Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK.
Neurobiol Aging. 2012 Mar;33(3):627.e1-627.e12. doi: 10.1016/j.neurobiolaging.2011.04.003. Epub 2011 May 18.
Medial temporal lobe atrophy (MTA) is a recognized marker of Alzheimer's disease (AD), however, it can be prominent in frontotemporal lobar degeneration (FTLD). There is an increasing awareness that posterior atrophy (PA) is important in AD and may aid the differentiation of AD from FTLD. Visual rating scales are a convenient way of assessing atrophy in a clinical setting. In this study, 2 visual rating scales measuring MTA and PA were used to compare atrophy patterns in 62 pathologically-confirmed AD and 40 FTLD patients. Anatomical correspondence of MTA and PA was assessed using manually-delineated regions of the hippocampus and posterior cingulate gyrus, respectively. Both MTA and PA scales showed good inter- and intrarater reliabilities (kappa > 0.8). MTA scores showed a good correspondence with manual hippocampal volumes. Thirty percent of the AD patients showed PA in the absence of MTA. Adding the PA to the MTA scale improved discrimination of AD from FTLD, and early-onset AD from normal aging. These results underline the importance of considering PA in AD diagnosis, particularly in younger patients where medial temporal atrophy may be less conspicuous.
内侧颞叶萎缩 (MTA) 是阿尔茨海默病 (AD) 的公认标志物，但也可能在额颞叶变性 (FTLD) 中突出。人们越来越意识到后部萎缩 (PA) 在 AD 中很重要，并且可能有助于 AD 与 FTLD 的区分。视觉评分量表是在临床环境中评估萎缩的一种方便方法。在这项研究中，使用了 2 种测量 MTA 和 PA 的视觉评分量表，比较了 62 例经病理证实的 AD 和 40 例 FTLD 患者的萎缩模式。使用手动划定的海马体和后扣带回区域分别评估 MTA 和 PA 的解剖对应关系。MTA 和 PA 量表的组内和组间可靠性均良好（kappa > 0.8）。MTA 评分与手动海马体体积具有良好的相关性。30%的 AD 患者在没有 MTA 的情况下出现 PA。将 PA 添加到 MTA 量表中可提高 AD 与 FTLD 的区分度，以及早发性 AD 与正常衰老的区分度。这些结果强调了在 AD 诊断中考虑 PA 的重要性，特别是在内侧颞叶萎缩不太明显的年轻患者中。
