摘要：

目的 探讨帕金森叠加综合征患者的神经精神症状和¹⁸F-脱氧葡萄糖（¹⁸F-FDG）PET 影像学特征。 方法 共8 例很可能的帕金森叠加综合征患者，包括以小脑共济失调为主要表现的多系统萎缩（MSA-C 型）1 例、进行性核上性麻痹4 例、皮质基底节变性1 例、路易体痴呆2 例，采用简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）评价认知功能，神经精神科问卷评价神经精神行为，汉密尔顿抑郁量表21 项评价情绪状态。 结果 1 例MSA-C 型患者仅表现为焦虑。4 例进行性核上性麻痹患者均存在不同程度认知功能障碍，其中3例还表现出明显抑郁、焦虑、易激惹和睡眠障碍。1 例皮质基底节变性患者表现为执行功能和视空间能力、言语功能、注意力和定向力障碍，以及抑郁、焦虑、易激惹和睡眠障碍。2 例路易体痴呆患者均不能复制MMSE 量表之五边形，MoCA 量表之画钟测验仅能勾画圆形轮廓，同时表现为幻觉、抑郁和淡漠。¹⁸F-FDG PET 显像，1 例MSA-C 型患者为小脑葡萄糖代谢降低；4 例进行性核上性麻痹患者均为双侧对称性额叶、前扣带回、顶叶代谢降低，尤以丘脑、基底节区和脑干显著；1 例皮质基底节变性患者为右侧额颞顶枕叶外侧、左侧顶叶外侧、双侧扣带回和楔前叶代谢降低；2 例路易体痴呆患者均为双侧颞枕叶代谢降低。 结论 帕金森叠加综合征早期易误诊为心理疾病而延误治疗，还可因使用镇静催眠药而加重运动障碍和锥体外系症状。神经心理学改变与认知功能障碍有关。PET 显像对疾病的早期诊断有重要临床价值。

关键词: 帕金森障碍, 神经症性障碍, 正电子发射断层显像术

Abstract:

Objective To explore the neuropsychiatric symptoms and ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET imaging features of Parkinson-plus syndromes. Methods There were 8 patients with probable Parkinson-plus syndromes, including one case of multiple system atrophy-cerebellar predominant (MSA-C), 4 cases of progressive supranuclear palsy (PSP), one case of corticobasal ganglionic degeneration (CBD) and 2 cases of dementia with Lewy bodies (DLB). Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function, Neuropsychiatric Inventory (NPI) was used to evaluate neuropsychiatric behaviors, and Hamilton Depression Rating Scale-21 Items (HAMD-21) was used to evaluate the emotional state of patients. Results One MSA-C patient showed only anxiety. Four PSP patients showed different degrees of cognitive disorders, of whom 3 cases also presented obvious depression, anxiety, irritability and sleep disorders. One case of CBD showed dysfunction in executive function, visual spatial ability, verbal function, attention and orientation, as well as depression, anxiety, irritability and sleep disorders. Two cases of DLB were found unable to copy pentagon in MMSE chart or draw a circle in Clock Drawing Test (CDT), and they also presented hallucination, depression and indifference. As for the result of ¹⁸F-FDG PET, one MSA-C patient showed cerebellarglucose hypometabolism; 4 PSP patients showed hypometabolism in bilateral symmetrical frontal lobes, anterior cingulate gyrus and parietal lobe, especially in thalamus, basal ganglia region and brain stem; one case of CBD showed hypometabolism in right lateral fronto-temporo-parieto-occipital lobes, left lateral parietal lobe, bilateral cingulate gyri and precuneus; 2 cases of DLB showed hypometabolism in bilateral temporo-occipital lobes. Conclusions Patients with early Parkinson-plus syndromes are easily misdiagnosed as mental illness and delayed treatment, in addition, their movement disorders and extrapyramidal symptoms would be aggravated due to misusage of sedative hypnotic drugs. Neuropsychological changes are found closely related to cognitive dysfunction. PET imaging has important clinical values to early diagnosis of Parkinson-plus syndromes.

Key words: Parkinsonian disorders, Neurotic disorders, Positron-emission tomography