后皮质萎缩患者神经心理及影像学特征的研究  

Research of neuropsychological and imaging features of patients with posterior cortical atrophy

作　　者：董丽华 李加梅 陈科良 雷小晶 陈淑芬 黄钰媛 郁金泰 Dong Lihua;Li Jiamei;Chen Keliang;Lei Xiaojing;Chen Shufen;Huang Yuyuan;Yu Jintai(Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurology,Rizhao People′s Hospital of Shandong Province,Rizhao 276800,China;School of Clinical Medicine,Weifang Medical University,Weifang 261000,China)

机构地区：[1]复旦大学附属华山医院神经内科、国家神经疾病医学中心,上海200040 [2]山东省日照市人民医院神经内科,日照276800 [3]潍坊医学院临床医学院,潍坊261000

出　　处：《中华神经科杂志》2024年第7期738-745,共8页Chinese Journal of Neurology

基　　金：日照市重点研发计划(2021ZDYF020201);上海市卫生健康委员会青年科研项目(20234Y0307)。

摘　　要：目的探讨后皮质萎缩(PCA)患者的神经心理学特征以及影像学特征。方法收集2019年9月27日至2021年9月24日于复旦大学附属华山医院认知障碍病房诊断的PCA患者、路易体痴呆(DLB)患者、典型阿尔茨海默病(t-AD)患者及同期在华山医院及日照市人民医院门诊及体检中心就诊的正常对照者,采集4组受试者的神经心理评估、头颅磁共振成像(MRI)和正电子发射体层摄影(PET)/CT资料,比较4组受试者神经心理学表现的差异,并总结PCA患者的影像学特征。结果最终共纳入11例PCA患者、17例DLB患者、31例t-AD患者及11名正常对照参与本研究。PCA组患者的认知功能[简易精神状态检查量表(MMSE)评分(13.52±1.81)分;蒙特利尔认知评估量表(MoCA)评分(7.06±1.72)分]较正常对照组显著受损[MMSE评分(27.85±1.75)分,t=-6.561,P<0.001;MoCA评分(23.60±1.59)分,t=-7.968,P<0.001],但与DLB组、t-AD组相比差异无统计学意义。PCA组患者的注意力、执行和语言功能损害[连线测试A评分(298.86±16.16)分,连线测试B评分(305.51±18.89)分,波士顿命名测试评分(8.67±1.53)分]较DLB组[(110.07±18.62)分,t=9.980,P<0.001;(230.34±23.59)分,t=2.865,P=0.024;(15.66±1.56)分,t=-2.682,P=0.013]和t-AD组[(148.91±12.77)分,t=7.071,P<0.001;(200.78±19.34)分,t=3.789,P=0.004;(15.15±1.05)分,t=-2.544,P=0.016]严重。PCA组的视空间及视知觉得分均显著低于正常对照组[1(0,1)分比3(3,3)分,Z=-4.023,P<0.001;0(0,1)分比35(34,36)分,Z=-3.704,P<0.001]。PCA患者的头颅MRI表现为顶枕叶萎缩,颞叶内侧萎缩不明显,可与t-AD相鉴别。PCA患者18氟-氟代脱氧葡萄糖PET/CT表现为双侧顶叶、枕叶、后扣带回葡萄糖代谢相对减低,18氟-florbetapir PET/CT表现为双侧额叶、顶叶、颞叶、扣带回的淀粉样蛋白沉积。结论PCA患者神经心理特征表现为视空间功能障碍,并在多个认知领域如记忆力、注意力和执行功能方面存在损害,其MRI典型特点为顶枕叶�Objective To investigate the neuropsychological and imaging features of patients with posterior cortical atrophy(PCA).Methods Patients of PCA,dementia with Lewy bodies(DLB),typical Alzheimer′s disease(t-AD)who were diagnosed in the Department of Neurology,Huashan Hospital,Fudan University from September 27,2019,to September 24,2021 were enrolled,and the normal controls who visited the Outpatient and Physical Examination Centers of Huashan Hospital,Fudan University and Rizhao People′s Hospital at the same time were enrolled,too.Neuropsychological assessments,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT data of the 4-group subjects were collected.Variance analysis was used to compare the differences in neuropsychological performance among the 4 groups,and the imaging features of PCA patients were summarized.Results Eleven PCA patients,17 DLB patients,31 t-AD patients,and 11 normal controls were included in the study.The cognitive function of patients in the PCA group[Mini-Mental State Examination(MMSE)score 13.52±1.81;Montreal Cognitive Assessment(MoCA)score 7.06±1.72]was significantly impaired compared to the normal control group(MMSE score 27.85±1.75,t=-6.561,P<0.001;MoCA score 23.60±1.59,t=-7.968,P<0.001].However,there was no statistically significant difference compared to the DLB group and the t-AD group.Patients in the PCA group exhibited more severe impairments in attention,executive function,and language compared to the DLB group(Trail Making Test A score:298.86±16.16 vs 110.07±18.62,t=9.980,P<0.001;Trail Making Test B score:305.51±18.89 vs 230.34±23.59,t=2.865,P=0.024;Boston Naming Test score:8.67±1.53 vs 15.66±1.56,t=-2.682,P=0.013)and the t-AD group(148.91±12.77,t=7.071,P<0.001;200.78±19.34,t=3.789,P=0.004;15.15±1.05,t=-2.544,P=0.016).Scores for visuospatial function[PCA group:1(0,1),normal control group:3(3,3),Z=-4.023,P<0.001]and visual perception[PCA group:0(0,1),normal control group:35(34,36),Z=-3.704,P<0.001]were significantly lower in the PCA group compa

关 键 词：阿尔茨海默病 萎缩 认知障碍 神经心理测验 正电子发射断层显像术 磁共振成像 

分 类 号：R817.4[医药卫生—影像医学与核医学] R742[医药卫生—放射医学]