阿尔茨海默病患者神经精神症状与脑白质高信号的相关性分析

Association between neuropsychiatric symptoms and white matter hyperintensities in Alzheimer disease patients

目的分析阿尔茨海默病(AD)患者脑白质高信号(WMH)与神经精神症状(NPSs)的相关性。方法选取2021年4月至2022年3月在成都市第四人民医院记忆门诊就诊的97例AD患者为研究对象。采用简易精神状态检查(MMSE)、日常生活活动能力量表(ADL)、神经精神科问卷(NPI)评估患者的认知功能、日常生活活动能力和NPSs。对患者的头部进行3T MRI扫描后,采用UBO-Detctor软件提取患者各脑区WMH体积。采用偏相关分析AD患者各脑区WMH体积与MMSE、ADL、NPI评分的相关性。结果97例AD患者的MMSE评分为11.0(5.5,19.0)分,ADL评分为38.0(26.0,54.0)分,NPI评分为16.0(3.0,34.0)分。AD患者的MMSE评分与全脑、脑室周围、左侧颞叶、右侧颞叶WMH体积呈负相关(r=-0.240、-0.239、-0.332、-0.208;P<0.05);ADL评分与左侧颞叶、右侧颞叶WMH体积呈正相关(r=0.352、0.257;P<0.05);NPI评分与左侧颞叶WMH体积呈正相关(r=0.373,P<0.05)。NPI的12项症状中,AD患者妄想与左侧枕叶WMH体积呈正相关(r=0.214,P<0.05);幻觉、激越/攻击性与左侧颞叶、顶叶WMH体积呈正相关(r=0.354、0.212、0.460、0.254;P<0.05);焦虑、情感高涨/欣快、睡眠/夜间行为、食欲/进食障碍与左侧颞叶WMH体积呈正相关(r=0.222、0.422、0.295、0.222;P<0.05)。结论脑白质的损伤程度与AD患者的认知功能、日常生活能力及NPSs存在相关性,不同脑区的白质损伤与不同的NPSs相关,预防脑白质的损伤或能改善AD患者的NPSs。

Objective To analyze the association between white matter hyperintensities(WMH)and neuropsychiatric symptoms(NPSs)in Alzheimer disease(AD)patients.Methods From April 2021 to March 2022,97 AD patients who visited the Memory Clinic of the Fourth People's Hospital of Chengdu were selected as the research subject.The cognitive function,ability of daily living,and NPS of patients were evaluated using the Mini Mental State Examination(MMSE),Activity of Daily Living Scale(ADL),and Neuropsychiatric Inventory(NPI).This study conducted the 3T MRI scan of the patient's head,and using UBO-Detector software to extract WMH volume of each brain region of the patients.Partial correlation was used to analyze the association between WMH volume in various brain regions and MMSE,ADL,and NPI scores of AD patients.Results The MMSE,ADL,and NPI scores of 97 AD patients were 11.0(5.5,19.0),38.0(26.0,54.0),and 16.0(3.0,34.0),respectively.The MMSE score of AD patients was negatively correlated with WMH volume in the whole brain,periventricular,left temporal lobe,and right temporal lobe(r=-0.240,-0.239,-0.332,-0.208;P<0.05).The ADL score was positively correlated with the volume of WMH in the left and right temporal lobes(r=0.352,0.257;P<0.05).The NPI score was positively correlated with the left temporal lobe WMH volume(r=0.373,P<0.05).Among the 12 symptoms of NPI,delusions in AD patients were positively correlated with left occipital WMH volume(r=0.214,P<0.05).Hallucinations,agitation/aggression were positively correlated with left temporal and parietal lobe WMH volume(r=0.354,0.212,0.460,0.254;P<0.05).Anxiety,elation/euphoria,sleep/nighttime behavior,appetite/eating disorders were positively correlated with left temporal lobe WMH volume(r=0.222,0.422,0.295,0.222;P<0.05).The above differences were statistically significant.Conclusions The degree of white matter damage in the brain is correlated with cognitive function,ability of daily living,and NPSs in AD patients.White matter damage in different brain regions is associated with different NPSs,and preventing white matter damage may improve NPSs in AD patients.