Nybäck H, Nyman H, Schalling D
Department of Psychiatry and Psychology, Karolinska Institute and Hospital, Stockholm, Sweden.
Acta Psychiatr Scand. 1987 Dec;76(6):648-56. doi: 10.1111/j.1600-0447.1987.tb02935.x.
Fifteen patients (51-78 yrs) with mild to moderately severe Alzheimer's dementia and 18 healthy subjects of the same age were examined by clinical rating scales and a battery of neuropsychological tests. Levels of the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenyl glycol (MHPG) and 5-hydroxyindoleacetic acid (5-HIAA) were determined in the lumbar cerebrospinal fluid (CSF). Correlations between clinical, psychological and biochemical measures were calculated in order to elucidate whether monoaminergic mechanisms are of importance for the maintenance of cognitive abilities in normal and pathological aging. The patients' performance was severely impaired in all neuropsychological tests. The mean levels of monoamine metabolites, however, did not differ between patients and volunteers. The correlations between psychological test scores and CSF metabolite levels were generally low, but mostly negative, associating a poor performance to a high activity of brain monoaminergic neurons. Thus, among the volunteers high 5-HIAA and MHPG levels correlated with poor performance in the Picture completion and the Trail making tests--measures of visuo-perceptual and visuo-motor skills. In the demented patients poor performance in the memory tests was associated with high levels of HVA and 5-HIAA. The results indicate that monoamine neuron activity is not a primary determinant for cognitive abilities in healthy elderly subjects or in demented patients. The slight negative correlation between cognitive function and metabolite concentrations in the patients may reflect a disturbance in a dopaminergic-cholinergic balance due to degenerative changes of central cholinergic pathways.
15名年龄在51至78岁之间、患有轻度至中度阿尔茨海默病痴呆症的患者以及18名同龄健康受试者接受了临床评定量表和一系列神经心理学测试。测定了腰椎脑脊液（CSF）中一元胺代谢物高香草酸（HVA）、3-甲氧基-4-羟基苯乙二醇（MHPG）和5-羟基吲哚乙酸（5-HIAA）的水平。计算了临床、心理和生化指标之间的相关性，以阐明单胺能机制在正常和病理性衰老过程中对维持认知能力是否重要。在所有神经心理学测试中，患者的表现均严重受损。然而，患者和志愿者之间一元胺代谢物的平均水平并无差异。心理测试分数与脑脊液代谢物水平之间的相关性通常较低，但大多为负相关，即较差的表现与脑单胺能神经元的高活性相关。因此，在志愿者中，高5-HIAA和MHPG水平与图片完成测试和连线测试（视觉感知和视觉运动技能的测量）中的较差表现相关。在痴呆患者中，记忆测试中的较差表现与高HVA和5-HIAA水平相关。结果表明，单胺能神经元活性不是健康老年受试者或痴呆患者认知能力的主要决定因素。患者认知功能与代谢物浓度之间的轻微负相关可能反映了由于中枢胆碱能通路的退行性变化导致的多巴胺能-胆碱能平衡紊乱。
