神经心理量表结合海马体积诊断早期Alzheimer's病的研究
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摘要
目的探讨蒙特利尔认知评估(Mo CA)量表评分结合海马体积测量对早期Alzheimer’s病(AD)的诊断价值。方法给60例记忆力减退老年患者和30名正常老年对照者(正常对照组)行Mo CA、日常生活能力量表(ADL)评分,以及MRI海马体积测量。根据患者的Mo CA、ADL评分和AD及轻度认知功能障碍(MCI)诊断标准,将记忆力减退老年患者分为早期典型AD组(早期AD组)和MCI组,每组各30例。比较3组的Mo CA评分和海马体积,并对AD和MCI患者的Mo CA评分与海马体积的关系进行相关性分析。结果早期AD组及MCI组的Mo CA评分[(24.60±0.50)分,(27.02±0.92)分]均显著低于正常对照组[(29.10±0.68)分](均P<0.05),而早期AD组与MCI组Mo CA评分的差异无统计学意义(P>0.05)。早期AD组左右两侧标准化后的海马体积为(0.81±0.23)cm~3、(0.76±0.21)cm~3,MCI组为(1.15±0.16)cm~3、(1.08±0.17)cm~3;正常对照组为(1.73±0.12)cm~3、(1.65±0.15)cm~3。3组标准化后的海马体积两两比较,差异均有统计学意义(均P<0.05)。早期AD组和MCI组患者左右两侧准标化后的海马体积与Mo CA评分之间均呈正相关(r:0.44~0.56,均P<0.05)。结论 Mo CA评分越低者的海马体积越小,其认知功能损害也越重。Mo CA评分结合海马体积测量对诊断早期AD有重要的临床价值。
Objective To explore the diagnostic value of Montreal cognitive assessment( Mo CA) scale combined with hippocampal volume measurement in the early Alzheimer's disease( AD). Methods The Mo CA scale,Daily life ability( ADL) scale were scored,and hippocampal volume was measured by MRI in 60 elderly patients with memory loss and 30 normal elderly controls( normal control group). According to the Mo CA and ADL scores and diagnostic criteria of AD and mild cognitive impairment( MCI),sixty elderly patients with memory loss patients were divided into the early typical AD group( early AD group) and MCI group,each group of 30 cases. The Mo CA scores and hippocampal volume were compared among the three groups. And a correlation analysis of the relationship between Mo CA scores and hippocampal volume was made in patient with early AD and MCI. Results The Mo CA scores of the early AD group and MCI group [( 24. 60 ± 0. 50),( 27. 02 ± 0. 92) ]were significantly lower than that of the normal control group( 29. 10 ± 0. 68)( all P < 0. 05). And there was no significant difference of Mo CA scores between the early AD group and the MCI group( P > 0. 05). The left and right sides of standardized hippocampal volume of the early AD group were( 0. 81 ± 0. 23) cm~3,( 0. 76 ± 0. 21) cm~3,MCI group were( 1. 15 ± 0. 16) cm~3,( 1. 08 ± 0. 17)cm~3,and normal control group were( 1. 73 ± 0. 12) cm~3,( 1. 65 ± 0. 15) cm~3. There was significant difference among the three groups in the hippocampal volume after standardization( all P < 0. 05). Hippocampal volume was positively related with Mo CA score in the early AD group and MCI group( r: 0. 44-0. 56,all P < 0. 05). Conclusions The lower Mo CA score is,the smaller hippocampal volume is,and the heavier cognitive impairment is. The Mo CA score combined with hippocampal volume measurement has important clinical value in the diagnosis of early AD.
