快速眼动睡眠期行为障碍患者运动和认知功能障碍及脑功能连接研究

摘要

目的 探讨快速眼动睡眠期行为障碍(RBD)患者运动和认知功能障碍以及黑质与各脑区的功能连接.方法 共14例快速眼动睡眠期行为障碍患者和8例性别、年龄、受教育程度相匹配的正常对照者,采用统一帕金森病评价量表第三部分(UPDRSⅢ)和Hoehn-Yahr分期评价运动功能,数字排序测验之注意力部分、符号数字模式测验(SDMT)、Stroop色词测验、连线测验(TMT)、Rey-Osterrieth复杂图形测验(ROCFT)、画钟测验、Boston命名测验和听觉词语学习测验(AVLT)评价认知功能,静息态fMRI观察左侧和右侧黑质与各脑区的功能连接.结果 两组受试者UPDRSⅢ评分和Hoehn-Yahr分期差异无统计学意义(均P＞ 0.05);RBD组患者SDMT评分(P=0.001)、ROCFT量表之临摹部分评分(P=0.013)和AVLT量表之第2次瞬时回忆部分评分(P=0.032)低于正常对照组,TMT-B测试部分评分高于正常对照组(P=0.005).与正常对照组相比,RBD组患者右侧黑质与左侧中央前回(P＜0.005)和右侧角回(P＜0.005)的功能连接下降.结论 快速眼动睡眠期行为障碍患者认知功能障碍早于运动障碍,且黑质与运动功能区和认知功能区均存在异常功能连接,为快速眼动睡眠期行为障碍患者的行为学改变提供脑功能连接异常的客观证据.%Objective To explore the relation between abnormal functional connectivity of substantia nigra and impairment of movement and cognition in patients with rapid eye movement sleep behavior disorder (RBD).Methods A total of 22 subjects,including 14 patients with RBD and 8 sex,age,education-matched healthy controls,were enrolled in this study according to international diagnostic criteria.Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) and Hoehn-Yahr Stage were used to evaluate motor function.Digit Ordering Test-Attention (DOT-A),Symbol Digit Modalities Test (SDMT),Stroop Color-Word Test (SCWT),Trail Making Test (TMT),Rey-Osterrieth Complex Figure Test (ROCFT),Clock Drawing Test (CDT),Boston Naming Test (BNT) and Auditory Verbal Learning Test (AVLT) were used to evaluate cognitive function.The functional connectivity from left and right substantia nigra to brain region were examined.Results There were no statistical differences of UPDRS Ⅲ and Hoehn-Yahr Stage between 2 groups (P ＞ 0.05,for all).In comparison with control group,SDMT (P =0.001),ROCFT-copy (P =0.013) and AVLT-N2 (P =0.032) were significantly lower,while TMT-B test was significantly higher (P =0.005) in RBD group.Compared with control group,the functional connectivity of right substantia nigra to left precentral gyrus (P ＜ 0.005) and right angular gyrus (P ＜ 0.005) were all decreased in RBD group.Conclusions The results suggest that cognitive impairment occurs earlier than movement disorders in RBD,and there are abnormal functional connectivity from right substantia nigra to left precentral gyrus and right angular gyrus,proving that abnormal functional connectivity is the base of behavior disorders in RBD.