Cho Maeng Je, Lyoo In Kyoon, Lee Dong Woo, Kwon Jun Soo, Lee Jae Sung, Lee Dong Soo, Jung June Key, Lee Myung Chul
Department of Neuropsychiatry, Clinical Research Institute, Seoul National University College of Medicine and Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744 South Korea.
J Affect Disord. 2002 May;69(1-3):159-66. doi: 10.1016/s0165-0327(01)00301-9.
Recently, there have been studies suggesting that depressive pseudodementia would include early-stage dementing disorder. Through the comparison of the 99mTc-HMPAO single photon emission computed tomography (SPECT) image of depressive pseudodementia subjects, healthy comparison subjects, depressed subjects free of cognitive impairment, and dementia of Alzheimer's type (DAT) subjects, we aimed to see part of pathophysiology of the depressive pseudodementia of elderly patients.
Study subjects consisted of seven patients with depressive pseudodementia, seven healthy comparison subjects, seven patients with depression free of cognitive impairment, and eleven patients with DAT. Depression patients were diagnosed according to DSM-III-R. DAT patients were diagnosed by DSM III-R and NINCDS-ADRDA criteria of DAT. Other measures for assessment include Hamilton Rating Scale for Depression and Mini Mental State Exam. All underwent 99mTc-HMPAO SPECT scan. The images of each group were analyzed using statistical parametric mapping of Friston, which compares the images on voxel-by-voxel basis.
The results were as follows (1) The DAT group showed significant decreases of cerebral blood flow (CBF) in the right frontal, right temporal region, and both parietal regions as compared with control group (P < 0.05). (2) The depression group showed a significant decrease of CBF in the left frontal region as compared with control group (P < 0.05). (3) The depressive pseudodementia group showed significant decreases of CBF in both parietal regions as compared with control group (P < 0.05). (4) The depressive pseudodementia group showed significant decreases of CBF in the right temporal region and both parietal regions as compared with depression group (P < 0.05). (5) The DAT group showed significant decreases of CBF in the right temporal region, both frontal regions, and both parietal regions as compared with depressive pseudodementia group (P < 0.05).
The small number of subjects may make it difficult to generalize from our results. Because decreased CBF in depressive pseudodementia is found while the subjects were depressed, we cannot tell whether it is a state marker or a trait marker.
The depressive pseudodementia group showed decreased CBF in the temporo-parietal region, similar to that of the DAT group and different from that of the depression group.
最近，有研究表明抑郁性假性痴呆可能包括早期痴呆症。通过比较抑郁性假性痴呆患者、健康对照者、无认知障碍的抑郁症患者以及阿尔茨海默病型痴呆（DAT）患者的99mTc-HMPAO单光子发射计算机断层扫描（SPECT）图像，我们旨在了解老年患者抑郁性假性痴呆的部分病理生理学机制。
研究对象包括7例抑郁性假性痴呆患者、7例健康对照者、7例无认知障碍的抑郁症患者和11例DAT患者。抑郁症患者根据DSM-III-R进行诊断。DAT患者根据DSM III-R和DAT的NINCDS-ADRDA标准进行诊断。其他评估措施包括汉密尔顿抑郁量表和简易精神状态检查。所有患者均接受99mTc-HMPAO SPECT扫描。使用Friston的统计参数映射对每组图像进行分析，该方法逐体素比较图像。
结果如下：（1）与对照组相比，DAT组右侧额叶、右侧颞叶和双侧顶叶的脑血流量（CBF）显著降低（P<0.05）。（2）与对照组相比，抑郁症组左侧额叶的CBF显著降低（P<0.05）。（3）与对照组相比，抑郁性假性痴呆组双侧顶叶的CBF显著降低（P<0.05）。（4）与抑郁症组相比，抑郁性假性痴呆组右侧颞叶和双侧顶叶的CBF显著降低（P<0.05）。（5）与抑郁性假性痴呆组相比，DAT组右侧颞叶、双侧额叶和双侧顶叶的CBF显著降低（P<0.05）。
研究对象数量较少可能使我们的结果难以推广。由于在抑郁性假性痴呆患者抑郁时发现CBF降低，我们无法确定它是状态标记还是特质标记。
抑郁性假性痴呆组颞顶叶区域的CBF降低，与DAT组相似，与抑郁症组不同。
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