RT Journal Article
SR Electronic
T1 Hypometabolism in the supplementary and anterior cingulate cortices is related to dysphagia in Parkinson's disease: a cross-sectional and 3-year longitudinal cohort study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e002249
DO 10.1136/bmjopen-2012-002249
VO 3
IS 3
A1 Akio Kikuchi
A1 Toru Baba
A1 Takafumi Hasegawa
A1 Michiko Kobayashi
A1 Naoto Sugeno
A1 Masatoshi Konno
A1 Emiko Miura
A1 Yoshiyuki Hosokai
A1 Toshiyuki Ishioka
A1 Yoshiyuki Nishio
A1 Kazumi Hirayama
A1 Kyoko Suzuki
A1 Masashi Aoki
A1 Shoki Takahashi
A1 Hiroshi Fukuda
A1 Yasuto Itoyama
A1 Etsuro Mori
A1 Atsushi Takeda
YR 2013
UL http://bmjopen.bmj.com/content/3/3/e002249.abstract
AB Objective Dysphagia is one of the cardinal symptoms of Parkinson’s disease (PD). It is closely related to the quality of life and longevity of PD patients. The aim of the study is to clarify the pathophysiological mechanisms responsible for dysphagia in PD. Design A cross-sectional and longitudinal comparative study. Setting Tohoku University Hospital. Participants Eight patients with dysphagia, 15 patients without dysphagia and 10 normal control subjects. Main outcome measures The time needed for swallowing initiation and changes in brain glucose metabolism at baseline and after a 3-year follow-up period. Results The time needed for swallowing initiation was significantly longer in the patients with dysphagia compared with the patients without dysphagia at baseline and after the 3-year follow-up period (p<0.05). The patients with dysphagia exhibited hypometabolism in the supplementary motor area (SMA) and the anterior cingulate cortex (ACC) compared with the 10 normal control subjects at baseline (uncorrected p<0.001). After the 3-year follow-up period, the number of brain areas showing hypometabolism increased, involving not only the SMA and the ACC but also the bilateral medial frontal lobes, middle cingulate cortex, thalamus and right superior, middle, inferior and orbital frontal gyri (uncorrected p<0.001). In contrast, the patients without dysphagia showed virtually no regional hypometabolism at baseline (uncorrected p<0.001) and only a small degree of hypometabolism in the SMA and ACC after the 3-year follow-up period (uncorrected p<0.001). Conclusions These results suggest that dysphagia in PD patients is mainly related to a difficulty in swallowing initiation that is based on a combination of poor movement planning due to SMA dysfunction and impaired cognitive processing due to ACC dysfunction.