Objective To explore the diagnostic value of Montreal cognitive assessment( Mo CA) scale combined with hippocampal volume measurement in the early Alzheimer's disease( AD). Methods The Mo CA scale,Daily life ability( ADL) scale were scored,and hippocampal volume was measured by MRI in 60 elderly patients with memory loss and 30 normal elderly controls( normal control group). According to the Mo CA and ADL scores and diagnostic criteria of AD and mild cognitive impairment( MCI),sixty elderly patients with memory loss patients were divided into the early typical AD group( early AD group) and MCI group,each group of 30 cases. The Mo CA scores and hippocampal volume were compared among the three groups. And a correlation analysis of the relationship between Mo CA scores and hippocampal volume was made in patient with early AD and MCI. Results The Mo CA scores of the early AD group and MCI group [( 24. 60 ± 0. 50),( 27. 02 ± 0. 92) ]were significantly lower than that of the normal control group( 29. 10 ± 0. 68)( all P < 0. 05). And there was no significant difference of Mo CA scores between the early AD group and the MCI group( P > 0. 05). The left and right sides of standardized hippocampal volume of the early AD group were( 0. 81 ± 0. 23) cm~3,( 0. 76 ± 0. 21) cm~3,MCI group were( 1. 15 ± 0. 16) cm~3,( 1. 08 ± 0. 17)cm~3,and normal control group were( 1. 73 ± 0. 12) cm~3,( 1. 65 ± 0. 15) cm~3. There was significant difference among the three groups in the hippocampal volume after standardization( all P < 0. 05). Hippocampal volume was positively related with Mo CA score in the early AD group and MCI group( r: 0. 44-0. 56,all P < 0. 05). Conclusions The lower Mo CA score is,the smaller hippocampal volume is,and the heavier cognitive impairment is. The Mo CA score combined with hippocampal volume measurement has important clinical value in the diagnosis of early AD.
引文
[1]Weiner MW,Veitch DP,Aisen PS,et al.The Alzheimer’s disease neuroimaging initiative:a review of papers published since its inception[J].Alzheimers Dement,2013,9:e111.
[2]Gauthier S,Reisberg B,Zaudig M,et al.Mild cognitive impairment[J].Lancet,2006,367:1262.
[3]Chertkow H,Nasreddine Z,Joanette Y,et al.Mild cognitive impairment and cognitive impairment,no dementia:Part A,concept and diagnosis[J].Alzheimers Dement,2007,3:266.
[4]Levey A,Lah J,Goldstein F,et al.Mild cognitive impairment:an opportunity to identify patients at high risk for progression to Alzheimer’s disease[J].Clin Ther,2006,28:991.
[5]Fujiwara Y,Suzuki H,Yasunaga M,et al.Brief screening tool for mild cognitive impairment in older Japanese:validation of the Japanese version of the Montreal cognitive assessment[J].Geriatr Gerontol Int,2010,10:225.
[6]Horton DK,Hynan LS,Lacritz LH,et al.An abbreviated Montreal cognitive assessment(Mo CA)for dementia screening[J].Clin Neuropsychol,2015,29:413.
[7]Yu J,Li J,Huang X.The Beijing version of the Montreal cognitive assessment as a brief screening tool for mild cognitive impairment:a community-based study[J].BMC Psychiatry,2012,12:156.
[8]Hancock P,Larner AJ.The diagnosis of dementia:diagnostic accuracy of an instrument measuring activities of daily living in a clinicbased population[J].Dement Geriatr Cogn Disord,2007,23:133.
[9]Dubois B,Feldman HH,Jacova C,et al.Advancing research diagnostic criteria for Alzheimer’s disease:the IWG-2 criteria[J].Lancet Neurol,2014,13:614.
[10]Pruessner JC,Collins DL,Pruessner M,et al.Age and gender predict volume decline in the anterior and posterior hippocampus in early adulthood[J].J Neurosci,2001,21:194.
[11]Cendes F,Andermann F,Gloor P,et al.MRI volumetric measurement of amygdala and hippocampus in temporal lobe epilepsy[J].Neurology,1993,43:719.
[12]Watson C,Andermann F,Gloor P,et al.Anatomic basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging[J].Neurology,1992,42:1743.
[13]Maller JJ,Regl A,De-Meslin C,et al.Sex and symmetry differences in hippocampal volumetrics:before and beyond the opening of the crus of the fornix[J].Hippocampus,2006,16:80.
