Differentiating between Alzheimer’s disease, amnestic mild cognitive impairment, and normal aging via diffusion kurtosis imaging

Diffusion kurtosis imaging can be used to assess pathophysiological changes in tissue structure and to diagnose central nervous system diseases. However, its sensitivity in assessing hippocampal differences between patients with Alzheimer’s disease and those with amnestic mild cognitive impairment has not been characterized. Here, we examined 20 individuals with Alzheimer’s disease (11 men and 9 women, mean 73.2 ± 4.49 years), 20 with amnestic mild cognitive impairment (10 men and 10 women, mean 71.55 ± 4.77 years), and 20 normal controls (11 men and 9 women, mean 70.45 ± 5.04 years). We conducted diffusion kurtosis imaging, using a 3.0 T magnetic resonance scanner, to compare hippocampal differences among the three groups. The results demonstrated that the right hippocampal volume and bilateral mean kurtosis were remarkably smaller in individuals with Alzheimer’s disease compared with those with amnestic mild cognitive impairment and normal controls. Further, the mean kurtosis was lower in the amnestic mild cognitive impairment group compared with the normal control group. The mean diffusion in the left hippocampus was lower in the Alzheimer’s disease group than in the amnestic mild cognitive impairment and normal control groups, while the mean diffusion in the right hippocampus was lower in the Alzheimer’s disease group than in the normal control group. Fractional anisotropy was similar among the three groups. These results verify that bilateral mean kurtosis and mean diffusion are sensitive to the diagnosis of Alzheimer’s disease and amnestic mild cognitive impairment. This study was approved by the Ethics Review Board of Affiliated Sixth People’s Hospital of Shanghai Jiao Tong University, China on May 4, 2010 (approval No. 2010(C)-6).

Study of brain morphology change in Alzheimer’s disease and amnestic mild cognitive impairment compared with normal controls

Background With an aggravated social ageing level, the number of patients with Alzheimer's disease (AD) is gradually increasing, and mild cognitive impairment (MCI) is considered to be an early form of Alzheimer's disease. How to distinguish diseases in the early stage for the purposes of early diagnosis and treatment is an important topic. Aims The purpose of our study was to investigate the differences in brain cortical thickness and surface area among elderly patients with AD, elderly patients with amnestic MCI (aMCI) and normal controls (NC). Methods 20 AD patients, 21 aMCIs and 25 NC were recruited in the study. FreeSurfer software was used to calculate cortical thickness and surface area among groups. Results The patients with AD had less cortical thickness both in the left and right hemisphere in 17 of the 36 brain regions examined than the patients with aMCI or NC. The patients with AD also had smaller cerebral surface area both in the left and right hemisphere in 3 of the 36 brain regions examined than the patients with aMCI or NC. Compared with the NC, the patients with aMCI only had slight atrophy in the inferior parietal lobe of the left hemisphere, and no significant difference was found. Conclusion AD, as well as aMCI (to a lesser extent), is associated with reduced cortical thickness and surface area in a few brain regions associated with cognitive impairment. These results suggest that cortical thickness and surface area could be used for early detection of AD.

AMPLITUDE OF LOW FREQUENCY FLUCTUATION AT DIFFERENT FREQUENCY BANDS IN EARLY AMNESTIC MILD COGNITIVE IMPAIRMENT: RESULTS FROM ADNI

