İdiyopatik parkinson hastalarında evrelere göre nörogörüntüleme ile hipokampal volüm ölçümleri ve bilişsel düzey ile korelasyonu
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Date
2021
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Parkinson hastalığı motor ve non motor semptomlar ile prezente olan ilerleyici nörodejeneratif bir hastalıktır. Tremor, bradikinezi, rijitide, postural instabilite kardinal motor semptomlardır. Düşünmede yavaşlama-bilişsel fonksiyonlarda bozulma, depresyon-duygudurum bozukluğu, uyku bozuklukları, ağrılar non motor semptomlar arasında yer alır. Bilişsel bozulma, hastaların günlük yaşam aktivitelerini etkileyen ve bakım gereksinimine yol açan, hastalığın ilerleyen evrelerinde ortaya çıkabilen ve hastalık süreci sırasında sıkı takip edilmesi gereken önemli non-motor bulgulardandır. Parkinson hastalığı evreleri sırasında değişen düzeylerde bilişsel bozukluk ortaya çıkabilmekte olup literatürde Parkinson hastalığına bağlı demans prevalansı %31 olarak bildirilmektedir (1). Hipokampal atrofi sıklıkla Alzheimer hastalığında rastlanan nörogörüntüleme bulgusuyken, Parkinson hastalığı demasında da kortikal atrofi tespit edilmiş olup bazı araştırmalarda Parkinson hastalığı demansında hipokampal atrofi izlendiği bildirilmiştir (2,3). Bizim araştırmamızda Parkinson ve Hareket Hastalıkları polikliniğimizde takip edilen İdyopatik Parkinson Hastalarının hipokampal hacim ölçümleri ve bilişsel düzey değerlendirmelerinin yapılarak, hastalık evreleriyle korelasyonunun araştırılması planlanmıştır. Çalışmamız İdiyopatik Parkinson hastalığı (İPH) tanısı almış 64 hasta üzerinde yapılmıştır. Hastalığın evrelendirilmesinde Modifiye Hoehn ve Yahr Skalası (H&Y) ve Birleşik Parkinson Hastalığı Değerlendirme Ölçeği (BPHDÖ) kulanılmıştır. Hipokampal hacim ölçümleri Manyetik Rezonans Görüntüleme (MRG) T1 Koronal Mprage sekansı ile manuel olarak hesaplandı. Klinik bilişsel düzeyler standartize minimental durum değerlendirme (MMDD) testi ve Montreal Bilişsel Değerlendirme (MOBİD) Ölçeği ile değerlendirilmiştir. Çalışmamız sonucunda hasta grubunda hipokampal volüm azalmış ve sol HKV MMDD ile ilişkili bulunmuştur. H&Y evresi arttıkça ve BPHDÖ motor skoru arttıkça MMDD ve MoCA skorlarında azalma gözlenmiştir. Çalışmamızda, İdiyopatik Parkinson hastalığında hastaların hipokampal volüm ölçümleri ile bilişsel düzeyleri arasında anlamlı bir ilişki olduğu ve bu ilişkinin hastalık evresi arttıkça daha belirgin olduğu izlenmiştir. Buradan yola çıkarak, bilişsel fonksiyon değerlendirmeleri ile koordine olarak hipokampal volüm kaybı izlenen İPH hastalarında erken bilişsel tedaviye başlanmasının, hastaların bilişsel rezervlerinin korunması ve yaşam kalitelerinin iyileştirilmesi açısından büyük önem taşıyacağı düşünülmektedir. Anahtar Kelimeler: Parkinson Hastalığı, Manyetik Rezonans Görüntüleme, Hipokampal Volüm Ölçümü, Bilişsel Düzey
Parkinson's disease is a progressive neurodegenerative disease that presents with motor and non-motor symptoms. Tremor, bradykinesia, rigidity, postural instability are cardinal motor symptoms. Slow thinking-impaired cognitive functions, depression-mood disorder, sleep disorders, pain are non-motor symptoms. Cognitive impairment is one of the most important non-motor findings that affect the daily life activities of the patients and lead to the need for care, can occur in the later stages of the disease, and must be followed closely during the disease process. Different levels of cognitive impairment may occur during the stages of Parkinson's disease, and the prevalence of dementia due to Parkinson's disease is reported as %31 in the literature (1). While hippocampal atrophy is often a neuroimaging finding in Alzheimer's disease, cortical atrophy has been detected in Parkinson's disease, and some studies have reported hippocampal atrophy in Parkinson's disease dementia (2,3). In our study, it was planned to investigate the correlation with the disease stages by making hippocampal volume measurements and cognitive level evaluations in Idiopathic Parkinson's Patients followed in our Parkinson and Movement Disorders polyclinic. Our study was conducted on 64 patients diagnosed with Idiopathic Parkinson's disease(IPH). Modified Hoehn and Yahr Scale (H&Y) and Unified Parkinson's Disease Rating Scale (UPDRS) were used in the staging of