轻度认知功能障碍和不同程度Alzheimer病患者认知功能与内颞叶结构体积的关系

The Correlation between Cognitive Functions and MR Volumetric Measurements of Medial Temporal Lobe in Mild Cognitive Impairment and Different-phase Alzheimer Disease

目的:研究轻度认知功能障碍(mild cognitive impairment,MCI)和不同程度阿尔茨海默病(Alzheimer disease,AD)患者的认知功能与内颞叶结构体积的相关关系。方法:16例MCI、20例轻度AD和19例中重度AD患者分别接受临床评估、神经心理学检查和头颅核磁共振(MR)扫描,在重建的图像上测量杏仁核、海马、内嗅皮质及颞角的体积并行标准化处理,然后对神经心理学指标与内颞叶结构MR指标进行相关性分析。其中神经心理学检查包括简易精神状态检查量表(mini mental state examination,MMSE)和无意义图形再认、逻辑记忆、数字广度、延迟回忆、画钟测验、词语流畅性测验及日常生活行为量表。结果:三组间各结构MR标化体积除左、右颞角外差异均无统计学意义(P>0.05)。在MCI组中,注意力计算力、数字广度测验得分与左侧杏仁核体积负相关(r=0.51～-0.57,P<0.05),无意义图形再认得分与右侧海马体积正相关(r=0.77,P<0.001);在轻度AD组中,MMSE总分、无意义图形再认得分与杏仁核体积正相关(r=0.46～0.55,P<0.05);在中重度AD组中,定向力得分与右侧内嗅皮质体积正相关(r =0.47,P=0.041)。结论:无意义图形再认和数字广度测验等与内颞叶结构MR体积之间存在中度相关关系;杏仁核在AD的发展过程中可能起着更重要的作用。

Objective： To study the correlation between cognitive functions and MR volumetric measurements of medial temporal lobe in people with mild cognitive impairment （MCI ） or different-phase Alzheimer disease （AD ） . Methods： Sixteen patients with MCI, 20 with mild AD and 19 with moderate-to-severe AD were examined by clinical evaluation and cognitive evaluation including the Mini-Mental State Examination （ MMSE） , Meaningless Graphic Recognition （ MGR）, Logical Memory （Ln）, Digit Span （DS）, Delayed Recall （DR）, Rapid Verbal Retrieve （RVR）, Clock drawing Test （ CDT） and Activities of Daily Living scale （ ADL） . M1 of the subjects were scanned by MRI. Then we did volumetric measurements of amygdale （ AMY）, hippocampus （ HP）, entorhinal cortex （ EC）, and temporal horns of lateral ventricle （TH ） on a serial reconstructed MR images, and analyzed all of these data by SPSS11.5 software. Results ： All MR volumes among the three groups had no statistical significance except left and right temporal horns （P 〉 0. 05 ） . Attention, ability of calculation （ MMSE items ） and DS scores were negatively correlated with left amygdala volumes （ r = - 0. 51 ~ - 0. 57, P 〈 0. 05 ） , and MGR scores were positively correlated with right hippocampus volumes （r =0. 77, P〈0. 001 ） in the MCI group. There were positive correlations between MMSE total scores and left amygdala volumes （ r = 0. 46, P = 0. 044 ）, MGR scores and both amygdala volumes （ right： r = 0. 46, P = 0. 040; left： r =0. 55, P =0. 012） , but negative correlation between orientation （ MMSE item） scores and left tempo- ral horn volumes （ r = - 0. 46, P = 0. 040 ） in the mild AD group. Finally, orientation scores and right entorhinal cortex volumes were positively correlated in the moderate-to-severe AD group （ r = 0. 47, P = 0. 041 ） . Conclusion：MGR, DS and MMSE items were well correlated with MR volumetric measurements of medial temporal lobe, while amygdala may play a more important role in the AD process.