We used resting-state functional magnetic resonance imaging(fMRI)to determine whether there are any abnormalities in different frequency bands between amplitude of low-frequency fluctuations(ALFF)and fractional ALFF(fALFF)and between 10 early amnestic mild cognitive impairment(EMCI)patients and eight normal controls participating in the Alzheimer’s Disease Neuroimaging Initiative(ADNI).We showed widespread difference in ALFF/fALFF between two frequency bands(slow-4:0.027-0.073 Hz,slow-5:0.01-0.027 Hz)in many brain areas including posterior cingulate cortex(PCC),medial prefrontal cortex(MPFC),suprasellar cistern(SC)and ambient cistern(AC).Compared to the normal controls,the EMCI patients showed increased ALFF values in PCu,cerebellum,occipital lobe and cerebellum posterior lobe in frequency band slow-4.While in frequency band slow-5,the EMCI patients showed decreased ALFF values in temporal lobe,left cerebrum and middle temporal gyrus5.Moreover,the EMCI patients showed increased fALFF values in frontal lobe and inferior frontal gyrus in band slow-5.While in frequency band slow-4,the EMCI patients showed decreased fALFF values in limbic lobe,cingulate gyrus and corpus callosum.These results demonstrated that EMCI patients had widespread abnormalities of amplitude of LFF in different frequency bands.

Spanish Version of Test MIS (*) with Delayed Memory Recall Normative Values and Results in a Population with Mild Cognitive Impairment

Background: Cognitive impairment becomes more common with ageing and may benefit from intervention. In a Spanish speaking population, detection of cognitive impairment by a general practitioner in Primary Care can be a problem, as many of the standard tests target English speaking populations. The Memory Impairment Screen (MIS-A) is a validated test using English words to detect Alzheimer’s Disease (AD) and other dementias. We have modified this test to suit a Spanish speaking population and added a new component, delayed recall. We have called our new test the Memory Impairment Screen with Delayed Recall (MIS-D). Objectives: 1) To test a Spanish version of MIS-A and MIS-D. 2) To assess the discriminative validity of MIS-D as a screening tool for the amnestic variant of Mild Cognitive Impairment (aMCI) in a group of Spanish speaking people aged 65 years old and over. Methods: A case-control study of a cohort of 739 native Spanish speaking residents of Buenos Aires aged 65 years old and over, of whom 436 were healthy controls and 303 had a diagnosis of aMCI. Measurements: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NVP) were estimated for MIS-D and MIS-A. Results: Normative values for MIS-A and MIS-D were obtained from the control population. Both age and education significantly affected these values (p < 0.0001). Control participants showed significant differences for both modalities, MIS-A and MIS-D. The cut-off for MIS-A should be 7.5 and for MIS-D, 5.5. Comparison between control population and aMCI population using ROC curve gave a result of 5.5 in MIS-D, with 97% specificity and 76% sensitivity. Conclusion: MIS-D was positively predictive of aMCI, with 97% specificity and 76% sensitivity in a sample of Spanish speaking patients aged 65 years old and over in Buenos Aires.

Cognitive and Functional Profiles in Mild-to-Moderate Alzheimer’s Disease and Mild Cognitive Impairment Compared to Healthy Elderly

Background: Amnestic mild cognitive impairment (aMCI) and mild-to-moderate Alzheimer’s disease (AD) are clinically distinct but impact cognitive and functional ability similarly. Comprehensive assessment of cognitive and functional deficits may prove useful in informing differential diagnosis in early stages of dementia and in informing endpoint selection in therapeutic AD trials. Objective: The objective of this study was to characterize patterns of cognitive and functional impairment in aMCI and mild-to-moderate AD subjects compared to cognitively intact healthy elderly (HE). Methods: Thirty-one healthy elderly, 20 aMCI and 19 AD participants were administered a cognitive test battery that included the ADAS-Cog and functional assessments. Z-scores were calculated for all endpoints based on the HE reference group. Results: Cognitive deficits were observed in AD and aMCI participants relative to the referent group. On average, aMCI participants performed 1 - 2 standard deviations below HE on cognitive tests, and AD participants performed 2 - 3 standard deviations below HE. Domain-specific functional deficits among AD participants (z- score -0.4 to -6.4) were consistently greater than those of aMCI participants (z-score 0 to -1.7). Conclusion: This study provides further support for comprehensive assessment and monitoring of cognitive and functional domain scores in the diagnosis and treatment of aMCI and mild AD. Domain-specific cognitive scores may be more useful than composite scores in characterizing impairment and decline. Measuring domains such as attention, processing speed and executive function may increase the sensitivity of detecting disease progression and therapeutic effects, particularly in mild-moderate AD where memory decline may be too slow to detect drug effects during a typical clinical trial.

