The Study Of Multimodal Magnetic Resonance Imaging In Parkinson’s Disease With Cognitive Impairment

Objectives To evaluate the brain functional and structural changes in Parkinson’s disease with cognitive impairment(PD-CI)and to provide imaging evidences for the diagnosis and pathogenesis of PD-CI via combining resting-state functional magnetic resonance imaging(rs-fMRI),three-dimensional T1-weighted imaging(3D-T1WI)and diffusion tensor imaging(DTI).Methods A total of 35 patients with Parkinson’s Disease(PD)who were diagnosed and treated in the Department of Neurology of Hebei General Hospital from May 2019 to January 2022 were selected,and 25 cases of healthy controls(HC)with normal cognitive function were collected from the Physical Examination Center of Hebei General Hospital during the same period,whose sex,age and years of education are matched with those of PD patients.Montreal cognitive assessment(MoCA)was employed to divide PD patients into two subgroups: PD-CI group of 18 patients and Parkinson’s disease with normal cognitive function(PD-NC)group of 17 patients.All subjects underwent rs-fMRI,3DT1 WI and DTI examinations in a quiet condition.To analyze relevant parameters with image preprocessing and statistical analysis performed using appropriate data processing tools.The values for regional homogeneity(ReHo),gray matter volume(GMV)and fractional anisotropy(FA)of brain regions with statistically significant differences among PD subgroups were extracted.And analyze the correlation between them and MoCA score of PD subgroups.Results 1 MoCA score were significantly different across the three groups(P<0.05),but age,gender,years of education and total intracranial volume were not significantly different(P>0.05).There were also no significant differences in the course of disease duration,unified Parkinson’s disease rating scale Ⅲ and levodopa equivalent dose daily between PD subgroups(P>0.05).2 ReHo values: the different brain areas among the three groups were in the right putamen.Comparison between groups showed that:compared with the HC group,the PD-CI group showed an increase in the ReHo values of the left middle frontal gyrus.And there was a decrease in the ReHo values of the right calcarine fissure and surrounding cortex,left lingual,left precuneus,left middle occipital gyrus,left postcentral gyrus,right median cingulate and paracingulate gyrus,and left superior occipital gyrus.Compared with the HC group,the PD-NC group demonstrated an increase in the ReHo values of the left middle frontal gyrus,left posterior cingulate cortex,right superior frontal gyrus and right precentral gyrus.And there was a decline in the ReHo values of the bilateral olfactory cortex,right median cingulate and paracingulate gyrus,left postcentral gyrus,left superior parietal gyrus and left inferior parietal gyrus.Compared with the PD-NC group,the PD-CI group indicated the ReHo values of the right putamen,right thalamus and right hippocampus went upward,and a reduction in the ReHo values of the right middle frontal gyrus and right postcentral gyrus.3 GMV values: the different brain regions among the three groups were in the left precuneus,the orbital part of the left middle frontal gyrus,the orbital part of the left inferior frontal gyrus and crus1 region of the right cerebellum.Comparison between groups showed that:compared with the HC group,the PD-CI group showed decreased GMV values of the crus2 region of the left cerebellum,cerebellar vermis region(34),the orbital part of the bilateral middle frontal gyrus,left caudate nucleus and right superior occipital gyrus.Compared with the HC group,the PD-NC group registered increased GMV values of the crus1 region of the right cerebellum,right postcentral gyrus,right superior temporal gyrus,and the orbital part of the left inferior frontal gyrus,and declined GMV values of the left caudate nucleus.Compared with the PD-NC group,the PD-CI group demonstrated reduced GMV values of the right inferior temporal gyrus,crus1 region of the right cerebellum,left parahippocampal gyrus,left precuneus and left superior frontal gyrus.4 FA values: the different brain regions among the three groups were in the left putamen,right superior parietal gyrus,left middle occipital gyrus and right precuneus.Comparison between groups showed that: compared with the HC group,the PD-CI group saw the decreased FA values of the crus2 region of right cerebellum,left putamen,left middle occipital gyrus and left thalamus.Compared with the HC group,the PD-NC group witnessed the increased values of the left middle occipital gyrus,left inferior occipital gyrus,right precuneus,right postcentral gyrus,right superior parietal gyrus and left caudate,and reduced FA values of the left putamen.Compared with the PD-NC group,the PD-CI group saw the increased FA values of the crus1 region of left cerebellum.And diminished FA values of the left middle temporal gyrus,right superior frontal gyrus,right precentral gyrus and left precuneus.5 The GMV values of the crus1 region of the right cerebellum,left parahippocampal gyrus and left superior frontal gyrus in the different brain regions of the PD subgroups were positively correlated with the MoCA score,with the correlation coefficients r being 0.724,0.411,0.406 respectively(P(27)0.05).There was no significant difference in the correlation between ReHo value,FA value and MoCA score in different brain regions of PD subgroups(p(29)0.05).Conclusions 1 The abnormalities of functional conduction pathway,structural conduction pathway and neurotransmitter system play an important role in the pathogenesis of PD-CI.2 PD-CI patients have simultaneous functional and structural changes in frontal lobe,occipital lobe and precuneus.These brain regions are the anatomical sites related to PD-CI that should be focused on.3 The combination of rs-fMRI,3D-T1 WI and DTI provides a new direction for the diagnosis and pathogenesis of PD-CI.Figure9;Table11;Reference168...