Pantel J, Schönknecht P, Essig M, Schröder J
Sektion Gerontopsychiatrie, Psychiatrische Universitätsklinik Heidelberg.
Fortschr Neurol Psychiatr. 2004 Apr;72(4):192-203. doi: 10.1055/s-2004-818394.
This study aims to systematically analyze the relationship between neuropsychological deficits and regional cerebral atrophic changes in Alzheimer's dementia (AD). As an extension of previous studies we not only investigated substructures of the medial temporal lobe but also included other relevant cerebral regions such as frontal, temporal, and parietal lobes. This approach was based on the assumption that morphological correlates of global and specific cognitive dysfunction might reflect to a certain degree the neuronal basis of the respective function. Accordingly, the functional role assigned to a certain cerebral structure or region can be further elucidated which might lead to a better understanding of the clinical and neuropsychological heterogeneity of AD. Fifty patients with AD (NINCDS-ADRDA criteria) and 20 healthy elderly control subjects were included. All patients and controls were examined on a standardized neuropsychological test battery. In addition, magnetic resonance imaging (MRI) of the brain was performed. Volumes of the whole brain, CSF-spaces, amygdala-hippocampus complex, frontal lobes, temporal lobes, and parietal lobes were measured using a standardized protocol. AD-patients were characterized by neuropsychological deficits with respect to memory, language, praxia, cognitive speed as well as attention and concentration. These deficits were differentially correlated with regional atrophic changes. In particular, volumes of the right amygdala-hippocampus complex were correlated with declarative memory performance in the non-verbal visual domain. Furthermore, an association between left temporo-parietal regions and aspects of semantic memory, as well as verbal recall and left frontal regions could be established. The validity of our results is supported by recent findings from neuropathological and functional neuroimaging studies. In conclusion, our data indicate that MRI-based volumetry can be successfully used to detect morphological correlates of neuropsychological heterogeneity in AD and that this methodological approach allows to fruitfully study the neuronal basis of cognitive functions.
本研究旨在系统分析阿尔茨海默病（AD）中神经心理学缺陷与局部脑萎缩变化之间的关系。作为先前研究的拓展，我们不仅研究了内侧颞叶的亚结构，还纳入了其他相关脑区，如额叶、颞叶和顶叶。该方法基于这样一种假设，即整体和特定认知功能障碍的形态学关联可能在一定程度上反映相应功能的神经基础。因此，可以进一步阐明赋予特定脑结构或区域的功能作用，这可能有助于更好地理解AD的临床和神经心理学异质性。纳入了50例符合NINCDS - ADRDA标准的AD患者和20名健康老年对照受试者。所有患者和对照均接受标准化神经心理测试组的检查。此外，还进行了脑部磁共振成像（MRI）检查。使用标准化方案测量全脑、脑脊液间隙、杏仁核 - 海马复合体、额叶、颞叶和顶叶的体积。AD患者在记忆、语言、运动功能、认知速度以及注意力和专注力方面存在神经心理学缺陷。这些缺陷与局部萎缩变化存在差异相关性。特别是，右侧杏仁核 - 海马复合体的体积与非言语视觉领域的陈述性记忆表现相关。此外，左侧颞顶叶区域与语义记忆方面以及言语回忆与左侧额叶区域之间存在关联。神经病理学和功能性神经影像学研究的最新发现支持了我们结果的有效性。总之，我们的数据表明基于MRI的体积测量法可成功用于检测AD中神经心理学异质性的形态学关联，并且这种方法学途径有助于卓有成效地研究认知功能的神经基础。