Analysis of entropies based on empirical mode decomposition in amnesic mild cognitive impairment of diabetes mellitus

EEG characteristics that correlate with the cognitive functions are important in detecting mild cognitive impairment(MCI)in T2DM.To investigate the complexity between aMCI group and age-matched non-aMCI control group in T2DM,six entropies combining empirical mode decomposition(EMD),including Approximate entropy(ApEn),Sample entropy(SaEn),Fuzzy entropy(FEn),Permutation entropy(PEn),Power spectrum entropy(PsEn)and Wavelet entropy(WEn)were used in the study.A feature extraction technique based on maximization of the area under the curve(AUC)and a support vector machine(SVM)were subsequently used to for features selection and classi¯cation.Finally,Pearson's linear correlation was employed to study associations between these entropies and cognitive functions.Compared to other entropies,FEn had a higher classification accuracy,sensitivity and specificity of 68%,67.1% and 71.9%,respectively.Top 43 salient features achieved classification accuracy,sensitivity and speci¯city of 73.8%,72.3% and 77.9%,respectively.P4,T4 and C4 were the highest ranking salient electrodes.Correlation analysis showed that FEn based on EMD was positively correlated to memory at electrodes F7,F8 and P4,and PsEn based on EMD was positively correlated to Montreal cognitive assessment(MoCA)and memory at electrode T4.In sum,FEn based on EMD in righttemporal and occipital regions may be more suitable for early diagnosis of the MCI with T2DM.

Advances in longitudinal studies of amnestic mild cognitive impairment and Alzheimer's disease based on multi-modal MRI techniques

Amnestic mild cognitive impairment （aMCI） is a prodromal stage of Alzheimer＇s disease （AD）, and 75%-80% of aMCI patients finally develop AD. So, early identification of patients with aMCI or AD is of great significance for prevention and intervention. According to cross-sectional studies, it is known that the hippocampus, posterior cingulate cortex, and corpus callosum are key areas in studies based on structural MRI （sMRI）, functional MRI （fMRI）, and diffusion tensor imaging （DTI） respectively. Recently, longitudinal studies using each MRI modality have demonstrated that the neuroimaging abnormalities generally involve the posterior brain regions at the very beginning and then gradually affect the anterior areas during the progression of aMCI to AD. However, it is not known whether follow-up studies based on multi-modal neuroimaging techniques （e.g., sMRI, fMRI, and DTI） can help build effective MRI models that can be directly applied to the screening and diagnosis of aMCI and AD. Thus, in the future, large-scale multi-center follow-up studies are urgently needed, not only to build an MRI diagnostic model that can be used on a single person, but also to evaluate the variability and stability of the model in the general population. In this review, we present longitudinal studies using each MRI modality separately, and then discuss the future directions in this field.

Alterations of brain local functional connectivity in amnestic mild cognitive impairment

