中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2013, Vol. 8 ›› Issue (27): 2548-2556.doi: 10.3969/j.issn.1673-5374.2013.27.006

• 原著:退行性病与再生 • 上一篇    下一篇

帕金森病患者为何易并发精神障碍？

  

  • 收稿日期:2013-04-07 修回日期:2013-07-23 出版日期:2013-09-25 发布日期:2013-09-25

Why psychosis is frequently associated with Parkinson’s disease?

Jingmei Zhong1, Shaoyuan Wu1, Ying Zhao2, Hui Chen1, Naiwei Zhao1, Kunwen Zheng1, Zhong Zhao1, Wenli Chen1, Bo Wang2, Kunhua Wu2   

  1. 1 Department of Neurology, First People’s Hospital of Yunnan Province, Kunming 650032, Yunnan Province, China

    2 Department of Magnetic Resonance Imaging, First People’s Hospital of Yunnan Province, Kunming 650032, Yunnan Province, China
  • Received:2013-04-07 Revised:2013-07-23 Online:2013-09-25 Published:2013-09-25
  • Contact: Shaoyuan Wu, Chief physician, Department of Neurology, First People’s Hospital of Yunnan Province, Kunming 650032, Yunnan Province, China, wu.shaoyuan@ yahoo.com.cn.
  • About author:Jingmei Zhong, Master, Associate chief physician.

PDF

1595

摘要：

帕金森病精神障碍是帕金森病常见的非运动症状，目前其发病机制尚不完全清楚。有研究表明帕金森病与精神障碍均可导致锥体外系与部分皮质区域受损。鉴于此，实验对未经抗精神病治疗的帕金森病精神障碍患者与帕金森病无精神症状的患者进行弥散张量成像检测。结果显示，有精神症状的帕金森病患者的左额叶、双侧枕叶、左扣带回、左海马白质纤维受损相对重于黑质；双侧额叶、枕叶、扣带回、左海马白质纤维受损也相对重于苍白球；额叶与扣带回的白质纤维受损更明显。与无精神症状的帕金森病患者相比，存在精神症状的帕金森病患者的左额叶、双侧枕叶、左扣带回、左海马与同侧黑质或苍白球的各向异性分数的比值均显著降低，说明其白质纤维受损程度更严重。说明，帕金森病精神障碍患者出现精神症状的原因可能和精神症状相关脑区额叶、枕叶、扣带回、海马与锥体外系黑质、苍白球之间的白质纤维比值失衡有关，精神症状相关脑区白质纤维受损程度重于锥体外系，这可能是帕金森病患者出现精神障碍的原因。

关键词: 神经再生, 脑损伤, 帕金森病, 精神障碍, 弥散张量成像, 各向异性分数值, 功能磁共振, 额叶, 枕叶, 扣带回, 海马, 锥体外系, 基金资助文章

Abstract:

Psychosis is a common non-motor symptom of Parkinson’s disease whose pathogenesis remains poorly understood. Parkinson’s disease in conjunction with psychosis has been shown to induce injury to extracorticospinal tracts as well as within some cortical areas. In this study, Parkinson’s disease patients with psychosis who did not receive antipsychotic treatment and those without psychosis underwent diffusion tensor imaging. Results revealed that in Parkinson’s disease patients with psychosis, damage to the left frontal lobe, bilateral occipital lobe, left cingulated gyrus, and left hippocampal white-matter fibers were greater than damage to the substantia nigra or the globus pallidus. Damage to white-matter fibers in the right frontal lobe and right cingulate gyrus were also more severe than in the globus pallidus, but not the substantia nigra. Damage to frontal lobe and cingulate gyrus white-matter fibers was more apparent than that to occipital or hippocampal fiber damage. Compared with Parkinson’s disease patients without psychosis, those with psychosis had significantly lower fractional anisotropy ratios of left frontal lobe, bilateral occipital lobe, left cingu-lated gyrus, and left hippocampus to ipsilateral substantia nigra or globus pallidus, indicating more severe damage to white-matter fibers. These results suggest that psychosis associated with Par-kinson’s disease is probably associated with an imbalance in the ratio of white-matter fibers be-tween brain regions associated with psychiatric symptoms (frontal lobe, occipital lobe, cingulate gyrus, and hippocampus) and those associated with the motor symptoms of Parkinson’s disease (the substantia nigra and globus pallidus). The relatively greater damage to white-matter fibers in psychiatric symptom-related brain regions than in extracorticospinal tracts might explain why psy-chosis often occurs in Parkinson’s disease patients.