Kandiah Nagaendran, Chander Russell, Zhang Angeline, Yee Cheong Chin
Dept of Neurology, National Neuroscience Institute, Singapore; Duke-NUS, Singapore.
Dept of Neurology, National Neuroscience Institute, Singapore.
J Neurol Sci. 2014 Feb 15;337(1-2):162-6. doi: 10.1016/j.jns.2013.11.042. Epub 2013 Dec 4.
To study the association between cerebral white matter disease and burden of behavioral and psychological symptoms (BPSD) among patients with moderate to severe AD.
Patients with moderate to severe AD having undergone MRI brain, cognitive and behavioral evaluations were studied. BPSD was diagnosed based on established clinical guidelines. White matter hyperintensity (WMH) and medial temporal lobe atrophy (MTA) were quantified by a blinded rater.
122 AD patients were studied. Age [76.84 vs. 72.70, p = 0.014] and MMSE [11.69 vs. 15.16, p < 0.001] was significantly higher in patients with BPSD. BPSD patients demonstrated higher periventricular [5.44 vs. 4.21, p < 0.001], deep subcortical [5.07 vs. 3.43, p < 0.001], and total WMH [10.51 vs. 7.65, p < 0.001] compared to non-BPSD patients. Higher proportion of BPSD patients had WMH in the highest tertile of severity (82.22% vs. 45.45%, p < 0.001). After correcting for age, baseline cognition and degree of MTA, total WMH remained significantly associated with a diagnosis of BPSD [odds ratio: 1.45 (1.14-1.85; p = 0.002)]. With severe WMH, the association is significantly increased [odds ratio: 4.3 (1.3-12.5); p = 0.016].
WMH is independently associated with BPSD in moderate to severe AD. Optimizing vascular risk factors may be a strategy to reduce the severity of BPSD in AD.
研究中重度阿尔茨海默病（AD）患者脑白质病变与行为和心理症状负担（BPSD）之间的关联。
对接受过脑部磁共振成像（MRI）检查、认知和行为评估的中重度AD患者进行研究。BPSD根据既定的临床指南进行诊断。由一位不知情的评估者对白质高信号（WMH）和内侧颞叶萎缩（MTA）进行量化。
共研究了122例AD患者。BPSD患者的年龄[76.84对72.70，p = 0.014]和简易精神状态检查表（MMSE）评分[11.69对15.16，p < 0.001]显著更高。与无BPSD的患者相比，BPSD患者的脑室周围WMH[5.44对4.21，p < 0.001]、深部皮质下WMH[5.07对3.43，p < 0.001]和总WMH[10.51对7.65，p < 0.001]更高。BPSD患者中处于最高三分位数严重程度的WMH比例更高（82.22%对45.45%，p < 0.001）。在校正年龄、基线认知和MTA程度后，总WMH仍与BPSD诊断显著相关[比值比：1.45（1.14 - 1.85；p = 0.002）]。对于严重WMH，这种关联显著增加[比值比：4.3（1.3 - 12.5）；p = 0.016]。
在中重度AD中，WMH与BPSD独立相关。优化血管危险因素可能是降低AD中BPSD严重程度的一种策略。
