Publication: İdiyopatik parkinson hastalığına bağlı kognitif bozulma sürecinde beyindeki beyaz cevher değişikliklerin değerlendirilmesi
Abstract
Amaç: Çalışmamızda Parkinson hastalarında (PH) kognitif bozukluğun beyaz cevher değişiklikleriyle olan ilişkisi değerlendirilerek, nöropsikolojik test sonuçları ile korelasyonunun belirlenmesi amaçlanmıştır. Yöntem: Çalışmaya Parkinson hastalığına bağlı hafif kognitif bozukluk (HKB-PH) tanılı 20 hasta, PH tanılı 14 hasta ve 20 tane sağlıklı kontrol dahil edilmiştir. Deneklerin kognitif profil analizi için, dikkat ve çalışma belleği, dil, yönetici-yürütücü işlevler ve bellek gibi alanları değerlendiren nöropsikolojik testler uygulanmıştır. Tüm hasta ve sağlıklı kontrollerin Difüzyon Tensör Görüntüleme (DTG) ile beyaz cevher değişiklikleri değerlendirilerek karşılaştırılmıştır. DTG yöntemi olarak iki ayrı analiz yapılmıştır. Birincisi gruplar arasında, beyaz cevher yapılarındaki Fraksiyonel Anizotropi (FA) oranlarını karşılaştırarak farklı alanları ortaya çıkaran Voksel Karşılaştırmalı Analizi; ikincisi ise nöropsikolojik testlerle beyaz cevherdeki FA düzeyleri arasındaki korelasyonu değerlendirebilmek için yapılan manuel Region of Interest (ROI) analizidir. Bulgular:Gruplar arasında yaş, eğitim yılı, hastalık başlangıç yaşı, hastalık süresi, motor ve non motor bulgular arasında anlamlı bir fark saptanmamıştır. HKB-PH grubunun sözel bellek süreçleri testinde, ikili benzerlikler, sözel akıcılık hayvan sayma, Stroop Testi ve Winsconsin Kart Eşleme Testinde (WKET) diğer gruplara göre daha başarısız oldukları görülmüştür.Yapılan karşılaştırmalı voksel analizlerinde HKB-PH grubunun PH grubuna göre korpus kallosumda, frontal, paryetal ve subkortikal beyaz cevher yapılarında FA düzeylerinin anlamlı olarak azaldığı gösterilmiştir. Ayrıca ROI yöntemiyle yapılan FA düzeyleri ile nöropsikolojik testler (özellikle sözel akıcılık, kognitif fleksibilite, kategori oluşturma ve problem çözme gibi yürütücü işlevler) arasında anlamlı bir korelasyon izlenmiştir. Sonuç: Nöropsikolojik testler ve DTG yöntemi, erken dönemde kognitif bozukluğun tanınabilmesinde öngördürücü bir belirteç olarak kullanılabilir. Parkinson Hastalığı, Hafif Kognitif Bozukluk, Difüzyon Tensör Görüntüleme, Nöropsikolojik Testler
Purpose: In our study our aim is to determine the corelation in patients with Parkinson's disease (PD) between cognitive impairment by evaluating the relationship with white matter changes and neuropsychological tests results. Method: In study we enrolled patients with PD cognitively normal (n:14), PD mild cognitive impairment (PD-MCI) (n:20) and healthy control subjects (n:19). The subjects for the analysis of the cognitive profile, attention and working memory, language, executive functions and memory functions such as executive-evaluating neuropsychological tests were administered. All patients and healthy controls had Diffusion Tensor Imaging (DTI) and white matter changes were evaluated and compared. Two separate analysis were performed as a method of DTI. First, between groups of white matter structures, Fractional Anisotropy (FA) by comparing rates reveal different areas, Voxelwise Analysis; secondly, were evaluated the correlation between the white matter FA levels and neuropsychological tests, was performed by manual ROI analysis. Results: There were no differences between the groups; age, years of education, age of onset, disease duration, motor and non-motor symptoms. Patients with PD-MCI were found to be less successful than the other groups in verbal memory processes test, similarities, verbal fluency (counting animals), Stroop Test and Wisconsin Card Sorting Test (WCST). The comparative analysis of voxels in the PD-MCI group compared to the PD group; corpus callosum, frontal, parietal and subcortical white matter structures has been shown to significantly decreased levels of FA. In addition by the ROI method, a significant correlation was observed between FA levels and neuropsychological test results (particularly verbal fluency, cognitive flexibility, problem solving categories, such as executive functions). Conclusion: Neuropsychological tests and DTI method can be used as a marker. for diagnosing early predictor of cognitive impairment. Key Words: Parkinson's Disease, Mild Cognitive Impairment, Diffusion Tensor Imaging, Neuropsychological Tests
Purpose: In our study our aim is to determine the corelation in patients with Parkinson's disease (PD) between cognitive impairment by evaluating the relationship with white matter changes and neuropsychological tests results. Method: In study we enrolled patients with PD cognitively normal (n:14), PD mild cognitive impairment (PD-MCI) (n:20) and healthy control subjects (n:19). The subjects for the analysis of the cognitive profile, attention and working memory, language, executive functions and memory functions such as executive-evaluating neuropsychological tests were administered. All patients and healthy controls had Diffusion Tensor Imaging (DTI) and white matter changes were evaluated and compared. Two separate analysis were performed as a method of DTI. First, between groups of white matter structures, Fractional Anisotropy (FA) by comparing rates reveal different areas, Voxelwise Analysis; secondly, were evaluated the correlation between the white matter FA levels and neuropsychological tests, was performed by manual ROI analysis. Results: There were no differences between the groups; age, years of education, age of onset, disease duration, motor and non-motor symptoms. Patients with PD-MCI were found to be less successful than the other groups in verbal memory processes test, similarities, verbal fluency (counting animals), Stroop Test and Wisconsin Card Sorting Test (WCST). The comparative analysis of voxels in the PD-MCI group compared to the PD group; corpus callosum, frontal, parietal and subcortical white matter structures has been shown to significantly decreased levels of FA. In addition by the ROI method, a significant correlation was observed between FA levels and neuropsychological test results (particularly verbal fluency, cognitive flexibility, problem solving categories, such as executive functions). Conclusion: Neuropsychological tests and DTI method can be used as a marker. for diagnosing early predictor of cognitive impairment. Key Words: Parkinson's Disease, Mild Cognitive Impairment, Diffusion Tensor Imaging, Neuropsychological Tests