Movement disorders:血管周间隙和帕金森病 关系密切

2022-11-25 Freeman MedSci原创 发表于广东省

小的BG-PVS与日常生活中的运动和非运动方面的经验有关

血管周围空间(PVS)是大脑血管周围充满液体的空间,是大脑液体和淋巴废物清除系统的重要通道。在神经退行性疾病患者和研究淀粉样蛋白清除的小鼠模型中,有临床和前临床证据表明,磁共振成像(MRI)上可见的PVS是脑小血管疾病和糖液清除功能障碍的标志。

图1: 论文封面图

除了MRI可见的PVS外,其他成熟的基于神经影像学的脑小血管疾病的标志物包括脑室周围和深部白质增生(WMHs)。

在帕金森病(PD)中,基底神经节区域的PVS负担(BG-PVS)已被认为是运动障碍和认知衰退进展的潜在指标。然而,有关认知方面的研究结果不一,有些研究报告说与PVS视觉负担得分没有明显的相关性。不幸的是,这些研究中有许多是用定性的视觉评分量表来评估BG-PVS的,而这种量表更容易受到评分者偏差以及上限和下限效应的影响。

有趣的是,两项基于人群的大型研究表明,大的(直径>3毫米)与小的(直径≤3毫米)PVS之间存在着病理生理上的差异,尽管在PD中没有具体证明。北曼哈顿研究的结果表明,小PVS的高负担与未来血管事件的风险增加有关,而AGES-Reykjavik研究显示,大PVS与信息处理速度下降和痴呆风险增加有关。

藉此,多伦多大学的Joel Ramirez等人, 在一个多中心的PD患者队列中,探究大型和小型BG-PVS的定量测量、全局认知和运动/非运动特征之间的关联。

他们考察了安大略省神经退行性疾病研究计划中登记的133名帕金森病患者的大、小BG-PVS与运动障碍协会统一帕金森病评定量表(MDS-UPDRS)I-IV部分和认知(蒙特利尔认知评估)之间的关联。

 


图2:论文结果图


他们发现:小BG-PVS的PD患者与MDS-UPDRS第一部分(P = 0.008)和第二部分(均P = 0.02)有关联,而大BG-PVS的患者与MDS-UPDRS第三部分(P < 0.0001)和第四部分(P < 0.001)有关联。

BG-PVS与认知能力不相关。

该研究的重要意义在于发现了:小的BG-PVS与日常生活中的运动和非运动方面的经验有关,而大的BG-PVS则与运动症状和运动并发症有关。


原文出处:
Ramirez J, Berberian SA, Breen DP, et al. Small and Large Magnetic Resonance Imaging–Visible Perivascular Spaces in the Basal Ganglia of Parkinson’s Disease Patients. _Movement Disorders_. Published online April 11, 2022:mds.29010. doi:[10.1002/mds.29010](https://doi.org/10.1002/mds.29010)

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    2022-10-31 anminleiryan
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帕金森病:想睡个好觉太难!

帕金森病(PD)患者昼夜节律的改变不仅会影响睡眠-觉醒周期调节,同样会对非运动症状造成影响。

论文解读|Huifang Shang教授团队最新研究揭示与帕金森病相关的PLXNA1基因的罕见变异

研究揭示了与神经系统疾病和帕金森综合症有关的PLXNA1基因罕见变异。

2024 NICE 诊断指南:帕金森病远程监测设备 [DG51]

英国国家卫生与临床优化研究所(NICE,National Institute for Health and Clinical Excellence) · 2024-01-25

2023 NICE 技术鉴定指南:左旋多巴/卡比多巴组合治疗伴有运动症状的晚期帕金森病[TA934]

英国国家卫生与临床优化研究所(NICE,National Institute for Health and Clinical Excellence) · 2023-11-29

帕金森病患者睡眠障碍评估与护理干预的最佳证据总结

浙江中医药大学护理学院 · 2023-08-10

早中期帕金森病患者运动管理的最佳证据总结

山东第一医科大学附属省立医院老年神经内科 · 2023-05-10