FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment
FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment
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DOI：
10.1080/13554790490896938
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发表时间：
2005-02-01
期刊：
影响因子：
0.8
通讯作者：
Desgranges, B
中科院分区：
文献类型：
--
作者：
Chételat, G;Eustache, F;Desgranges, B
在阿尔茨海默病（AD）的痴呆前阶段，准确预测患者随后的临床演变将是治疗和研究观点的重大突破。遗忘型轻度认知功能障碍（MCI）是目前最常见的参考，以解决前痴呆阶段的AD。然而，以前的纵向研究与MCI患者评估神经心理学和PET标记物的未来转换为AD是稀疏和产量不一致的结果，而这两类措施的相对准确性的全面比较仍然缺乏。在本研究中，我们在18个月的随访期内评估了18例遗忘型MCI患者的Mattis量表测量的整体认知下降，研究该量表的哪个子测试显示随时间推移显着恶化。使用记忆神经心理学评估和PET的基线测量值，我们评估了全球认知变化的重要标志物，即马蒂斯量表总分的年度变化百分比，并寻找这种全球认知下降的最佳预测因子。总的来说，我们的研究结果显示，在18个月的随访期间，马蒂斯量表的总分和语言启动和记忆回忆子分数显着下降。Mattis总分的年度变化百分比与年龄和延迟情景记忆回忆以及语义自传和类别词流畅性的基线表现显著相关。关于功能成像，还发现与右颞顶叶和内侧额叶区的基线PET值显著相关。年龄和右颞顶叶PET值是随后整体认知能力下降的最重要预测因素，也是逐步回归分析中唯一幸存的因素。我们的研究结果是一致的，与以往的作品显示主要的延迟回忆和语义记忆障碍，在前痴呆阶段的AD，以及早期代谢缺陷的颞顶叶联合皮层。然而，他们认为，只有后者预测与MCI患者在首次评估后18个月内随后的认知下降特异性和准确性相关。
The accurate prediction, at a pre-dementia stage of Alzheimer's disease (AD), of the subsequent clinical evolution of patients would be a major breakthrough from both therapeutic and research standpoints. Amnestic mild cognitive impairment (MCI) is presently the most common reference to address the pre-dementia stage of AD. However, previous longitudinal studies on patients with MCI assessing neuropsychological and PET markers of future conversion to AD are sparse and yield discrepant findings, while a comprehensive comparison of the relative accuracy of these two categories of measure is still lacking. In the present study, we assessed the global cognitive decline as measured by the Mattis scale in 18 patients with amnestic MCI over an 18-month follow-up period, studying which subtest of this scale showed significant deterioration over time. Using baseline measurements from neuropsychological evaluation of memory and PET, we then assessed significant markers of global cognitive change, that is, percent annual change in the Mattis scale total score, and searched for the best predictor of this global cognitive decline. Altogether, our results revealed significant decline over the 18-month follow-up period in the total score and the verbal initiation and memory-recall subscores of the Mattis scale. The percent annual change in the total Mattis score significantly correlated with age and baseline performances in delayed episodic memory recall as well as semantic autobiographical and category word fluencies. Regarding functional imaging, significant correlations were also found with baseline PET values in the right temporo-parietal and medial frontal areas. Age and right temporo-parietal PET values were the most significant predictors of subsequent global cognitive decline, and the only ones to survive stepwise regression analyses. Our findings are consistent with previous works showing predominant delayed recall and semantic memory impairment at a pre-dementia stage of AD, as well as early metabolic defects in the temporo-parietal associative cortex. However, they suggest that only the latter predictor is specifically and accurately associated with subsequent cognitive decline in patients with MCI within 18 months of first assessment.