三种神经心理量表改变与阿尔茨海默病脑葡萄糖代谢的关系  

Relationship between three neuropsychological tests and cerebral glucose metabolism in Alzheimer′s disease

作　　者：张新卿[1] 闵宝权[1] 马云川[2] 杨培杰[1] 李德鹏[2] 

机构地区：[1]首都医科大学宣武医院神经内科,北京市老年病医疗研究中心100053 [2]北京PET中心

出　　处：《中华医学杂志》2003年第2期100-102,共3页National Medical Journal of China

摘　　要：目的　探讨阿尔茨海默病 (AD)患者智力状态检查表 (MMSE)、扩充痴呆量表 (ESD)、Blessed痴呆量表 (BDS)分数与正电子发射断层摄影术 (PET)所显示的脑葡萄糖代谢之间的关系。方法　AD组 2 1例 ,平均年龄 6 7 6± 7 0岁。轻度痴呆 10例 ,中度痴呆 6例 ,重度痴呆 5例。采用SIEMENSECAT 47PET扫描仪进行脑显像。记录正常对照组与AD组的双侧顶叶、额叶、颞叶与小脑单位面积的放射性计数 ;计算出双侧顶叶、额叶、颞叶与同侧小脑单位面积放射性计数的比值 ,以此比值作为研究的半定量观察指标。认知功能用MMSE、ESD及BDS测量。结果　AD组MMSE及ESD得分均与双侧的顶叶、额叶、颞叶的葡萄糖代谢降低呈正相关 ;BDS得分与双侧的顶叶、额叶、颞叶的葡萄糖低代谢呈负相关。MMSE与ESD的相关系数r =0 886 ;ESD与BDS的相关系数r =- 0 76 3;MMSE与BDS的相关系数r=- 0 773,P均 <0 0 1。以各脑区的葡萄糖代谢比值为自变量X ,分别以MMSE、ESD、BDS得分为因变量Y ,建立 3个回归方程 :Y =40 11 X - 2 5 32 ,Y =30 9 19 X - 180 9,Y =19 97 16 5 3 X。进入 3个回归方程的自变量X均为左侧顶叶 /小脑比值。结论　AD患者认知功能的减退与脑的葡萄糖代谢降低程度一致 ;3种量表在反映认知功能方面损害方面具有一致性。Objective To study the relationship between the scores of 3 neuropsychological scales: MMSE, extended scale of dementia (ESD) and Blessed dementia scale (BDS) and cerebral glucose metabolism in Alzheimer′s disease (AD) indicated by positron emission tomography (PET). Methods Brain scanning was performed with SIEMENS ECAT 47 PET scanner among 21 AD patients, aged 60～83 (10 mild, 6 moderate, and 5 severe), and 15 healthy persons, aged 57～73. The ratio of mean radioactivity of cerebral lobe to that of cerebellum as semi-quantitative parameters was used to evaluate the cerebral glucose metabolism. Cognitive function was assessed by three neuropsycholigical scales: MMSE, ESD and BDS. Results The average MMSE score was 13.3±6.3 (range 2～25), the average ESD score was 120.5±54.8 (range 28～200), and the average BDS score was 4.7±3.1 (range 0.5～10) in the AD patients. The decreases of glucose metabolism in parietal, frontal and temporal lobes were significantly positively correlated with MMSE and ESD scores, and negatively correlated with BDS scores in AD patients (P< 0.05). The correlations between MMSE and ESD (r=0.886), MMSE and BDS (r=-0.763), and ESD and BDS (r=-0.773) were significant in AD patients (all P<0.01). Taking the ratio of radioactivity of cerebral lobe to that of cerebellum as an independent variable X, the MMSE, ESD and BDS scorsas dependent variable Y, three regression equations were established as follows: Y=40.11 * X- 25.32, Y=309.19 * X- 180.9, Y=19.97-16.53 * X. The independent variable entering the three regression equations was always the ratio of radioactivity of left parietal lobe to that of cerebellum. The ratio of radioactivity of left parietal lobe to that of cerebellum was a significant predictor for cognitive dysfunction measured by MMSE, ESD and BDS in AD patients (P<0.01). Conclusion MMSE, ESD and BDS scores correlate well with impaired cerebral glucose metabolism in AD. The function of left parietal lobe may play an important role in the progress of the disease. MMSE

关 键 词：神经心理量表 阿尔茨海默病 脑葡萄糖代谢 

分 类 号：R749.1[医药卫生—神经病学与精神病学]