基于磁共振成像和灌注单光子发射计算机断层扫描的阿尔茨海默病亚型特征分析。

Characterization of Alzheimer's Disease Subtypes Based on Magnetic Resonance Imaging and Perfusion Single-Photon Emission Computed Tomography.

机构信息

Dementia Research Center, Tokyo General Hospital, Tokyo, Japan.

Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan.

出版信息

J Alzheimers Dis. 2022;87(2):781-789. doi: 10.3233/JAD-215674.

DOI:10.3233/JAD-215674

PMID:35367967

Abstract

BACKGROUND

Alzheimer's disease (AD) is a biologically heterogenous disease. Previous studies have reported the existence of various AD subtypes, and the various clinical features of the subtypes. However, inconsistent results have been obtained.

OBJECTIVE

To clarify the clinical characteristics of the various AD subtypes, by classifying probable AD into subtypes based on magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) findings.

METHODS

A total of 245 patients with probable AD were classified into the typical AD (TAD) subtype, limbic-predominant (LP) subtype, hippocampal-sparing (HS) subtype, and minimal-change (MC) subtype, based on the presence of medial temporal lobe atrophy on MRI and posterior cerebral hypoperfusion on SPECT. Demographics, including age, sex, body mass index, disease duration, education years, comorbidities, frailty, leisure activity, and neuropsychological findings were compared between the AD subtypes.

RESULTS

he frequency of TAD, LP, HS, and MC subtypes was 49%, 20%, 18%, and 13%, respectively. Patients with the LP subtype were older and characterized by fewer major comorbidities, higher frailty, and slower progression of disease. Patients with the HS subtype were younger and characterized by shorter disease duration, lower frailty, and preserved memory, but had prominent constructional dysfunction. Patients of the MC subtype were characterized by shorter disease duration, lower education level, less leisure activity, less impaired memory and orientation, and slower progression.

CONCLUSION

Patients with different AD subtypes differed in their demographic and clinical features. The characterization of patients' AD subtypes may provide effective support for the diagnosis, treatment, and care of AD patients.

摘要

背景

阿尔茨海默病（AD）是一种生物学异质性疾病。先前的研究报告了各种 AD 亚型的存在，以及亚型的各种临床特征。然而，得到的结果并不一致。

目的

通过基于磁共振成像（MRI）和单光子发射计算机断层扫描（SPECT）的发现将可能的 AD 分类为亚型，阐明各种 AD 亚型的临床特征。

方法

根据 MRI 上内侧颞叶萎缩和 SPECT 上后脑灌注不足的存在，将 245 例可能的 AD 患者分为典型 AD（TAD）亚型、边缘优势（LP）亚型、海马保留（HS）亚型和最小变化（MC）亚型。比较 AD 亚型之间的人口统计学资料，包括年龄、性别、体重指数、疾病持续时间、教育年限、合并症、虚弱、休闲活动和神经心理学发现。

结果

TAD、LP、HS 和 MC 亚型的频率分别为 49%、20%、18%和 13%。LP 亚型患者年龄较大，主要合并症较少，虚弱程度较高，疾病进展较慢。HS 亚型患者较年轻，疾病持续时间较短，虚弱程度较低，记忆力保存，但存在明显的结构功能障碍。MC 亚型患者的疾病持续时间较短，教育程度较低，休闲活动较少，记忆和定向障碍较轻，疾病进展较慢。