Tokuchi Ryou, Deguchi Kentaro, Yamashita Toru, Abe Koji
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University.
Nihon Ronen Igakkai Zasshi. 2014;51(4):342-9. doi: 10.3143/geriatrics.51.342.
The purpose of this study was to determine the relationship between the combined presence of medial temporal atrophy (MTA) and white matter lesions (WMLs: periventricular hyperintensity (PVH) and deep white matter hyperintensity) and the cognitive/emotional function in Alzheimer's disease (AD) patients.
The subjects included 193 patients with AD and 30 normal elderly controls. On MRI, MTA was rated using the Voxel-based specific regional analysis system for AD (VSRAD). WMLs was also estimated using the Fazekas scale. The MRI measurements were classified as follows: MTA=VSRAD<2 or ≥2; WML absent (-) 0/1 or present (+) 2/3. A total of five groups were assessed, including four groups with AD and a control group. The cognitive and emotional functions were evaluated with neuropsychological tests (Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Geriatric Depression Scale (GDS) and Apathy scale).
Four AD groups showed significant declines in the both the MMSE and FAB scores compared to that observed in the control group (()p<0.001, ()p<0.01, ()p<0.05). Among these four AD groups, the MMSE and FAB scores of in the VSRAD<2 and WML (-) groups significantly declined to VSRAD≥2 and WML (+), respectively group (()p<0.05). VSRAD≥2 and WML (+) groups showed demonstrated significantly higher scores than the control group on the GDS (()p<0.05), and the PVH (+) group exhibited significantly higher scores than the control group on the apathy scale ((*)p<0.05). Multiple regression analysis identified a VSRAD score of ≥2 and the presence of WMLs to be most significantly associated with the cognitive and emotional functions.
Combined presence of MTA and WML is associated with lower MMSE and FAB scores. Furthermore, depression is also associated with MTA and WML, while PVH independently affects the degree of apathy.
本研究旨在确定内侧颞叶萎缩（MTA）与白质病变（WMLs：脑室周围高信号（PVH）和深部白质高信号）共同存在与阿尔茨海默病（AD）患者认知/情感功能之间的关系。
研究对象包括193例AD患者和30名正常老年对照。在MRI上，使用基于体素的AD特异性区域分析系统（VSRAD）对MTA进行评分。WMLs也采用Fazekas量表进行评估。MRI测量结果分类如下：MTA = VSRAD <2或≥2；WML不存在（-）0/1或存在（+）2/3。共评估了五组，包括四组AD患者和一组对照组。通过神经心理学测试（简易精神状态检查表（MMSE）、额叶评估量表（FAB）、老年抑郁量表（GDS）和淡漠量表）对认知和情感功能进行评估。
与对照组相比，四组AD患者的MMSE和FAB评分均显著下降（（）p<0.001，（）p<0.01，（）p<0.05）。在这四组AD患者中，VSRAD<2和WML（-）组的MMSE和FAB评分分别显著下降至VSRAD≥2和WML（+）组（（）p<0.05）。VSRAD≥2和WML（+）组在GDS上的得分显著高于对照组（（）p<0.05），PVH（+）组在淡漠量表上 的得分显著高于对照组（（*）p<0.05）。多元回归分析确定VSRAD评分≥2和WML的存在与认知和情感功能最显著相关。
MTA和WML共同存在与较低的MMSE和FAB评分相关。此外，抑郁也与MTA和WML相关，而PVH独立影响淡漠程度。
