Neuroscience Research Center, Magna Graecia University, Catanzaro, Italy.
Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy.
J Neuropsychol. 2021 Sep;15(3):301-318. doi: 10.1111/jnp.12232. Epub 2020 Nov 24.
Progressive supranuclear palsy (PSP) is a rare, rapidly progressive neurodegenerative disease. Richardson's syndrome (PSP-RS) and predominant parkinsonism (PSP-P) are characterized by wide range of cognitive and behavioural disturbances, but these variants show similar cognitive pattern of alterations, leading difficult differential diagnosis. For this reason, we explored with an Artificial Intelligence approach, whether cognitive impairment could differentiate the phenotypes. Forty Parkinson's disease (PD) patients, 25 PSP-P, 40 PSP-RS, and 34 controls were enrolled following the consensus criteria diagnosis. Participants were evaluated with neuropsychological battery for cognitive domains. Random Forest models were used for exploring the discriminant power of the cognitive tests in distinguishing among the four groups. The classifiers for distinguishing diseases from controls reached high accuracies (86% for PD, 95% for PSP-P, 99% for PSP-RS). Regarding the differential diagnosis, PD was discriminated from PSP-P with 91% (important variables: HAMA, MMSE, JLO, RAVLT_I, BDI-II) and from PSP-RS with 92% (important variables: COWAT, JLO, FAB). PSP-P was distinguished from PSP-RS with 84% (important variables: JLO, WCFST, RAVLT_I, Digit span_F). This study revealed that PSP-P, PSP-RS and PD had peculiar cognitive deficits compared with healthy subjects, from which they were discriminated with optimal accuracies. Moreover, high accuracies were reached also in differential diagnosis. Most importantly, Machine Learning resulted to be useful to the clinical neuropsychologist in choosing the most appropriate neuropsychological tests for the cognitive evaluation of PSP patients.
进行性核上性麻痹(PSP)是一种罕见的、快速进展的神经退行性疾病。Richardson 综合征(PSP-RS)和以帕金森病为主型(PSP-P)的特征是广泛的认知和行为障碍,但这些变体表现出相似的认知模式改变,导致难以进行鉴别诊断。出于这个原因,我们采用人工智能方法探索认知障碍是否可以区分表型。根据共识标准诊断,我们纳入了 40 名帕金森病(PD)患者、25 名 PSP-P、40 名 PSP-RS 和 34 名对照组。参与者接受了认知域神经心理学测试。随机森林模型用于探索认知测试在区分四组人群中的判别能力。用于区分疾病和对照组的分类器达到了较高的准确率(PD 为 86%,PSP-P 为 95%,PSP-RS 为 99%)。关于鉴别诊断,PD 与 PSP-P 可通过 91%(重要变量:HAMA、MMSE、JLO、RAVLT_I、BDI-II)进行区分,与 PSP-RS 可通过 92%(重要变量:COWAT、JLO、FAB)进行区分。PSP-P 与 PSP-RS 可通过 84%(重要变量:JLO、WCFST、RAVLT_I、Digit span_F)进行区分。这项研究表明,与健康对照组相比,PSP-P、PSP-RS 和 PD 具有独特的认知缺陷,它们可以以最佳的准确率进行区分。此外,在鉴别诊断中也达到了较高的准确率。最重要的是,机器学习对于临床神经心理学家在选择最适合 PSP 患者认知评估的神经心理学测试方面非常有用。