Division of Behavioral Neurology, Department of Neurology, and Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S41-4. doi: 10.1016/S1353-8020(11)70015-3.
The objective of this paper is to compare and contrast the clinical, neuropsychological, and neuroimaging findings in patients with mild cognitive impairment (MCI) associated with underlying Alzheimer's disease (AD) versus Lewy body disease (LBD) pathology. MCI refers to a clinical syndrome with impairment in one or more cognitive domains, with essentially normal performance of activities of daily living. Patients with the amnesic subtype of MCI often develop the dementia syndrome and neuroimaging findings characteristic of AD [e.g., hippocampal atrophy on magnetic resonance imaging (MRI), temporoparietal and posterior cingulate hypometabolism on fluorodeoxyglucose positron emission tomography (FDG-PET), positive uptake on amyloid PET, normal striatonigral uptake on dopamine transporter scanning (DAT), etc.]. In contrast, the MCI syndrome associated with LBD pathology regardless of the coexisting presence or absence of parkinsonism is usually characterized by impairment in the executive and/or visuospatial domains, and the cognitive features are often preceded by REM sleep behavior disorder by many years. There is minimal hippocampal atrophy on MRI, minimal if any cortical uptake on amyloid-PET, and one would predict that hypometabolism would be maximal in the occipital cortex on FDG-PET and uptake would be decreased on DAT. The early data suggests that differentiating underlying AD vs LBD in the MCI phase will be feasible.
本文旨在比较和对比伴有潜在阿尔茨海默病（AD）与路易体病（LBD）病理学的轻度认知障碍（MCI）患者的临床、神经心理学和神经影像学表现。MCI 是指一种临床综合征，存在一个或多个认知领域的损害，日常生活活动的表现基本正常。遗忘型 MCI 患者常发展为痴呆综合征和 AD 的神经影像学表现[例如，磁共振成像（MRI）上的海马萎缩，氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）上的颞顶和后扣带回代谢低下，淀粉样 PET 上的阳性摄取，多巴胺转运蛋白扫描（DAT）上的纹状体摄取正常等]。相比之下，无论是否伴有帕金森病，与 LBD 病理学相关的 MCI 综合征通常以执行和/或视空间领域的损害为特征，认知特征通常在 REM 睡眠行为障碍多年前就出现了。MRI 上的海马萎缩最小，如果有的话，皮质上的淀粉样蛋白摄取也最小，人们预计 FDG-PET 上的枕叶皮层代谢低下最大，DAT 上的摄取减少。早期数据表明，在 MCI 阶段区分潜在的 AD 与 LBD 是可行的。
