Shinno Hideto, Inagaki Takuji, Miyaoka Tsuyoshi, Okazaki Shihoh, Kawamukai Tetsuya, Utani Etsuko, Inami Yasushi, Horiguchi Jun
Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan.
J Neurol Sci. 2007 Sep 15;260(1-2):132-8. doi: 10.1016/j.jns.2007.04.017. Epub 2007 May 30.
The cognitive decline in Alzheimer's disease (AD) patients has been reported to involve alterations in the medial temporal lobe and the posterior cingulate gyrus. On the other hand, the neurochemical pathologies of the behavioral and psychological symptoms of dementia (BPSD) have not been sufficiently discussed. The aim of this study was to clarify the pathologies of BPSD in AD patients.
Thirty patients with probable AD were included and underwent the following assessments: Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), Story Recall Test (SRT), Behavioral pathology in Alzheimer's disease (BEHAVE-AD) and proton MRS ((1)H-MRS). None of them had been medicated for BPSD.
The MRS study revealed that MMSE, CDT, and SRT scores were positively related to N-acetyl-aspartate (NAA)/creatine(Cr) and negatively related to myoinositol (mI)/Cr in the posterior cingulate gyrus, but not in the anterior cingulate gyrus. On the other hand, the scores obtained in two categories of BEHAVE-AD (delusional thought/ activity disturbances) were negatively related with NAA/Cr and positively related with mI/Cr in the anterior cingulate gyrus, but not in the posterior cingulate gyrus.
We conclude that BPSD and the decline in cognitive function in AD might have separate pathologies.
据报道，阿尔茨海默病（AD）患者的认知衰退涉及内侧颞叶和后扣带回的改变。另一方面，痴呆的行为和心理症状（BPSD）的神经化学病理学尚未得到充分讨论。本研究的目的是阐明AD患者BPSD的病理学特征。
纳入30例可能患有AD的患者，并进行以下评估：简易精神状态检查表（MMSE）、画钟试验（CDT）、故事回忆测试（SRT）、阿尔茨海默病行为病理学（BEHAVE-AD）和质子磁共振波谱（（1）H-MRS）。他们均未接受过BPSD的药物治疗。
磁共振波谱研究显示，MMSE、CDT和SRT评分在后扣带回中与N-乙酰天门冬氨酸（NAA）/肌酸（Cr）呈正相关，与肌醇（mI）/Cr呈负相关，但在前扣带回中并非如此。另一方面，BEHAVE-AD两类（妄想思维/活动障碍）的得分在前扣带回中与NAA/Cr呈负相关，与mI/Cr呈正相关，但在后扣带回中并非如此。
我们得出结论，AD患者的BPSD和认知功能衰退可能具有不同的病理学特征。
