Wan Mei-Dan, Liu Hui, Liu Xi-Xi, Zhang Wei-Wei, Xiao Xue-Wen, Zhang Si-Zhe, Jiang Ya-Ling, Zhou Hui, Liao Xin-Xin, Zhou Ya-Fang, Tang Bei-Sha, Wang Jun-Ling, Guo Ji-Feng, Jiao Bin, Shen Lu
Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.
Front Aging Neurosci. 2022 Jul 29;14:906519. doi: 10.3389/fnagi.2022.906519. eCollection 2022.
The relationships between multiple visual rating scales based on structural magnetic resonance imaging (sMRI) with disease severity and cerebrospinal fluid (CSF) biomarkers in patients with Alzheimer's disease (AD) were ambiguous. In this study, a total of 438 patients with clinically diagnosed AD were recruited. All participants underwent brain sMRI scan, and medial temporal lobe atrophy (MTA), posterior atrophy (PA), global cerebral atrophy-frontal sub-scale (GCA-F), and Fazekas rating scores were visually evaluated. Meanwhile, disease severity was assessed by neuropsychological tests such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clinical Dementia Rating (CDR). Among them, 95 patients were tested for CSF core biomarkers, including Aβ, Aβ, AβAβ, p-tau, and t-tau. As a result, the GCA-F and Fazekas scales showed positively significant correlations with onset age ( = 0.181, < 0.001; = 0.411, < 0.001, respectively). Patients with late-onset AD (LOAD) showed higher GCA-F and Fazekas scores ( < 0.001, < 0.001). With regard to the disease duration, the MTA and GCA-F were positively correlated ( = 0.137, < 0.05; = 0.106, < 0.05, respectively). In terms of disease severity, a positively significant association emerged between disease severity and the MTA, PA GCA-F, and Fazekas scores ( < 0.001, < 0.001, < 0.001, < 0.05, respectively). Moreover, after adjusting for age, gender, and alleles, the MTA scale contributed to moderate to severe AD in statistical significance independently by multivariate logistic regression analysis ( < 0.05). The model combining visual rating scales, age, gender, and alleles showed the best performance for the prediction of moderate to severe AD significantly (AUC = 0.712, sensitivity = 51.5%, specificity = 84.6%). In addition, we observed that the MTA and Fazekas scores were associated with a lower concentration of Aβ ( < 0.031, < 0.022, respectively). In summary, we systematically analyzed the benefits of multiple visual rating scales in predicting the clinical status of AD. The visual rating scales combined with age, gender, and alleles showed best performance in predicting the severity of AD. MRI biomarkers in combination with CSF biomarkers can be used in clinical practice.
基于结构磁共振成像（sMRI）的多种视觉评分量表与阿尔茨海默病（AD）患者的疾病严重程度及脑脊液（CSF）生物标志物之间的关系尚不明确。在本研究中，共招募了438例临床诊断为AD的患者。所有参与者均接受了脑部sMRI扫描，并对内侧颞叶萎缩（MTA）、后部萎缩（PA）、全脑萎缩-额叶亚量表（GCA-F）和 Fazekas评分进行了视觉评估。同时，通过简易精神状态检查（MMSE）、蒙特利尔认知评估（MoCA）和临床痴呆评定量表（CDR）等神经心理学测试评估疾病严重程度。其中，95例患者检测了CSF核心生物标志物，包括Aβ、Aβ、AβAβ、磷酸化tau蛋白（p-tau）和总tau蛋白（t-tau）。结果显示，GCA-F量表和 Fazekas量表与发病年龄呈显著正相关（分别为r = 0.181，P < 0.001；r = 0.411，P < 0.001）。晚发型AD（LOAD）患者的GCA-F量表和 Fazekas评分更高（P < 0.001，P < 0.001）。关于病程，MTA与GCA-F呈正相关（分别为r = 0.137，P < 0.05；r = 0.106，P < 0.05）。在疾病严重程度方面，疾病严重程度与MTA、PA、GCA-F量表和 Fazekas评分之间存在显著正相关（分别为P < 0.001，P < 0.001，P < 0.001，P < 0.05）。此外，在调整年龄、性别和ε4等位基因后，通过多因素逻辑回归分析，MTA量表对中度至重度AD具有独立的统计学意义（P < 0.05）。结合视觉评分量表、年龄、性别和ε4等位基因的模型对中度至重度AD的预测表现最佳（AUC = 0.712，敏感性 = 51.5%，特异性 = 84.6%）。此外，我们观察到MTA和 Fazekas评分与较低的Aβ浓度相关（分别为P < 0.031，P < 0.022）。总之，我们系统分析了多种视觉评分量表在预测AD临床状况方面的益处。结合年龄、性别和ε4等位基因的视觉评分量表在预测AD严重程度方面表现最佳。MRI生物标志物与CSF生物标志物联合可用于临床实践。
