阿尔茨海默病患者额叶、扣带回皮层萎缩模式观察及意义

Atrophy pattern and significance of frontal cortex and cingulate cortex in patients with Alzheimer's disease

目的观察阿尔茨海默病(AD)患者额叶、扣带回皮层的萎缩模式,并探讨其意义。方法根据简易智能状态检查(MMSE)评分及临床痴呆评定量表(CDR)评分将28例AD患者分为轻度AD组、中度AD组各14例,同期体检健康者20例作为正常对照组。采用MMSE、CDR、蒙特利尔认知评估量表(MOCA)、日常生活活动量表(ADL)、汉密尔顿抑郁量表(HAMD)、神经精神量表(NPI),评估各组的认知功能。各组均行头颅MRI检查,FreeSurfer v5.1.0软件分析图像及数据。结果正常对照组、轻度AD组及中度AD组的MMSE、MOCA均依次降低,CDR、ADL、NPI均依次升高;组间两两比较,P均<0.05。额叶皮层各亚区中,轻度AD组、中度AD组双侧内侧眶回、外侧眶回及眶部皮层厚度均小于正常对照组,中度AD组左侧额中回后部皮层厚度小于轻度AD组,P均<0.05。扣带回皮层各亚区中,轻度AD组、中度AD组双侧扣带回峡部、后扣带回及前扣带回膝部皮层厚度小于正常对照组,P均<0.05;轻度AD组及中度AD组比较,P均>0.05。左侧额中回后部及左侧外侧眶回皮层厚度减少是AD进展的危险因素(OR分别为44.621、2.021),P均<0.05。结论轻度AD患者额叶、扣带回皮层即出现萎缩,萎缩模式为非均匀性,左侧额中回后部及左侧外侧眶回皮层萎缩可用于评估AD患者的疾病进展。

Objective To investigate the atrophy pattern and its significance of frontal cortex and cingulate cortex in Alzheimer′s disease （ AD） .Methods According to the scors of MMSE and CDR , 28 AD patients were divided into the mild AD group （n=14） and the moderate AD group （n=14）;20 healthy person were as the normol control group （NC group）.The cognitive function were assessed by MMSE , CDR, MOCA, ADL, HAMD and NPI.All subjects received MRI inspection.Then analysis of image and data was based on the model using FreeSurfer v 5.1.0 software.Results In NC, the mild and moderate AD groups , the scores of MMSE and MOCA decreased gradually , the scores of CDR , ADL and NPI increased gradually （all P〈0.05）.For the frontal cortex, compared with NC group, the thickness of bilateral lateral orbit-ofrontal gyrus , medial orbitofrontal gyrus , pars orbitalis gyrus in mild and moderate AD groups were significant smaller （ P〈0.05）, the thickness of left caudal middle frontal gyrus in the moderate AD group was smaller than the mild AD group （P〈0.05）.For the cingulate cortex, the thickness of bilateral isthmus cingulate gyrus , posterior cingulate gyrus and ros-tral anterior cingulated gyrus in two AD groups was thinner than NC group （P〈0.05）, but there was no difference of the thickness between the mild AD and moderate AD groups （P〉0.05）.The left caudal middle frontal and the left lateral or-bito frontal were the risk factors for dementia in AD （all P〈0.05）.Conclusions The atrophy of frontal lobe and cingu-late cortex existed in mild AD patients and the atrophy of each subregion was inhomogeneity .The left caudal middle frontal and the left lateral orbito frontal could predict cognitive impairment in AD .