Amyloid deposits and response to shunt surgery in idiopathic normal-pressure hydrocephalus
Amyloid deposits and response to shunt surgery in idiopathic normal-pressure hydrocephalus
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DOI：
10.1016/j.jns.2015.06.029
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发表时间：
2015-09-15
影响因子：
4.4
通讯作者：
Yanai, Kazuhiko
中科院分区：
文献类型：
--
作者：
Hiraoka, Kotaro;Narita, Wataru;Yanai, Kazuhiko
目的：在先前的研究中，特发性常压脑积水（iNPH）患者在脑脊液分流术或颅内压监测期间偶尔在额叶皮质活检中显示阿尔茨海默病病理。在临床实践中，iNPH与阿尔茨海默病（AD）的鉴别诊断可能存在问题，特别是因为一些iNPH病例表现出AD合并症。在这项研究中，我们评估了淀粉样蛋白沉积在大脑中的患者与iNPH分流手术前，并调查脑淀粉样蛋白沉积和临床改善之间的关联后surgery.Materials & Methods：淀粉样蛋白成像与iNPH或AD患者，也在健康对照组使用正电子发射断层扫描（PET）和放射性标记的药物化合物，C-11-BF 227。使用小脑半球作为参考区域，估计新皮质的标准摄取值比率（SUVR），并将其用作淀粉样蛋白沉积的指标。在iNPH患者中，分流手术前和手术后3个月评估临床症状。结果：10例iNPH患者中有5例的新皮质SUVR与AD受试者一样高，而5例患者的SUVR与健康对照者一样低。在iNPH.Conclusions中观察到新皮质SUVR和分流术后认知改善之间的显著负相关性：iNPH患者的大脑中淀粉样蛋白沉积量范围广泛，并与分流术后认知改善的程度相关。(C)2015 Elsevier B. V.版权所有。
Objectives: In previous studies, patients with idiopathic normal-pressure hydrocephalus (iNPH) occasionally showed Alzheimer's pathology in frontal lobe cortical biopsy during cerebrospinal fluid shunt surgery or intracranial pressure monitoring. In clinical practice, the differential diagnosis of iNPH from Alzheimer's disease (AD) can be problematic, particularly because some iNPH cases exhibit AD comorbidity. In this study, we evaluated amyloid deposition in the brains of patients with iNPH before shunt surgery, and investigated the association between brain amyloid deposits and clinical improvement following the surgery.Materials & methods: Amyloid imaging was performed in patients with iNPH or AD and also in healthy control subjects by using positron emission tomography (PET) and a radiolabeled pharmaceutical compound, C-11-BF227. Using the cerebellar hemispheres as reference regions, the standard uptake value ratio (SUVR) of the neocortex was estimated and used as an index for amyloid deposition. In patients with iNPH, clinical symptoms were assessed before shunt surgery and 3 months after surgery.Results: Five of the 10 patients with iNPH had neocortical SUVRs that were as high as those of AD subjects, whereas the SUVRs of the 5 patients were as low as those of healthy controls. A significant inverse correlation between neocortical SUVRs and cognitive improvements after shunt surgery was observed in iNPH.Conclusions: The amount of amyloid deposits ranges widely in the brains of patients with iNPH and is associated with the degree of cognitive improvement after shunt surgery. (C) 2015 Elsevier B.V. All rights reserved.