ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy.
Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Eur J Neurol. 2021 Mar;28(3):745-753. doi: 10.1111/ene.14637. Epub 2020 Dec 3.
The aim of this study was to evaluate brain metabolic correlates of apathy in amyotrophic lateral sclerosis (ALS).
A total of 165 ALS patients underwent F-2-fluoro-2-deoxy-D-glucose positron emission tomography ( F-FDG-PET) and Frontal Systems Behaviour Scale (FrSBe) evaluation. FrSBe provides "before" and "after" apathy subscores, referring to premorbid and morbid conditions. "After" apathy subscore and "before-after" gap, i.e. the difference between "before" and "after" subscores, were regressed against whole-brain metabolism. Among patients with a pathological "after" apathy subscore (i.e., ≥65), we compared patients with "before" apathy subscores ≥65 and <65, and patients with "before-after" gaps of <22 and ≥22.
In the whole sample, the "after" apathy subscore negatively correlated with metabolism in the dorsolateral prefrontal cortex (DLPFC), dorsomedial prefrontal cortex (DMPFC), ventrolateral prefrontal cortex (VLPFC), premotor cortex (PMC) and anterior cingulate cortex (ACC), and insula bilaterally. A positive correlation was found in the cerebellum and pons. The "before-after" gap negatively correlated with metabolism in bilateral DLPFC, DMPFC and PMC, and left VLPFC and ACC, and positively correlated with cerebellar and pontine clusters. Among patients with an "after" apathy subscore ≥65, we found no difference between those with "before" apathy subscores ≥65 and <65. Patients with a "before-after" gap ≥22, compared to patients with a gap <22, showed relative hypometabolism in bilateral DLPFC and DMPFC, and left ACC and PMC, and relative cerebellar and pontine hypermetabolism.
No studies on brain F-2-fluoro-2-deoxy-D-glucose positron emission tomography correlates of apathy have been performed in ALS. We found that FrSBe "after" apathy subscore correlated with metabolic changes in brain regions known as neuroanatomical correlates of apathy. Furthermore, our findings support the relevance of the gap between premorbid and morbid conditions to detect behavioural changes due to the neurodegenerative process underlying ALS.
本研究旨在评估肌萎缩侧索硬化症（ALS）患者的脑代谢与淡漠的相关性。
共 165 例 ALS 患者接受了 F-2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（ F-FDG-PET）和额叶系统行为量表（FrSBe）评估。FrSBe 提供了“之前”和“之后”淡漠的亚评分，分别指的是发病前和发病后的情况。将“之后”淡漠亚评分和“之前-之后”差值（即“之前”和“之后”亚评分之间的差异）回归到全脑代谢。在病理性“之后”淡漠亚评分（即≥65）的患者中，我们比较了“之前”淡漠亚评分≥65 和＜65 的患者，以及“之前-之后”差值＜22 和≥22 的患者。
在全样本中，“之后”淡漠亚评分与背外侧前额叶皮质（DLPFC）、背内侧前额叶皮质（DMPFC）、腹外侧前额叶皮质（VLPFC）、运动前皮质（PMC）和前扣带回皮质（ACC）以及双侧岛叶的代谢呈负相关。与小脑和脑桥呈正相关。“之前-之后”差值与双侧 DLPFC、DMPFC 和 PMC 以及左侧 VLPFC 和 ACC 的代谢呈负相关，与小脑和脑桥簇呈正相关。在“之后”淡漠亚评分≥65 的患者中，我们发现“之前”淡漠亚评分≥65 和＜65 的患者之间没有差异。“之前-之后”差值≥22 的患者与差值＜22 的患者相比，双侧 DLPFC 和 DMPFC 以及左侧 ACC 和 PMC 的代谢相对降低，小脑和脑桥的代谢相对升高。
目前尚未有关于肌萎缩侧索硬化症患者脑 F-2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描与淡漠相关性的研究。我们发现 FrSBe“之后”淡漠亚评分与已知的淡漠神经解剖学相关的脑区的代谢变化相关。此外，我们的发现支持在发病前和发病后条件之间的差值来检测由于 ALS 潜在的神经退行性过程引起的行为变化的相关性。