Background:Resting-state functional magnetic resonance imaging studies using a regional homogeneity(ReHo)method have reported that amnestic mild cognitive impairment(aMCI)was associated with abnormalities in local functional connectivity.However,their results were not conclusive.Methods:Seed-based d Mapping was used to conduct a coordinate-based meta-analysis to identify consistent ReHo alterations in aMCI.Results:We identified 10 studies with 11 datasets suitable for inclusion,including 378 patients with aMCI and 435 healthy controls.This meta-analysis identified significant ReHo alterations in patients with aMCI relative to healthy controls,mainly within the default mode network(DMN)(bilateral posterior cingulate cortex[PCC],right angular gyrus,bilateral middle temporal gyri,and left parahippocampal gyrus/hippocampus),executive control network(right superior parietal lobule and dorsolateral prefrontal cortex),visual network(right lingual gyrus and left middle occipital gyrus),and sensorimotor network(right paracentral lobule/supplementary motor area,right postcentral gyrus and left posterior insula).Significant heterogeneity of ReHo alterations in the bilateral PCC,left parahippocampal gyrus/hippocampus,and right superior parietal lobule/angular gyrus was observed.Exploratory meta-regression analyses indicated that general cognitive function,gender distribution,age,and education level partially contributed to this heterogeneity.Conclusions:This study provides provisional evidence that aMCI is associated with abnormal ReHo within the DMN,executive control network,visual network,and sensorimotor network.These local functional connectivity alterations suggest coexistence of functional deficits and compensation in these networks.These findings contribute to the modeling of brain functional connectomes and to a better understanding of the neural substrates of aMCI.Confounding factors merit much attention and warrant future investigations.

Characteristics of Agraphia in Chinese Patients with Alzheimer＇s Disease and Amnestic Mild Cognitive Impairment

Background： Patients with Alzheimer＇s disease （AD） manifest progressive decline in writing abilities. Most studies on agraphia in AD have been performed in the alphabetic system, such as English. However, these findings may not be applicable to other written language systems. The unique features of the Chinese written script could affect the patterns of agraphia in Chinese AD patients. The aim of this study was to explore the features of writing errors in Chinese patients with AD and amnestie mild cognitive impairment （a-MCI）, as well as to study the relationship between their writing errors and neuropsychological functions. Methods： In this study, we performed an observational study in a group of subjects including 17 AD patients, 14 patients with a-MCI, and 16 elderly healthy controls. We analyzed the writing errors in these subjects and also studied the relationship between their writing errors and neuropsychological functions. Results： Our study showed that in patients whose mother tongue is Chinese, writing ability was comparatively well preserved in the MCI phase but significantly impaired when the disease progressed to the stage of AD. The writing errors showed corresponding increase with the severity of cognition decline, both in the types of errors and rate of occurrence. Analysis of the writing errors showed that word substitution and unintelligible words were the most frequent error types that occurred in all the three study groups. The occurrence rate of unintelligible words was significantly higher in the AD group compared with the a-MCI group （P = 0.024） and control group （P = 0.018）. In addition, the occurrence rates of word substitution were also significantly higher in AD （P = 0.013） and a-MCI groups （P = 0.037） than that of control group. However, errors such as totally no response, visuospatial impairment, paragraph agraphia, ideograph, and perseverative writing errors were only seen in AD group. Besides, we also found a high occurrence rate of visuoconstructional errors （13.3%） in our AD group. Conclusions： Our study confirmed that agraphia is an important feature in patients with AD. The writing error profile in patients whose native language is Chinese was unique compared to patients using the alphabetic language system.

Can multi-modal neuroimaging evidence from hippocampus provide biomarkers for the progression of amnestic mild cognitive impairment?

Impaired structure and function of the hippocampus is a valuable predictor of progression from amnestic mild cognitive impairment（a MCI） to Alzheimer＇s disease（AD）. As a part of the medial temporal lobe memory system,the hippocampus is one of the brain regions affected earliest by AD neuropathology,and shows progressive degeneration as a MCI progresses to AD. Currently,no validated biomarkers can precisely predict the conversion from a MCI to AD. Therefore,there is a great need of sensitive tools for the early detection of AD progression. In this review,we summarize the specifi c structural and functional changes in the hippocampus from recent a MCI studies using neurophysiological and neuroimaging data. We suggest that a combination of advanced multi-modal neuroimaging measures in discovering biomarkers will provide more precise and sensitive measures of hippocampal changes than using only one of them. These will potentially affect early diagnosis and disease-modifying treatments. We propose a new sequential and progressive framework in which the impairment spreads from the integrity of fibers to volume and then to function in hippocampal subregions. Meanwhile,this is likely to be accompanied by progressive impairment of behavioral and neuropsychological performance in the progression of a MCI to AD.

