Department of Geriatric Neurology, Shiga Medical Centre, Moriyama-city, Shiga 524-8524, Japan.
Brain. 2010 Feb;133(Pt 2):557-67. doi: 10.1093/brain/awp295. Epub 2009 Nov 17.
The aim of this study was to investigate the association between psychotic symptoms in dementia with Lewy bodies and brain perfusion on single photon emission tomography. Based on factor analysis in 145 patients, psychotic symptoms were classified into five symptom domains (factor 1 to 4-related symptoms and delusions). The relationship between each symptom domain and brain perfusion was assessed in 100 patients with dementia with Lewy bodies, while accounting for the effects of age, sex, dementia severity, parkinsonism and dysphoria. Factor 1 symptoms (Capgras syndrome, phantom boarder, reduplication of person and place and misidentification of person) represented misidentifications, and were significantly related to hypoperfusion in the left hippocampus, insula, ventral striatum and bilateral inferior frontal gyri. Factor 3 symptoms (visual hallucination of person and feeling of presence) represented hallucinations of person and were related to hypoperfusion in the left ventral occipital gyrus and bilateral parietal areas. Delusions of theft and persecution were associated with relative hyperperfusion in the right rostral medial frontal cortex, left medial superior frontal gyrus and bilateral dorsolateral frontal cortices. This study revealed that different psychotic symptoms in dementia with Lewy bodies were associated with distinguishable cerebral networks. Visual hallucinations were related to dysfunction of the parietal and occipital association cortices, misidentifications were related to dysfunction of the limbic-paralimbic structures and delusions were related to dysfunction of the frontal cortices. Our findings provide important insights into the pathophysiological mechanisms underlying psychotic symptoms in dementia with Lewy bodies.
本研究旨在探讨路易体痴呆患者的精神病症状与单光子发射断层扫描脑灌注之间的关系。基于 145 例患者的因子分析，将精神病症状分为五个症状领域（因子 1 至 4 相关症状和妄想）。在 100 例路易体痴呆患者中，评估了每个症状领域与脑灌注的关系，同时考虑了年龄、性别、痴呆严重程度、帕金森病和情绪低落的影响。因子 1 症状（卡普格拉综合征、幻影边界、人物和地点的重复以及人物的错误识别）代表错误识别，与左海马体、脑岛、腹侧纹状体和双侧额下回皮质灌注不足显著相关。因子 3 症状（人物的幻觉）代表人物的幻觉，与左腹侧枕叶和双侧顶叶区域的灌注不足有关。盗窃和迫害妄想与右侧额内侧前皮质、左侧内侧额上回和双侧背外侧额皮质的相对高灌注有关。本研究表明，路易体痴呆患者的不同精神病症状与可区分的大脑网络有关。视觉幻觉与顶叶和枕叶联合皮质功能障碍有关，错误识别与边缘-边缘结构功能障碍有关，妄想与额叶皮质功能障碍有关。我们的发现为路易体痴呆患者精神病症状的病理生理机制提供了重要的见解。
