Parkinson's disease (PD) patients show cognitive deficits that are relevant in terms of prognosis and quality of life. Degeneration of striatal dopaminergic afferents proceeds from dorsal/caudal to anterior/ventral and is discussed to account for some of these symptoms. Treatment with dopamine (DA) has differential effects on cognitive dysfunctions, improving some and worsening others. We hypothesized that cognitive performance during the dopaminergic OFF state correlates with DAT availability in the associative striatum. 16 PD patients underwent motor and cognitive examination ON and OFF DA. Global cognition was measured using the Montréal Cognitive Assessment (MoCA) test and executive functioning using a Stroop test. Nigrostriatal dopaminergic innervation was characterized with [123I]FP-CIT SPECT. A connectivity atlas of the striatum was used to assess DAT availability in functionally defined striatal subregions. Correlations between imaging data and behavioral data OFF medication were calculated. Correlations between DAT availability and MoCA performance in the dopaminergic OFF state was strongest in the associative part of the striatum (r = 0.674, p = 0.004). MoCA test performance did not differ between the ON and the OFF state. There was no correlation of DAT availability with Stroop performance in the OFF state but performance was significantly better during the ON state. Not only motor but also cognitive dysfunctions in PD are associated with striatal dopaminergic depletion. Cognitive decline in non-demented PD patients goes along with nigrostriatal degeneration, most pronounced in the associative subdivision of the striatum. In addition, the present findings suggest that executive dysfunctions are ameliorated by DA whereas global cognition is not improved by dopaminergic medication.

译文

帕金森氏病 (PD) 患者表现出与预后和生活质量相关的认知缺陷。纹状体多巴胺能传入的变性从背侧/尾部到前/腹侧进行,并讨论了其中一些症状。多巴胺 (DA) 治疗对认知功能障碍有不同的影响,改善了一些,恶化了另一些。我们假设多巴胺能关闭状态下的认知表现与联想纹状体中的DAT可用性相关。16例PD患者在DA和DA上进行了运动和认知检查。使用蒙特利尔认知评估 (MoCA) 测试测量全球认知,并使用Stroop测试测量执行功能。黑质纹状体多巴胺能神经支配的特征是用 [123I]FP-CIT SPECT。纹状体的连通性图谱用于评估功能定义的纹状体子区域中的DAT可用性。计算药物外的成像数据和行为数据之间的相关性。多巴胺能关闭状态下DAT可用性和MoCA性能之间的相关性最强纹状体的关联部分 (r = 0.674,p = 0.004)。MoCA测试性能在开启和关闭状态之间没有差异。在关闭状态下,DAT可用性与Stroop性能没有相关性,但在开启状态下,性能明显更好。PD不仅运动功能障碍,而且认知功能障碍与纹状体多巴胺能耗竭有关。非痴呆性PD患者的下降伴随着黑质纹状体变性,在纹状体的关联细分中最明显。此外,目前的发现表明,DA可以改善执行功能障碍,而多巴胺能药物不能改善整体认知。

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