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1 Hyeonyong Lee, Hyonghu Park, Jaeseung Lee, Inchul Im Department of Radiology, Inje Univiersity Busan Paik Hospital, Department of Radiology, Bongseng Memorial Hospital**, Department of Radiological Science, Dongeui University 이현용, 박형후, 이재승, 임인철 인제대학교부산백병원영상의학과, 봉생병원영상의학과, 동의대학교방사선학과 This study is to investigate neuro-anatomical correlation between neuropsychological results and cerebral cortex thickness of cognitive ability in the brain MRI targeting the patients with mild cognitive impairment. It was that 78 people who were diagnosed as first Parkinson s disease followed by neuropsychological screening battery(parkinson s disease with mild cognitive impairment: 39 people; Parkinson s disease with normal cognition: 39 people) and 32 people of normal group were selected. Correlation between mild cognitive impairment and normal cognitive impairment and correlation between neuropsychological screening battery and cerebral cortex thickness in the brain MRI were performed by independent sample t-test or Pearson correlation coefficient and then level of significance of collected data was verified in p<0.05. As a result, cerebral cortex thickness of the Parkinson s disease with mild cognitive impairment in both side precuneas and right inferiortemporal lobe had statistically significant decrease. In addition, function of visuospatial ability, verbal and visual memory was reduced in neuropsychological screening battery for cognitive assessment. Especially, there was correlation between neuropsychological screening battery of verbal and visual memory anatomical left precuneus. Key Words : Brain Magnetic resonance image (MRI), Cerebral cortex thickness, Parkinson's disease, impairment (PD-MCI), Neuropsychological screening battery (NSB) Parkinson's disease with mild cognitive. Corresponding Author: Inchul Im icim@deu.ac.kr Tel: No , Dong-Eui University, 995 Eomgwang-no, Busanjin-gu, Busan, korea Received : April 30, 2014 Revised :June 15, 2014 Accepted : June 25, 2014

2 78 ( : 39 ; : 39 ) 32. T p<0.05.,.. :,,,, Ⅰ. (substantia nigra) (pars compacta) (Parkinson's disease. PD) 0.3%, % , , %. 70% (trmor), (brady), (rigidity), (postural instability) (cognitive impairment), (dementia), (depressive disorder), (mental disorders).,,,, (activities of daily living). (mild cognitive impairment. MCI). (neuropsychological screening battery. NSB), (cognitive assessment. CA), (autonomic function test. AFT). (gradient echo. GE) (susceptibility weighted image. SWI) (Fe) (magnetic resonance image. MRI). 23%.. Ⅱ (, Parkinson's disease with mild cognitive impairment. PD-MCI: 39 ;, Parkinson's disease with normal cognition. PD-NC: 39 ).

32. 1987 MDS-UPDRS (Movement Disorder Society-The Unified Parkinson's Disease Rating Scale) (non-motor experiences of daily living: Part 1), (motor experiences of daily living: Part 2), (Motor

3 MDS-UPDRS (Movement Disorder Society-The Unified Parkinson's Disease Rating Scale) (non-motor experiences of daily living: Part 1), (motor experiences of daily living: Part 2), (Motor examination: Part 3), (Motor complication: Part 4). 5 "0" (normal), "1" (slight), "2" (mild), "3" (moderate), "4" (severe) Fig. 1. (cytoarchitectonic) 52 (Brodmann),,,, 5. (clinical dementia rating scale. CDR) (global deterioration scale. GDS) (CDR>1) (GDS>4). 3.0T MR(Achieva 3.0T TX, Philips, netherlands) 16 (Sense-NV-16 coil, Philips, netherlands). T1 T2 (T1- and T2-weighted image) (fluid attenuation inversion recovery. FLAIR). 3 T1 (sagittal) Table 1. Parameters 3-D sagittal images TR/TE (msec) 9.8/4.6 FOV (mm) Flip angle ( ) 8 Slice thickness (mm) 1 Matrix/Pixel size 254/254 NEX 1 Scan time (min:sec) 5:16 Note) TR/TE: repetition time/echo time, FOV: field of view, NEX: number of excitations. MR techniques was used the number of slice 170, fold over direction AP, SENSE, P reduction 1, S reduction 2, and Phase of data sample factor 1.5. (Pia mater) (inter-subject registration),, (brain folding) (Freesurfer Ver. 5.1, MGH: Massachusetts General Hospital, Boston MA, USA). Fig. 2.

