典型与额叶变异型阿尔茨海默病和行为变异型额颞叶痴呆
的神经心理特征及临床影像比较研究
刘淑玲;石志鸿;王颖;刘帅;蔡莉;韩彤;周玉颖;纪勇
【期刊名称】《中华老年医学杂志》 【年(卷),期】2017(036)012
【摘要】目的 比较典型阿尔茨海默病(TAD)与额叶变异型阿尔茨海默病(fvAD)和行为变异型额颞叶痴呆(bvFTD)患者神经心理特征及其他临床及影像特点. 方法 应用神经心理学量表评价9例fvAD患者、30例bvFTD患者和32例TAD患者的认知功能、神经精神症状.结合载脂蛋白E(ApoE)ε4等位基因检查和头颅核磁共振(MRI)、11C-匹兹堡化合物B正电子发射断层显像(PIB-PET)、18F-脱氧葡萄糖正电子发射断层显像(FDG-PET)影像学检查对fvAD及bvFTD进行鉴别诊断.结果 bvFTD组、fvAD组及TAD组患者总体认知功能及日常活动能力差异无统计学意义(均P＞0.05),但其中蒙特利尔认知评估(MoCA)量表中认知亚项得分:bvFTD组患者和fvAD组患者较TAD患者在视空间与执行功能、延迟回忆、定向能力方面差异有统计学意义(Z执行功能=7.891、P=0.035,Z延迟回忆=7.412、P=0.031,Z定向能力=6.437、P=0.043),而在命名、注意、语言和抽象等方面三组差异无统计学意义(均P＞0.05);三组画钟测验(CDT)评分TAD组高于bvFTD组及fvAD组(Z=8.673、P=0.020);而神经精神问卷(NPI) bvFTD组及fvAD组评分均高于TAD组(Z=7.577、P=0.023);神经精神问卷(NPI)分项比较,其中bvFTD组及fvAD组在激越、脱抑制和异常行为三方面发生率高于TAD组(x2=11.139、P=0.004,x2=6.481、P=0.039,x2=6.812、P=0.033).fvAD组患者携带ApoE4等位基因的频率为44.4％,而bvFTD为
33.3％,与TAD为40.6％比较差异无统计学意义(x2=0.529,P=0.767).FDG-PET、PIB-PET影像学检查发现fvAD患者额颞叶代谢减低,并且存在皮层淀粉样蛋白沉积. 结论 神经心理学评价对于鉴别TAD与fvAD和bvFTD是有参考价值的,而fvAD和bvFTD患者的各项认知领域及神经精神症状评分及携带ApoEε4等位基因的频率具有相似性,对于特殊类型痴呆PIB-PET、FDG-PET影像学检查是有助于鉴别fvAD、bvFTD的重要方法.%Objective To compare the neuropsychological features and other clinical and imaging characteristics among patients with typical Alzheimer's disease (TAD),frontal variant Alzheimer's disease (fvAD) and behavioral variant frontotemporal dementia (bvFTD).Methods Neuropsychological scales were used to evaluate the cognitive function and neuropsychiatric symptoms of nine patients with fvAD,30 patients with bvFTD and 32 patients with typical AD (TAD).The apolipoprotein E (ApoE) ε4 allele and brain imaging techniques,including the magnetic resonance imaging (MRI),11 C-Pittsburgh compound B positron emission tomography (PIB-PET),and 18F-deoxyglucose positron emission tomography (FDG-PET),were used for the differential diagnosis of fvAD and bvFTD.Results There were no significant differences in general cognitive function or daily activity in patients among the three groups.However,the cognitive subscale
scores
of
Montreal
Cognitive
Assessment
(MoCA)
scale,including visual acuity and executive function,delayed recall,and orientation,were significantly different among the groups (Z =7.891,P
=0.035;Z =7.412,P =0.031;Z=6.437,P=0.043,respectively).The clock
drawing test (CDT) score of TAD group was higher than that in the bvFTD
and
fvAD
groups
(Z=8.673,P=0.020),while
the
neuropsychological questionnaire (NPI) scores of the bvFTD and fvAD groups were higher than those of the TAD group (Z=7.577,P =0.023).Meanwhile,the
incidences
of
agitation,disinhibition
and
abnormal behavior of NPI in the bvFTD and fvAD groups were higher than those in the TAD group (x2 =11.139,P =0.004;x2 =6.481,P =0.039;x2 =6.812,P =0.033,respectively).The frequencies of the ApoE ε4 allele were 44.4％ in the fvAD group and 33.3％ in the bvFTD group,which were not significant different from that in the TAD group (40.6％).Furthermore,patients in the fvAD group were associated with decreased regional cerebral glucose metabolism and amyloid deposition in the temporalparietal cortex evaluated by FDG-PET and PIP-PET.Conclusions Neuropsychological evaluation is valuable for the differential diagnosis of TAD,fvAD and bvFTD.The frequencies of the ApoEε4 allele are similar among the three groups.FDG-PET and PIB-PET imaging plays an important role in the diagnosis of variant types of Alzheimer's disease. 【总页数】6页(1283-1288)
【关键词】阿尔茨海默病;额叶;痴呆;神经心理学测验;载脂蛋白E4;正电子发射断层显像术
典型与额叶变异型阿尔茨海默病和行为变异型额颞叶痴呆的神经心理
