Regional cerebral blood flow in Parkinson disease with nonpsychotic visual hallucinations
Regional cerebral blood flow in Parkinson disease with nonpsychotic visual hallucinations
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DOI：
10.1212/01.wnl.0000187116.13370.e0
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发表时间：
2005-12-13
期刊：
影响因子：
9.9
通讯作者：
Fukuyama, H
中科院分区：
文献类型：
--
作者：
Oishi, N;Udaka, F;Fukuyama, H
背景资料：帕金森病（PD）患者经常出现幻视（VH），但仍有自知力（非精神病性），但确切的机制尚不清楚。目的：为了阐明哪些神经基质参与PD患者的非精神病性VH，作者评价了PD和VH患者的局部脑血流量（rCBF）变化。研究方法：作者使用N-异丙基-p-[I-123]碘苯丙胺SPECT图像比较了24例患有非精神病性VH（幻觉剂）的PD患者和41例从未发生VH（非幻觉剂）的PD患者。两组患者的年龄、性别、病程、PD药物剂量、Hoehn和Yahr量表或简易精神状态检查（MMSE）评分无显著差异。采用统计参数图（SPM）分析rCBF数据。结果：幻觉症患者右侧梭状回的rCBF低于非幻觉症患者（在聚类水平校正p < 0.05）。幻觉症患者右侧颞上级回和颞中回的rCBF高于非幻觉症患者（未校正p < 0.001）。这些显著差异是在MMSE评分和疾病持续时间（与VH相关的相关因素）被协变量排除后得到证明的。结论：帕金森病（PD）的非精神病性幻视可能与右侧梭状回灌注不足和右侧上级和颞中回灌注过度有关。这些颞区是重要的视觉物体识别和这些区域的脑血流变化与不适当的视觉处理，并负责非精神病性幻视PD。
Background: Patients with Parkinson disease (PD) often experience visual hallucinations (VH) with retained insight (nonpsychotic) but the precise mechanism remains unclear. Objective: To clarify which neural substrates participate in nonpsychotic VH in PD, the authors evaluated regional cerebral blood flow (rCBF) changes in patients with PD and VH. Methods: The authors compared 24 patients with PD who had nonpsychotic VH ( hallucinators) and 41 patients with PD who had never experienced VH (non-hallucinators) using SPECT images with N-isopropyl-p-[I-123] iodoamphetamine. There were no significant differences in age, sex, duration of disease, doses of PD medications, Hoehn and Yahr scale, or Mini-Mental State Examination (MMSE) scores between the two groups. The rCBF data were analyzed using statistical parametric mapping (SPM). Results: The rCBF in the right fusiform gyrus was lower in the hallucinators than in the non-hallucinators ( corrected p < 0.05 at cluster levels). The hallucinators revealed higher rCBF in the right superior and middle temporal gyri than the non-hallucinators ( uncorrected p < 0.001). These significant differences were demonstrated after MMSE scores and duration of disease, which are the relevant factors associated with VH, were covariated out. Conclusions: Nonpsychotic visual hallucinations in Parkinson disease (PD) may be associated with hypoperfusion in the right fusiform gyrus and hyperperfusion in the right superior and middle temporal gyri. These temporal regions are important for visual object recognition and these regional cerebral blood flow changes are associated with inappropriate visual processing and are responsible for nonpsychotic visual hallucinations in PD.