The Study Of Non-motor Symptoms And Brain Iron Deposit Using MRI In Parkinson Disease

Part OneThe Study of Non-motor Symptoms in PDObjective The aim of this study was to explore the incidence of non-motor symptoms in PD.We also observed the diversity of non-motor symptoms among groups with different severity of disease,age of onset,duration of disease and type of motor symptom.Materials and Methods We evaluated 110 PD patients in outpatient using questionnaire about non-motor symptoms.The diagnosis of PD was made according to the UK PD Brain Bank criteria.Then we got the incidence of non-motor symptoms. The data were analyzed using SPSS13.0 for Chi-square test.A level of significance of P＜0.05 was used.Nonmotor symptoms were compared between four groups with different age of onset,severity,duration and type of motor symptom of disease.Results①The most common no-nmotor symptoms are:fatigue(70.0%), constipation(65.5%),frequency or urgency of urine(61.8%),sleep dysfunction (52.7%),MCI(49.1%),unpleasant sensations in limbs at night or while resting(49.1%),olfactory dysfunction(45.5%),depression(43.6%),over-sweating (40.9%),unexplained Pains(38.0%),sexual dysfunction(35.5%),dementia (18.2%).②Except for unpleasant sensations in limbs at night or while resting and Sexual dysfunction,a significantly difference was observed in other non-motor symptoms between different age of onset PD groups.③Between tremor dominant and bradynetic-rigid PD groups,a significantly difference was observed in fatigue,sleep dysfunction,MCI,over-sweating,sexual dysfunction and dementia,especially a highly significantly difference in MCI,over-sweating and dementia(p＜0.01).④A significantly difference was observed in constipation,frequency or urgency of urine,sleep dysfunction,over-sweating and Sexual dysfunction between different duration of PD groups.⑤A significantly difference was only observed in fatigue and depression between different severity of PD groups.⑥Preceding the classic motor features of Parkinson disease(PD),there were 21 cases of constipation(19.1%),13 cases of depression(11.8%) and 9 cases of olfactory dysfunction(7.3%).Conclusion①A significantly difference was observed in most of nonmotor symptoms between different age of onset,it suggests that there are higher incidence of non-motor symptoms in late onset patients.②MCI,ver-sweating and dementia were significantly difference on tremor dominant and bradynetic-rigid PD groups, and bradynetic-rigid PD patients may suffer worse quality of life.③With longer duration of disease,there will be higher incidence of constipation,frequency or urgency of urine,sleep dysfunction,over-sweating and sexual dysfunction,the over five-year PD goups may have more autonomic dysfunction.④Fatigue and depression were significantly associated with Hoehn and Yahr stages.⑤Some NMS can occur preceding the classic motor features of Parkinson disease(PD),these patients were more likely to be misdiagnosed initially and were more likely to have been referred to other diseases rather than PD.So NMS should be more carefully examined to target "at risk" populations before clinical onset of disease.and NMS can be useful screening measures to help clinicians to diagnosis PD.Part TwoMeasurement of brain iron in patients with Parkinson' s disease using susceptibility weighted imagingObjective To comprehensively measure iron content in nucleus of midbrain and basal ganglia in patients with Parkinson disease(PD) on phase images of susceptibility weighted imaging(SWI)sequence.Materials and Methods 42 PD patients and 37 healthy subjects were examined by using SWI sequence.Corrected phase images were obtained after postprocessed. Nucleus of midbrain and basal ganglia were drawn by hand and the phase values were measured on corrected phase images.The regions evaluated included substantia nigra compacta(SNc),substantia nigra reticulate(SNr),red nucleus(RN),subthalamic nucleus(STN),fasicula nigrale(FN),putamen(PUT),globus pallidus(GP),caudate nucleus(CN) and thalamus(THA).According to the anatomical and pathological features,corresponding brain regions were subdivided into several subregions furthermore.The correlation between phase values of 37 healthy subjects in our study and values of regional brain iron concentration in published in literatures were analyzed.Phase values were compared between PD patients and 23 age,sex-matched normal controls(NC).Phase values were also compared between two groups with different severity and duration of disease.Results①Phase values of healthy subjects were negatively correlated with published values of regional brain iron concentration(r~2=-0.839,p=0.037).②Phase values of SNc-internal and SNc-external in PD were significantly lower than that in the NC,but other brain regions no.Phase values of the more affected SNc were lower than that of the less affected side.③A significantly difference in phase values was observed in the more affected SNc-internal and SNc-external between early stage and advanced PD groups,but not in other brain regions.Phase values of the more affected SNc-internal and SNc-external in early stage group were significantly lower than that in advanced group.④No difference in phase values was observed in any brain regions between two groups with different duration of disease.Conelusion①Specific increasement of iron content of PD was observed only in SNc,but not in other brain regions.This suggests excessive iron accumulation is closely related to the apoptosis of dopaminergic neurons in SNc and the specific distribution pattern can afford useful information to differeate from other diseases.②Iron content was significantly difference on bilateral SNcs and the more affected SNc were higher than that of the less affected side.Iron content of the more affected SNc increased with evolution of PD patient's pathogenetic condition,but not with disease duration.These suggest excessive iron accumulation is likely to be a primary pathogenesis and iron measurement can be an important biomarker to evaluate the severity of disease.③SWI can be used to improve the visibility of the STN for precise surgical targeting because of higher iron content in normal STN.④The phase images acquired by SWI sequence have superb anatomic resolution.It is the optimal modality to measure brain iron content in vivo and has important significance in the study of PD and other neural degeneration diseases.