联合社会行为评估可提高行为变异型额颞叶痴呆与阿尔茨海默病的鉴别诊断：寻找神经心理学标志物。

Combined Socio-Behavioral Evaluation Improves the Differential Diagnosis Between the Behavioral Variant of Frontotemporal Dementia and Alzheimer's Disease: In Search of Neuropsychological Markers.

机构信息

Department of Clinical Neuroscience, San Raffaele Turro Hospital and Scientific Institute, Milan, Italy.

Istituto Universitario di Studi Superiori, Pavia, Italy.

出版信息

J Alzheimers Dis. 2018;61(2):761-772. doi: 10.3233/JAD-170650.

DOI:10.3233/JAD-170650

PMID:29254091

Abstract

BACKGROUND

Current diagnostic criteria for behavioral variant of frontotemporal dementia (bvFTD) and typical Alzheimer's disease (AD) include a differential pattern of neuropsychological impairments (episodic memory deficit in typical AD and dysexecutive syndrome in bvFTD). There is, however, large evidence of a frequent overlap in neuropsychological features, making the differential diagnosis extremely difficult.

OBJECTIVES

In this retrospective study, we evaluated the diagnostic value of different cognitive and neurobehavioral markers in bvFTD and AD patient groups.

METHODS

We included 95 dementia patients with a clinical and biomarker evidence of bvFTD (n = 48) or typical AD (n = 47) pathology. A clinical 2-year follow-up confirmed clinical classification. Performances at basic cognitive tasks (memory, executive functions, visuo-spatial, language) as well as social cognition skills and neurobehavioral profiles have been recorded. A stepwise logistic regression model compared the neuropsychological profiles between groups and assessed the accuracy of cognitive and neurobehavioral markers in discriminating bvFTD from AD.

RESULTS

Statistical comparison between patient groups proved social cognition and episodic memory impairments as main cognitive signatures of bvFTD and AD neuropsychological profiles, respectively. Only half of bvFTD patients showed attentive/executive deficits, questioning their role as cognitive marker of bvFTD. Notably, the large majority of bvFTD sample (i.e., 70%) poorly performed at delayed recall tasks. Logistic regression analysis identified social cognition performances, Frontal Behavioral Inventory and Mini-Mental State Examination scores as the best combination in distinguishing bvFTD from AD.

CONCLUSION

Social cognition tasks and socio-behavioral questionnaires are recommended in clinical settings to improve the accuracy of early diagnosis of bvFTD.

摘要

背景

行为变异额颞叶痴呆（bvFTD）和典型阿尔茨海默病（AD）的当前诊断标准包括神经心理学损伤的差异模式（典型 AD 中的情景记忆缺陷和 bvFTD 中的执行功能障碍综合征）。然而，大量证据表明神经心理学特征经常重叠，使得鉴别诊断极为困难。

目的

在这项回顾性研究中，我们评估了不同认知和神经行为标志物在 bvFTD 和 AD 患者组中的诊断价值。

方法

我们纳入了 95 名痴呆症患者，他们具有 bvFTD（n=48）或典型 AD（n=47）病理学的临床和生物标志物证据。为期 2 年的临床随访证实了临床分类。记录了基本认知任务（记忆、执行功能、视空间、语言）以及社会认知技能和神经行为特征的表现。逐步逻辑回归模型比较了组间的神经心理学特征，并评估了认知和神经行为标志物在鉴别 bvFTD 和 AD 中的准确性。

结果

对患者组的统计比较证明，社会认知和情景记忆损伤分别是 bvFTD 和 AD 神经心理学特征的主要认知特征。只有一半的 bvFTD 患者表现出注意力/执行缺陷，质疑其作为 bvFTD 认知标志物的作用。值得注意的是，绝大多数 bvFTD 样本（即 70%）在延迟回忆任务中表现不佳。逻辑回归分析确定社会认知表现、额叶行为量表和简易精神状态检查分数是区分 bvFTD 和 AD 的最佳组合。