Distinct subtypes of Alzheimer's disease based on patterns of brain atrophy: longitudinal trajectories and clinical applications.
Distinct subtypes of Alzheimer's disease based on patterns of brain atrophy: longitudinal trajectories and clinical applications.
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DOI：
10.1038/srep46263
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发表时间：
2017-04-18
影响因子：
4.6
通讯作者：
Westman E
中科院分区：
文献类型：
--
作者：
Ferreira D;Verhagen C;Hernández-Cabrera JA;Cavallin L;Guo CJ;Ekman U;Muehlboeck JS;Simmons A;Barroso J;Wahlund LO;Westman E
MRI上的萎缩模式可以可靠地预测阿尔茨海默病（AD）的三种神经病理亚型：典型、边缘为主或海马保留。目前尚缺乏一种能够在临床常规中对其进行研究的方法。我们的目的是(1)验证视觉评定量表在AD亚型识别中的联合使用；(2)在基线和两年内确定这些亚型的特征；(3)研究萎缩模式和非记忆认知域对记忆损伤的影响。采用Scheltens颞叶内侧萎缩量表（MTA）、Koedam后叶萎缩量表（PA）和Pasquier额叶萎缩量表（GCA-F），将AD患者分为典型AD （n = 100）、边缘优势型AD （n = 33）和海马保留型AD （n = 35）。第四组也没有萎缩（n = 30）。230名健康对照者也包括在内。在人口统计学、临床和认知变量的亚型之间有很大的重叠。海马保留组和无萎缩组的记忆表现更依赖于非记忆认知功能。海马保留组和无萎缩组表现出较少的侵袭性疾病进展。视觉评定量表可用于识别不同的AD亚型。认识到阿尔茨海默病的异质性是很重要的，视觉评定量表可以促进临床常规中阿尔茨海默病异质性的研究。
Atrophy patterns on MRI can reliably predict three neuropathological subtypes of Alzheimer’s disease (AD): typical, limbic-predominant, or hippocampal-sparing. A method to enable their investigation in the clinical routine is still lacking. We aimed to (1) validate the combined use of visual rating scales for identification of AD subtypes; (2) characterise these subtypes at baseline and over two years; and (3) investigate how atrophy patterns and non-memory cognitive domains contribute to memory impairment. AD patients were classified as either typical AD (n = 100), limbic-predominant (n = 33), or hippocampal-sparing (n = 35) by using the Scheltens’ scale for medial temporal lobe atrophy (MTA), the Koedam’s scale for posterior atrophy (PA), and the Pasquier’s global cortical atrophy scale for frontal atrophy (GCA-F). A fourth group with no atrophy was also identified (n = 30). 230 healthy controls were also included. There was great overlap among subtypes in demographic, clinical, and cognitive variables. Memory performance was more dependent on non-memory cognitive functions in hippocampal-sparing and the no atrophy group. Hippocampal-sparing and the no atrophy group showed less aggressive disease progression. Visual rating scales can be used to identify distinct AD subtypes. Recognizing AD heterogeneity is important and visual rating scales may facilitate investigation of AD heterogeneity in clinical routine.