后部皮质萎缩症患者日常生活活动的神经功能相关性。

Neurofunctional Correlates of Activities of Daily Living in Patients with Posterior Cortical Atrophy.

机构信息

Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China.

出版信息

J Alzheimers Dis. 2023;93(1):295-305. doi: 10.3233/JAD-221229.

DOI:10.3233/JAD-221229

PMID:36970906

Abstract

BACKGROUND

Research on posterior cortical atrophy (PCA) has focused on cognitive decline, especially visual processing deficits. However, few studies have examined the impact of PCA on activities of daily living (ADL) and the neurofunctional and neuroanatomic bases of ADL.

OBJECTIVE

To identify brain regions associated with ADL in PCA patients.

METHODS

A total of 29 PCA patients, 35 typical Alzheimer's disease (tAD) patients, and 26 healthy volunteers were recruited. Each subject completed an ADL questionnaire that included basic and instrumental subscales (BADL and IADL, respectively), and underwent hybrid magnetic resonance imaging and 18F fluorodeoxyglucose positron emission tomography. Voxel-wise regression multivariable analysis was conducted to identify specific brain regions associated with ADL.

RESULTS

General cognitive status was similar between PCA and tAD patients; however, the former had lower total ADL scores and BADL and IADL scores. All three scores were associated with hypometabolism in bilateral parietal lobes (especially bilateral superior parietal gyri) at the whole-brain level, PCA-related hypometabolism level, and PCA-specific hypometabolism level. A cluster that included the right superior parietal gyrus showed an ADL×group interaction effect that was correlated with the total ADL score in the PCA group (r = -0.6908, p = 9.3599e-5) but not in the tAD group (r = 0.1006, p = 0.5904). There was no significant association between gray matter density and ADL scores.

CONCLUSION

Hypometabolism in bilateral superior parietal lobes contributes to a decline in ADL in patients with PCA and can potentially be targeted by noninvasive neuromodulatory interventions.

摘要

背景

后部皮质萎缩（PCA）的研究主要集中在认知能力下降上，尤其是在视觉处理方面。然而，很少有研究探讨 PCA 对日常生活活动（ADL）的影响以及 ADL 的神经功能和神经解剖学基础。

目的

确定与 PCA 患者 ADL 相关的脑区。

方法

共纳入 29 例 PCA 患者、35 例典型阿尔茨海默病（tAD）患者和 26 名健康志愿者。每位受试者完成了一份 ADL 问卷，包括基本和工具性日常生活活动（BADL 和 IADL）子量表，同时接受了混合磁共振成像和 18F 氟脱氧葡萄糖正电子发射断层扫描。采用体素回归多元分析来确定与 ADL 相关的特定脑区。

结果

PCA 患者和 tAD 患者的总体认知状态相似；然而，前者的 ADL 总分以及 BADL 和 IADL 评分较低。所有这三项评分都与全脑水平双侧顶叶（特别是双侧顶上回）代谢减低、PCA 相关代谢减低程度以及 PCA 特异性代谢减低程度相关。包括右侧顶上回的一个脑区与 PCA 组的总 ADL 评分呈 ADL×组交互效应相关（r=-0.6908，p=9.3599e-5），但与 tAD 组不相关（r=0.1006，p=0.5904）。灰质密度与 ADL 评分之间无显著相关性。