Antonelli Incalzi Raffaele, Marra Camillo, Giordano Alessandro, Calcagni Maria Lucia, Cappa Antonella, Basso Salvatore, Pagliari Gabriella, Fuso Leonello
Dept. of Geriatrics, Catholic University, Rome, Italy.
J Neurol. 2003 Mar;250(3):325-32. doi: 10.1007/s00415-003-1005-4.
Some analogy exists between cognitive impairment in hypoxemic patients with chronic obstructive pulmonary disease (COPD) and Alzheimer's disease (AD). We purposed to verify whether the analogy extends to the cerebral perfusion pattern. Ten normal subjects, 15 COPD patients with and 18 without hypoxemia, and 15 patients with mild AD matched for age and educational level underwent brain perfusion single photon emission computed tomography (SPECT) and neuropsychological assessment. Normal subjects and non hypoxemic COPD patients had comparable perfusion patterns. The average perfusion decreased from non hypoxemic to hypoxemic COPD and, then, to AD patients. Hypoperfusion of associative areas was the hallmark of AD, whereas the average perfusion of anterior cortical and subcortical regions did not distinguish AD and hypoxemic COPD patients. Both COPD groups scored higher than AD patients (p </= 0.01) in 13 cognitive tests but below the normal in selected tests of verbal attainment, attention and deductive thinking. Perfusion of anterior cortical and subcortical regions of the dominant hemisphere was directly correlated with the number of correctly performed neuropsychologic tests. In conclusion, anterior cerebral hypoperfusion and selected neuropsychological dysfunctions characterized hypoxemic COPD patients and could herald frontal-type cognitive decline with the worsening of the hypoxemia.
慢性阻塞性肺疾病（COPD）低氧血症患者的认知障碍与阿尔茨海默病（AD）之间存在一些相似之处。我们旨在验证这种相似性是否扩展到脑灌注模式。10名正常受试者、15名有低氧血症和18名无低氧血症的COPD患者以及15名年龄和教育水平相匹配的轻度AD患者接受了脑灌注单光子发射计算机断层扫描（SPECT）和神经心理学评估。正常受试者和无低氧血症的COPD患者具有相似的灌注模式。平均灌注从无低氧血症的COPD患者到有低氧血症的COPD患者，然后到AD患者逐渐降低。联合区域灌注不足是AD的标志，而额叶皮质和皮质下区域的平均灌注并不能区分AD患者和低氧血症的COPD患者。在13项认知测试中，两个COPD组的得分均高于AD患者（p≤0.01），但在语言能力、注意力和演绎思维的特定测试中低于正常水平。优势半球额叶皮质和皮质下区域的灌注与正确完成的神经心理学测试数量直接相关。总之，大脑前叶灌注不足和特定的神经心理学功能障碍是低氧血症COPD患者的特征，并且随着低氧血症的加重可能预示着额叶型认知衰退。
