Deconstructing psychosis and misperception symptoms in Parkinson's disease
Deconstructing psychosis and misperception symptoms in Parkinson's disease
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DOI：
10.1136/jnnp-2017-315741
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发表时间：
2017-09-01
影响因子：
11
通讯作者：
Mori, Etsuro
中科院分区：
文献类型：
--
作者：
Nishio, Yoshiyuki;Yokoi, Kayoko;Mori, Etsuro
目的路易体病患者表现出多种精神病性和错觉症状，包括视幻觉和妄想，以及“轻微幻觉”，即存在感、通道幻觉和视错觉。虽然这些症状被认为具有共同的潜在机制，但它们之间的共性和差异尚未在神经水平上进行系统的研究。方法对67例帕金森病患者进行神经心理和行为评估、体积MRI和18f -氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）。进行因子分析以发现精神病和误解症状、其他行为症状和神经心理表现之间的相关性。采用偏最小二乘相关分析探讨这些症状与MRI和FDG-PET关节特征的关系。结果存在感、通道幻觉和视错觉构成单一行为因素（轻微幻觉/幻觉）。视觉幻觉与妄想、抑郁和认知波动（精神病/烦躁不安）一起形成了另一个行为因素。发现了三种不同的脑行为相关模式：(1)与轻微幻觉/幻觉和视觉空间障碍相关的后皮层萎缩/低代谢；(2)与精神病/烦躁不安相关的上脑干和丘脑萎缩/低代谢；(3)与非视觉认知相关的额皮质萎缩/低代谢。在仅有轻微幻觉的患者和同时有视幻觉的患者之间，神经影像学结果没有显著差异。结论：上脑干/丘脑和后新皮层的联合损伤是轻微幻觉/幻觉和视觉幻觉的基础，前者病理与视觉幻觉/坦率精神病更相关，后者病理与轻微幻觉/幻觉更相关。
Objective Patients with Lewy body disease develop a variety of psychotic and misperception symptoms, including visual hallucinations and delusions, as well as 'minor hallucinations', that is, a sense of presence, passage hallucinations and visual illusions. Although these symptoms have been suggested to have common underlying mechanisms, the commonalities and differences among them have not been systematically investigated at the neural level.Methods Sixty-seven patients with Parkinson's disease underwent neuropsychological and behavioural assessments, volumetric MRI and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). A factor analysis was performed to discover correlations among psychotic and misperception symptoms, other behavioural symptoms and neuropsychological performances. Partial least-squares correlation analysis was used to investigate the relationship between these symptoms and the joint features of MRI and FDG-PET.Results A sense of presence, passage hallucinations and visual illusions constituted a single behavioural factor (minor hallucinations/illusions). Visual hallucinations formed another behavioural factor along with delusions, depression and fluctuating cognition (psychosis/dysphoria). Three distinct brain-behaviour correlation patterns were identified: (1) posterior cortical atrophy/hypometabolism associated with minor hallucinations/illusions and visuospatial impairment; (2) upper brainstem and thalamic atrophy/hypometabolism associated with psychosis/dysphoria and (3) frontal cortical atrophy/hypometabolism associated with non-visual cognition. No significant differences in neuroimaging findings were identified between patients who had minor hallucinations/illusions alone and patients who also had visual hallucinations.Conclusions Our findings suggest that combined damage to the upper brainstem/thalamus and the posterior neocortex underlies both minor hallucinations/illusions and visual hallucinations and that the former pathology is more associated with visual hallucinations/frank psychosis and the latter is more associated with minor hallucinations/illusions.