the disease. Hippocampal volume measurements were calculated manually with the Magnetic Resonance Imaging (MRI) T1 Coronal Mprage sequence. Clinical cognitive levels were evaluated with the standardized minimental state test (MMST) and the Montreal Cognitive Assessment (MoCA) Scale. As a result of our study, the hippocampal volume decreased in the patient group and left HCV was found to be associated with MMST. As the H&Y stage increased and the UPDRS motor score increased, a decrease was observed in the MMST and MoCA scores. In our study, it was observed that there is a significant relationship between hippocampal volume measurements and cognitive levels of patients in idiopathic Parkinson's disease, and this relationship becomes more evident as the disease stage increases. Based on this, it is thought that early initiation of cognitive treatment in patients with IPD who has hippocampal volume loss in coordination with cognitive function evaluations will be of great importance in terms of preserving the cognitive reserves of the patients and improving their quality of life. Keywords: Parkinson's Disease, Magnetic Resonance Imaging, Hippocampal Volume Measurement, Cognitive Level
Parkinson's disease is a progressive neurodegenerative disease that presents with motor and non-motor symptoms. Tremor, bradykinesia, rigidity, postural instability are cardinal motor symptoms. Slow thinking-impaired cognitive functions, depression-mood disorder, sleep disorders, pain are non-motor symptoms. Cognitive impairment is one of the most important non-motor findings that affect the daily life activities of the patients and lead to the need for care, can occur in the later stages of the disease, and must be followed closely during the disease process. Different levels of cognitive impairment may occur during the stages of Parkinson's disease, and the prevalence of dementia due to Parkinson's disease is reported as %31 in the literature (1). While hippocampal atrophy is often a neuroimaging finding in Alzheimer's disease, cortical atrophy has been detected in Parkinson's disease, and some studies have reported hippocampal atrophy in Parkinson's disease dementia (2,3). In our study, it was planned to investigate the correlation with the disease stages by making hippocampal volume measurements and cognitive level evaluations in Idiopathic Parkinson's Patients followed in our Parkinson and Movement Disorders polyclinic. Our study was conducted on 64 patients diagnosed with Idiopathic Parkinson's disease(IPH). Modified Hoehn and Yahr Scale (H&Y) and Unified Parkinson's Disease Rating Scale (UPDRS) were used in the staging of the disease. Hippocampal volume measurements were calculated manually with the Magnetic Resonance Imaging (MRI) T1 Coronal Mprage sequence. Clinical cognitive levels were evaluated with the standardized minimental state test (MMST) and the Montreal Cognitive Assessment (MoCA) Scale. As a result of our study, the hippocampal volume decreased in the patient group and left HCV was found to be associated with MMST. As the H&Y stage increased and the UPDRS motor score increased, a decrease was observed in the MMST and MoCA scores. In our study, it was observed that there is a significant relationship between hippocampal volume measurements and cognitive levels of patients in idiopathic Parkinson's disease, and this relationship becomes more evident as the disease stage increases. Based on this, it is thought that early initiation of cognitive treatment in patients with IPD who has hippocampal volume loss in coordination with cognitive function evaluations will be of great importance in terms of preserving the cognitive reserves of the patients and improving their quality of life. Keywords: Parkinson's Disease, Magnetic Resonance Imaging, Hippocampal Volume Measurement, Cognitive Level
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Keywords
Parkinson Hastalığı, Manyetik Rezonans Görüntüleme, Hipokampal Volüm Ölçümü, Bilişsel Düzey, Parkinson's Disease, Magnetic Resonance Imaging, Hippocampal Volume Measurement, Cognitive Level, Nöroloji, Neurology, Biliş, Cognition, Bilişsel işlevler, Cognitive functions, Hipokampus, Hippocampus, Manyetik rezonans görüntüleme, Magnetic resonance imaging, Nörogörüntüleme, Neuroimaging, Parkinson hastalığı, Parkinson disease
