White matter hyperintensities on MRI in dementia with Lewy bodies, Parkinson's disease with dementia, and Alzheimer's disease
White matter hyperintensities on MRI in dementia with Lewy bodies, Parkinson's disease with dementia, and Alzheimer's disease
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DOI：
10.1016/j.jns.2017.12.018
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发表时间：
2018-02-15
影响因子：
4.4
通讯作者：
Tanaka, Fumiaki
中科院分区：
文献类型：
--
作者：
Joki, Hideto;Higashiyama, Yuichi;Tanaka, Fumiaki
背景资料：在路易体痴呆（DLB）和帕金森病痴呆（PDD）中，MRI上的白色高信号（WMH）是否反映动脉粥样硬化性脑血管病变或阿尔茨海默病（AD）相关病理如脑淀粉样血管病仍有争议。检查AD相关的病理DLB和PDD，我们比较了严重程度的WMH和内侧颞叶萎缩的患者与DLB，PDD，非痴呆PD（PDND），AD。方法：我们回顾性研究了性别和年龄匹配的门诊患者AD，DLB，PDD，PDND，以及受试者没有中枢神经系统疾病作为正常对照组（n = 50）。所有受试者均接受1.5 T MRI检查，根据Fazekas方法对T2加权图像或液体衰减反转恢复图像检测到的WMH进行半定量。结果：AD、DLB和PDD患者的WMH较PDND患者和正常对照组（NC）更为明显。DLB和AD的WMH比PDD严重。内侧颞叶萎缩的视觉评估显示，AD患者的萎缩最严重，其次是DLB，PDD和PDND患者，NC受试者按此顺序。结论：DLB的MRI表现与AD的相似性高于PDD，提示DLB的WMH可能主要反映AD相关的病理改变，而非动脉粥样硬化性脑血管病变。
Background: In dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD), it is still debated whether white matter hyperintensities (WMH) on MRI reflect atherosclerotic cerebrovascular changes or Alzheimer's disease (AD)-related pathology such as cerebral amyloid angiopathy. To examine AD-related pathology in DLB and PDD, we compared the severity of WMH and medial temporal lobe atrophy among patients with DLB, PDD, non-demented PD (PDND), and AD.Methods: We retrospectively studied sex- and age-matched outpatients with AD, DLB, PDD, and PDND, as well as subjects without central nervous system disorders as normal controls (n = 50 each). All subjects underwent 1.5-T MRI examinations, and WMH detected by T2-weighted images or fluid-attenuated inversion recovery images were semiquantified according to the Fazekas method. Medial temporal lobe atrophy (MTA) was visually assessed by the MTA score.Results: WMH were more prominent in AD, DLB, and PDD patients than in PDND patients and normal controls (NCs). DLB as well as AD showed more severe WMH than PDD. Visual assessment of medial temporal lobe atrophy showed that AD patients had the most severe atrophy, followed by DLB, PDD, and PDND patients, and NC subjects in that order. MTA scores showed significant correlations with WMH severity.Conclusion: Our results indicated that DLB was more similar to AD than to PDD in terms of MRI findings, suggesting that WMH in DLB may reflect mainly AD-related pathology rather than atherosclerotic cerebrovascular changes.