Abstract：
OBJECTIVE: Although both Multiple system atrophy (MSA) and Parkinson\'s disease (PD) belong to alpha-synucleinopathy, they have divergent clinical courses and prognoses. The degeneration of white matter has a considerable impact on cognitive performance, yet it is uncertain how PD and MSA affect its functioning in a similar or different manner.
METHODS: In this study, a total of 116 individuals (37 PD with mild cognitive impairment (PD-MCI), 37 MSA (parkinsonian variant) with mild cognitive impairment (MSA-MCI), and 42 healthy controls) underwent diffusion tensor imaging (DTI) and cognitive assessment. Utilizing probabilistic fiber tracking, association fibers, projection fibers, and thalamic fibers were reconstructed. Subsequently, regression, support vector machine, and SHAP (Shapley Addictive exPlanations) analyzes were conducted to evaluate the association between microstructural diffusion metrics and multiple cognitive domains, thus determining the white matter predictors of MCI.
RESULTS: MSA-MCI patients exhibited distinct white matter impairment extending to the middle cerebellar peduncle, corticospinal tract, and cingulum bundle. Furthermore, the fractional anisotropy (FA) and mean diffusivity (MD)values of the right anterior thalamic radiation were significantly associated with global efficiency (FA: B = 0.69, P < 0.001, VIF = 1.31; MD: B = -0.53, P = 0.02, VIF = 2.50). The diffusion metrics of white matter between PD-MCI and MSA-MCI proved to be an effective predictor of the MCI, with an accuracy of 0.73 (P < 0.01), and the most predictive factor being the MD of the anterior thalamic radiation.
CONCLUSIONS: Our results demonstrated that MSA-MCI had a more noticeable deterioration in white matter, which potentially linked to various cognitive domain connections. Diffusion MRI could be a useful tool in comprehending the neurological basis of cognitive impairment in Parkinsonian disorders.
METHODS: In this study, a total of 116 individuals (37 PD with mild cognitive impairment (PD-MCI), 37 MSA (parkinsonian variant) with mild cognitive impairment (MSA-MCI), and 42 healthy controls) underwent diffusion tensor imaging (DTI) and cognitive assessment. Utilizing probabilistic fiber tracking, association fibers, projection fibers, and thalamic fibers were reconstructed. Subsequently, regression, support vector machine, and SHAP (Shapley Addictive exPlanations) analyzes were conducted to evaluate the association between microstructural diffusion metrics and multiple cognitive domains, thus determining the white matter predictors of MCI.
RESULTS: MSA-MCI patients exhibited distinct white matter impairment extending to the middle cerebellar peduncle, corticospinal tract, and cingulum bundle. Furthermore, the fractional anisotropy (FA) and mean diffusivity (MD)values of the right anterior thalamic radiation were significantly associated with global efficiency (FA: B = 0.69, P < 0.001, VIF = 1.31; MD: B = -0.53, P = 0.02, VIF = 2.50). The diffusion metrics of white matter between PD-MCI and MSA-MCI proved to be an effective predictor of the MCI, with an accuracy of 0.73 (P < 0.01), and the most predictive factor being the MD of the anterior thalamic radiation.
CONCLUSIONS: Our results demonstrated that MSA-MCI had a more noticeable deterioration in white matter, which potentially linked to various cognitive domain connections. Diffusion MRI could be a useful tool in comprehending the neurological basis of cognitive impairment in Parkinsonian disorders.
摘要：
目的：尽管多系统萎缩（MSA）和帕金森病（PD）都属于α-突触核蛋白病，他们有不同的临床课程和预后。脑白质的退化对认知表现有相当大的影响,然而，尚不确定PD和MSA如何以相似或不同的方式影响其功能。
方法：在本研究中，共116例(37例PD伴轻度认知障碍(PD-MCI)，37MSA（帕金森病变异）伴轻度认知障碍（MSA-MCI），和42名健康对照）接受了扩散张量成像（DTI）和认知评估。利用概率纤维跟踪，缔合纤维，投射纤维，重建丘脑纤维。随后，回归，支持向量机，和SHAP（Shapley成瘾扩张）分析进行了评估微观结构扩散指标和多个认知领域之间的关联，从而确定MCI的白质预测因子。
结果：MSA-MCI患者表现出明显的白质损害，延伸至小脑中段，皮质脊髓束，和扣带束。此外，右前丘脑辐射的各向异性分数(FA)和平均扩散率(MD)值与总有效率显著相关(FA:B=0.69,P<0.001,VIF=1.31;MD:B=-0.53,P=0.02,VIF=2.50).PD-MCI和MSA-MCI之间的白质扩散指标被证明是MCI的有效预测指标，准确度为0.73（P<0.01）。和最预测的因素是前丘脑辐射的MD。
结论：我们的结果表明，MSA-MCI的白质恶化更明显，这可能与各种认知领域的联系有关。弥散MRI可能是理解帕金森病认知障碍的神经基础的有用工具。
方法：在本研究中，共116例(37例PD伴轻度认知障碍(PD-MCI)，37MSA（帕金森病变异）伴轻度认知障碍（MSA-MCI），和42名健康对照）接受了扩散张量成像（DTI）和认知评估。利用概率纤维跟踪，缔合纤维，投射纤维，重建丘脑纤维。随后，回归，支持向量机，和SHAP（Shapley成瘾扩张）分析进行了评估微观结构扩散指标和多个认知领域之间的关联，从而确定MCI的白质预测因子。
结果：MSA-MCI患者表现出明显的白质损害，延伸至小脑中段，皮质脊髓束，和扣带束。此外，右前丘脑辐射的各向异性分数(FA)和平均扩散率(MD)值与总有效率显著相关(FA:B=0.69,P<0.001,VIF=1.31;MD:B=-0.53,P=0.02,VIF=2.50).PD-MCI和MSA-MCI之间的白质扩散指标被证明是MCI的有效预测指标，准确度为0.73（P<0.01）。和最预测的因素是前丘脑辐射的MD。
结论：我们的结果表明，MSA-MCI的白质恶化更明显，这可能与各种认知领域的联系有关。弥散MRI可能是理解帕金森病认知障碍的神经基础的有用工具。
