Profiles of neuropsychological impairment in autopsy-defined Alzheimer's disease and cerebrovascular disease
Profiles of neuropsychological impairment in autopsy-defined Alzheimer's disease and cerebrovascular disease
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DOI：
10.1093/brain/awl385
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发表时间：
2007-03-01
期刊：
影响因子：
14.5
通讯作者：
Chui, Helena C.
中科院分区：
文献类型：
--
作者：
Reed, Bruce R.;Mungas, Dan M.;Chui, Helena C.
区分脑血管疾病，特别是小血管疾病的认知影响与阿尔茨海默病的认知影响是一个困难的临床挑战。皮质下脑血管疾病如何导致认知功能障碍的一个有影响力的模型认为，额纹状体环路的损伤损害额叶功能，导致执行功能的主要损害和相关认知功能（如记忆）的继发性损害。与此相一致的是，对临床诊断患者的神经心理学研究报告称，与阿尔茨海默病患者相比，血管性痴呆患者在记忆测试中表现更好，在执行功能测试中表现更差。这一观察结果表明，主要的认知执行功能障碍可能作为一个有用的诊断标志物血管性痴呆。我们试图在一系列具有尸检定义病理的病例中测试这一想法。受试者为62例尸检病例，来自一项血管对痴呆的贡献的前瞻性研究。仅使用神经病理学特征，23例被诊断为阿尔茨海默病（AD），11例脑血管病（CVD），9例两者（混合病理）和19例正常老年人大脑（NEB）。三个心理测量匹配的复合量表的不同认知能力：言语记忆，非言语记忆和执行功能。对组数据的分析表明，阿尔茨海默病的记忆分数平均低于执行功能的标准差。相反，与模型相反，CVD在执行功能、言语记忆和非言语记忆方面受到相当程度的损害。通过基于神经心理学评分之间的可靠差异定义三种配置文件来检查认知障碍的个体模式，以表征具有主要记忆障碍、主要执行功能障碍和“其他”模式的病例。对个体损伤特征的分析表明，71%的阿尔茨海默病患者存在主要的记忆损伤，而主要的执行功能障碍仅描述了45%的CVD。一个更强的模式出现时，认知正常的情况下，被排除在外，在6个认知功能障碍的CVD患者中，4个有主要的执行功能障碍，没有一个有主要的记忆障碍。本报告由大量尸检证实的病例组成，描述了与小血管脑血管病和阿尔茨海默病相关的神经心理障碍的模式。研究结果表明，阿尔茨海默病患者的记忆丧失通常超过执行功能障碍，而CVD患者的情况并非如此。作为一个整体，结果表明，小血管脑血管疾病的认知影响是可变的，并不是特别明显，从而提出了执行功能障碍作为血管性痴呆的诊断标志物的效用的问题。
Differentiating the cognitive effects of cerebrovascular disease, particularly small vessel disease, from those of Alzheimer's disease is a difficult clinical challenge. An influential model of how subcortical cerebrovascular disease causes cognitive dysfunction posits that damage to frontostriatal loops impairs frontal lobe function, leading to predominant impairment of executive function and secondary impairments of associated cognitive functions such as memory. Consistent with this, neuropsychological studies of clinically diagnosed patients have reported that individuals with vascular dementia do better on memory tests and worse on executive function tests compared with patients with Alzheimer's disease. This observation has led to the suggestion that predominant cognitive executive dysfunction might serve as a useful diagnostic marker for vascular dementia. We sought to test this idea in a series of cases with autopsy-defined pathologies. Subjects were 62 autopsied cases from a prospective study of vascular contributions to dementia. Using neuropathological features alone, 23 were diagnosed with Alzheimer's disease (AD), 11 with cerebrovascular disease (CVD), 9 with both (mixed pathology) and 19 with normal elderly brain (NEB). Three psychometrically matched composite scales of different cognitive abilities were used: Verbal Memory, Nonverbal Memory and Executive Function. Analysis of group data showed that for Alzheimer's disease memory scores were lower than Executive Function by nearly a standard deviation on average. In contrast, and contrary to the model, CVD was rather equally impaired on Executive Function, Verbal Memory and Nonverbal Memory. Individual patterns of cognitive impairment were examined by defining three profiles based on reliable differences between neuropsychological scores to characterize cases with predominant memory impairment, predominant executive dysfunction, and 'other' patterns. Analysis of individual impairment profiles showed that predominant memory impairment was present in 71% of Alzheimer's disease while predominant executive dysfunction described only 45% of CVD. A stronger pattern emerged when cognitively normal cases were excluded; among the six cognitively impaired CVD patients four had predominant executive dysfunction and none had predominant memory impairment. This report, comprised of a substantial sample of autopsy confirmed cases, delineates the patterns of neuropsychological impairment associated with small vessel cerebrovascular disease and Alzheimer's disease While the findings show that memory loss usually exceeds executive dysfunction in patients with Alzheimer's disease, the reverse is not the case in CVD. Taken as a whole, the results indicate that the cognitive effects of the small vessel cerebrovascular disease are variable and not especially distinct, thus raising question about the utility of executive impairment as a diagnostic marker for vascular dementia.