在早期阿尔茨海默病中，随着时间推移，局部18F-氟脱氧葡萄糖代谢减低与更高的淡漠评分相关。
Regional 18F-Fluorodeoxyglucose Hypometabolism is Associated with Higher Apathy Scores Over Time in Early Alzheimer Disease.
作者信息
Gatchel Jennifer R, Donovan Nancy J, Locascio Joseph J, Becker J Alex, Rentz Dorene M, Sperling Reisa A, Johnson Keith A, Marshall Gad A
机构信息
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
出版信息
Am J Geriatr Psychiatry. 2017 Jul;25(7):683-693. doi: 10.1016/j.jagp.2016.12.017. Epub 2017 Jan 4.
OBJECTIVES
Apathy is among the earliest and most pervasive neuropsychiatric symptoms in prodromal and mild Alzheimer disease (AD) dementia that correlates with functional impairment and disease progression. We investigated the association of apathy with regional 18F-fluorodeoxyglucose (FDG) metabolism in cognitively normal, mild cognitive impairment, and AD dementia subjects from the Alzheimer's Disease Neuroimaging Initiative database.
DESIGN
Cross-sectional and longitudinal studies.
SETTING
57 North American research sites.
PARTICIPANTS
402 community dwelling elders.
MEASUREMENTS
Apathy was assessed using the Neuropsychiatric Inventory Questionnaire. Baseline FDG metabolism in five regions implicated in the neurobiology of apathy and AD was investigated in relationship to apathy at baseline (cross-sectional general linear model) and longitudinally (mixed random/fixed effect model). Covariates included age, sex, diagnosis, apolipoprotein E genotype, premorbid intelligence, cognition, and antidepressant use.
RESULTS
Cross-sectional analysis revealed that posterior cingulate hypometabolism, diagnosis, male sex, and antidepressant use were associated with higher apathy scores. Longitudinal analysis revealed that the interaction of supramarginal hypometabolism and time, posterior cingulate hypometabolism, and antidepressant use were associated with higher apathy scores across time; only supramarginal hypometabolism was positively related to rate of increase of apathy.
CONCLUSIONS
Results support an association of apathy with hypometabolism in parietal regions commonly affected in early stages of AD, rather than medial frontal regions implicated in the neurobiology of apathy in later stages. Further work is needed to substantiate whether this localization is specific to apathy rather than to disease stage, and to investigate the potential role of AD proteinopathies in the pathogenesis of apathy.
目的
淡漠是前驱期和轻度阿尔茨海默病（AD）痴呆中最早出现且最为普遍的神经精神症状之一，与功能损害及疾病进展相关。我们从阿尔茨海默病神经影像倡议数据库中，研究了认知正常、轻度认知障碍及AD痴呆受试者中淡漠与区域18F-氟脱氧葡萄糖（FDG）代谢之间的关联。
设计
横断面研究和纵向研究。
地点
北美57个研究站点。
参与者
402名社区居住的老年人。
测量
使用神经精神科问卷评估淡漠。研究了与淡漠及AD神经生物学相关的五个区域的基线FDG代谢与基线时淡漠的关系（横断面一般线性模型）以及纵向关系（混合随机/固定效应模型）。协变量包括年龄、性别、诊断、载脂蛋白E基因型、病前智力、认知及抗抑郁药使用情况。
结果
横断面分析显示，后扣带回代谢减低、诊断、男性性别及抗抑郁药使用与较高的淡漠评分相关。纵向分析显示，缘上回代谢减低与时间的交互作用、后扣带回代谢减低及抗抑郁药使用与随时间推移较高的淡漠评分相关；仅缘上回代谢减低与淡漠增加率呈正相关。
结论
结果支持淡漠与AD早期通常受累的顶叶区域代谢减低有关，而非与后期淡漠神经生物学所涉及的内侧额叶区域有关。需要进一步开展工作，以证实这种定位是否特定于淡漠而非疾病阶段，并研究AD蛋白病变在淡漠发病机制中的潜在作用。
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