伴行为和精神症状痴呆患者的脑葡萄糖代谢研究

Study on cerebral glucose metabolism of dementia with behavioral and psychological symptoms

目的:研究有、无痴呆的行为和精神症状(BPSD)的阿尔茨海默病(AD)患者脑葡萄糖代谢的不同特点,以探讨AD患者BPSD的病理生理及其与大脑神经病理之间的关系。方法:对13例符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的AD患者,其中6例有BPSD(BPSD组),7例无BPSD(NBPSD组),并进行PET检查,对各脑区局部脑葡萄糖代谢率(rCMRglc)及多个核团进行测定,并用统计参数图(SPM)对两组脑PET图像进行像素间比较。结果:①BPSD组的AD患者额叶放射性减低者多于NBPSD组(4/6∶2/7);②应用感兴趣区(ROI)方法进行比较,BPSD组和NBPSD组在所选脑区中的rCMRglc差异无显著性(P>0.05);③应用SPM方法进行比较发现,BPSD组和NBPSD组rCMRglc显著减低的脑区主要分布在前额叶、顶枕交界处和颞下回。BPSD组比NBPSD组rCMRglc减低面积大,左侧额叶上回、右侧颞叶前内部、右侧岛叶前下部葡萄糖代谢减低。结论:AD患者,不管有无BPSD,rCMRglc减低区主要位于前额叶、顶枕叶交界处和颞叶下回;有BPSD的AD患者比无BPSD的患者rCMRglc的减低区面积大,分布广,程度重,提示BPSD可能是AD病程中的一个症状,而并非是另一种AD类型;额叶rCMRglc减低可能与BPSD的发生有关。

Objective： To study on cerebral glucose metabolism of matched Alzheimer Disease （AD） with or without behavioral and psychological symptoms of dementia （ BPSD）, the pathophysiological charac, ter of BPSD and the relationship between cerebral neuro-pathology and BPSD. Method： Positron emission tomography （PEF） were performed in 13 AD patients （6 with BPSD and 7 without） The regional cerebral metabolism rate of glucose （rMRglc） of some brain regions and nucleus were detected, The PET images were compared between the two groups with statistic parameter mapping （SPM） pixel by pixel. Results：①The radioactivity of frontal lobe in AD patients with BPSD was lower than those NBPSD （4/6：2/7） ：②The rCMRglc of selected regions was nonsignificant between the two groups with regions of interest （ROI） ; ③The rCMRgle of prefrontal lobe, occipito-parietal lobe and infferior temporal gyms was marked decreased beth in BPSD group and NBPSD group. But there was a larger area in BPSD group than in NBPSD group. The rCMRgle of the left superior frontal lobe, the right anterior medial temporal lobe and the rigbt anterior inferiot insular lobe decreased more in BPSD group than those in NBPSD group. Conclusion： AD patients, no matter with or without BPSD, have rCMRgle decreasing mainly in prefrontal, occipito-parietal lobe and inferior temporal gyms. There was a larger area, broader distribution and higher degree in AD patients with BPSD than in those without BPSD. BPSD is a symptom of AD during the course of the disease, not another type of AD. The decreasing of rCMRgle of frontal lobe may be related to onset of BPSD.