阿尔茨海默病正电子发射计算机断层扫描和神经心理测定的初步研究

The study of Alzheimer's disease with PET and neuropsychological test.

目的 探讨阿尔茨海默病(Alzheimer’s disease,AD)的脑葡萄糖代谢、神经心理学特点及AD的正电子发射计算机断层扫描(positron emission photography,PET)诊断。方法 对13例AD患者和11例年龄、性别和文化程度相匹配的健康对照者(HC)进行PET检查、简易智能状态检查(mini-mental state examination,MMSE)、韦克斯勒记忆量表测定(wechsler memory scale,WMS)和日常生活能力量表(activity of daily living,ADL)测定。结果 ①AD组MMSE、WMS分值明显低于HC组(P<0.01)。②肉眼读片,AD组存在脑萎缩,尤其是颞叶萎缩;大脑皮层放射性分布不均匀;健康老人可出现顶叶局部脑葡萄糖代谢率(regional cerebral metabolism rate of glucose,rCMRglc)的减低,但程度较轻;AD组全脑rGMRglc减低,以顶叶为最明显,其次为颞叶,再次为额叶。③AD组在双侧额叶上、中、下回、眶回、直回、颞叶中下回、顶上小叶、缘上回、前扣带回、尾状核、岛叶、丘脑,左侧角回、左侧杏仁核等脑区rCMRglc半定量指标降低较明显,与健康对照组相比,差异具有显著性或高度显著性((P<0.05-P<0.001);AD组病人额叶上中下回葡萄糖代谢半定量指标降低最为明显,其次为丘脑和尾状核。④相关分析表明,MMSE评分与性别呈负相关(P=0.025);

Objective To study the feature of regional cerebral metabolism rate of glucose (rCMRglc) and neuropsychology in patients with Alzheimer's disease(AD) and the relationship between them.Methods Positron emission tomography (PET)、mi-ni-mental state examination (MMSE) 、Wechsler memory scale (WMS) 、activity of daily living (ADL) and global deterioration scale (CDS) were administered to 13 patients with AD and 11 health controls (HC) . Results (1) Scores of MMSE and WMS of AD patients were significantly lower than those of HC ( < 0.01). (2) Watched by naked eyes, encephalatrophy, especially, temporal lobe atrophy, and unevenness distribution of radiation in cortex were seen in AD group. There was mild reduction of rCMRglc in the HC group, while marked in AD group, especially in parietal lobe, then temporal lobe and frontal lobe. (3) The rCMRglc of many parts of brain such as the superior, middle and inferior frontal gyms, orbital gyrus, rectus gyrus, the middle and inferior temporal gyrus, the superior parietal lobe, supramarginal gyrus, anterior cingulate gyrus, caudate nucleus, insular lobe thalamus and the left angular gyrus, the left amygdaloid nucleus were significantly lower in AD group than that in HC group ( P < 0.05 - P < 0.01). (4) Correlation analysis showed that scores of MMSE were correlated to sex in AD group( P = 0.025) . The rCMRglc of the right superior parietal lobe and the right thalamus was correlated to sex ( P = 0.038) . The rCMRglc of the left thalamus was correlated to age negatively ( P = 0.025). The rCMRglc of the right anterior central gyrus and the left medial occipital was correlated to years of education ( P < 0.025) . The rCMRglc of the right lateral occipital gyrus was correlated to scores of MMSE posi-tively ( P = 0.023). Conclusions The rCMRglc is lower in many parts of brain in AD patients. Decreasing of rCMRglc of parietal lobe is more sensitive, the next noe is temporal lobe and even the next is frontal lobe. The rCMRglc of some parts of brain is correlated with the sex, age, years of education or MMSE, The rCMRglc of some regions of brain can play an improtant role in diagnosis of AD.