Brain perfusion abnormalities in Alzheimer's disease: comparison between patients with focal temporal lobe dysfunction and patients with diffuse cognitive impairment
Brain perfusion abnormalities in Alzheimer's disease: comparison between patients with focal temporal lobe dysfunction and patients with diffuse cognitive impairment
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DOI：
10.1136/jnnp.70.1.22
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发表时间：
2001-01-01
影响因子：
11
通讯作者：
Gainotti, G
中科院分区：
文献类型：
--
作者：
Cappa, A;Calcagni, ML;Gainotti, G
目的：阿尔茨海默病（AD）患者表现出情景和语义记忆的选择性损伤，最近被归类为受局灶性颞叶功能障碍（FTLD）的影响，并被认为是受特定形式AD影响的患者的一个独特亚组。目的是比较AD患者与FTLD和AD患者的脑灌注与更典型的配置文件的弥漫性认知功能障碍（dAD）。方法10例AD患者与FTLD，14例AD患者与dAD，和12名正常对照进行了研究。所有24例AD患者均接受了完整的神经心理学评估。使用四头脑专用断层扫描仪对患者和对照组进行[Tc-99 m]-HMPAO SPECT检查。在27个感兴趣的区域（ROI）中定量示踪剂摄取，包括外侧和内侧颞区。对照组、FTLD患者和dAD患者的27个ROI的平均计数使用ANOVA进行比较，重复测量Bonferroni校正。一个逻辑回归分析，其次是受试者工作特征（ROC）分析，也适用于选择SPECT模式，显着区分患者与FTLD和那些与dAD.Results-Two脑电地形图模式的异常，形成一个双重分离FTLD和dAD组之间，出现：双侧颞叶内侧低灌注，FTLD的特征和后顶骨（和颞顶叶）低灌注特征的患者dAD. Conclusions，这些动脉造影结果提供了进一步支持的假设，FTLD是不是一个单纯的阶段，但AD的一个独特的解剖临床形式。神经心理学测试和[Tc-99 m]-HMPAO SPECT的组合可能在从更广泛的dAD患者组中识别FTLD患者方面非常有用。这个问题特别值得关注，因为越来越多的证据表明FTLD患者的认知能力下降速度较慢。
Objectives-Patients with Alzheimer's disease (AD) showing a selective impairment of episodic and semantic memory have recently been classified as affected by focal temporal lobe dysfunction (FTLD) and considered as a distinct subgroup of patients affected by a particular form of AD. The aim was to compare the cerebral perfusion of patients with AD with FTLD and patients with AD with the more typical profile of diffuse cognitive impairment (dAD).Methods-Ten patients with AD with FTLD, 14 patients with AD with dAD, and 12 normal controls were studied. All the 24 patients with AD underwent a complete neuropsychological assessment. SPECT examination with [Tc-99m]-HMPAO, using a four head brain dedicated tomograph, was performed in patients and controls. Tracer uptake was quantified in 27 regions of interest (ROIs), including lateral and mesial temporal areas. Mean counts in the 27 ROIs of controls, patients with FTLD and those with dAD were compared using an ANOVA for repeated measures with Bonferroni's correction. A logistic regression analysis, followed by a receiver operating characteristic (ROC) analysis, was also applied to select SPECT patterns which significantly differentiated patients with FTLD and those with dAD.Results-Two scintigraphic patterns of abnormalities, shaping a double dissociation between the FTLD and dAD groups, emerged: a bilateral mesial temporal hypoperfusion, characteristic of FTLD and a posterior parietal (and temporal parietal) hypoperfusion characteristic of patients with dAD.Conclusions-These scintigraphic findings provide further support to the hypothesis that FTLD is not a mere stage but a distinct anatomoclinical form of AD. The combination of neuropsychological tests and [Tc-99m]-HMPAO SPECT may be very useful in identifying patients with FTLD from the wider group of patients with dAD. This issue is particularly worthwhile, as there is increasing evidence that patients with FTLD have a slower rate of cognitive decline.