| PartⅠ Olfactory bulb volume changes in Parkinson’s disease: Asystematic review and meta-analysisObjective: The changes of olfactory bulb(OB) volume in Parkinson’s disease(PD) have not yet been fully evaluated. The primary objective of this systematic review and meta-analysis was to determine whether significant differences in OB volume were present in PD patients compared to healthy controls.Methods: Pub Med and Embase were searched from inception to March 2015 with no language restriction. Two reviewers independently extracted data on study characteristics, patient characteristics, and OB volume outcomes and assessed the study quality. A systematic review and meta-analyses were conducted using STATA 12.0 software. Subgroup analyses were performed to explore the source of possible heterogeneity. Publication bias was determined using funnel plots and Egger’s and Begg’s tests.Results: Six original case-control studies yielding 216 PD patients and 175 healthy controls were analyzed. The pooled mean difference(MD) of the OB volume was-8.071 for the right-side and-10.124 for the left-side, which suggested a significant decrease as compared with healthy controls. In addition, a difference was found in the lateralized OB volume in PD patients with a pooled MD of 1.618 indicating predominance of the right-side OB volume. By contrast, no lateralized difference was found in healthy controls. No statistical evidence of a publication bias among studies was found by Egger’sor Begg’stests. Sensitivity analyses found that results were consistent and robust.Conclusions: Overall, OB volume in PD patients was significantly decreased in both the right- and left-side compared to healthy controls. However, significant heterogeneity and insufficient numbers of studies underscored a need for further observational research.PartⅡ Changes of olfactory function in Parkinson’s disease andvascular parkinsonismObjective: To study olfactory function changes in Parkinson’s disease(PD) and vascular parkinsonism(VP) and their influence factors, and to explore the application value of olfactory function examination by Sniffin’ Sticks test(SST) in diagnosis and differential diagnosis of PD.Methods: 40 participants with PD, VP and healthy control(HC) group each were included in the study. All of them were enrolled in the Second Affiliated Hospital of Nantong University from March 2015 to December 2015 with gender and age matched. Baseline characteristic information such as age, gender, MMSE score of all participants were reported while disease duration, the scores of H-Y stage rating and UPDRS-Ⅲ were recorded in PD and VP patients. SST was used to assess olfactory function of all participants in three groups including odor threshold(OT), odor discrimination(OD), odor identification(OI) and TDI total score. TDI score comparison was performed among PD, VP and HC groups. The relationship between smell and age, gender, MMSE, disease duration, H-Y stage rating and UPDRS- Ⅲ score was analyzed. Receiver operator characteristic curve(ROC) was used to evaluate the application value of TDI score in diagnosis of PD.Results: The comparison of baseline characteristic information among PD, VP and HC group showed no statistical difference. The prevalence of olfactory dysfunction in PD group was significantly higher than both VP and HC groups with the value 92.5% comparing to 37.5% and 35% respectively. The TDI score was 20.07±4.45 in PD group, 30.53±5.90 in VP group and 31.00±4.99 in HC group. Compared to VP and HC group, TDI score was significantly decreased in PD patients, while no statistical difference was found between VP and HC groups. TDI score was correlated negatively with age(r=-0.987, P<0.05) and positively with MMSE score(r=0.866,P<0.05) in HC group, while negatively with disease duration(r=-0.484, P<0.05) and positively with MMSE score(r=0.618,P<0.05) and had nothing to do with age, gender, H-Y rating and UPDRS-Ⅲ score in PD patients. Besides, negative correlation was found between TDI and age, disease duration and H-Y rating in VP patients(r=-0.989, P<0.05; r=-0.770, P<0.05; r=-0.353, P<0.05 respectively) with positive correlation of MMSE(r=0.838, P<0.05) and none correlation of gender and UPDRS-Ⅲ score. The area under ROC curve(AUC) of TDI for discriminating PD and HC was 0.944 with cut-off value 23.313 and 82.5% sensitivity and 97.5% specificity. The TDI score AUC for discriminating PD and VP was 0.911 with cut-off value 23.563 and 87.5% of sensitivity and 82.5% of specificity.Conclusions: SST is a simple used, reliable