Lee Young-Min, Park Je-Min, Lee Byung-Dae, Moon Eunsoo, Jeong Hee-Jeong, Chung Young-In, Kim Ji-Hoon, Kim Hak-Jin, Mun Chi-Woong, Kim Tae-Hyung, Kim Young-Hoon
Departments of Psychiatry and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
J Clin Psychiatry. 2016 Jan;77(1):e8-13. doi: 10.4088/JCP.14m09740.
The purpose of this study was to determine whether gray matter volumes are associated with treatment response of psychotic symptoms in Alzheimer's disease (AD) patients.
Risperidone, which is commonly used as an atypical antipsychotic drug, was administered in a clinical setting for 6 weeks from April 2012 to February 2013 to 25 antipsychotic-naïve AD patients with psychosis, diagnosed according to Jeste and Finkel's proposed diagnostic criteria for psychosis of Alzheimer's disease. Psychotic symptoms were rated with the Korean version of the Neuropsychiatric Inventory (K-NPI) at baseline and at 6 weeks, and treatment response was defined as the change in K-NPI score from baseline to 6 weeks. Gray matter volumes were measured with magnetic resonance imaging and voxel-based morphometry at baseline. Age, gender, years of education, total intracranial volume, apolipoprotein E genotype, dosage of risperidone, the baseline scores on the Korean version of the Mini-Mental State Examination, and the baseline psychotic and nonpsychotic symptoms scores on the K-NPI were measured as covariates of no interest.
We found that treatment response of psychotic symptoms to risperidone in antipsychotic-naïve AD patients was positively associated with both left and right putamina, left parahippocampal gyrus, and left amygdala volume after controlling covariates of no interest (uncorrected P < .001, KE > 100 voxels).
Therefore, we conclude that gray matter volumes of putamina, left parahippocampal gyrus, and left amygdala are associated with treatment response of psychotic symptoms after 6 weeks of treatment with risperidone in antipsychotic-naïve AD patients with psychosis. These results suggest that the volumes of specific gray matter regions probably contribute to treatment response of psychotic symptoms in AD patients.
ClinicalTrials.gov identifier: NCT01198093.
本研究旨在确定灰质体积是否与阿尔茨海默病（AD）患者精神病性症状的治疗反应相关。
2012年4月至2013年2月，在临床环境中，对25例未使用过抗精神病药物、患有精神病的AD患者使用常用的非典型抗精神病药物利培酮进行为期6周的治疗，这些患者根据杰斯特和芬克尔提出的阿尔茨海默病精神病诊断标准进行诊断。在基线和6周时用韩国版神经精神科问卷（K-NPI）对精神病性症状进行评分，治疗反应定义为K-NPI评分从基线到6周的变化。在基线时用磁共振成像和基于体素的形态测量法测量灰质体积。测量年龄、性别、受教育年限、总颅内体积、载脂蛋白E基因型、利培酮剂量、韩国版简易精神状态检查表的基线分数以及K-NPI上的基线精神病性和非精神病性症状分数作为无关协变量。
在控制无关协变量后，我们发现未使用过抗精神病药物的AD患者对利培酮的精神病性症状治疗反应与左右壳核、左侧海马旁回和左侧杏仁核体积呈正相关（未校正P<0.001，KE>100体素）。
因此，我们得出结论，在未使用过抗精神病药物、患有精神病的AD患者中，经利培酮治疗6周后，壳核、左侧海马旁回和左侧杏仁核的灰质体积与精神病性症状的治疗反应相关。这些结果表明特定灰质区域的体积可能有助于AD患者精神病性症状的治疗反应。
ClinicalTrials.gov标识符：NCT01198093。
