Hypometabolism in the supplementary and anterior cingulate cortices is related to dysphagia in Parkinson's disease: a cross-sectional and 3-year longitudinal cohort study.
Hypometabolism in the supplementary and anterior cingulate cortices is related to dysphagia in Parkinson's disease: a cross-sectional and 3-year longitudinal cohort study.
复制标题
DOI：
10.1136/bmjopen-2012-002249
复制
发表时间：
2013-03-01
期刊：
影响因子：
2.9
通讯作者：
Takeda A
中科院分区：
文献类型：
--
作者：
Kikuchi A;Baba T;Hasegawa T;Kobayashi M;Sugeno N;Konno M;Miura E;Hosokai Y;Ishioka T;Nishio Y;Hirayama K;Suzuki K;Aoki M;Takahashi S;Fukuda H;Itoyama Y;Mori E;Takeda A
吞咽困难是帕金森病（PD）的主要症状之一。它与PD患者的生活质量和寿命密切相关。本研究的目的是阐明PD患者吞咽困难的病理生理机制。横断面和纵向比较研究。东北大学医院。有吞咽困难8例，无吞咽困难15例，正常对照10例。在基线和3年随访期后开始吞咽所需的时间和脑葡萄糖代谢的变化。在基线和3年随访期后，吞咽困难患者吞咽起始所需时间明显长于无吞咽困难患者（p<0.05）。与10名正常对照者相比，吞咽困难患者的辅助运动区（SMA）和前扣带皮层（ACC）在基线时表现出代谢低下（未校正p<0.001）。经过3年的随访，显示低代谢的脑区数量增加，不仅包括SMA和ACC，还包括双侧内侧额叶、中扣带皮层、丘脑和右侧上、中、下、眶额回（未校正p<0.001）。相比之下，没有吞咽困难的患者在基线时几乎没有出现区域低代谢（未校正p<0.001），在3年的随访期后，SMA和ACC只有小程度的低代谢（未校正p<0.001）。这些结果表明，PD患者的吞咽困难主要与吞咽启动困难有关，吞咽启动困难是基于由SMA功能障碍引起的运动计划不良和ACC功能障碍引起的认知加工受损的组合。
Dysphagia is one of the cardinal symptoms of Parkinson’s disease (PD). It is closely related to the quality of life and longevity of PD patients. The aim of the study is to clarify the pathophysiological mechanisms responsible for dysphagia in PD. A cross-sectional and longitudinal comparative study. Tohoku University Hospital. Eight patients with dysphagia, 15 patients without dysphagia and 10 normal control subjects. The time needed for swallowing initiation and changes in brain glucose metabolism at baseline and after a 3-year follow-up period. The time needed for swallowing initiation was significantly longer in the patients with dysphagia compared with the patients without dysphagia at baseline and after the 3-year follow-up period (p<0.05). The patients with dysphagia exhibited hypometabolism in the supplementary motor area (SMA) and the anterior cingulate cortex (ACC) compared with the 10 normal control subjects at baseline (uncorrected p<0.001). After the 3-year follow-up period, the number of brain areas showing hypometabolism increased, involving not only the SMA and the ACC but also the bilateral medial frontal lobes, middle cingulate cortex, thalamus and right superior, middle, inferior and orbital frontal gyri (uncorrected p<0.001). In contrast, the patients without dysphagia showed virtually no regional hypometabolism at baseline (uncorrected p<0.001) and only a small degree of hypometabolism in the SMA and ACC after the 3-year follow-up period (uncorrected p<0.001). These results suggest that dysphagia in PD patients is mainly related to a difficulty in swallowing initiation that is based on a combination of poor movement planning due to SMA dysfunction and impaired cognitive processing due to ACC dysfunction.
登录
查看更多内容
影响因子：
4.4
作者：
Kikuchi, A;Takeda, A;Itoyama, Y
通讯作者：
Itoyama, Y
影响因子：
2.5
作者：
Deiber, MP;Ibanez, V;Hallett, M
通讯作者：
Hallett, M
影响因子：
6.7
作者：
BIRD, MR;WOODWARD, MC;FONDA, D
通讯作者：
FONDA, D
影响因子：
11.2
作者：
GRAFTON, ST;WATERS, C;COULDWELL, W
通讯作者：
COULDWELL, W
影响因子：
29.4
作者：
Kern, MK;Birn, RM;Shaker, R
通讯作者：
Shaker, R