探索阿尔茨海默病中镜像自我识别的神经机制。

Exploring the Neural Mechanisms of Mirrored-Self Misidentification in Alzheimer's Disease.

机构信息

Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.

Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.

出版信息

Int J Geriatr Psychiatry. 2024 Oct;39(10):e6148. doi: 10.1002/gps.6148.

DOI:10.1002/gps.6148

PMID:39334521

Abstract

OBJECTIVE

Alzheimer's disease (AD) is a complex neurodegenerative condition that causes a range of cognitive disturbances, including mirror-self misidentification syndrome (MSM), in which patients cannot recognize themselves in a mirror. However, the mechanism of action of MSM is not precisely known. This study aimed to explore the possible neural mechanisms of action of MSM in AD using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).

METHODS

This study included 48 AD patients, 13 in the MSM group and 35 in the non-MSM group. The permeability of the blood-brain barrier (BBB) was quantitatively monitored by measuring the transfer rate (K) of the contrast agent from the vasculature to the surrounding tissue using DCE-MRI. The concentration of contrast agents in different brain regions was measured, and the Patlak model was used to calculate K. K values were compared between the left and right cerebral hemispheres in different brain areas between the MSM and non-MSM groups. Additionally, the difference in K values between mild and severe MSM was assessed. Logistic regression analysis was used to examine the risk factors for MSM.

RESULTS

The Mann‒Whitney U test was used to compare two groups and revealed elevated K values in the left thalamus, left putamen, left globus pallidus, left corona radiata, and right caudate in the MSM group (p < 0.05). Logistic regression analysis revealed that increased K values in the left putamen (OR = 1.53, 95% CI = 1.04, 2.26) and left globus pallidus (OR = 1.54, 95% CI = 1.02, 2.31) may be risk factors for MSM. After dividing MSM patients into mild and moderate-severe groups, the K values of the thalamus in the moderate-severe group were greater than those in the mild group (p < 0.05).

CONCLUSION

Our study revealed the relationship between BBB permeability and MSM in AD. MSM is associated with BBB breakdown in the left putamen and globus pallidus. The left putamen and globus pallidus may function in mirror self-recognition. Higher BBB permeability in the thalamus may reflect the severity of AD in MSM.

摘要

目的

阿尔茨海默病（AD）是一种复杂的神经退行性疾病，可导致一系列认知障碍，包括镜像自我识别综合征（MSM），患者无法在镜子中识别自己。然而，MSM 的作用机制尚不清楚。本研究旨在使用动态对比增强磁共振成像（DCE-MRI）探索 AD 中 MSM 的可能作用机制。

方法

本研究纳入了 48 例 AD 患者，其中 MSM 组 13 例，非 MSM 组 35 例。通过 DCE-MRI 定量监测对比剂从血管到周围组织的转运率（K），监测血脑屏障（BBB）的通透性。测量不同脑区对比剂的浓度，采用 Patlak 模型计算 K。比较 MSM 组和非 MSM 组左、右侧不同脑区的 K 值。此外，还评估了 MSM 轻度和重度患者之间 K 值的差异。采用 Logistic 回归分析探讨 MSM 的危险因素。

结果

采用 Mann-Whitney U 检验比较两组，结果显示 MSM 组左侧丘脑、左侧壳核、左侧苍白球、左侧放射冠和右侧尾状核的 K 值升高（p<0.05）。Logistic 回归分析显示，左侧壳核（OR=1.53，95%CI=1.04，2.26）和左侧苍白球（OR=1.54，95%CI=1.02，2.31）的 K 值增加可能是 MSM 的危险因素。将 MSM 患者分为轻度和中重度后，中重度组丘脑的 K 值大于轻度组（p<0.05）。