Frontal paralimbic network atrophy in very mild behavioral variant frontotemporal dementia
Frontal paralimbic network atrophy in very mild behavioral variant frontotemporal dementia
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DOI：
10.1001/archneurol.2007.38
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发表时间：
2008-02-01
影响因子：
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通讯作者：
Gorno-Tempini, Maria Luisa
中科院分区：
文献类型：
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作者：
Seeley, William W.;Crawford, Richard;Gorno-Tempini, Maria Luisa
背景资料：行为变异性额颞叶痴呆（bvFTD）对额叶的打击最大，但最早的损伤部位仍不清楚。目的：确定bvFTD不同临床阶段的萎缩模式，检验最温和阶段仅限于额叶边缘皮质的假设。设计：bvFTD队列研究。设置：大学医院痴呆症诊所。参与者：临床痴呆评定（CDR）量表评分为0.5（n=15）、1（n=15）或2 - 3（n=15）的bvFTD患者，年龄和性别彼此匹配，并与45名健康对照组匹配。磁共振体素为基础的形态测量估计灰质和白色物质萎缩，在每个疾病阶段与controls.Results相比：患者的CDR评分为0.5有灰质损失额边缘皮质，但萎缩也涉及网络的前皮质和皮质下区域。CDR评分为1分显示更广泛的额叶灰质萎缩和胼胝体和脑干中的白色物质损失。CDR评分为2 - 3分显示额外的后额叶、海马和顶叶受累，在假定的额叶投射纤维中有白色物质萎缩。结论：非常轻度的bvFTD靶向额叶和岛叶区域的特定亚群。更严重的病变累及与最早损伤部位紧密相连的白色物质和后部灰质结构。
Background: Behavioral variant frontotemporal dementia (bvFTD) strikes hardest at the frontal lobes, but the sites of earliest injury remain unclear.Objective: To determine atrophy patterns in distinct clinical stages of bvFTD, testing the hypothesis that the mildest stage is restricted to frontal paralimbic cortex.Design: A bvFTD cohort study.Setting: University hospital dementia clinic.Participants: Patients with bvFTD with Clinical Dementia Rating (CDR) scale scores of 0.5 (n=15), 1 (n=15), or 2 to 3 (n=15) age and sex matched to each other and to 45 healthy controls.Main Outcome Measures: Magnetic resonance voxel-based morphometry estimated gray matter and white matter atrophy at each disease stage compared with controls.Results: Patients with a CDR score of 0.5 had gray matter loss in frontal paralimbic cortices, but atrophy also involved a network of anterior cortical and subcortical regions. A CDR score of 1 showed more extensive frontal gray matter atrophy and white matter losses in corpus callosum and brainstem. A CDR score of 2 to 3 showed additional posterior insula, hippocampus, and parietal involvement, with white matter atrophy in presumed frontal projection fibers.Conclusions: Very mild bvFTD targets a specific subset of frontal and insular regions. More advanced disease affects white matter and posterior gray matter structures densely interconnected with the sites of earliest injury.