Pain and temperature processing in dementia: a clinical and neuroanatomical analysis
Pain and temperature processing in dementia: a clinical and neuroanatomical analysis
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DOI：
10.1093/brain/awv276
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发表时间：
2015-11-01
期刊：
影响因子：
14.5
通讯作者：
Warren, Jason D.
中科院分区：
文献类型：
--
作者：
Fletcher, Phillip D.;Downey, Laura E.;Warren, Jason D.
痴呆疾病中已经描述了疼痛和温度处理改变的症状，可能对临床表型有重要贡献，特别是在额颞叶退行性变谱中，但这些症状的基础尚未详细描述。在这里，我们使用半结构照顾者问卷来分析疼痛和温度症状，记录了额颞叶变性患者(n=58，女性25，年龄52-84岁，代表主要临床症状和C9orf72和MAPT基因的典型致病突变)和健忘型阿尔茨海默病患者(n=20，女性8，年龄5374岁)的疼痛和温度变化的行为反应。使用盲目视觉评分和基于体素的脑磁共振图像形态测量来评估神经解剖学关联。确定了某些症状特征：疼痛和体温症状在行为变异型额颞叶痴呆(71%的病例)和语义性痴呆(65%的病例)中特别普遍，并与C9orf72突变有关(6/6例)，但也在阿尔茨海默病(45%的病例)和进行性非流利性失语(25%的病例)中发展。虽然温度反应改变比疼痛反应改变更常见，但对疼痛和温度的反应迟钝与行为变异额颞叶痴呆(40%的症状病例)和语义性痴呆(73%的症状病例)和阿尔茨海默病(78%的症状病例)的高反应性尤其相关。在额颞叶变性队列的基于体素的形态计量学分析中，疼痛和体温症状与包括脑岛在内的右侧网络中的灰质丢失有关(P
Symptoms suggesting altered processing of pain and temperature have been described in dementia diseases and may contribute importantly to clinical phenotypes, particularly in the frontotemporal lobar degeneration spectrum, but the basis for these symptoms has not been characterized in detail. Here we analysed pain and temperature symptoms using a semi-structured caregiver questionnaire recording altered behavioural responsiveness to pain or temperature for a cohort of patients with frontotemporal lobar degeneration (n = 58, 25 female, aged 52-84 years, representing the major clinical syndromes and representative pathogenic mutations in the C9orf72 and MAPT genes) and a comparison cohort of patients with amnestic Alzheimer's disease (n = 20, eight female, aged 5374 years). Neuroanatomical associations were assessed using blinded visual rating and voxel-based morphometry of patients' brain magnetic resonance images. Certain syndromic signatures were identified: pain and temperature symptoms were particularly prevalent in behavioural variant frontotemporal dementia (71% of cases) and semantic dementia (65% of cases) and in association with C9orf72 mutations (6/6 cases), but also developed in Alzheimer's disease (45% of cases) and progressive non-fluent aphasia (25% of cases). While altered temperature responsiveness was more common than altered pain responsiveness across syndromes, blunted responsiveness to pain and temperature was particularly associated with behavioural variant frontotemporal dementia (40% of symptomatic cases) and heightened responsiveness with semantic dementia (73% of symptomatic cases) and Alzheimer's disease (78% of symptomatic cases). In the voxel-based morphometry analysis of the frontotemporal lobar degeneration cohort, pain and temperature symptoms were associated with grey matter loss in a right-lateralized network including insula (P