olfaction evaluation tool. Obvious olfactory dysfunction was observed in PD patients compared with VP and HC groups. No significant olfaction difference was found between VP and HC groups. The use of SST may provide important clinical information with its high sensitivity and specificity in the diagnosis and differential diagnosis of PD.PartⅢ Changes of olfactory bulb volume in Parkinson’s disease andvascular parkinsonismObjective: To study olfactory bulb(OB) volume changes in Parkinson’s disease(PD) and vascular parkinsonism(VP) and their influence factors, and to explore the application value of OB volume assessment via high-resolution magnetic resonance imaging(MRI) in diagnosis and differential diagnosis of PD.Methods: 40 participants with PD, VP and healthy control(HC) group each were included in the study. All of them were enrolled in the Second Affiliated Hospital of Nantong University from March 2015 to December 2015 with gender and age matched. Baseline characteristic information such as age, gender, MMSE score of all participants were reported while disease duration, the scores of H-Y stage rating and UPDRS-Ⅲ were recorded in PD and VP patients. SST was used to assess olfactory function of all participants in three groups including odor threshold(OT), odor discrimination(OD), odor identification(OI) and TDI total score. Siemens Verio 3.0-T MRI and 16 channel head coil was used to measure both left and right side of OB volume in PD, VP and HC groups. OB volume comparison of both sides was carried out among PD, VP and HC groups respectively, with the relationship between olfactory function and age, gender, MMSE, disease duration, H-Y stage rating and UPDRS- Ⅲ score being analyzed. Receiver operator characteristic curve(ROC) was performed to evaluate the application value of both-sides OB volume in diagnosis of PD.Results: The comparison of baseline characteristic information among PD, VP and HC group showed no statistical difference. The left-side OB volume was 32.00±4.60 in PD group, 38.53±2.41 in VP group and 38.85±2.47 in HC group, while 32.07±4.72, 38.56±2.51 and 38.79±2.56 in the right side respectively. Significant differences were found among the three groups in both left and right side of OB volume. Compared to VP and HC group, OB volume was significantly decreased in PD patients, while no statistical difference was found between VP and HC groups in both sides. There was no significant difference observed between left and right side of OB volume in all three groups. OB volume was correlated negatively with age(r=-0.989, P<0.05; r=-0.984,P<0.05 respectively), positively with MMSE score(r=0.907, P<0.05;r=0.901, P<0.05respectively) in both sides of HC group. The correlation between OB volume and MMSE was found positive in both sides(r=0.427, P<0.05; r=0.412, P<0.05 respectively) while remained irrelevant involving age, gender, disease duration, H-Y rating and UPDRS-Ⅲscore in PD group. Besides, OB volume was negatively correlated with age and disease but remained irrelevant with H-Y rating and UPDRS-Ⅲscore in both sides in VP group. TDI score was observed as positively correlated with OB volume in HC group(r=0.978, P<0.05; r=0.979, P<0.05 respectively) and also positively correlated in VP group(r=0.954, P<0.05; r=0.933, P<0.05 respectively) in both sides. And TDI score remained irrelevant with OB volume in both sides in PD patients. The area under ROC curve(AUC) of left-side OB volume for discriminating PD and HC was 0.883 with cut-off value 35.055 and AUC 0.872 with cut-off value 0.872 in the right. The sensitivity and specificity were 67.5% and 97.5% in the left-side and 67.5% and 95% in the right-side respectively. When discriminating PD and VP, the left-side AUC was 0.879 with cut-off value 34.721 and the right-side AUC was 0.869 with cut-off value 35.650. The sensitivity and specificity were 67.5% and 95% in the left-side and 67.5% and 92.5% in the right-side respectively.Conclusions: OB volume can be reliably measured via high-resolute MRI. Obvious OB volume loss was observed in both sides in PD patients compared with VP and HC groups. There was no change correlation between OB volume and SST assessed olfaction in neither side in PD group. Compared to HC group, no significant OB volume changes was found in VP group and the changes in OB volume were in line with olfactory function assessed by SST. The measurement of OB volume via MRI can provide important clinical information in the diagnosis and differential diagnosis of PD. |
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