Bilgiç Başar, Bayram Ali, Hanağasi Haşmet A, Tümaç Ayfer, Uysal Pınar, Şentürk Gülben, Alpsan Hale, Lohmann Ebba, Gürvit Hakan, Emre Murat
İstanbul University İstanbul Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, İstanbul, Turkey.
İstanbul Neuropsychiatry Hospital, Neuroscience Center, İstanbul, Turkey.
Noro Psikiyatr Ars. 2013 Dec;50(4):360-363. doi: 10.4274/Npa.y6603. Epub 2013 Dec 1.
Cerebral white matter hyperintensities (WMHs) detected on magnetic resonance imaging scans are frequently seen in both Alzheimer's disease (AD) and depression patients and believed to play an important role in cognition and mood. Depressive symptoms and depression may accompany AD in all stages of the disease. The aim of the study was to evaluate the relationship of regional WMHs with depressive symptoms, cognitive status, medial temporal lobe atrophy, and daily living activities in early-stage AD patients.
Forty-five patients with very mild or mild AD were examined. All subjects underwent MRI and were assessed by the Geriatric Depression Scale (GDS) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) for the evaluation of depressive symptom severity and cognitive status, respectively. The patients were divided into two groups based on the selected cut-off point in the GDS. CDR sum of the boxes (CDR-sb) scores were calculated as a measure of activities of daily living (ADLs). MRI T2-FLAIR slices were used to rate the white-matter lesions according to the Age-Related White Matter Changes Rating Scale, assessing the WMHs in frontal, parietooccipital, temporal, infratentorial and basal ganglia areas individually. Medial temporal lobe atrophy was assessed with high-resolution T1 images using visual rating scale.
In the depressive group, frontal WMH scores were found to be higher than in the non-depressive group (p=0.006). ACE-r, CDR-sb and medial temporal lobe atrophy scores did not differ among the groups. CDR-sb scores showed a significant correlation with frontal WMH scores (left frontal WMH r=0.439, p=0.003, right frontal AMH r=0.459, p=0.001). Linear regression models revealed the effect of WMHs on depressive symptoms among the other factors including age, functionality and atrophy in the medial temporal areas.
Our findings underscore the potential role of regional, particularly frontal AMHs in depressive symptoms and functionality of the early AD patients.
在磁共振成像扫描中检测到的脑白质高信号（WMHs）在阿尔茨海默病（AD）患者和抑郁症患者中均很常见，并被认为在认知和情绪方面发挥重要作用。抑郁症状和抑郁症可能在AD病程的各个阶段伴随出现。本研究的目的是评估早期AD患者脑白质高信号区域与抑郁症状、认知状态、内侧颞叶萎缩及日常生活活动之间的关系。
对45例极轻度或轻度AD患者进行检查。所有受试者均接受了磁共振成像检查，并分别通过老年抑郁量表（GDS）和修订版的Addenbrooke认知检查（ACE-R）评估抑郁症状严重程度和认知状态。根据GDS选定的临界点将患者分为两组。计算总体衰退量表框和（CDR-sb）评分作为日常生活活动（ADLs）的衡量指标。使用磁共振成像T2-FLAIR序列图像，根据年龄相关性白质改变评分量表对白质病变进行评分，分别评估额叶、顶枕叶、颞叶、幕下和基底节区的脑白质高信号。使用视觉评分量表通过高分辨率T1图像评估内侧颞叶萎缩情况。
在抑郁组中，发现额叶脑白质高信号评分高于非抑郁组（p=0.006）。两组间ACE-r、CDR-sb和内侧颞叶萎缩评分无差异。CDR-sb评分与额叶脑白质高信号评分呈显著相关（左侧额叶脑白质高信号r=0.439，p=0.003；右侧额叶脑白质高信号r=0.459，p=0.001）。线性回归模型揭示了在包括年龄、功能状态和内侧颞叶萎缩等其他因素中，脑白质高信号对抑郁症状的影响。
我们的研究结果强调了区域脑白质高信号，尤其是额叶脑白质高信号在早期AD患者抑郁症状和功能状态方面的潜在作用。
