Frontiers in neurology · 2026
Regional brain dysfunction patterns associated with rapid eye movement sleep behavior disorder and visual hallucinations in Parkinson's disease: a resting-state fMRI study with exploratory ROI-based factorial analysis.
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She Lifang, Wei Xiong, Cai Hongyang, Zhou Liuchen, Li Zonghong, Pan Yang
Аннотация
BACKGROUND: Rapid eye movement sleep behavior disorder (RBD) and visual hallucinations (VH) are prognostically relevant non-motor symptoms in Parkinson's disease (PD), but their combined effects on local brain dysfunction remain unclear.
OBJECTIVE: To characterize regional brain dysfunction patterns associated with RBD and VH in PD and to explore candidate-region symptom-related effects within regions showing overall between-group differences.
METHODS: In this cross-sectional study, 96 patients with PD were divided into four groups according to the presence or absence of RBD and VH (24 per group). Resting-state functional MRI was analyzed using amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo). Whole-brain four-group analyses were first used to identify regions with overall between-group differences, followed by exploratory ROI-based 2 × 2 factorial analyses within candidate regions. Additional whole-brain voxel-wise 2 × 2 factorial analyses were performed as supplementary analyses. Correlations between imaging indices and clinical scales were also examined.
RESULTS: Patients with both RBD and VH showed the greatest clinical burden and worse cognitive performance. Whole-brain analyses revealed abnormalities in frontal, temporal, cerebellar, supplementary motor, and precuneus regions. Exploratory candidate-region analyses with Benjamini-Hochberg FDR correction showed RBD-related patterns in precuneus ReHo, cerebellar lobule VIII ReHo, and SMA ALFF; VH-related patterns in OFC ReHo, precuneus ReHo, cerebellar Crus I ReHo, SMA ALFF, and temporal pole ALFF; and interaction-like patterns in OFC ReHo and temporal pole ALFF. These ROI-based findings were interpreted as post hoc exploratory results rather than independent confirmatory evidence. Imaging abnormalities were correlated with RBD severity, freezing of gait, hallucination burden, and cognition.
CONCLUSION: Coexisting RBD and VH may identify a clinically more severe PD subtype associated with regional abnormalities involving cerebellar, motor, default mode, and association-related regions. Symptom-related main and interaction patterns should be interpreted as candidate-region exploratory findings requiring further confirmation in larger studies.
OBJECTIVE: To characterize regional brain dysfunction patterns associated with RBD and VH in PD and to explore candidate-region symptom-related effects within regions showing overall between-group differences.
METHODS: In this cross-sectional study, 96 patients with PD were divided into four groups according to the presence or absence of RBD and VH (24 per group). Resting-state functional MRI was analyzed using amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo). Whole-brain four-group analyses were first used to identify regions with overall between-group differences, followed by exploratory ROI-based 2 × 2 factorial analyses within candidate regions. Additional whole-brain voxel-wise 2 × 2 factorial analyses were performed as supplementary analyses. Correlations between imaging indices and clinical scales were also examined.
RESULTS: Patients with both RBD and VH showed the greatest clinical burden and worse cognitive performance. Whole-brain analyses revealed abnormalities in frontal, temporal, cerebellar, supplementary motor, and precuneus regions. Exploratory candidate-region analyses with Benjamini-Hochberg FDR correction showed RBD-related patterns in precuneus ReHo, cerebellar lobule VIII ReHo, and SMA ALFF; VH-related patterns in OFC ReHo, precuneus ReHo, cerebellar Crus I ReHo, SMA ALFF, and temporal pole ALFF; and interaction-like patterns in OFC ReHo and temporal pole ALFF. These ROI-based findings were interpreted as post hoc exploratory results rather than independent confirmatory evidence. Imaging abnormalities were correlated with RBD severity, freezing of gait, hallucination burden, and cognition.
CONCLUSION: Coexisting RBD and VH may identify a clinically more severe PD subtype associated with regional abnormalities involving cerebellar, motor, default mode, and association-related regions. Symptom-related main and interaction patterns should be interpreted as candidate-region exploratory findings requiring further confirmation in larger studies.