阿尔茨海默病伴精神行为症状患者低频振幅功能磁共振研究

Application of fMRI with amplitude of low-frequency fluctuation to behavioral and psychological symptoms in patients with Alzheimer's disease

目的应用功能磁共振(MRI)低频振幅(ALFF)分析方法对阿尔茨海默病(AD)伴精神行为症状(BPSD)患者的影像学特征进行研究。方法选取在杭州市第一人民医院就诊的AD伴BPSD患者作为病例组,选取正常老年人作为对照组。病例组根据精神神经科问卷(NPI)再分为BPSD重度组和轻度组。对照组、 BPSD轻度组和重度组对象分别在静息状态下使用f MRI并进行ALFF分析,比较3组对象脑区损害的影像学特征差异。结果共纳入病例组24例,其中BPSD轻度组和重度组各12例;对照组12人。相比对照组, BPSD轻度组患者功能激活区在颞中回、内侧额叶脑回、下顶叶、额中回和小脑后叶,功能减弱区在颞上回、枕叶、楔前叶和中央后回; BPSD重度组患者的功能激活区在小脑后叶、颞上回和颞叶,功能减弱区在枕中回、后扣带回、顶叶、楔前叶、额叶和额中回。BPSD轻度组和重度组患者分别与对照组脑功能激活区和减弱区的ALFF值比较,差异均有统计学意义(P<0.01)。相比BPSD轻度组,重度组患者功能激活区在下顶叶,功能减弱区在梭状回、舌回和颞中回; BPSD轻度组和重度组患者脑功能激活区和减弱区的ALFF值比较,差异均有统计学意义(P<0.01)。结论 AD伴BPSD患者存在静息态默认网区域的损伤,并且随着BPSD加重,视觉、注意、情感和认知调控网络也将受损。

Objective To investigate the behavioral and psychological symptoms of dementia(BPSD)in patients with Alzheimer's disease(AD)by measuring the amplitude of low-frequency fluctuation(ALFF)in functional magnetic resonance imaging(fMRI).Methods The AD patients with BPSD treated at the First People's Hospital of Hangzhou were enrolled as the case group,and the matched healthy elderly were unified recruited as the control group.The case group was further divided into two groups by neuropsychiatric inventory(NPI)questionnaire as the severe BPSD group and the mild BPSD group.All the three groups were separately received fMRI scan in resting state and compared by analysis of ALFF,and the specific damage manifestation of imaging features in the three groups were analyzed.Results There were 12 people in the control group and 24 AD patients with BPSD in the case group,with 12 patients in the mild BPSD group and 12 patients in the severe BPSD group.Compared with the control group,the activated areas of the mild BPSD group were in the middle temporal gyrus,medial frontal gyrus,inferior parietal lobe,middle frontal gyrus and posterior cerebellar lobe,and the weakened areas were in the superior temporal gyrus,occipital lobe,anterior cuneate lobe and posterior central gyrus.In the severe BPSD group,the activated areas were in the posterior cerebellum,superior temporal gyrus and temporal lobe,and the weakened areas were in the middle occipital gyrus,posterior cingulate gyrus,parietal lobe,anterior cuneate lobe,frontal lobe and middle frontal gyrus.The ALFF values of brain activated and weakened areas in the mild BPSD group and the severe BPSD group were significantly different from those in the control group(P<0.01).Compared with the mild BPSD group,the activated areas were in the lower parietal lobe,and the weakened areas were in the fusiform gyrus,lingual gyrus and middle temporal gyrus.The ALFF values in the activated areas and weakened areas between the severe BPSD group and the mild BPSD group were significantly different(P<0.01).Conclusion AD patients with BPSD have impaired resting default network areas,and visual,attention,emotional and cognitive regulatory networks are impaired as psychiatric symptoms worsen.