帕金森病合并工作记忆障碍患者低频振幅和功能连接静息态磁共振成像研究

doi:10.3969/j.issn.1672-6731.2020.12.003

摘要/Abstract

摘要：

目的探讨帕金森病合并工作记忆障碍患者静息态低频振幅（ALFF）和功能连接（FC）特点，以及其与认知功能的相关性，以揭示工作记忆障碍相关脑区异常神经元活动和可能的神经影像学机制。方法纳入2019年1月至2020年9月确诊的原发性帕金森病患者39例，采用简易智能状态检查量表（MMSE）、数字广度测验[DST，包括数字顺背测验（DSFT）和数字倒背测验（DSBT）]、画钟测验（CDT）和动物词语流畅性测验（VFT）评价认知功能，并行静息态fMRI检查，计算ALFF值以及差异脑区与全脑的FC值，Spearman秩相关分析差异脑区ALFF值与认知功能的相关性。结果根据DSFT评分分为帕金森病合并工作记忆障碍组（PD-WI组，17例）或帕金森病未合并工作记忆障碍组（PD-normal组，22例），PD-WI组患者MMSE总评分（Z=-2.149，P=0.032）和记忆力（Z=-2.465，P=0.014）、注意力和计算力（Z=-2.239，P=0.025）、语言功能（Z=-2.575，P=0.010）分评分，以及DST（Z=-5.357，P=0.000）、DSBT（Z=-3.967，P=0.000）和CDT（Z=-3.410，P=0.001）评分均低于PD-normal组；ALFF值升高脑区主要位于右侧扣带后回、右侧丘脑和右侧楔前叶（GRF校正；voxel P<0.05，cluster P<0.05），以右侧扣带后回为兴趣区，与其FC值升高的脑区主要位于左侧眶部额中回和右侧舌回（GRF校正；voxel P<0.05，cluster P<0.05）。Spearman秩相关分析显示，右侧扣带后回ALFF值与DSFT评分呈负相关（r_s=-0.530，P=0.001）。结论帕金森病合并工作记忆障碍患者存在不同程度的认知功能障碍，脑默认网络核心脑区右侧扣带后回的自发性神经元活动增强及其与左侧眶部额中回和右侧舌回的功能连接增强，是对早期工作记忆障碍的代偿。

关键词: 帕金森病, 认知障碍, 扣带回, 磁共振成像

Abstract:

Objective To explore the characteristics of resting-state amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) in patients with Parkinson's disease (PD) and working memory impairment, and to explore its correlation with cognitive function in order to reveal the abnormal neuronal activity and possibility of brain regions related to working memory impairment neuroimaging mechanism. Methods Thirty-nine patients with primary PD from January 2019 to September 2020 were enrolled, using Mini-Mental State Examination (MMSE), Digital Span Test[DST, including Digit Span Forward Test (DSFT) and Digit Span Backward Test (DSBT)], Clock Drawing Test (CDT) and Animal Verbal Fluency Test (VFT) to evaluate the cognitive function, resting-state fMRI (rs-fMRI) examination, calculation of ALFF value and FC value between different brain regions and the whole brain. The corrdation between ALFF value and the cognitive function was analysed by Spearman rank correlation. Results According to the DSFT score, 39 patients were divided into PD with working memory impairment group (PD-WI group, n=17) and PD without working memory impairment group (PD-normal group, n=22). MMSE total score (Z=-2.149, P=0.032) and memory (Z=-2.465, P=0.014), attention and calculation (Z=-2.239, P=0.025), language function (Z=-2.575, P=0.010) scores, and DST (Z=-5.357, P=0.000) scores, DSBT (Z=-3.967, P=0.000) and CDT (Z=-3.410, P=0.001) scores in PD-WI group were lower than those in PD-normal group. The increased ALFF value was mainly located in the right posterior cingulate gyrus, right thalamus and right precuneus (GRF correction; voxel P<0.05, cluster P<0.05). The right posterior cingulate gyrus was the region of interest (ROI). The brain regions with increased FC value were mainly located in the left orbital middle frontal gyrus and the right lingual gyrus (GRF correction; voxel P<0.05, cluster P<0.05). Spearman rank correlation analysis showed that the ALFF value at the right cingulate was negatively correlated with the DSFT score (r_s=-0.530, P=0.001). Conclusions PD with working memory impairment patients have different degrees of cognitive dysfunction. The spontaneous neuronal activity in the right posterior cingulate gyrus of the core brain region of the brain default network is enhanced and its correlation with the left orbital middle frontal gyrus and the right lingual gyrus, which is a compensation for early working memory impairment.

Key words: Parkinson disease, Cognition disorders, Gyrus cinguli, Magnetic resonance imaging

张伟文, 陈鹏, 蒋曼丽, 熊赤, 汪莹, 牛朝诗. 帕金森病合并工作记忆障碍患者低频振幅和功能连接静息态磁共振成像研究[J]. 中国现代神经疾病杂志, 2020, 20(12): 1037-1044.

ZHANG Wei-wen, CHEN Peng, JIANG Man-li, XIONG Chi, WANG Ying, NIU Chao-shi. Alternation of amplitude of low-frequency fluctuation and functional connectivity in the patients of Parkinson's disease with working memory impairment: a resting-state fMRI study[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1037-1044.

https://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I12/1037

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Alternation of amplitude of low-frequency fluctuation and functional connectivity in the patients of Parkinson's disease with working memory impairment: a resting-state fMRI study

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