Sachdev P, Brodaty H, Rose N, Haindl W
School of Psychiatry, University of New South Wales, Little Bay, Australia.
Schizophr Res. 1997 Oct 30;27(2-3):105-17. doi: 10.1016/s0920-9964(97)00088-1.
Functional neuroimaging studies have been performed in many young patients with schizophrenia, but late-onset schizophrenia (LOS) remains largely unexamined by these techniques. We predicted that LOS would demonstrate regional cerebral blood flow (rCBF) abnormalities similar to those seen in early-onset schizophrenia (EOS), but with a basis in demonstrable coarse brain disease. The subjects were 15 LOS and 7 EOS patients and 27 healthy controls. Each was given a detailed clinical and neuropsychological assessment and underwent MRI and Tc99m-HMPAO single photon emission computed tomography (SPECT) scans. The LOS subjects had a significantly lower cerebral hemispheric perfusion than controls, with a lower perfusion in the frontal and temporal lobes bilaterally. The LOS group also had significantly lower left-to-right hemisphere blood flow ratios. EOS subjects had a lower frontal perfusion than the controls, which was significant in the left frontal region. The temporal perfusion in the EOS subjects was greater than in the LOS group, and not different from the control subjects. Left temporal perfusion was the most discriminating variable between LOS and control subjects on logistic regression. Correlations of perfusion with MRI were generally low with the exception that the asymmetry indices were significantly correlated, and basal ganglia perfusion correlated with basal ganglia hyperintensities on MRI. The total cerebral perfusion index correlated significantly with the mini-mental state examination (MMSE) score, and the temporal lobe perfusion correlated with MMSE scores and some verbal memory measures. In the schizophrenic groups, perfusion correlated nonsignificantly with symptom profiles. We conclude that our findings of temporal and frontal rCBF abnormalities, especially on the left side, in LOS are similar to those reported in schizophrenia in general. The results do not provide evidence for coarse brain disease underlying the rCBF abnormalities in LOS, or support the specificity of these abnormalities for particular subsyndromes of schizophrenia.
许多年轻的精神分裂症患者都接受过功能性神经影像学研究，但晚发性精神分裂症（LOS）在很大程度上仍未被这些技术所研究。我们预测，LOS会表现出与早发性精神分裂症（EOS）类似的局部脑血流量（rCBF）异常，但这种异常有明显的脑器质性病变基础。研究对象包括15例LOS患者、7例EOS患者和27名健康对照者。每位受试者都接受了详细的临床和神经心理学评估，并进行了MRI和Tc99m-HMPAO单光子发射计算机断层扫描（SPECT）。LOS受试者的大脑半球灌注明显低于对照组，双侧额叶和颞叶的灌注较低。LOS组的左右半球血流量比值也明显较低。EOS受试者的额叶灌注低于对照组，在左侧额叶区域差异显著。EOS受试者的颞叶灌注大于LOS组，与对照组无差异。在逻辑回归分析中，左侧颞叶灌注是LOS与对照受试者之间最具鉴别性的变量。灌注与MRI的相关性一般较低，但不对称指数显著相关，基底节灌注与MRI上的基底节高信号相关。全脑灌注指数与简易精神状态检查（MMSE）评分显著相关，颞叶灌注与MMSE评分及一些言语记忆指标相关。在精神分裂症组中，灌注与症状特征的相关性不显著。我们得出结论，我们在LOS中发现的颞叶和额叶rCBF异常，尤其是左侧的异常，与一般精神分裂症中报道的异常相似。结果没有为LOS中rCBF异常的脑器质性病变提供证据，也不支持这些异常对精神分裂症特定亚综合征的特异性。