[14]Li TQ,Wahlund LO.The search for neuroimaging biomarkers of Alzheimer’s disease with advanced MRI techniques[J].Acta RADiol,2011,52:211.
[15]Nasreddine ZS,Phillips NA,Bedirian V,et al.The Montreal Cognitive Assessment,Mo CA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53:695.
[16]Lee JY,Dong WL,Cho SJ,et al.Brief screening for mild cognitive impairment in elderly outpatient clinic:validation of the Korean version of the Montreal cognitive assessment[J].J Geriatr Psychiatry Neurol,2008,21:104.
[17]Lu J,Li D,Li F,et al.Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals:a populationbased study[J].J Geriatr Psychiatry Neurol,2011,24:184.
[18]Laske C,Sohrabi HR,Frost SM,et al.Innovative diagnostic tools for early detection of Alzheimer’s disease[J].Alzheimers Dement,2015,11:561.
[18]Larner AJ.Screening utility of the Montreal cognitive assessment(Mo CA):in place of—or as well as—the MMSE?[J].Int Psychogeriatr,2012,24:391.
[20]Tan JP,Li N,Gao J,et al.Optimal cutoff scores for dementia and mild cognitive impairment of the Montreal Cognitive Assessment among elderly and oldest-old Chinese population[J].J Alzheimers Dis,2015,43:1403.
[21]Jr Jack CR,Barnes J,Bernstein MA,et al.Magnetic resonance imaging in Alzheimer’s disease neuroimaging initiative 2[J].Alzheimer Dement,2015,11:740.
[22]Spulber G,Simmons A,Muehlboeck JS,et al.An MRI-based index to measure the severity of Alzheimer’s disease-like structural pattern in subjects with mild cognitive impairment[J].J Int Med,2013,273:396.
[23]Braak H,Braak E.Neuropathological stageing of Alzheimer-related changes[J].Acta Neuropathol,1991,82:239.
[24]Price JL,Morris JC.Tangles and plaques in nondemented aging and“preclinical”Alzheimer disease[J].Ann Neurol,1999,45:358.
[25]Guillozet AL,Weintraub S,Mash DC,et al.Neurofibrillary tangles,amyloid,and memory in aging and mild cognitive impairment[J].Arch Neurol,2003,60:729.
[26]Price JL,Mckeel DJ,Buckles VD,et al.Neuropathology of nondemented aging:presumptive evidence for preclinical Alzheimer disease[J].Neurobiol Aging,2009,30:1026.
[27]Devanand DP,Bansal R,Liu J,et al.MRI hippocampal and entorhinal cortex mapping in predicting conversion to Alzheimer’s disease[J].Neuroimage,2012,60:1622.
[28]Mueller SG,Schuff N,Yaffe K,et al.Hippocampal atrophy patterns in mild cognitive impairment and Alzheimer’s disease[J].Hum Brain Mapp,2010,31:1339.
[2]Gauthier S,Reisberg B,Zaudig M,et al.Mild cognitive impairment[J].Lancet,2006,367:1262.
[3]Chertkow H,Nasreddine Z,Joanette Y,et al.Mild cognitive impairment and cognitive impairment,no dementia:Part A,concept and diagnosis[J].Alzheimers Dement,2007,3:266.
[4]Levey A,Lah J,Goldstein F,et al.Mild cognitive impairment:an opportunity to identify patients at high risk for progression to Alzheimer’s disease[J].Clin Ther,2006,28:991.
[5]Fujiwara Y,Suzuki H,Yasunaga M,et al.Brief screening tool for mild cognitive impairment in older Japanese:validation of the Japanese version of the Montreal cognitive assessment[J].Geriatr Gerontol Int,2010,10:225.
[6]Horton DK,Hynan LS,Lacritz LH,et al.An abbreviated Montreal cognitive assessment(Mo CA)for dementia screening[J].Clin Neuropsychol,2015,29:413.
[7]Yu J,Li J,Huang X.The Beijing version of the Montreal cognitive assessment as a brief screening tool for mild cognitive impairment:a community-based study[J].BMC Psychiatry,2012,12:156.
