Cerebral glucose metabolic features of Parkinson disease and incident dementia: longitudinal study.
Cerebral glucose metabolic features of Parkinson disease and incident dementia: longitudinal study.
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DOI：
10.2967/jnumed.111.089946
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发表时间：
2011-06
期刊：
影响因子：
--
通讯作者：
Kuhl DE
中科院分区：
文献类型：
--
作者：
Bohnen NI;Koeppe RA;Minoshima S;Giordani B;Albin RL;Frey KA;Kuhl DE
在非痴呆帕金森病（PD）受试者的纵向研究提供了一个机会，研究最早的区域大脑皮层下和皮层代谢变化的基础事件痴呆在这种疾病。23例无痴呆的PD受试者（Hoehn和Yahr分期I-III，年龄61.8 ± 9.7岁;简易精神状态检查28.0 ± 1.4岁）和27例健康对照（HC）受试者（年龄59.8 ±11.5岁）在研究入组时接受了[18 F]-2-氟-2-脱氧-D-葡萄糖（FDG）PET成像。PD受试者每年接受一次临床评估，以确定是否转化为痴呆。平均随访时间为3.9 ±1.2年（2.0 - 6.8年）。随访18F-FDG-PET在2年或2年以上的受试者亚组中可用。进行了感兴趣体积和三维立体定向表面投影（3D-SSP）分析。6例受试者变为痴呆（PD[+]D），发展为痴呆的平均时间为3.8 ± 1.7年（范围：1.9 - 6.0年）。痴呆发作前的平均病程为9.7 ± 4.2（范围3.1 - 14）年。与HC相比，PD[+]D受试者在基线时、痴呆诊断前的枕叶（−11.8% vs. HC，F（2，22）= 7.0，P=0.002）和后扣带回（−12.1% vs. HC，F=5.2，P=0.009）皮质代谢显著降低。视觉联合皮层的代谢减少最多（布罗德曼面积[BA] 18; −20.0% vs. HC，F（2，22）=8.45，P=0.0007）。尾状核中存在轻度低代谢（−8.4% vs. HC，F（2，22）=3.2，P<0.05）。颞叶或额叶无明显代谢减退。与HCs相比，没有痴呆的PD受试者（PD[−]D）的初级枕叶皮质（BA 17）的大脑代谢降低，这仅通过3D-SSP分析显示。5名PD[+]D受试者在研究入组后2年的随访扫描显示，与研究入组扫描相比，受试者内的变化具有显著的间隔：丘脑（−11.4%）、后扣带回（−9%）、枕叶（− 7%）、顶叶（−7%）和额叶皮质（− 7%），以及颞叶皮质（−5%）和海马（−3%）的轻度减少。特发性PD中的痴呆事件是由视觉联合（BA 18）和后扣带回皮质的代谢降低预示的，尾状核也有轻度受累。来自5名PD[+]D转换者的两年随访数据显示，进展为痴呆与皮质下和皮质的混合变化相关，这些变化也涉及近中额叶。这些发现提供了对帕金森氏痴呆症早期代谢特征的见解。
Longitudinal studies in non-demented Parkinson disease (PD) subjects offer an opportunity to study the earliest regional cerebral subcortical and cortical metabolic changes underlying incident dementia in this disorder. Twenty-three PD subjects without dementia (Hoehn and Yahr stages I - III, age 61.8 ± 9.7 yr; Mini Mental State Examination 28.0 ± 1.4) and twenty-seven healthy control (HC) subjects (age 59.8 ±11.5 yr) underwent [18F]-2-fluoro-2-deoxy-D-glucose (FDG) PET imaging at study entry. PD subjects underwent yearly clinical assessment to determine conversion to dementia. The mean duration of follow-up was 3.9 ±1.2 yr (2.0 - 6.8 yr). Follow-up 18F-FDG-PET was available in a subset of subjects at 2 or more years. Both volume-of-interest and three-dimensional stereotactic surface projections (3D-SSP) analyses were performed. Six subjects became demented (PD[+]D) with a mean time to development to dementia of 3.8 ± 1.7 yr (range: 1.9 - 6.0 yr). Mean duration of disease prior to onset of dementia was 9.7 ± 4.2 (range 3.1 - 14) yr. There were significant metabolic reductions in the occipital (−11.8% vs. HCs, F(2,22)= 7.0, P=0.002) and posterior cingulate (−12.1% vs. HCs, F=5.2, P=0.009) cortices in PD[+]D subjects at baseline, before diagnosis of dementia, compared with HCs. Metabolism was most diminished in the visual association cortex (Brodmann Area [BA] 18; −20.0% vs. HCs, F(2,22)=8.45, P=0.0007). There was mild hypometabolism in the caudate nucleus (−8.4% vs. HCs, F(2,22)=3.2, P<0.05). There was no significant hypometabolism in the temporal or frontal lobes. PD subjects who did not become demented (PD[−]D), compared with HCs, had reduced cerebral metabolism in the primary occipital cortex (BA 17) that was revealed only by 3D-SSP analysis. Follow-up scans in 5 PD[+]D subjects at 2-years after study entry demonstrated significant interval within-subject change: thalamus (−11.4%), posterior cingulate (−9%), occipital (−7%), parietal (−7%), and frontal cortices (−7%), and mild reductions in temporal cortex (−5%) and hippocampus (−3%) compared to study entry scans. Incident dementia in idiopathic PD is heralded by decreased metabolism in the visual association (BA 18) and posterior cingulate cortices, with mild involvement also of the caudate nucleus. Two-year follow-up data from 5 PD[+]D converters show that progression to dementia is associated with mixed subcortical and cortical changes that involve the mesiofrontal lobes also. These findings provide insights into early metabolic features of parkinsonian dementia.
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影响因子：
9.9
作者：
Hilker, R;Thomas, AV;Heiss, WD
通讯作者：
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DOI：
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