(raw data) RF(radio frequency) (eddy currents) (intensity bias correction) (normalization). (Talairach template) T1 watershed (skull, eyes, neck, dura) (triangular tesselation) (smoothing).

4 (raw data) RF(radio frequency) (eddy currents) (intensity bias correction) (normalization). (Talairach template) T1 watershed (skull, eyes, neck, dura) (triangular tesselation) (smoothing). (mesh) (Euclidean distance).,,,, 5,,,. T (Pearson correlation coefficient) p<0.05. Ⅲ. Table Table 3 5. (attention), (language), (visuospatial ability), (memory), (Frontal/executive functions) 5 (p<0.05). (Rey complex figure test. RCFT) 12.3% (verbal memory) (delay recall) 48.4%, (visual memory) (immediately recall) 37.6%. SPSS Windows Ver.19.0(SPSS Inc., Chicago, USA). (Chi square test) (Fisher exact test). (n=39) Characteristics PD-MCI PD-NC p-value Sex (female. %) Age (year) 68.15± ± Age at onset (year) 66.40± ± Disease duration (month) 18.80± ± Education (year) 8.60± ± Note) PD-MCI: Parkinson's disease patients with mild cognitive impairment, PD-NC: Parkinson's disease patients with normal cognitive.

(n=39) Items PD-MCI PD-NC p-value Attention Forward digit span Backward digit span Stroop-color reading Language korean-boston naming teat Calculation 5.10±1.60 5.50±1.40 3.02±0.80 3.50±1.00 67.40±27.

5 (n=39) Items PD-MCI PD-NC p-value Attention Forward digit span Backward digit span Stroop-color reading Language korean-boston naming teat Calculation 5.10± ± ± ± ± ± ± ± ± ± Visuospatial ability Rey complex figure test 27.00± ± Memory Verbal memory Immediately recall Delay recall Recognition Visual memory Immediately recall Delay recall Recognition Frontal/executive functions mean contrast program score mean go-no-go test score 14.90± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Note) PD-MCI: Parkinson's disease patients with mild cognitive impairment, PD-NC: Parkinson's disease patients with normal cognitive. Fig. 3 Linux-centos 4. 3 T1 ( ) ( ). (left and right precuneus), (right-inferiortemporal lobe) (p<0.05). 5.63±1.83mm2, 4.51±0.94mm2, 2.26±1.06mm2 (Talairach) X, Y, Z 48.80, , (Table 4). Table 5 6. Item Area (mm 2 ) PD-MCI PD-NC Neuroanatomical area RIT RP LP ± ± ± ± ± ±12.36 Difference (mm 2 ) 5.63± ± ±1.06 Talairach * X Y Z NVC Note) RIT: right-inferiortemporal lobe, RP and LP: right and left precuneus, PD-MCI: Parkinson's disease patients with mild cognitive impairment, PD-NC: Parkinson's disease patients with normal cognitive. *, Talairach (MN1305) coordinate of the maximum., number of the vertices in cluster. NSB items Right-inferiortemporal lobe r-value * p-value Visuospatial ability Rey complex figure test *, the result value by Pearson correlation analysis., the result value by independent two sample T test

6 NSB items Memory Verbal memory Immediately recall Delay recall Recognition Visual memory Immediately recall Delay recall Recognition Left precuneus Right precuneus r-value * p-value r-value * p-value *, the result value by Pearson correlation analysis., the result value by independent two sample T test (r) (p>0.05). (verbal and visual memory) (immediately and delay recall) (r) 0.613, 0.588, 0.564, (p<0.05). (r<±0.1 r<±0.3, p>0.05). IV.. 84% 5 17%... 5 (visuospatial ability) (Rey complex figure test. RCFT) (memory) (verbal memory) (visual memory). Yarnall (amnestic MCI) (non-amnestic MCI) (Alzheimer's disease) (dementia with Lewy body). 3 T1 (left and right precuneus), (right-inferiortemporal lobe) (Pearson correlation coefficient. r>±0.5). (p>0.05). (Seoul neuropsychological screening battery. SNSB)

