Nobili Flavio, Frisoni Giovanni B, Portet Florence, Verhey Frans, Rodriguez Guido, Caroli Anna, Touchon Jacques, Calvini Piero, Morbelli Silvia, De Carli Fabrizio, Guerra Ugo P, Van de Pol Laura A, Visser Pieter-Jelle
Clinical Neurophysiology Unit, Dept. of Endocrinological and Medical Sciences, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy.
J Neurol. 2008 Sep;255(9):1344-53. doi: 10.1007/s00415-008-0897-4. Epub 2008 Aug 1.
The Development of Screening Guidelines and Clinical Criteria of Predementia Alzheimer's Disease (DESCRIPA) multicenter study enrolled patients with MCI or subjective cognitive complaints (SUBJ), a part of whom underwent optional brain perfusion SPECT. These patients were classified as SUBJ (n = 23), nonamnestic MCI (naMCI; n = 17) and amnestic MCI (aMCI; n = 40) based on neuropsychology. Twenty healthy subjects formed the control (CTR) group. Volumetric regions of interest (VROI) analysis was performed in six associative cortical areas in each hemisphere. ANOVA for repeated measures, corrected for age and center, showed significant differences between groups (p = 0.01) and VROI (p < 0.0001) with a significant group-region interaction (p = 0.029). In the post hoc comparison, SUBJ did not differ from CTR. aMCI disclosed reduced uptake in the left hippocampus and bilateral temporal cortex (compared with CTR) or in the left hippocampus and bilateral parietal cortex (compared with SUBJ). In the naMCI group, reduced VROI values were found in the bilateral temporal cortex and right frontal cortex. In the comparison between aMCI and naMCI, the former had lower values in the left parietal cortex and precuneus. Discriminant analysis between SUBJ/CTR versus all MCI patients allowed correct allocations in 73 % of cases. Mean VROI values were highly correlated (p < 0.0001) with the learning measure of a verbal memory test, especially in the bilateral precunei and parietal cortex and in the left hippocampus. In a subset of 70 patients, mean VROI values showed a significant correlation (p < 0.05) with the white matter hyperintensities score on MRI. In conclusion, MCI subtypes have different perfusion patterns. The aMCI group exhibited a pattern that is typical of early Alzheimer's disease, while the naMCI group showed a more anterior pattern of hypoperfusion. Instead, a homogeneous group effect was lacking in SUBJ.
痴呆前阿尔茨海默病筛查指南与临床标准的制定（DESCRIPA）多中心研究纳入了轻度认知障碍（MCI）或有主观认知主诉（SUBJ）的患者，其中部分患者接受了选择性脑灌注单光子发射计算机断层扫描（SPECT）。这些患者根据神经心理学被分为SUBJ组（n = 23）、非遗忘型MCI（naMCI；n = 17）和遗忘型MCI（aMCI；n = 40）。20名健康受试者组成对照组（CTR）。对每个半球的六个联合皮质区域进行了感兴趣区容积（VROI）分析。经年龄和中心校正的重复测量方差分析显示，组间（p = 0.01）和VROI之间存在显著差异（p < 0.0001），且存在显著的组 - 区域交互作用（p = 0.029）。在事后比较中，SUBJ与CTR无差异。aMCI显示左侧海马及双侧颞叶皮质摄取减少（与CTR相比），或左侧海马及双侧顶叶皮质摄取减少（与SUBJ相比）。在naMCI组中，双侧颞叶皮质和右侧额叶皮质的VROI值降低。在aMCI与naMCI的比较中，前者在左侧顶叶皮质和楔前叶的值较低。SUBJ/CTR与所有MCI患者之间的判别分析在73%的病例中能够正确分类。平均VROI值与言语记忆测试的学习测量高度相关（p < 0.0001），尤其是在双侧楔前叶和顶叶皮质以及左侧海马。在70名患者的子集中，平均VROI值与MRI上的白质高信号评分显著相关（p < 0.05）。总之，MCI亚型具有不同的灌注模式。aMCI组表现出典型的早期阿尔茨海默病模式，而naMCI组显示出更靠前的灌注不足模式。相反，SUBJ组缺乏同质的组效应。
