背景:震颤显性(TD)和姿势不稳定/步态困难(PIGD)是帕金森病的常见亚型,每个都有不同的临床表现和预后。这些亚型的神经机制尚不清楚。本研究旨在探讨不同类型帕金森病患者额叶皮质和辅助运动区(SMA)的连通性改变。
方法:173名参与者的数据,包括41名TD患者,65名PIGD患者,和67个健康对照,进行回顾性分析。所有受试者均接受静息状态功能磁共振成像(rs-fMRI)和临床评估。低频波动幅度差异(ALFF),逐体素功能连通性(FC),比较三组间的功能性网络连接(FNC),其次是偏相关分析。
结果:与健康对照组相比,PIGD和TD患者的左背外侧额上回(DLSFG)ALFF均显着增加。左侧DLSFG和左侧SMA之间的FC,以及左中央旁小叶和右DLSFG之间,显著下降。同样,视觉网络和听觉网络之间的FNC减少。与TD患者相比,PIGD患者在左侧DLSFG中显示出显著较高的ALFF,并且在左侧DLSFG和左侧SMA之间显示出显著降低的FC。此外,仅在PIGD患者中,左侧DLSFG-SMA的FC与PIGD评分呈负相关.仅在TD患者中,视觉-听觉网络的FNC与震颤评分呈负相关。
结论:左侧DLSFG-SMA连通性降低可能是PIGD亚型的关键特征,而减少的VN-AUD连通性可以表征TD亚型。
BACKGROUND: Tremor-dominant (TD) and postural instability/gait difficulty (PIGD) are common subtypes of Parkinson\'s disease, each with distinct clinical manifestations and prognoses. The neural mechanisms underlying these subtypes remain unclear. This study aimed to investigate the altered connectivity of the frontal cortex and supplementary motor area (SMA) in different types of Parkinson\'s disease.
METHODS: Data of 173 participants, including 41 TD patients, 65 PIGD patients, and 67 healthy controls, were retrospectively analyzed. All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) and clinical assessments. Differences in amplitude of low frequency fluctuation (ALFF), voxel-wise functional connectivity (FC), and functional network connectivity (FNC) among the three groups were compared, followed by partial correlation analysis.
RESULTS: Compared to healthy controls, the left dorsolateral superior frontal gyrus (DLSFG) ALFF was significantly increased in both PIGD and TD patients. The FC between the left DLSFG and the left SMA, as well as between the left paracentral lobule and the right DLSFG, was significantly decreased. Similarly, the FNC between the visual network and the auditory network was reduced. Compared to TD patients, PIGD patients showed a significantly higher ALFF in the left DLSFG and a notably reduced FC between the left DLSFG and left SMA. Additionally, the FC of the left DLSFG-SMA was inversely correlated with the PIGD score exclusively in PIGD patients. The FNC of the visual-auditory network was inversely associated with the tremor score only in TD patients.
CONCLUSIONS: Decreases in the left DLSFG-SMA connectivity may be a key feature of the PIGD subtype, while reduced VN-AUD connectivity may characterize the TD subtype.