Hypoperfusion in the supplementary motor area, dorsolateral prefrontal cortex and insular cortex in Parkinson's disease
Hypoperfusion in the supplementary motor area, dorsolateral prefrontal cortex and insular cortex in Parkinson's disease
复制标题
DOI：
10.1016/s0022-510x(01)00641-4
复制
发表时间：
2001-12-15
影响因子：
4.4
通讯作者：
Itoyama, Y
中科院分区：
文献类型：
--
作者：
Kikuchi, A;Takeda, A;Itoyama, Y
研究了帕金森病（PD）患者局部脑血流量（rCBF）的变化。由于脑容量和脑萎缩程度的个体差异，先前的功能成像研究涉及潜在的方法学困难。本研究采用统计参数映射技术，将18例PD患者的（99m）锝标记的六甲基丙烯胺肟脑单光子发射计算机断层图像转换为标准的基于大脑的立体定向坐标空间，然后与年龄和脑萎缩程度相匹配的I I对照受试者的图像进行比较。在总结的PD图像中，与对照组相比，在辅助运动区（SMA）和背外侧前额皮质（DLPFC）观察到rCBF的减少（p < 0.005）。在Hoehn-Yahr III/IV期的亚组（11例）中，rCBF的减少不仅出现在SMA中，还出现在DLPFC和岛叶皮层中（p < 0.001）。DLPFC或岛叶皮质rCBF减少程度与帕金森病统一评定量表评分有相关性（p < 0.05），而SMA rCBF减少程度与疾病严重程度无相关性。SMA的功能与黑质纹状体通路密切相关，其损伤可以解释PD的基本动力学症状，这些症状对左旋多巴治疗有反应。另一方面，DLPFC和岛叶皮质可能在晚期损伤的特定症状中发挥关键作用，如工作记忆受损、姿势不稳定和自主神经功能障碍。我们推测DLPFC和岛岛功能的损害与疾病的进展有关，并与多巴胺难治性症状有关，而多巴胺难治性症状是晚期PD患者护理的主要问题。(C) 2001 Elsevier Science B.V.版权所有
The changes of regional cerebral blood flow (rCBF) in Parkinson's disease (PD) were investigated. Because of individual differences in brain volume and the extent of brain atrophy, previous functional imaging studies involved potential methodological difficulties. In this study, using the statistical parametric mapping technique, (99m)Technetium-labeled hexamethylpropyleneamineoxime brain single-photon emission computed tomography images from 18 patients with PD were transformed into standard brain-based stereotaxic coordinate spaces and then compared with such images for I I control subjects matched for age and extent of brain atrophy. A rCBF decrement in the supplementary motor area (SMA) and such decrement in the dorsolateral prefrontal cortex (DLPFC) were observed in the summarized PD images as compared with controls (p < 0.005). In a subgroup in the Hoehn-Yahr III/IV stage (11 cases), the rCBF decrement was demonstrated not only in the SMA, but also in the DLPFC and insular cortex (p < 0.001). There was a correlation between the degree of the rCBF decrement in the DLPFC or the insular cortex and the score of the unified Parkinson's disease rating scale (p < 0.05), while the rCBF decrement in the SMA showed no relationship with the severity of disease. The function of the SMA is closely associated with the nigro-striatal pathway and its impairment can explain the basic akinetic symptoms in PD, which are responsive to L-DOPA treatment. On the other hand, the DLPFC and insular cortex may play key roles in specific symptoms of impairment at advanced stages, such as impaired working memory, postural instability and autonomic dysfunction. We hypothesize that the impairment of the DLPFC and insular function is correlated with the progression of the disease and is related to DOPA-refractory symptoms, which are major problems in the care of patients with advanced PD. (C) 2001 Elsevier Science B.V. All rights reserved.