7 ., (episodic memory), (reflective self-awareness) (scan time) (raw data). V... (voxel-based morphometry. VBM) (inter-subject registration),.. Acknowledgement 2014.( 2014AA045) Reference L. M. de Lau, M. M. Breteler, "Epidemiology of Parkinson's disease", Lancet. Neurology, Vol. 5, No. 6, pp , A. Schrag, Y. Ben-Shlomo, N. P. Quinn, "Cross sectional prevalence survey of idiopathic Parkinson's disease and Parkinsonism in London", BMJ, Vol.321, No.7252, pp , Health Insurance Review & Assessment Service, "Ministry for health, welfare and family affairs", 2010 ( A. W. Willis, M. Schootman, N. Kung, B. A. Evanoff, J. S. Perlmutter, B. A. Racette, "Predictors of survival in patients with Parkinson disease", Arch. Neurol., Vol. 69, No. 5, pp , K. R. Chaudhuri, D. G. Healy, A. H. Schapira, "Non-motor symptoms of Parkinson's disease: diagnosis and management", Lancet. Neurol., Vol. 5, No. 2, pp , A. Sauerbier, K. Ray Chaudhuri, "Non-motor symptoms: the core of multi-morbid Parkinson's disease", Br. J. Hosp. Med., Vol. 75, No. 1, pp , M. W. Bondi, G. E. Smith, "Mild cognitive impairment: a concept and diagnostic entity in need of input from neuropsychology", J. Int. Neuropsychol. Soc., Vol. 20, No. 2, pp , K. Matsuura, M. Maeda, K. Yata, Y. Ichiba, T. Yamaguchi, K. Kanamaru, H. Tomimoto, "Neuromelanin magnetic resonance imaging in Parkinson's disease and multiple system atrophy", Eur. Neurol., Vol. 70, No. 1-2, pp , 2013.

8 H. J. Ahn, J. Chin, A. Park, B. H. Lee, S. W. Seo, D. L. Na, "Seoul Neuropsychological Screening Battery-dementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients", J. Korean Med. Sci., Vol. 25, No. 7, pp , A. Gmitrowicz, A. Kucharska, "Developmental disorders in the fourth edition of the American classification: diagnostic and statistical manual of mental disorders (DSM IV - optional book)", Psychiatr. Pol., Vol. 28, No. 5, pp , , T. W. Kjaer, M. Nowak, H. C. Lou, "Reflective self-awareness and conscious states: PET evidence for a common midline parietofrontal core", Neuroimage, Vol. 17, No. 2, pp , H. C. Lou, B. Luber, M. Crupain, et. al., "Parietal cortex and representation of the mental Self", Proc. Natl. Acad. Sci. USA., Vol. 101, No. 17, pp , D. A. Regier, W. E. Narrow, M. B. First, T. Marshall, "The APA classification of mental disorders: future perspectives", Psychopatholog, yvol. 35, No. 2-3, pp , C. G. Goets, W. Poewe, O. Rascol, C. Sampaio, G. T. Stebbins, C. Counsell, N. Giladi, R. G. Holloway, C. G. Moore, G. K. Wenning, M. D. Yahr, L. Seidl; Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease, "The Unified Parkinson's Disease Rating Scale (UPDRS): Status and recommendations", Mov. Disord., Vol. 18, No. 7, pp , M. J. Falvo, B. K. Schilling, G. M. Earhart, "Parkinson's disease and resistive exercise: rationale, review, and recommendations", Mov. Disord., Vol. 23, No. 1, pp. 1-11, S. A. Choi, J. H. Kim, M. S. Lee, "Status of Korea patients with Parkinson's disease before diagnosis", J. Korean Neurol. Assoc., Vol. 18, No. 6, pp , Korean Neurological Association, "Neurology" 2nd Edition, Panmun Education, p. 452, A. J. Yarnall, L. Rochester, D. J. Burn, "Mild cognitive impairment in Parkinson's disease", Age. Ageing, Vol. 42, No. 5, pp , H. Hildebrandt, F. Fink, A. Kastrup, M. Haupts, P. Eling, "Cognitive profiles of patients with mild cognitive impairment or dementia in Alzheimer's or Parkinson's disease", Dement. Geriatr. Cogn. Dis. Extra., Vol. 3, No. 1, pp , S. H. Choi, "Cognitive Function and MRI Parameters in Mild Cognitive Impairment Subjects", University of Ulsan graduate school, J. E. Lee, "Neuroanatomic basis of amnestic MCI differs in patients with and without Parkinson disease", Yonsei University graduate school, P. C. Fletcher, C. D. Frith, S. C. Baker, T. Shallice, R. S. Frackowiak, R. J. Dolan, "The mind's eye-precuneus activation in memory-related imagery", Neuroimage, Vol. 2, No. 3, pp.

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