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目的:探讨PD患者轻度认知障碍（MCI）导致的脑功能连接密度（FCD）的改变及其与不同认知域评分的相关性。方法:选择南通大学第六附属医院神经内科自2022年1月至2024年4月收治的43例PD患者，采用蒙特利尔认知评估（MoCA）量表评估患者的认知功能，将其分为PD-MCI组（MoCA评分<26分）和PD伴认知正常（PD-NC）组（MoCA评分≥26分）。另外同时期招募年龄、性别和受教育年限与PD患者相匹配的中老年健康对照（HC）者23例作为HC组。采集3组受试者的静息态功能磁共振成像（rs-fMRI）数据并计算全脑FCD。比较3组受试者间临床资料、全脑FCD、有差异脑区FCD值的差异。通过受试者工作特征（ROC）曲线分析PD-MCI组、PD-NC组之间有差异脑区FCD值对PD-MCI、PD-NC的鉴别诊断效能，采用Pearson相关性分析检验各差异脑区FCD值与MoCA及各认知域评分的相关性。结果:PD-MCI组患者23例、PD-NC组患者20例。PD-MCI组患者的视空间与执行功能、抽象和延迟回忆评分低于PD-NC组患者，差异均有统计学意义（ P<0.05）。3组受试者FCD存在差异的脑区位于右侧海马旁回、左侧直回、右侧中央沟盖、左侧枕中回、右侧中央前回、左侧额中回、左侧内侧额上回。与HC组比较，PD-NC组与PD-MCI组患者右侧海马旁回、左侧直回、右侧中央沟盖FCD值均较高，右侧中央前回、左侧额中回、左侧内侧额上回FCD值均较低，差异均有统计学意义（ P<0.05）。与HC组比较，PD-MCI组左侧枕中回FCD值较高，差异有统计学意义（ P<0.05）。与PD-NC组比较，PD-MCI组患者右侧海马旁回FCD值较低，左侧枕中回、左侧额中回FCD值较高，差异均有统计学意义（ P<0.05）。联合应用有差异脑区FCD值鉴别PD-MCI、PD-NC的曲线下面积（AUC）为0.878，敏感度为90.0%，特异度为91.3%。PD患者右侧海马旁回、左侧枕中回及左侧额中回FCD值与MoCA评分均呈负相关关系（ P<0.05）。PD患者右侧海马旁回FCD值与视空间与执行功能、延迟回忆评分呈正相关关系（ P<0.05），左侧枕中回FCD值与视空间与执行功能、抽象评分呈负相关关系（ P<0.05），左侧额中回FCD值与视空间与执行功能、抽象及延迟回忆评分呈负相关关系（ P<0.05）。 结论:PD患者部分脑区FCD存在异常，且PD-MCI和PD-NC患者间FCD存在差异。联合应用各差异脑区FCD值对PD-MCI和PD-NC具有较高的鉴别诊断价值，且各差异脑区FCD值与认知功能改变有关。

Objective:To explore the alterations in functional connectivity density (FCD) resulted from mild cognitive impairment (MCI) and their correlations with cognitive scores in various cognitive domains in patients with Parkinson's disease (PD).Methods:Forty-three PD patients admitted to Department of Neurology, Sixth Affiliated Hospital of Nantong University from January 2022 to April 2024 were selected and divided into PD-MCI group (MoCA scores<26) and PD with normal cognition (PD-NC) group (MoCA scores≥26) according to Montreal Cognitive Assessment (MoCA). Another 23 middle-aged and elderly healthy volunteers (HC group) matched with PD patients in age, gender and education level were recruited at the same period. Resting-state functional MRI (rs-fMRI) data were collected and whole brain FCD was calculated. Differences of clinical data, whole brain FCD, and FCD in brain regions with significantly different FCD among the 3 groups were compared. Efficiency of FCD in brain regions with significantly different FCD between PD-MCI group and PD-NC group in differentially diagnosing PD-MCI and PD-NC was analyzed by receiver operating characteristic (ROC) curve. Pearson correlation was used to the analyze the correlations of FCD in brain regions with significantly different FCD with MoCA score and cognitive scores in various cognitive domains.Results:Among the 43 patients, 23 were into the PD-MCI group and 20 into the PD-NC group. PD-MCI group had significantly lower scores in the visuospatial and executive function, abstraction, and delayed memory cognitive domains than PD-NC group ( P<0.05). Brain regions with significantly different FCD among the 3 groups were the right parahippocampal gyrus, left gyrus rectus, right rolandic operculum, left middle occipital gyrus, right precentral gyrus, left middle frontal gyrus, and left medial superior frontal gyrus. Compared with the HC group, the PD-MCI group and PD-NC group had significantly increased FCD at the right parahippocampal gyrus, left gyrus rectus and right rolandic operculum, statistically decreased FCD at the right precentral gyrus, left middle frontal gyrus, and left medial superior frontal gyrus ( P<0.05). Compared with the HC group, the PD-MCI group had significantly increased FCD at the left middle occipital gyrus ( P<0.05). Compared with the PD-NC group, the PD-MCI group had significantly decreased FCD at the right parahippocampal gyrus, and statistically increased FCD at the left middle occipital gyrus and left middle frontal gyrus ( P<0.05). Area under ROC curve (AUC) of FCD in brain regions with significantly different FCD in discriminating PD-MCI and PD-NC was 0.878, with sensitivity of 90.0% and specificity of 91.3%. FCD at right parahippocampal gyrus, left middle occipital gyrus and left middle frontal gyrus was negatively correlated with MoCA score ( P<0.05); FCD at right parahippocampal gyrus was positively correlated with cognitive scores in the visuospatial and executive function, and delayed memory domains ( P<0.05); FCD at left middle occipital gyrus was negatively correlated with cognitive scores in the executive function and visual-spatial skills, and abstraction domains ( P<0.05); FCD at the left medial frontal gyrus was negatively correlated with cognitive scores in the visuospatial and executive function, abstraction and delayed memory domains ( P<0.05). Conclusions:Abnormal FCD can be noted in some brain regions of PD patients, enjoying differences between PD-MCI patients and PD-NC patients. Combined FCD in brain regions with significantly different FCD has high value in differentially diagnosing PD-MCI and PD-NC, and FCD in brain regions with significantly different FCD is correlated with cognitive function changes in PD patients.