Interhemispheric functional connectivity for Alzheimer's disease and amnestic mild cognitive impairment based on the triple network model

The purpose of this study was to explore the differences in interhemispheric functional connectivity in patients with Alzheimer’s disease(AD) and amnestic mild cognitive impairment(aMCI) based on a triple network model consisting of the default mode network(DMN), salience network(SN), and executive control network(ECN). The technique of voxel-mirrored homotopic connectivity(VMHC) analysis was applied to explore the aberrant connectivity of all patients. The results showed that:(1) the statistically significant connections of interhemispheric brain regions included DMN-related brain regions(i.e. precuneus, calcarine, fusiform, cuneus, lingual gyrus, temporal inferior gyrus, and hippocampus), SN-related brain regions(i.e. frontoinsular cortex), and ECN-related brain regions(i.e. frontal middle gyrus and frontal inferior);(2) the precuneus and frontal middle gyrus in the AD group exhibited lower VMHC values than those in the aMCI and healthy control(HC) groups, but no significant difference was observed between the a MCI and HC groups; and(3) significant correlations were found between peak VMHC results from the precuneus and Mini Mental State Examination(MMSE) and Montreal Cognitive Scale(MOCA) scores and their factor scores in the AD, a MCI, and AD plus aMCI groups, and between the results from the frontal middle gyrus and MOCA factor scores in the a MCI group. These findings indicated that impaired interhemispheric functional connectivity was observed in AD and could be a sensitive neuroimaging biomarker for AD. More specifically, the DMN was inhibited, while the SN and ECN were excited. VMHC results were correlated with MMSE and MOCA scores, highlighting that VMHC could be a sensitive neuroimaging biomarker for AD and the progression from aMCI to AD.

老年遗忘型轻度认知障碍执行功能的神经机制及数字干预

阿尔茨海默病具有极高的发病率和致死率。遗忘型轻度认知障碍(Amnestic Mild Cognitive Impairment,aMCI)作为临床前驱期,探究其形成和发展机制有助于预防阿尔茨海默病的发生。现有研究显示,多个执行域缺陷与aMCI记忆衰退密切相关,但尚未回答何种执行域是关键致病因子、关键干预治疗靶标等科学问题。为突破以往研究将执行功能视作整体抑或割裂元素的局限性,本研究拟从执行功能结构全貌着眼,在提出aMCI执行功能与记忆损害关系假说的基础上,利用脑电技术系统考察aMCI抑制、刷新和转换三种执行功能子成分的时域、时频和动态脑网络特征;并结合三维卷积神经网络筛选、识别执行功能缺陷的特异性神经靶标,探索将抑制域相关神经标记物加入aMCI早期识别的可能性;最后,通过纵向因果设计分析不同靶向数字干预对aMCI患者的训练效果及神经基础,以揭示抑制域相关额顶控制网络在干预中的重要作用。本研究有望从计算认知神经视角阐明抑制是aMCI执行功能缺损和干预的认知新靶点,进而为aMCI早期识别和制定精准化诊疗方案提供循证依据。

天智颗粒联合常规西药治疗遗忘型轻度认知功能障碍患者的效果

目的:观察天智颗粒联合常规西药治疗遗忘型轻度认知功能障碍(aMCI)患者的效果。方法:选取2020年1月至2021年1月该院收治的120例aMCI患者进行前瞻性研究,按随机数字表法将其分为对照组与研究组各60例。对照组采用常规西药治疗,研究组在对照组基础上联合天智颗粒治疗,比较两组临床疗效,治疗前后认知功能[简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)]评分、记忆能力[Rivermead行为记忆试验(RBMT)]评分,以及不良反应发生率。结果:研究组治疗总有效率为91.67%(55/60),高于对照组的76.67%(46/60),差异有统计学意义(P<0.05);治疗后,两组MMSE、MoCA评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);两组RBMT评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:天智颗粒联合常规西药治疗aMCI患者可提高治疗总有效率、认知功能评分和记忆能力评分,其效果优于单纯常规西药治疗。

