究。大多数成像研究使用正电子发射断层扫描或单光子发射计算机断层扫描技术。这些研究通常表明，抑郁症患者的前额叶区域的神经活动增加，前额叶-边缘系统网络之间的功能连接减少。功能成像研究显示，帕金森病患者的尾状核和壳核多巴胺能密度与焦虑的严重程度呈负相关。丘脑多巴胺能神经元密度与焦虑无一致性相关。研究表明，冷漠与纹状体、杏仁核、前额、颞叶和顶叶区域的代谢或活动之间存在正相关和负相关。研究受试者的临床变异性以及图像预处理和分析策略的差异可能导致这些研究中的不一致结果。黑质纹状体和黑质纹状体外通路（特别是额叶及其连接区）在PD的情绪障碍中受到影响。确定这些神经通路在运动和情绪症状重叠的PD患者中的相对贡献，可以为受影响患者开发更好的治疗靶点提供新的病理生理学线索。
Depression, anxiety and apathy are common mood disturbances in Parkinson's disease (PD) but their pathophysiology is unclear. Advanced neuroimaging has been increasingly used to unravel neural substrates linked to these disturbances. A systematic review is provided of neuroimaging findings in depression, anxiety and apathy in PD. A PubMed, MEDLINE and EMBASE search of peer‐reviewed original research articles on these mood disturbances in PD identified 38 studies on depression, eight on anxiety and 14 on apathy in PD. Most of the imaging studies used either position emission tomography or single‐photon emission computed tomography techniques. These studies generally suggest increased neural activity in the prefrontal regions and decreased functional connectivity between the prefrontal−limbic networks in depressed patients. Functional imaging studies revealed an inverse correlation between dopaminergic density in the caudate and putamen with the severity of anxiety in PD. There was no consistent correlation between dopaminergic density of thalamus and anxiety. Studies demonstrated both positive and inverse correlations between apathy and metabolism or activity in the striatum, amygdalar, prefrontal, temporal and parietal regions. The clinical variability of study subjects and differences in image pre‐processing and analytical strategies may contribute to discrepant findings in these studies. Both nigrostriatal and extra‐nigrostriatal pathways (in particular the frontal region and its connecting areas) are affected in mood disorders in PD. Identifying the relative contributions of these neural pathways in PD patients with overlapping motor and mood symptoms could provide new pathophysiological clues for the development of better therapeutic targets for affected patients.
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