Rascovsky K, Salmon D P, Ho G J, Galasko D, Peavy G M, Hansen L A, Thal L J
Department of Neurosciences, University of California at San Diego, La Jolla 92093-0948, USA.
Neurology. 2002 Jun 25;58(12):1801-8. doi: 10.1212/wnl.58.12.1801.
Frontotemporal dementia (FTD) is currently distinguished from AD primarily on the basis of behavioral features because studies of cognition have shown negligible or inconsistent differences. However, the poor discriminability of cognitive measures may relate to reliance on imprecise clinically diagnosed groups. Therefore, a retrospective examination of neuropsychological test performance in autopsy-confirmed patients is warranted.
To compare the pattern of cognitive deficits exhibited by patients with autopsy-confirmed FTD and AD.
The profiles of cognitive deficits exhibited by patients with neuropathologic diagnosis of FTD (n = 14) or AD (n = 28) were compared. The Mattis Dementia Rating Scale (MDRS), letter and category fluency tests, Wechsler Intelligence Scale for Children-Revised block design test, Boston naming test, and clock drawing test were administered.
Multivariate analysis of covariance controlling for age, education, and level of dementia revealed that patients with FTD performed significantly worse than patients with AD on letter and category fluency tests but significantly better on the MDRS memory subscale, block design test, and clock drawing test. A logistic regression model, validated in an independent clinical sample, used letter fluency, MDRS memory, and block design scores to correctly classify 91% of AD patients and 77% of FTD patients.
A double dissociation in the pattern of cognitive deficits exhibited by FTD and AD patients was demonstrated. The FTD patients were more impaired than AD patients on word generation tasks (i.e., verbal fluency) that are sensitive to frontal lobe dysfunction but less impaired on tests of memory and visuospatial abilities sensitive to dysfunction of medial temporal and parietal association cortices.
目前，额颞叶痴呆（FTD）主要基于行为特征与阿尔茨海默病（AD）相区分，因为认知研究显示两者之间的差异可忽略不计或不一致。然而，认知测量的辨别力较差可能与依赖临床诊断不准确的分组有关。因此，有必要对经尸检确诊的患者的神经心理测试表现进行回顾性研究。
比较经尸检确诊的FTD和AD患者所表现出的认知缺陷模式。
比较了经神经病理学诊断为FTD（n = 14）或AD（n = 28）的患者所表现出的认知缺陷概况。进行了马蒂斯痴呆评定量表（MDRS）、字母和类别流畅性测试、韦氏儿童智力量表修订版积木设计测试、波士顿命名测试和画钟测试。
控制年龄、教育程度和痴呆程度的多变量协方差分析显示，FTD患者在字母和类别流畅性测试中的表现明显比AD患者差，但在MDRS记忆子量表、积木设计测试和画钟测试中的表现明显更好。在一个独立的临床样本中验证的逻辑回归模型，使用字母流畅性、MDRS记忆和积木设计分数，正确分类了91%的AD患者和77%的FTD患者。
FTD和AD患者所表现出的认知缺陷模式存在双重分离。FTD患者在对额叶功能障碍敏感的单词生成任务（即言语流畅性）上比AD患者受损更严重，但在对内侧颞叶和顶叶联合皮质功能障碍敏感的记忆和视觉空间能力测试中受损较轻。