[8]Hancock P,Larner AJ.The diagnosis of dementia:diagnostic accuracy of an instrument measuring activities of daily living in a clinicbased population[J].Dement Geriatr Cogn Disord,2007,23:133.
[9]Dubois B,Feldman HH,Jacova C,et al.Advancing research diagnostic criteria for Alzheimer’s disease:the IWG-2 criteria[J].Lancet Neurol,2014,13:614.
[10]Pruessner JC,Collins DL,Pruessner M,et al.Age and gender predict volume decline in the anterior and posterior hippocampus in early adulthood[J].J Neurosci,2001,21:194.
[11]Cendes F,Andermann F,Gloor P,et al.MRI volumetric measurement of amygdala and hippocampus in temporal lobe epilepsy[J].Neurology,1993,43:719.
[12]Watson C,Andermann F,Gloor P,et al.Anatomic basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging[J].Neurology,1992,42:1743.
[13]Maller JJ,Regl A,De-Meslin C,et al.Sex and symmetry differences in hippocampal volumetrics:before and beyond the opening of the crus of the fornix[J].Hippocampus,2006,16:80.
[14]Li TQ,Wahlund LO.The search for neuroimaging biomarkers of Alzheimer’s disease with advanced MRI techniques[J].Acta RADiol,2011,52:211.
[15]Nasreddine ZS,Phillips NA,Bedirian V,et al.The Montreal Cognitive Assessment,Mo CA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53:695.
[16]Lee JY,Dong WL,Cho SJ,et al.Brief screening for mild cognitive impairment in elderly outpatient clinic:validation of the Korean version of the Montreal cognitive assessment[J].J Geriatr Psychiatry Neurol,2008,21:104.
[17]Lu J,Li D,Li F,et al.Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals:a populationbased study[J].J Geriatr Psychiatry Neurol,2011,24:184.
[18]Laske C,Sohrabi HR,Frost SM,et al.Innovative diagnostic tools for early detection of Alzheimer’s disease[J].Alzheimers Dement,2015,11:561.
[18]Larner AJ.Screening utility of the Montreal cognitive assessment(Mo CA):in place of—or as well as—the MMSE?[J].Int Psychogeriatr,2012,24:391.
[20]Tan JP,Li N,Gao J,et al.Optimal cutoff scores for dementia and mild cognitive impairment of the Montreal Cognitive Assessment among elderly and oldest-old Chinese population[J].J Alzheimers Dis,2015,43:1403.
[21]Jr Jack CR,Barnes J,Bernstein MA,et al.Magnetic resonance imaging in Alzheimer’s disease neuroimaging initiative 2[J].Alzheimer Dement,2015,11:740.
[22]Spulber G,Simmons A,Muehlboeck JS,et al.An MRI-based index to measure the severity of Alzheimer’s disease-like structural pattern in subjects with mild cognitive impairment[J].J Int Med,2013,273:396.
[23]Braak H,Braak E.Neuropathological stageing of Alzheimer-related changes[J].Acta Neuropathol,1991,82:239.
[24]Price JL,Morris JC.Tangles and plaques in nondemented aging and“preclinical”Alzheimer disease[J].Ann Neurol,1999,45:358.
[25]Guillozet AL,Weintraub S,Mash DC,et al.Neurofibrillary tangles,amyloid,and memory in aging and mild cognitive impairment[J].Arch Neurol,2003,60:729.
[26]Price JL,Mckeel DJ,Buckles VD,et al.Neuropathology of nondemented aging:presumptive evidence for preclinical Alzheimer disease[J].Neurobiol Aging,2009,30:1026.
[27]Devanand DP,Bansal R,Liu J,et al.MRI hippocampal and entorhinal cortex mapping in predicting conversion to Alzheimer’s disease[J].Neuroimage,2012,60:1622.
[28]Mueller SG,Schuff N,Yaffe K,et al.Hippocampal atrophy patterns in mild cognitive impairment and Alzheimer’s disease[J].Hum Brain Mapp,2010,31:1339.