Minor hallucinations reflect early gray matter loss and predict subjective cognitive decline in Parkinson's disease
Minor hallucinations reflect early gray matter loss and predict subjective cognitive decline in Parkinson's disease
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DOI：
10.1111/ene.14576
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发表时间：
2020-11-05
影响因子：
5.1
通讯作者：
Kulisevsky, J.
中科院分区：
文献类型：
--
作者：
Bejr-kasem, H.;Sampedro, F.;Kulisevsky, J.
背景和目的：帕金森氏病(PD)患者结构良好的幻觉与预后不良和痴呆有关。然而，轻微精神病现象对认知恶化的预测价值并不为人所知。横断面研究表明，有轻微幻觉的帕金森病患者的皮质萎缩比没有幻觉者更严重，但缺乏解决这些大脑差异的演变的基线和纵向研究。探讨轻度幻觉对早期帕金森病认知障碍和皮质萎缩进展的影响。方法：纳入131例帕金森进展标志物计划的初诊帕金森病患者，并进行脑部磁共振成像扫描。在随访期间比较有和没有轻微幻觉的患者5年后的认知结果。此外，使用基于灰质体积(GMV)体素的形态计量学方法，研究了不同组间横断面(基线时)和纵向(GMV消失1年和2年)脑结构的差异。结果：在随访期间，351%的患者出现轻微幻觉。5年后，与非幻觉者相比，这些患者表现出主观性认知下降的患病率增加(44.1%比13.9%；p<；0.001)，但没有正式的认知损害。此外，与非幻觉者相比，他们在视觉感受区基线时GMV降低，在左侧颞区GMV丢失增加(p<；0.05校正)。结论：轻微幻觉似乎是神经变性增加的早期临床标志，并与中期主观认知能力下降有关。需要更长的跟踪分析来进一步确定这些发现是否反映了未来认知恶化的更高风险。
Background and purpose: Well-structured hallucinations in Parkinson's disease (PD) are associated with poor prognosis and dementia. However, the predictive value of minor psychotic phenomena in cognitive deterioration is not well known. Cross-sectional studies have shown that PD patients with minor hallucinations have more severe cortical atrophy than non-hallucinators, but baseline and longitudinal studies addressing the evolution of these brain differences are lacking. The impact of developing minor hallucinations on cognitive impairment and cortical atrophy progression in early PD was explored.Methods: One hundred and thirty-one de novo PD patients from the Parkinson's Progression Marker Initiative for whom brain magnetic resonance imaging scans were available were included. Cognitive outcome at 5 years was compared between patients with and without minor hallucinations during follow-up. Additionally, using gray matter volume (GMV) voxel-based morphometry, cross-sectional (at baseline) and longitudinal (1- and 2-year GMV loss) structural brain differences between groups were studied.Results: During follow-up, 35.1% of patients developed minor hallucinations. At 5 years, these patients showed an increased prevalence of subjective cognitive decline compared to non-hallucinators (44.1% vs. 13.9%; p < 0.001), but not formal cognitive impairment. Additionally, compared to non-hallucinators, they exhibited reduced GMV at baseline in visuoperceptive areas and increased GMV loss in left temporal areas (p < 0.05 corrected).Conclusions: Minor hallucinations seem to be an early clinical marker of increased neurodegeneration and are associated with mid-term subjective cognitive decline. Longer follow-up analyses would be needed to further define if these findings could reflect a higher risk of future cognitive deterioration.