伴有元认知损害的主观认知下降患者的自我参照网络特征研究  

Self-referential network characteristics in patients with subjective cognitive decline accompanied by metacognitive impairment

作　　者：席悦 陈姗姗 吴佳艺 冀昱翔 陈柯心 林兴建[2] Xi Yue;Chen Shanshan;Wu Jiayi;Ji Yuxiang;Chen Kexin;Lin Xingjian(Fourth Clinical School,Nanjing Medical University,Nanjing 210029,China;Department of Neurology,Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第四临床医学院,南京210029 [2]南京医科大学附属脑科医院神经内科,南京210029

出　　处：《中华神经医学杂志》2023年第10期1030-1037,共8页Chinese Journal of Neuromedicine

基　　金：江苏省基础研究计划自然科学基金(面上项目)(BK20221185);南京医科大学科技发展基金(一般项目)(NMUB20220130);江苏省高等学校大学生创新创业训练计划项目(202110312065Y)。

摘　　要：目的:探讨不同元认知水平主观认知下降(SCD)人群的自我参照网络(SRN)功能连接特点。方法:纳入阿尔茨海默病神经影像学倡议(ADNI)数据库中71例受试者进入研究,其中认知正常组受试者25例,SCD受试者46例。采用每日认知量表(ECog)评估SCD受试者的元认知水平并将其分为元认知正常组(25例,元认知得分>-0.074分)和元认知损害组(21例,元认知得分≤-0.074分)。收集并比较3组受试者老年抑郁量表(GDS)、蒙特利尔认知量表(MoCA)、简易智力状态检查量表(MMSE)、Rey听觉词语学习测试(RAVLT)、逻辑记忆量表评分结果,病理标志物[脑脊液β-淀粉样蛋白(Aβ)、总tau蛋白(t-tau)和磷酸化tau蛋白(p-tau)]表达水平、脑内葡萄糖代谢水平,以及功能磁共振(fMRI)图像。使用独立成分分析(ICA)方法提取SRN并分析3组受试者之间差异脑区;采用Pearson相关分析检验SRN功能连接变化与受试者认知量表、病理标志物之间的相关性。结果:3组受试者年龄、性别等人口学特征,GDS、MoCA、MMSE评分,以及Aβ、t-tau、p-tau、脑葡萄糖代谢水平差异均无统计学意义(P>0.05)。元认知得分中,元认知损害SCD组受试者较元认知正常SCD组及认知正常组受试者评分显著降低,差异均有统计学意义(P<0.05)。3组受试者双侧前扣带回/眶额叶皮层、双侧眶额叶皮层的SRN功能连接差异有统计学意义(TFCE-FWE校正,P<0.01,体素数>100)。进一步两两比较结果提示,与认知正常组相比,元认知损害SCD组的双侧眶额叶皮层功能连接降低,元认知正常SCD组的双侧眶额叶皮层功能连接增强,差异均有统计学意义(TFCE-FWE校正,P<0.01,体素数>100)。与元认知正常SCD组相比,元认知损害SCD组的双侧眶额叶皮层功能连接降低,差异有统计学意义(TFCE-FWE校正,P<0.01,体素数>100)。相关分析结果显示,元认知损害SCD组和认知正常组受试者双侧眶额叶功能连接差异与RAVLT即刻记忆评�Objective To explore the characteristics of self-referential network(SRN)functional connectivity in subjective cognitive decline(SCD)patients with normal and impaired metacognition.Methods Seventy-one subjects were selected from Alzheimer's Disease Neuroimaging Initiative(ADNI)database,with 25 cognitively normal controls and 46 SCD patients.The metacognitive level of SCD patients was assessed by Everyday Cognition Scale(ECog),and then,they were divided into a metacognitively normal group(n=25,metacognitive scores>-0.074)and a metacognitively impaired group(n=21,metacognitive scores≤-0.074).Results of Geriatric Depression Scale(GDS),Montreal Cognitive Scale(MoCA),Mini‐Mental State Examination(MMSE),Rey Auditory Word Learning Test(RAVLT),Logical Memory Scale,expressions of pathological markers(cerebrospinal fluidβ-amyloid protein[Aβ],total tau protein[t-tau]and phosphorylated tau protein[p-tau]),brain glucose metabolism,and functional magnetic resonance imaging(fMRI)were collected and compared among the 3 groups.Independent component analysis(ICA)was used to extract SRN and analyze the different brain regions among the 3 groups;Pearson correlation was used to analyze the correlations of SRN functional connectivity changes with cognitive scales and pathological markers.Results No significant differences in demographic characteristics(age and gender),scores of GDS,MoCA and MMSE,or levels of Aβ,t-tau,p-tau and brain glucose metabolism were noted among the 3 groups(P>0.05).The metacognitive scores in metacognitively impaired group were significantly lower than those in metacognitively normal group and cognitively normal controls(P<0.05).Significant difference in the functional connectivity of bilateral anterior cingulate gyrus and bilateral orbitofrontal cortex was noted among the 3 groups(TFCE-FWE correction,P<0.01,voxel>100);compared with the cognitively normal controls,the metacognitively impaired group showed significantly decreased functional connectivity of bilateral orbitofrontal cortex,while the metacogn

关 键 词：自我参照网络 主观认知下降 元认知损害 阿尔茨海默病 

分 类 号：R749.16[医药卫生—神经病学与精神病学]