Doganyigit Burak, Defrancesco Michaela, Schurr Timo, Steiger Ruth, Gizewski Elke R, Mangesius Stephanie, Galijasevic Malik, Hofer Alex, Tuovinen Noora
Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria.
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Front Psychiatry. 2024 Nov 19;15:1485620. doi: 10.3389/fpsyt.2024.1485620. eCollection 2024.
The increasing prevalence of Alzheimer's disease (AD) has created an urgent need for rapid and cost-effective methods to diagnose and monitor people at all stages of the disease. Progressive memory impairment and hippocampal atrophy are key features of the most common so-called typical variant of AD. However, studies evaluating detailed cognitive measures combined with region of interest (ROI)-based imaging markers of progression over the long term in the AD dementia (ADD) stage are rare.
We conducted a retrospective longitudinal follow-up study in patients with mild to moderate ADD (aged 60-92 years). They underwent magnetic resonance imaging (MRI; 3 Tesla, MPRAGE) as well as clinical and neuropsychological examination (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] -Plus test battery) at baseline and at least one follow-up visit. ROI-based brain structural analysis of baseline MRIs was performed using the Computational Anatomy Toolbox (CAT) 12. Clinical dementia progression (progression index [PI]) was measured by the annual decline in the Mini Mental State Examination (MMSE) scores. MRI, demographic, and neuropsychological data were included in univariate and multiple linear regression models to predict the PI.
104 ADD patients (age 63 to 90 years, 73% female, mean MMSE score 22.63 ± 3.77, mean follow-up 4.27 ± 2.15 years) and 32 age- and gender-matched cognitively intact controls were included. The pattern of gray matter (GM) atrophy and the cognitive profile were consistent with the amnestic/typical variant of ADD in all patients. Deficits in word list learning together with temporal lobe GM atrophy had the highest predictive value for rapid cognitive decline in the multiple linear regression model, accounting for 25.4% of the PI variance.
Our results show that temporal atrophy together with deficits in the encoding of verbal material, rather than in immediate or delayed recall, is highly predictive for rapid cognitive decline in patients with mild to moderate amnestic/typical ADD. These findings point to the relevance of combining detailed cognitive and automated structural imaging analyses to predict clinical progression in patients with ADD.
阿尔茨海默病（AD）患病率的不断上升，迫切需要快速且经济高效的方法来诊断和监测处于该疾病各个阶段的人群。进行性记忆障碍和海马萎缩是最常见的所谓典型AD变体的关键特征。然而，在AD痴呆（ADD）阶段，长期评估详细认知指标并结合基于感兴趣区域（ROI）的进展成像标志物的研究很少。
我们对轻度至中度ADD患者（年龄60 - 92岁）进行了一项回顾性纵向随访研究。他们在基线和至少一次随访时接受了磁共振成像（MRI；3特斯拉，MPRAGE）以及临床和神经心理学检查（阿尔茨海默病注册协会[CERAD]-Plus测试套件）。使用计算解剖工具箱（CAT）12对基线MRI进行基于ROI的脑结构分析。临床痴呆进展（进展指数[PI]）通过简易精神状态检查表（MMSE）分数的年度下降来衡量。MRI、人口统计学和神经心理学数据被纳入单变量和多元线性回归模型以预测PI。
纳入了104例ADD患者（年龄63至90岁，73%为女性，平均MMSE分数22.63±3.77，平均随访4.27±2.15年）和32名年龄及性别匹配的认知正常对照。所有患者的灰质（GM）萎缩模式和认知特征与ADD的遗忘/典型变体一致。在多元线性回归模型中，单词列表学习缺陷与颞叶GM萎缩对快速认知下降具有最高的预测价值，占PI方差的25.4％。
我们的结果表明，颞叶萎缩以及言语材料编码缺陷，而非即时或延迟回忆缺陷，对轻度至中度遗忘/典型ADD患者的快速认知下降具有高度预测性。这些发现表明，结合详细的认知和自动结构成像分析对于预测ADD患者的临床进展具有重要意义。
