Communications Biology:视力测试可提前18个月预测帕金森病相关的认知能力下降

2021-01-20 MedSci原创 MedSci原创

根据伦敦大学学院研究人员的一项新研究,简单的视力测试可以预测哪些帕金森氏症患者在18个月后会出现认知障碍和可能的痴呆症。 

此前,一项发表在Movement Disorders杂志上的研究进一步证明,视力变化的发生先于认知能力下降,而认知能力下降在许多(但不是所有)帕金森病患者身上都有发生。

与帕金森病(PD)相关的痴呆症的特征是认知和知觉的改变,包括视觉幻觉、妄想和注意力的波动。它通常先于并伴有视觉功能障碍,并与后脑区的低代谢有关。尤其是高阶视觉功能障碍,在1年的随访中与较差的认知有关。虽然帕金森病以路易体包涵体为特征,但帕金森病认知障碍的神经相关性,特别是结构和功能变化仍不清楚。在近日发表在Communications Biology杂志上的另一项新研究中,同一研究小组发现,帕金森病患者大脑各区域的结构和功能连接在整个大脑中变得分离,尤其是视力有问题的人。

这两项研究共同揭示了许多帕金森病患者所经历的认知障碍是如何由大脑线路的缺失和变化造成的。研究者发现,有视觉问题的帕金森病患者更有可能患痴呆症,这似乎可以解释为他们脑回路的潜在变化。

视力测试可能为我们提供了一个机会窗口,在帕金森痴呆症开始之前预测它,这可能帮助我们找到阻止认知能力下降的方法,以免为时过晚。研究者指出。

在第一篇研究中,研究者使用基于像素的分析来检测帕金森病患者的纵向白质变化。在基线检查时对77例患者(22例视力低下/55例视力正常,13PD轻度认知障碍/51例认知正常)和25例对照组进行弥散成像和临床评估,18个月后再次进行。

研究发现,PD伴视功能障碍的患者随访时认知表现较差,较视力正常的患者更容易发生轻度认知障碍(P = 0.008)。视觉功能差的帕金森患者基线时表现出弥漫性的微观结构和宏观结构变化,而轻度认知障碍患者基线变化较少。在随访中,低视觉功能的帕金森患者表现出广泛的宏观结构改变,包括双侧额枕束、外囊和中小脑梗即使将两组合并,在基线或转换时轻度认知障碍的患者中也未见纵向变化。

帕金森病患者的白质宏观结构随时间的变化和低视力表现

随着时间的推移,视觉功能较差的帕金森患者的白质损伤增加,进一步证明视觉功能是认知能力即将下降的标志。

在第二篇新的研究中发现,那些继续发展为帕金森痴呆的人的大脑线路受损,包括与视觉和记忆有关的区域。研究人员使用最近开发的方法来分析非常详细的核磁共振扫描,使他们能够发现大脑白质的损伤。

研究人员发现,连接大脑前后的一些长距离线路受到了白质损伤,这些线路有助于大脑形成一个有凝聚力的整体网络

研究涉及88名帕金森病患者(其中33人有视觉功能障碍,因此被判定为痴呆的高风险患者)30名健康成年人作为对照组,他们的大脑通过核磁共振扫描成像。

研究人员发现,患有帕金森氏症的人在整个大脑中表现出更高程度的脱钩。帕金森氏症患者的大脑后部和较不特殊的区域脱耦最严重。视觉功能障碍的帕金森患者在某些大脑区域(但不是所有大脑区域)有更多的脱钩,特别是在与记忆相关的颞叶区域。

帕金森病(PD)患者结构-功能连接耦合的控制和变化

研究小组还发现,有认知能力下降风险的人体内某些神经递质(化学信使)的水平发生了变化,这表明这些递质的受体可能是治疗帕金森痴呆的新药的潜在靶点。值得注意的是,虽然已知多巴胺与帕金森症有关,研究人员发现其他神经递质——乙酰胆碱、血清素和去甲肾上腺素——在认知能力下降风险人群中特别受影响。

研究人员指出:这两篇论文一起帮助我们理解了患有帕金森症的人的大脑中发生了什么。这些人的认知能力下降似乎是由连接大脑不同区域的神经连接中断造成的,这对临床试验很有价值,视力测试可以帮助我们确定新药试验的目标人群,这可能有助于减缓帕金森症。如果最终找到了有效的治疗方法,那么这些简单的测试可能会帮助我们确定谁将从哪种治疗中受益。

参考文献:

1.Angeliki Zarkali, Peter McColgan, Louise-Ann Leyland, Andrew J. Lees, Geraint Rees, Rimona S. Weil. Organisational and neuromodulatory underpinnings of structural-functional connectivity decoupling in patients with Parkinson’s diseaseCommunications Biology, 2021; 4 (1) DOI: 10.1038/s42003-020-01622-9

2. Angeliki Zarkali, Peter McColgan, Louise‐Ann Leyland, Andrew J. Lees, Rimona S. Weil. Visual Dysfunction Predicts Cognitive Impairment and White Matter Degeneration in Parkinson's DiseaseMovement Disorders, 2021; DOI: 10.1002/mds.28477

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    2021-05-01 liuli5079
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    2021-07-07 sunylz
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    2021-03-09 carrotlyl

    谢谢分享

    0

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    2021-03-05 147e4706m08暂无昵称

    学习了

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=2087881, encodeId=0f09208e88166, content=<a href='/topic/show?id=490750196b' target=_blank style='color:#2F92EE;'>#COMMUN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5019, encryptionId=490750196b, topicName=COMMUN)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7931272, createdName=liuli5079, createdTime=Sat May 01 18:45:13 CST 2021, time=2021-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1919199, encodeId=35d8191919954, content=<a href='/topic/show?id=4f26341994' target=_blank style='color:#2F92EE;'>#Bio#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3419, encryptionId=4f26341994, topicName=Bio)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Wed Jul 07 16:45:13 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=946653, encodeId=b17b946653f2, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Tue Mar 09 08:32:22 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=945767, encodeId=fa5b945e670e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb355252510, createdName=147e4706m08暂无昵称, createdTime=Fri Mar 05 17:44:11 CST 2021, time=2021-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1767821, encodeId=539c1e678216b, content=<a href='/topic/show?id=64f5343e2f' target=_blank style='color:#2F92EE;'>#Biol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3437, encryptionId=64f5343e2f, topicName=Biol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=446937890434, createdName=12498ebem31暂无昵称, createdTime=Sun Nov 28 20:45:13 CST 2021, time=2021-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401285, encodeId=1878140128518, content=<a href='/topic/show?id=011f912607c' target=_blank style='color:#2F92EE;'>#认知能力下降#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91260, encryptionId=011f912607c, topicName=认知能力下降)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e642309178, createdName=hukaixun, createdTime=Fri Jan 22 03:45:13 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918477, encodeId=ce3b9184e7a7, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201118/df82e0cde01a4cf691cd117ea1d92f92/e8f5384bf5a046e39e049573730dd6ec.jpg, createdBy=4b6d3851900, createdName=pqssy, createdTime=Wed Jan 20 17:36:58 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918436, encodeId=a25b91843688, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc115448783, createdName=ms1000002016287811, createdTime=Wed Jan 20 15:45:28 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918392, encodeId=109a91839281, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb355252510, createdName=147e4706m08暂无昵称, createdTime=Wed Jan 20 14:08:45 CST 2021, time=2021-01-20, status=1, ipAttribution=)]
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    2021-01-20 pqssy

    学习了

    0

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    2021-01-20 ms1000002016287811

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    2021-01-20 147e4706m08暂无昵称

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