特发性正常压力脑积水临床前期患者的脑形态变化。
Changes in brain morphology in patients in the preclinical stage of idiopathic normal pressure hydrocephalus.
机构信息
Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan.
出版信息
Psychogeriatrics. 2019 Nov;19(6):557-565. doi: 10.1111/psyg.12445. Epub 2019 Apr 5.
BACKGROUND
Specific ventriculomegaly features, including tight high-convexity and medial subarachnoid spaces, are found on magnetic resonance images in patients with idiopathic normal pressure hydrocephalus (iNPH). However, some healthy elderly individuals with no typical triad symptoms of iNPH also exhibit specific magnetic resonance image features of iNPH. Therefore, this study quantitatively clarified the brain morphology of suspected iNPH patients with no objective triad symptoms (iNPH-NOS).
METHODS
We recruited patients with suspected iNPH and divided them into two groups based on their iNPH grading scale scores: the iNPH-NOS group and the iNPH with apparent objective triad symptoms (iNPH-AOS) group. Data for normal controls (NC) were taken from the database used in our previous study. We compared the relative volumes of ventricle systems (VS), Sylvian fissures (SF), and sulci at high convexity and the midline (SHM), adjusted by the intracranial volume, of the iNPH-NOS, iNPH-AOS, and NC groups. Additionally, we compared the relative volumes of VS, SF, and SHM in iNPH-NOS patients between their first visit and follow-up 1 year later.
RESULTS
Fifteen iNPH-NOS patients and 45 iNPH-AOS patients were recruited, and 24 NCs were found in the database. The relative volumes of VS and SF were significantly smaller than in NCs than in the iNPH-NOS and iNPH-AOS groups, and the relative volume of SHM was significantly larger in NCs. The relative volume of SHM was significantly larger in the iNPH-NOS group than in the iNPH-AOS group, but there were no significant differences in the relative volumes of VS and SF between these groups. In the iNPH-NOS group, the relative volumes of VS and SF were significantly smaller at the first visit than 1 year later, whereas the relative volume of SHM was significantly larger. In 6 of 15 iNPH-NOS patients, objective symptoms appeared during the observation period.
CONCLUSIONS
Our results indicate that iNPH-NOS patients were in the transitional stage between normal and iNPH-AOS, both morphologically and clinically.
背景
特发性正常压力脑积水（iNPH）患者的磁共振图像上存在特定的脑室扩大特征，包括紧绷的高凸和内侧蛛网膜下腔空间。然而，一些没有 iNPH 典型三联征症状的健康老年人也表现出 iNPH 的特定磁共振图像特征。因此，本研究定量阐明了无客观三联征症状的疑似 iNPH 患者（iNPH-NOS）的脑形态。
方法
我们招募了疑似 iNPH 的患者，并根据 iNPH 分级量表评分将他们分为 iNPH-NOS 组和 iNPH 伴有明显客观三联征症状（iNPH-AOS）组。正常对照组（NC）的数据取自我们之前研究中使用的数据库。我们比较了 iNPH-NOS、iNPH-AOS 和 NC 组的脑室系统（VS）、大脑外侧裂（SF）和高凸中线（SHM）的相对体积，这些体积通过颅内体积进行了调整。此外，我们比较了 iNPH-NOS 患者首次就诊和 1 年后随访时 VS、SF 和 SHM 的相对体积。
结果
共招募了 15 例 iNPH-NOS 患者和 45 例 iNPH-AOS 患者，在数据库中发现了 24 例 NC。VS 和 SF 的相对体积明显小于 iNPH-NOS 和 iNPH-AOS 组，而 NC 的 SHM 相对体积明显较大。与 iNPH-AOS 组相比，iNPH-NOS 组的 SHM 相对体积明显较大，但两组的 VS 和 SF 相对体积无明显差异。在 iNPH-NOS 组中，首次就诊时 VS 和 SF 的相对体积明显小于 1 年后随访时，而 SHM 的相对体积明显较大。在 15 例 iNPH-NOS 患者中，有 6 例在观察期间出现了客观症状。
结论
我们的研究结果表明，iNPH-NOS 患者在形态学和临床上均处于正常和 iNPH-AOS 之间的过渡阶段。
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