Conversion of mild cognitive impairment to Alzheimer disease predicted by hippocampal atrophy maps
Conversion of mild cognitive impairment to Alzheimer disease predicted by hippocampal atrophy maps
复制标题
DOI：
10.1001/archneur.63.5.693
复制
发表时间：
2006-05-01
影响因子：
--
通讯作者：
Thompson, Paul M.
中科院分区：
文献类型：
--
作者：
Apostolova, Liana G.;Dutton, Rebecca A.;Thompson, Paul M.
背景：虽然大多数轻度认知障碍(MCI)患者转变为阿尔茨海默病(AD)，但也有一些患者发展为非AD痴呆，仍处于MCI状态，或有所改善。目的：检验以下假设：较小的海马体体积预示着MCI向AD的转变，而较大的海马体体积预示着认知的稳定和/或改善；设计：前瞻性纵向队列研究地点：加州大学洛杉矶分校阿尔茨海默病研究中心。患者：我们对20名MCI患者进行了为期3年的临床和神经心理学随访。主要观察指标：用感兴趣区和三维海马区标测技术分析基线区域海马区萎缩。结果：在3年的研究中，6名患者发展为AD(MCI-c)，7名保持稳定(MCI-NC)，7名改善(MCL-I)。与MCI-NC患者相比，MCI-c患者左侧和右侧平均海马体体积分别缩小9%和13%。放射状萎缩图显示MCI-c组CA1亚区萎缩程度更大。MCI-c患者的海马区明显小于MCI-I患者(左侧，24%；右侧，27%)。体积分析显示，与MCI-I患者相比，MCI-NC患者有更大的海马区萎缩趋势(例如，16%的体积损失)。在多次比较后的排列测试校正后，萎缩图在右侧显示了显著的差异。MCI-c和MCI-I患者之间、MCI-NC和MCI-I患者之间存在亚支差异。多元线性回归分析证实，群体效应非常显著，与年龄、大脑半球和Mini-Intelligence State基线检查分数无关。结论：较小的海马区，特别是CA1和丘下受累，与从MCI转变为AD的风险增加有关。MCI-I患者倾向于有更大的海马体体积和相对保存的下丘脑和CA1。
Background: While most patients with mild cognitive impairment (MCI) transition to Alzheimer disease (AD), others develop non-AD dementia, remain in the MCI state, or improve.Objective: To test the following hypotheses: smaller hippocampal volumes predict conversion of MCI to AD, whereas larger hippocampal volumes predict cognitive stability and/or improvement; and patients with MCI who convert to AD have greater atrophy in the CA1 hippocampal subfield and subiculum.Design: Prospective longitudinal cohort studySetting: University of California-Los Angeles Alzheimer's Disease Research Center.Patients: We followed up 20 MCI subjects clinically and neuro psychologically for 3 years.Main Outcome Measure: Baseline regional hippocampal atrophy was analyzed with region-of-interest and 3-dimensional hippocampal mapping techniques.Results: During the 3-year study, 6 patients developed AD (MCI-c), 7 remained stable (MCI-nc), and 7 improved (MCl-i). Patients with MCI-c had 9% smaller left and 13% smaller right mean hippocampal volumes compared with MCI-nc patients. Radial atrophy maps showed greater atrophy of the CA1 subregion in MCI-c. Patients with MCI-c had significantly smaller hippocampi than MCI-i patients (left, 24%; right, 27%). Volumetric analyses showed a trend for greater hippocampal atrophy in MCI-nc relative to MCI-i patients (eg, 16% volume loss). After permutation tests corrected for multiple comparison, the atrophy maps showed a significant difference on the right. Subicular differences were seen between MCI-c and MCI-i patients, and MCI-nc and MCI-i patients. Multiple linear regression analysis confirmed the group effect to be highly significant and independent of age, hemisphere, and Mini-Mental State Examination scores at baseline.Conclusions: Smaller hippocampi and specifically CA1 and subicular involvement are associated with increased risk for conversion from MCI to AD. Patients with MCI-i tend to have larger hippocampal volumes and relative preservation of both the subiculum and CA1.