Ting Windsor Kwan-Chun, Fischer Corinne E, Millikin Colleen P, Ismail Zahinoor, Chow Tiffany W, Schweizer Tom A
Keenan Research Centre for Biomedical Science, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1T8.
Curr Alzheimer Res. 2015;12(2):165-72. doi: 10.2174/1567205012666150204130456.
Grey matter atrophy in the right hemisphere has been shown to be more severe in dementia patients with delusions, suggesting a neuroanatomical localization that may be pertinent to impending neurodegeneration. Delusional symptoms may arise when atrophy in these areas reduces the regulatory functions of the right hemisphere, in tandem with asymmetric neuropathology in the left hemisphere. We hypothesized that delusional patients with either amnestic mild cognitive impairment (MCI) or early Alzheimer Disease (AD) would experience more pronounced grey matter atrophy in the right frontal lobe compared with matched patients without delusions.
We used neuroimaging and clinical data obtained from the Alzheimer's Disease Neuroimaging Initiative. A comparison group of twenty-nine nondelusional MCI/early AD participants were compared with twenty-nine delusional participants using voxel-based morphometry, matched at baseline by age, sex, education, and Mini-Mental State Exam score. All included participants were diagnosed with amnestic MCI at study baseline.
Fifteen voxel clusters of decreased grey matter in participants with delusions were detected. Prominent grey matter decrease was observed in the right precentral gyrus, right inferior frontal gyrus, right insula, and left middle occipital gyrus, areas that may be involved in control of thought and emotions.
Greater right fronto-temporal grey matter atrophy was observed in MCI or early AD participants with delusions compared to matched patients without delusions. Consistent with our predictions, asymmetric grey matter atrophy in the right hemisphere may contribute to development of delusions through loss of executive inhibition.
研究表明，患有妄想症的痴呆患者右半球灰质萎缩更为严重，这表明可能存在与即将发生的神经退行性变相关的神经解剖学定位。当这些区域的萎缩降低右半球的调节功能，并与左半球的不对称神经病理学同时出现时，可能会出现妄想症状。我们假设，与无妄想的匹配患者相比，患有遗忘型轻度认知障碍（MCI）或早期阿尔茨海默病（AD）的妄想症患者右额叶灰质萎缩会更明显。
我们使用了从阿尔茨海默病神经影像学倡议中获得的神经影像学和临床数据。使用基于体素的形态测量法，将29名无妄想的MCI/早期AD参与者的对照组与29名妄想症参与者进行比较，两组在基线时按年龄、性别、教育程度和简易精神状态检查得分进行匹配。所有纳入的参与者在研究基线时均被诊断为遗忘型MCI。
在妄想症参与者中检测到15个灰质减少的体素簇。在右侧中央前回、右侧额下回、右侧岛叶和左侧枕中回观察到明显的灰质减少，这些区域可能参与思维和情绪的控制。
与无妄想的匹配患者相比，患有妄想症的MCI或早期AD参与者右额颞叶灰质萎缩更严重。与我们的预测一致，右半球不对称的灰质萎缩可能通过执行抑制功能丧失导致妄想的发生。
