Giannakopoulos P, Gold G, Duc M, Michel J P, Hof P R, Bouras C
Department of Psychiatry, Clinic of Geriatric Psychiatry, HUG Belle-Idée, Geneva, Switzerland.
Acta Neuropathol. 2000 Aug;100(2):189-95. doi: 10.1007/s004019900166.
To examine the neuroanatomical correlates of spatial and temporal disorientation in Alzheimer's disease (AD), we performed an anterograde clinicopathological study of 29 patients with clinically and neuropathologically confirmed AD. Spatial and temporal disorientation was assessed using the locational orientation subtests of the Mini Mental State Examination and the Benton's test for temporal orientation. Quantitative analysis of neurofibrillary tangles and senile plaques were performed in the CA1 field of the hippocampus, layers II and V of the entorhinal cortex, and layers II-III and V-VI of areas 9, 7, 39, 19, 37, 20 and 23 in the right hemisphere. Forward stepwise logistic regression was used to assess the relationship between lesion densities and the presence of either spatial or temporal disorientation; severity scores and brain weight were included as covariants. A statistically significant relationship was found between neurofibrillary tangle densities in Brodmann's areas 7, 23 and the CA1 field of hippocampus and both spatial and temporal disorientation. Senile plaque counts did not correlate with any of the neuropsychological parameters. Both temporal and spatial disorientation in AD are related to the degeneration of the same pathways linking the hippocampus with the superior parietal and posterior cingulate cortex in the right hemisphere. These observations are discussed with respect to the notion of global corticocortical disconnection in AD.
为研究阿尔茨海默病（AD）患者空间和时间定向障碍的神经解剖学相关性，我们对29例临床和神经病理学确诊为AD的患者进行了一项顺行性临床病理研究。使用简易精神状态检查表的位置定向子测试和本顿时间定向测试评估空间和时间定向障碍。在海马CA1区、内嗅皮质第II和V层以及右侧半球9、7、39、19、37、20和23区的第II - III层和V - VI层对神经原纤维缠结和老年斑进行定量分析。采用向前逐步逻辑回归评估病变密度与空间或时间定向障碍之间的关系；将严重程度评分和脑重量作为协变量纳入。发现布罗德曼7区、23区以及海马CA1区的神经原纤维缠结密度与空间和时间定向障碍均存在统计学显著关系。老年斑计数与任何神经心理学参数均无相关性。AD患者的时间和空间定向障碍均与右侧半球将海马与顶上叶和后扣带回皮质相连的相同通路的退化有关。结合AD中整体皮质 - 皮质失联的概念对这些观察结果进行了讨论。