亚甲基四氢叶酸还原酶基因多态性与阿尔茨海默病的相关性临床研究

目的探讨阿尔茨海默病(AD)进程中,亚甲基四氢叶酸还原酶(MTHFR)C677T多态性与疾病的相关性,以及是否受APOE基因影响。方法共纳入74例AD患者、85例遗忘型轻度认知障碍患者(aMCI)和81例健康对照者(HC),检测3组血清同型半胱氨酸(Hcy)、叶酸和维生素B12水平,以及MTHFR C677T及APOE基因型,通过Logistic回归分析比较MTHFR C677T不同等位基因和基因型分别与aMCI和AD风险之间的关联,以及在不同APOEε4亚组中的表现。结果AD组和aMCI组的血清Hcy水平均较对照组显著升高(P<0.001,P<0.001),而aMCI组血清叶酸水平较HC组明显降低(P=0.017)。与MTHFR CC、CT基因型者相比,TT基因型者的血清叶酸水平明显降低(P=0.038),血清Hcy水平明显升高(P=0.002)。回归分析结果显示:在APOEε4非携带者亚组中,MTHFR TT基因型可能增加aMCI患病风险(OR=3.670,95%CI=1.077-12.509,P=0.038),在APOEε4携带者中则无相应表现。结论MTHFR C677T多态性可导致血清Hcy水平增高和叶酸水平降低。在APOEε4非携带者中,MTHFR TT基因型可能增加aMCI的患病风险。

基于DKI技术对遗忘型轻度认知障碍患者皮层微结构改变特征的研究

目的:采用扩散峰度成像(DKI)技术研究遗忘型轻度认知障碍(aMCI)患者皮层微结构的改变特征。方法:前瞻性搜集47例aMCI患者和46例正常对照(NC)进行结构像和扩散序列功能像扫描,利用FreeSurfer软件基于皮层分析方法比较两组受试者灰质DKI参数的差异,包括平均扩散系数(MD)、径向扩散系数(RD)、轴向扩散系数(Ad)、各向异性分数(FA)、峰度各向异性(KFA)、平均峰度系数(MK)、径向峰度系数(RK)和轴向峰度系数(AK)。采用Spearman方法对DKI参数与简易智能状态检查量表(MMSE)评分进行相关性分析,利用受试者操作特征(ROC)曲线评估各参数值对aMCI的诊断效能。结果:与NC组相比,aMCI组多脑区的MD、RD、Ad值显著上升(P<0.05);FA、KFA、RK、MK值显著下降(P<0.05);NC组与aMCI组的AK值差异无统计学意义(P>0.05)。左侧岛回的MD值(r=-0.510,P<0.001)、左侧岛回的Ad值(r=-0.494,P<0.001)、左侧颞下回的RD值(r=-0.539,P<0.001)与MMSE评分呈负相关;左侧额中回上部的KFA值(r=0.480,P<0.001)与MMSE评分呈正相关。右侧中央前回的KFA值诊断aMCI的AUC最大(AUC=0.794)。结论:aMCI患者存在皮层微结构完整性的破坏,基于皮层分析DKI参数的改变反映了aMCI患者皮层微结构的受损特征。KFA值对aMCI具有最佳诊断效能,可能成为新型影像标志物。

