帕金森病认知障碍患者静息态功能连接的改变及其鉴别价值

Altered Resting-State Functional Connectivity in Parkinson’s Disease with Cognitive Impairment and Its Discriminative Value

摘要: 目的：帕金森病认知障碍(Parkinson’s Disease with Cognitive Impairment, PD-CI)严重影响患者生活质量，且缺乏客观诊断指标。本研究旨在探讨PD-CI患者静息态功能磁共振成像(Resting-state functional Magnetic Resonance Imaging, rs-fMRI)中功能连接(Functional Connectivity, FC)的异常模式，并评估其鉴别价值。方法：纳入23例PD-CI患者、20例PD认知正常(Parkinson’s Disease with Normal Cognition, PD-NC)患者及20名健康对照(Healthy Control, HC)。采集所有受试者的rs-fMRI数据，基于预定义感兴趣区(Region of Interest, ROI)进行全脑FC分析。比较组间FC差异，分析差异脑区FC值与蒙特利尔认知评估(Montreal Cognitive Assessment, MoCA)评分的相关性，并采用受试者工作特征(Receiver Operating Characteristic, ROC)曲线评估这些FC值对PD-CI的鉴别效能。结果：与PD-NC组相比，PD-CI患者在双侧颞中回及左侧楔叶表现为FC增强，而在右侧扣带回中部表现为FC减弱。相关性分析显示，左侧颞中回(r = −0.585, P < 0.0001)与左侧楔叶(r = −0.529, P = 0.0003)的FC值与MoCA评分呈显著负相关。ROC曲线分析表明，左侧颞中回的FC值对PD-CI具有最佳的鉴别能力，其曲线下面积(Area Under the Curve, AUC)为0.8739。结论：PD-CI患者存在以双侧颞中回连接增强为典型特征的功能网络重组，该特征与认知损伤密切相关。左侧颞中回的功能连接强度可作为鉴别PD-CI的高度潜力的神经影像学生物标志物。

Abstract: Objective: Cognitive impairment in Parkinson’s disease (PD-CI) significantly impacts patients’ quality of life, and objective diagnostic biomarkers are currently lacking. This study aimed to investigate the aberrant patterns of functional connectivity (FC) using resting-state functional magnetic resonance imaging (rs-fMRI) in PD-CI patients and to evaluate their potential for differential diagnosis. Methods: The study enrolled 23 PD-CI patients, 20 PD patients with normal cognition (PD-NC), and 20 healthy controls (HC). rs-fMRI data were acquired from all participants. Whole-brain FC analysis was performed based on predefined regions of interest (ROIs). Inter-group differences in FC were compared. Correlations between FC values in regions showing significant differences and Montreal Cognitive Assessment (MoCA) scores were analyzed. The receiver operating characteristic (ROC) curve was employed to assess the efficacy of these FC values in discriminating PD-CI. Results: Compared to the PD-NC group, PD-CI patients exhibited increased FC within the bilateral middle temporal gyri and the left cuneus, alongside decreased FC in the right mid-cingulate cortex. Correlation analysis revealed significant negative correlations between MoCA scores and FC values in the left middle temporal gyrus (r = −0.585, P < 0.0001) and the left cuneus (r = −0.529, P = 0.0003). ROC curve analysis demonstrated that the FC value of the left middle temporal gyrus had the best discriminatory power for PD-CI, with an area under the curve (AUC) of 0.8739. Conclusion: Patients with PD-CI display a reorganization of functional networks, characterized notably by enhanced connectivity within the bilateral middle temporal gyri, which is closely associated with cognitive deficits. The functional connectivity strength of the left middle temporal gyrus may serve as a highly promising neuroimaging biomarker for identifying PD-CI.