Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Neurology, Yokohama City University Medical Center, Yokohama, Japan.
J Neurol Sci. 2018 Feb 15;385:99-104. doi: 10.1016/j.jns.2017.12.018. Epub 2017 Dec 19.
In dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD), it is still debated whether white matter hyperintensities (WMH) on MRI reflect atherosclerotic cerebrovascular changes or Alzheimer's disease (AD)-related pathology such as cerebral amyloid angiopathy. To examine AD-related pathology in DLB and PDD, we compared the severity of WMH and medial temporal lobe atrophy among patients with DLB, PDD, non-demented PD (PDND), and AD.
We retrospectively studied sex- and age-matched outpatients with AD, DLB, PDD, and PDND, as well as subjects without central nervous system disorders as normal controls (n=50 each). All subjects underwent 1.5-T MRI examinations, and WMH detected by T2-weighted images or fluid-attenuated inversion recovery images were semiquantified according to the Fazekas method. Medial temporal lobe atrophy (MTA) was visually assessed by the MTA score.
WMH were more prominent in AD, DLB, and PDD patients than in PDND patients and normal controls (NCs). DLB as well as AD showed more severe WMH than PDD. Visual assessment of medial temporal lobe atrophy showed that AD patients had the most severe atrophy, followed by DLB, PDD, and PDND patients, and NC subjects in that order. MTA scores showed significant correlations with WMH severity.
Our results indicated that DLB was more similar to AD than to PDD in terms of MRI findings, suggesting that WMH in DLB may reflect mainly AD-related pathology rather than atherosclerotic cerebrovascular changes.
在路易体痴呆（DLB）和帕金森病伴痴呆（PDD）中，MRI 上的白质高信号（WMH）是否反映动脉粥样硬化性脑血管改变或阿尔茨海默病（AD）相关病理学，如脑淀粉样血管病，仍存在争议。为了研究 DLB 和 PDD 中的 AD 相关病理学，我们比较了 DLB、PDD、非痴呆性帕金森病（PDND）和 AD 患者的 WMH 严重程度和海马体萎缩。
我们回顾性研究了性别和年龄匹配的 AD、DLB、PDD 和 PDND 门诊患者，以及无中枢神经系统疾病的正常对照组（每组 50 人）。所有患者均接受 1.5-T MRI 检查，根据 Fazekas 方法，通过 T2 加权图像或液体衰减反转恢复图像检测 WMH，并进行半定量分析。通过海马体评分（MTA）对海马体萎缩进行视觉评估。
AD、DLB 和 PDD 患者的 WMH 比 PDND 患者和正常对照组更明显。DLB 和 AD 的 WMH 比 PDD 更严重。通过视觉评估海马体萎缩发现，AD 患者的萎缩最严重，其次是 DLB、PDD 和 PDND 患者，而正常对照组的萎缩程度最低。MTA 评分与 WMH 严重程度呈显著相关。
我们的研究结果表明，从 MRI 表现来看，DLB 与 AD 更相似，而与 PDD 不同，这提示 DLB 中的 WMH 可能主要反映 AD 相关病理学，而不是动脉粥样硬化性脑血管改变。