中医药治疗遗忘型轻度认知障碍随机对照试验的结局指标分析

目的:评价目前中医药治疗遗忘型轻度认知障碍随机对照试验结局指标的现状,为未来核心指标集研究提供依据。方法:计算机检索中国知网(CNKI)、万方(WanFang Database)、重庆维普(VIP)、PubMed、EMbase和the Cochrane Library等6个数据库,同时追踪已检出文献的参考文献,收集中医药治疗遗忘型轻度认知障碍的随机对照试验。按照预先设定的纳入和排除标准由2名评价员独立筛选文献并提取资料,描述纳入的随机对照试验结局指标的使用情况。结果:纳入的23篇文献共使用了26个疗效指标,居前5位的疗效指标依次为:简易精神状态量表(MMSE)评分18篇(78.3%)、蒙特利尔认知评估(MoCA)量表14篇(60.9%)、中医证候积分量表14篇(60.9%)、日常生活和社会能力评估(ADL)量表10篇(43.5%)、临床疗效6篇(26.1%)。78%的研究访视时间在3个月之内。结论:中医药治疗遗忘型轻度认知障碍的随机对照试验在结局指标的选择、测量和报告方面存在较大异质性。建议进行核心指标集的研究,完善随机对照试验疗效指标评价体系。

逍遥丸调控海马功能连接改善肝气郁结型aMCI认知功能的神经影像机制研究

目的探讨逍遥丸辨证干预长期肝气郁结(肝郁)遗忘型轻度认知功能障碍(aMCI)的神经作用机制。方法筛选出正常志愿者及6个月以上肝郁aMCI,以年龄(前后差异小于2.5岁)、性别及受教育年限三项为匹配条件,将所有补试分为正常对照组、肝郁aMCI治疗组与非治疗组。非治疗组正常组不予药物干预处理,治疗组给予逍遥丸服用3个月。分别在3个月前后对各组开展行为学MoCA认知功能检测、中医肝郁症状积分及基于体素的全脑功能连接神经脑影像测评分析。结果行为学方面:3个月后,治疗组的MoCA总体认知功能比非治疗组显著提升(P<0.05),治疗组MoCA总分与视空间/执行功能恢复至正常水平;非治疗组3个月前未受损的命名功能在3个月后出现了下降,明显低于治疗组(P<0.05),且非治疗组命名与语言功能均低于正常组(P<0.05)。功能磁共振方面:3个月后,治疗组左海马与右舌状回、右距状裂周围皮层功能连接显著强于未治疗组(P<0.05,FWE团块校正),且功能连接改变与延迟回忆功能呈正相关(r=0.3014,P<0.05)。结论逍遥丸能够提升肝气郁结型aMCI大脑总体认知功能,其机制可能与增强海马、舌回及距状裂周围皮层间的功能连接,调节大脑负责抑制干扰信息及注意动机启动功能并进一步改善aMCI延迟回忆有关。

基于3D结构核磁分析遗忘型轻度认知功能障碍及阿尔茨海默病患者脑灰质体积的改变及与认知损害的相关性

目的:探讨遗忘型轻度认知功能障碍(amnestic mild cognitive impairment,aMCI)和阿尔茨海默病(Alzheimer’s disease,AD)患者与正常老年人的灰质体积和皮质厚度差异,分析其与认知水平之间的关系,为临床诊断aMCI及早期AD提供依据。方法:前瞻性纳入a MCI患者23例、AD患者22例及正常对照(Healthy control,HC)组23例。对所有受试者进行脑结构MRI扫描,使用CAT12的Segment功能对3D-T1MRI图像行基于体素的形态学测量和表面形态学测量,获得所有受试者特定脑区的灰质体积及皮质厚度。并运用神经心理学量表进行认知功能评测。分析3组间主要结构灰质体积、皮质厚度的差异,从差异脑区中提取感兴趣区,并探究其与认知量表评分的相关性。结果:3组间方在多个脑区存在差异(FWE校正,P<0.05),差异脑区体积与蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表评分有明显相关性(P<0.05);且不同脑区体积与认知域的相关性大小有明显差异(P<0.05)。结论:a MCI及AD患者脑灰质体积及脑皮质存在不均匀分布的减小。左侧海马、嗅皮质、脑岛的提前萎缩可能是影响AD患者早期认知功能的原因。

