Shimada Aiko, Hashimoto Hiroshi, Kawabe Joji, Higashiyama Shigeaki, Kai Toshihiro, Kataoka Kouhei, Tagawa Ryo, Kawarada Youjirou, Nakanishi Aki, Inoue Koki, Shiomi Susumu, Kiriike Nobuo
Departments of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Japan.
Osaka City Med J. 2011 Jun;57(1):11-9.
Donepezil hydrochloride (Donepezil) is an acetylcholinesterase inhibitor (AChEI) that is used for the symptomatic treatment of Dementia of the Alzheimer's Type (DAT). Recently, the effects of AChEI in patients with DAT have been investigated using positron emission tomography (PET) or single photon emission computed tomography (SPECT). This study is to evaluate the usefulness of fluorine-18-fluorodeoxyglucose (FDG)-PET in assessing the therapeutic response of Donepezil to DAT using Regions of Interest (ROI) analysis.
The participants included eleven outpatients diagnosed as having DAT according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The patients were performed FDG-PET before initiating Donepezil therapy and after 12 weeks of medication. Cognitive change was measured using the Japanese version of the Alzheimer's disease Assessment Scale cognitive subscale (ADAS-J cog) and the group was divided into Responders and Non-responders based on these results. We used FDG-PET to investigate glucose metabolism of the brain and measured FDG uptake in the ROI set in each lobe of the brain. Then the ratios of the post-treatment uptake to pre-treatment uptake were determined.
In the Responders, the mean ratios in the frontal, temporal, occipital, parietal, and temporoparietal lobes were 2.18, 1.62, 1.15, 1.12, and 1.09 respectively. The mean ratios of the Non-responders were 0.69, 0.88, 0.75, 0.98, and 0.68 respectively. Significant differences were found between the ratios of the Responders and Non-responders in the frontal and occipital lobes (p < 0.05).
These findings suggest that FDG-PET could be useful for the evaluation for monitoring response to Donepezil.
盐酸多奈哌齐是一种乙酰胆碱酯酶抑制剂，用于阿尔茨海默病型痴呆（DAT）的对症治疗。最近，已使用正电子发射断层扫描（PET）或单光子发射计算机断层扫描（SPECT）研究了乙酰胆碱酯酶抑制剂对DAT患者的影响。本研究旨在使用感兴趣区（ROI）分析评估氟-18-氟脱氧葡萄糖（FDG）-PET在评估多奈哌齐对DAT治疗反应中的作用。
参与者包括11名根据《精神疾病诊断与统计手册》第四版（DSM-IV）诊断为患有DAT的门诊患者。患者在开始多奈哌齐治疗前和用药12周后进行FDG-PET检查。使用日本版阿尔茨海默病评估量表认知分量表（ADAS-J cog）测量认知变化，并根据这些结果将患者分为反应者和无反应者。我们使用FDG-PET研究大脑的葡萄糖代谢，并测量在大脑每个叶中设置的ROI中的FDG摄取。然后确定治疗后摄取与治疗前摄取的比率。
在反应者中，额叶、颞叶、枕叶、顶叶和颞顶叶的平均比率分别为2.18、1.62、1.15、1.12和1.09。无反应者相应的平均比率分别为0.69、0.88、0.75、0.98和0.68。反应者和无反应者在额叶和枕叶的比率之间存在显著差异（p<0.05）。
这些发现表明，FDG-PET可用于评估多奈哌齐治疗反应的监测。
