Study On The Diffusion Tensor Imaging Of Parkinson’s Disease With Cognitive Impairment

Background and Objective:Parkinson’s disease(PD)is a degenerative disease of the central nervous system that mainly threatens the health of the middle-aged and elderly people.The disease is insidious and slowly progressing.The clinical manifestations are mainly due to the decrease of dopamine in the substantia nigra and the increase of acetylcholine.In recent years,non-motor symptoms such as Parkinson’s disease with cognitive impairment(PD-CI)have become more and more important to patients’ lives,which has gradually attracted the attention of researchers and clinicians.Because some patients have mild symptoms of early cognitive impairment and clinical manifestations are not typical,they do not attract attention and attention from caregivers and clinicians.They not only can cause serious impairment of self-care ability of patients,but also increase the risk of death of patients and families.The economic burden.Therefore,early screening and identification of cognitive impairment in patients with PD,drug treatment to improve their cognitive function status,to improve the quality of life of patients,reduce family and social burden plays a decisive role.However,due to the differences in diagnostic criteria and cognitive assessment scales used in current studies,the current diagnosis of PD-CI is still based on clinical diagnosis,lacks objectivity,and lacks effective and simple neuroimaging techniques.As for the missed diagnosis and misdiagnosis of the disease,it often occurs.Therefore,the clinical application of functional magnetic resonance diffusion tensor imaging(DTI)tends to study cognitive dysfunction in patients.Researchers at home and abroad have applied DTI extensively in the study of cognitive impairment in Parkinson’s disease and found that the white matter structure of patients with PD-CI is abnormal.It is believed that damage of white matter fiber bundles is closely related to cognitive impairment.However,most of the previous studies are manually delineating areas of interest of the white matter.Due to the differences in operators and methods,experimental data may be biased,which may affect the assessment of PD-CI diagnosis.Therefore,the use of computer software to automatically divide and name fiber bundles,and analyze its relationship with the evaluation of patients’ cognitive function,is of great significance for the accurate diagnosis of PD-CI.In this study,Montreal Cognitive Assessment(MOCA)scale was used to evaluate the cognitive function status of PD patients.DTI was used to detect whether the white matter fiber bundles of PD patients were abnormal.The aim was to investigate the white matter fibrosis and Parkinson’s disease combined with cognitive impairment(PD-CI).Relationship.Provides important reference and basis for PD-CI early detection,early intervention,and early diagnosis and treatment.Methods:35 patients with Parkinson’s disease at the Department of Neurology was continuously screened,First Affiliated Hospital of Zhengzhou University from September 2016 to September 2017.According to the different cognitive status,they can be divided into two groups.14 cases of Parkinson’s disease with normal cognitive function(PD-CN)and 21 cases of Parkinson’s disease combined with cognitive impairment(PD-CI)were selected and 20 healthy volunteers in the same period were selected as the control group to be evaluated by the MOCA scale.Magnetic resonance images of PD patients and controls were processed by DTI combined with FSL software to obtain the fractional anisotropy(FA)of 48 root white matter fiber bundles.Spatial analysis(tract-based spatial statistics,TBSS)software to analyze the differences between the PD group and the control group,including genu of corpus callosum,body of corpus callosum,splenium of corpus callosum,right cingulum(hippocampus),left cingulum(hippocampus),right fornix(cres)/stria terminalis,left fornix(cres)/stria terminalis,right superior fronto-occipital fasciculus,left superior fronto-occipital fasciculus,right uncinate fasciculus,left uncinate fasciculus etc.11 fiber bundles,and then PD-CN group andPD-CI group Statistics with the control group Analysis.Fiber bundles with no significant differences in FA values were excluded and then statistically analyzed in PD-CN and PD-CI groups.Finally,the Pearson correlation analysis was used to analyze the relationship between the FA values of the statistically significant fiber bundles in the PD-CI group and the MoCA scale scores.Results:1.There was no significant difference in gender,age,and years of education between the PD-CN group,the PD-CI group and the control group(P>0.05),and the difference in scores on the MOCA scale was statistically significant(P<0.05);there was no significant difference in disease duration and H&Y grade between PD-CN group and PD-CI group(P>0.05).2.The FA values of genu of corpus callosum,body of corpus callosum,s plenium of corpus callosum,right cingulum(hippocampus),left cingulum(hippoc ampus),right fornix(cres)/stria terminalis,left fornix(cres)/stria terminalis,right superior fronto-occipital fasciculus,left superior fronto-occipital fasciculus,right uncinate fasciculus,left uncinate fasciculus were statistically analyzed in the P D-CN group,the PD-CI group and the control group.The final results showed that there was no statistically significant difference in FA values between right uncinate fasciculus,left uncinate fasciculus,and the differences among the rem aining 9 fiber bundles were statistically significant(P<0.05).3.The statistically significant white matter fiber bundles in the above three groups were statistically analyzed again in the PD-CN group and the PD-CI group.Finally,no differences were found in the FA values of right fornix(cres)/stria terminalis.The significance of the study was that the differences among the remaining 8 fiber bundles were statistically significant(P<0.05).4.The Pearson correlation analysis method was used to analyze the above 8 fiber bundle FA values and MOCA scale scores,and the results showed that splenium of corpus callosum,right cingulum(hippocampus),right superior fronto-occipital fasciculus,left superior fronto-occipital fasciculus and MOCA volume Table scores were positively correlated(P<0.05).Conclusions:1.PD patients with cognitive impairment associated with the damage of the white matter fiber bundles,involved in a wide range of brain white matter.2.The use of DTI to detect abnormal changes in white matter fiber bundles may be one of the objective methods for early cognitive decline in PD patients.3.The degree of cognitive impairment in patients with PD was positively correlated with the severity of splenium of corpus callosum,right cingulum(hip pocampus),right superior fronto-occipital fasciculu and left superior fronto-occi pital fasciculus.