脂质代谢相关通路蛋白基因多态性的分布特征及与aMCI关系研究

目的研究遗忘型轻度认知功能障碍(amnestic mild cognitive impairment,aMCI)脂质代谢相关通路蛋白[载脂蛋白E(ApoE)、低密度脂蛋白受体(LDLR)、ATP结合盒转运蛋白A7(ABCA7)]基因多态性的分布特征,并探索以上蛋白基因多态性与aMCI发病的相关性。方法遵循病例对照研究原则,在沈阳市2家三级甲等医院及6个养老中心招募常住受试者600例,其中aMCI组300例,与之年龄、性别、疾病构成匹配的认知正常组300例。对所有受试者进行病史和一般临床资料采集及精神神经量表检测,采用iMDLR多重单核苷酸多态性(SNP)分型技术检测aMCI病人血液中ApoE(ε2、ε3、ε4)、LDLR(rs688和rs5925)、ABCA7(rs3752246)基因多态性分布特征,并探讨其与aMCI发病的相关性。结果 (1)2组间ApoE、ABCA7 rs3752246、LDLR rs688基因多态性差异有统计学意义(P <0. 05或P <0. 01)。(2)ApoEε4等位基因(OR=1. 453,95%CI:0. 976~2. 246)、LDLR rs688 T等位基因(OR=1. 356,95%CI:0. 218~1. 417)、ABCA7 rs3752246 C等位基因(OR=2. 092,95%CI:1. 477~5. 028)是aMCI的易感等位基因;ApoEε2等位基因是aMCI的保护等位基因(OR=0. 498,95%CI:0. 370~0. 821)。结论脂质代谢相关通路蛋白基因多态性与aMCI的发病存在一定相关性。

基于功能磁共振成像技术探讨针刺治疗遗忘型轻度认知障碍患者脑活动效应研究

目的:基于功能磁共振成像(Functional Magnetic Resonance Imaging,fMRI)技术探讨针刺治疗遗忘型轻度认知障碍(Amnestic Mild Cognitive Impairment,aMCI)患者脑活动效应。方法:选取黑龙江中医药大学附属第一医院2021年2月-2023年6月收治的遗忘型轻度认知障碍患者80例作为研究对象,根据随机数字表法分为对照组和观察组,每组40例。对照组采用假针刺治疗,观察组采用真针刺治疗。比较两组患者治疗前后的认知功能、记忆力、精神行为症状;并开展fMRI扫描,对治疗前后的f MRI的低频振幅(Amplitude of Low Frequency Fluctuation,ALFF)值与局部一致性(Regional Homogeneity,ReHo)值进行观察比较。结果:治疗后,两组蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、Rivermead行为记忆能力试验(Rivermead Behavioural Memory Test,RBMT)评分均较治疗前升高,神经精神症状问卷(Neuropsychiatric Inventory,NPI)评分均较治疗前降低,且观察组MoCA评分、RBMT评分均高于对照组,NPI评分低于对照组,组间差异有统计学意义(P<0.05)。相比于治疗前,观察组ALFF值明显升高的区域为左侧中央前回、左侧楔叶,ALFF值明显降低的区域为右侧梭状回,对照组ALFF值明显降低的区域为左侧顶上回。相比于治疗前,观察组分数低频振幅(Fraction Amplitude of Low Frequency Fluctuation,f ALFF)值明显升高的区域为左侧中央后回、右侧颞中回,对照组fALFF明显下降的区域为右侧小脑下部。相比于治疗前,观察组ReHo值明显升高的区域为右侧颞下回,对照组ReHo值明显升高的区域为右侧中央沟盖。结论:针刺治疗不但对遗忘型轻度认知障碍患者的认知功能改善显著,而且还能重塑一致性脑区功能及结构,同时功能指标能对针刺疗效进行预测;不但能为针刺治疗遗忘型轻度认知障碍患者提供客观和准确的理论依据,而且能为疗效评估提供指导。