Wahlund L O, Julin P, Lannfelt L, Lindqvist J, Svensson L
Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden.
Dement Geriatr Cogn Disord. 1999 Jul-Aug;10(4):262-8. doi: 10.1159/000017130.
We investigated the influence of the apolipoprotein (ApoE) epsilon4 allele on the rate of brain atrophy in patients with clinical dementia and in subjects at risk for dementia. Eighty-one subjects, consecutively referred to a memory clinic due to symptoms of dementia, went through a comprehensive examination, including cerebral magnetic resonance imaging. After an initial investigation these subjects were divided into one of six diagnostic groups; Alzheimer's disease (AD, n = 23), objective cognitive impairment (OCI, n = 27), subjective cognitive impairment (SCI, n = 17), vascular dementia (VaD), frontotemporal dementia (FTD) and unspecified dementia (USD). The last three groups were joined into one diagnostic group designated 'other dementia' (OD, altogether n = 14). In order to study the progression of cognitive impairment as well as the rate of atrophy in different brain regions all subjects were reinvestigated after an average period of 16 months. Interest was focused on investigating if those subjects with one or two epsilon4 alleles differed in either dementia progression or rate of brain atrophy compared to those without the epsilon4 allele. We found that the ApoE epsilon4 carriers had a statistically significantly larger increase in ventricular volume as compared with the ApoE epsilon4 noncarriers. In all diagnostic groups the ApoE epsilon4 carriers showed a greater rate of ventricular volume increase, as compared to the noncarriers. However, this difference was statistically significant only for the OD subjects. No statistical significant changes over time were seen for whole brain volume or volume of the temporal lobes and the medial temporal lobes. The diagnostic groups differed in dementia progression with the AD subjects having the most pronounced reduction in MMSE scores as compared to subjects at risk for AD (OCI and SCI subjects). The presence of ApoE epsilon4 allele did not influence the change in MMSE in any of the diagnostic groups.
我们研究了载脂蛋白（ApoE）ε4等位基因对临床痴呆患者及有痴呆风险受试者脑萎缩率的影响。81名因痴呆症状连续转诊至记忆门诊的受试者接受了包括脑磁共振成像在内的全面检查。初步检查后，这些受试者被分为六个诊断组之一：阿尔茨海默病（AD，n = 23）、客观认知障碍（OCI，n = 27）、主观认知障碍（SCI，n = 17）、血管性痴呆（VaD）、额颞叶痴呆（FTD）和未分类痴呆（USD）。最后三组合并为一个诊断组，称为“其他痴呆”（OD，共n = 14）。为了研究认知障碍的进展以及不同脑区的萎缩率，所有受试者在平均16个月后再次接受检查。我们关注的是，与没有ε4等位基因的受试者相比，那些携带一个或两个ε4等位基因的受试者在痴呆进展或脑萎缩率方面是否存在差异。我们发现，与ApoE ε4非携带者相比，ApoE ε4携带者的脑室体积增加在统计学上具有显著差异。在所有诊断组中，与非携带者相比，ApoE ε4携带者的脑室体积增加率更高。然而，这种差异仅在OD受试者中具有统计学意义。全脑体积、颞叶和内侧颞叶体积随时间未出现统计学上的显著变化。各诊断组在痴呆进展方面存在差异，与AD风险受试者（OCI和SCI受试者）相比，AD受试者的简易精神状态检查表（MMSE）评分下降最为明显。ApoE ε4等位基因的存在在任何诊断组中均未影响MMSE的变化。
