阿尔茨海默病患者精神行为异常与脑白质损害的相关性

Correlation between behavioural and psychological symptoms and cerebral whte matter lesions in patients with Alzheimer＇s disease

目的探讨阿尔茨海默病（Alzheimer＇s disease，AD）患者精神行为异常与脑白质损害的相关性。方法纳入60例60岁以上的AD患者（AD组）和40例年龄、性别相匹配的认知功能正常的老年人（对照组），盲法分析其CT资料，双侧额区、顶枕区、颞区和幕下共8个区域白质损害的总和作为白质损害的总分，并检测CT显示的脑血管病变。AD组分别进行神经精神科问卷评分（Neuropsychiatric Inventory,NPI）。结果AD组脑白质损害总分、左额区、右额区、左顶枕区、右顶枕区白质损害和脑血管病变分别为1.450±2．310、0．340±0．340、0．310±0．560、0．240±0．360、0．140±0．230和0．120±0．330，而对照组分别为9．640±1．566、1．720±0．248、1．680±0．312、1．550±0．244、0．140±0．230和2．230±0．378，两组有显著差异（P分别为0．000、0．001、0．001、0．012、0．006和0．002）。Spearman相关分析表明，NPI与白质损害总评分、左额区、右额区、左顶枕区和右顶枕区白质损害评分相关，rs（P）分别为0．487（0．016）、0．490（0．014）、0．502（0．014）、0．507（0．012）和0．521（0．014），而与脑血管病变无关（rs=0．132，P=0．590）。结论脑白质损害和脑血管病变对AD的发病及病情发展至关重要，脑白质损害与AD患者的精神行为异常密切相关。

Objective To investigate the correlation between behavioural and psychological symptoms and cerebral white matter lesions （WMLs） in patients with Alzheimer＇s disease （AD）. Methods Sixty patients with AD aged more than 60 years （AD group） and 40 age-, sex-matched subjects with normal cognitive function （control group） were recruited. The data of cerebral CT were analyzed blindly. The sum of WMLs in 8 regions, such as bilateral frontal region, parieto-occipital region, temporal region, and subtentorial region, etc were used as the total score of WMLs, and the cerebrovascular lesions revealed on CT were detected. The AD group was assessed with the Neuropsychiatric Inventory （NPI）. Results There were significant differences in total WML score （1. 450 ±2.310 vs. 9. 640 ± 1. 566, P =0. 000）, left frontal WMLs （0. 340 ± 0. 340 vs. 1. 720 ± 0. 248, P = 0. 001 ）, right frontal WMLs （0. 310 ±0. 560 vs. 1. 680 ±0. 312, P =0. 001）, left parieto-occipital WMLs （0. 240 ±0. 360 vs. 1. 550 ±0. 244, P =0. 012）, right parieto-occipital WMLs （ 0. 140 ±0. 230 vs. 1. 450 ± 0. 231, P = 0. 006） and cerebrovascular lesions （0. 120 ± 0. 330 vs. 2. 230 ± 0. 378, P = 0. 002） between the AD group and the control group. Spearman correlation analysis showed that NPI was correlated with the total WML score （rs =0. 487, P = 0. 016）, left frontal WMLs （rs =0. 490, P = 0. 014）, right frontal WMLs （rs = 0. 502, P = 0. 014）, left parieto-occipital WMLs （rs =0. 507, P =0. 012） and right parieto-occipital WMLs （rs =0. 521, P = 0. 014）, and it was not correlated with the cerebrovascular lesions （rs = 0. 132, P = 0. 590 ）.Conclusions WMLs and cerebrovascular lesions are essential in the onset of AD and disease development. WMLs are closely correlated with the behavioural and psychological symptoms in patients with AD.