【摘要】 目的应用单光子发射计算机断层成像(single photo emission computerized tomography,SPECT)脑血流灌注显像与神经心理学检查,分析阿尔茨海默病(Alzheimer’s disease,AD)和行为变异型额颞叶痴呆(behavioral variant frontotemporal dementia,bv FTD)患者局部脑血流量(regional cerebral blood?ow,r CBF)与淡漠的相关性,研究不同类型痴呆患者淡漠的神经机制。方法选取2015年6月至2018年6月在中日友好医院就诊的57例AD患者与25例bv FTD患者进行临床病史采集及神经心理学检查。所有患者完善SPECT脑血流灌注显像以评价r CBF。应用基于体素的形态测量学(voxel-based morphometry,VBM)相关回归分析神经精神问卷(neuropsychiatric inventory,NPI)中淡漠亚项评分与r CBF的相关性。结果 61.4%的AD患者和74.1%的bv FTD的患者具有不同程度的淡漠症状,bv FTD患者淡漠评分显著高于AD患者,差异有显著性(P<0.05)。VBM相关分析显示,AD患者淡漠评分与双侧眶额区、额极区、背外侧前额叶、额下回皮质,岛叶及前扣带回、右侧额下回的r CBF呈负相关,而bv FTD患者淡漠评分与双侧背侧前扣带回及背外侧前额叶皮质的r CBF呈负相关。结论 AD和bv FTD患者的淡漠均与额叶前部及背侧前扣带回相关,但AD患者涉及的区域更为广泛,提示淡漠是一种多维度的临床综合征,在不同类型痴呆中的神经生理机制可能不同。更多还原

【Abstract】 Objective By comparing the clinical profi le of apathy and analyzing the relationship between apathy and brain regional cerebral blood flow(rCBF), which measured by single photo emission computerized tomography(SPECT), in Alzheimer’s disease(AD) and behavioral variant frontotemporal dementia(bvFTD), we aimed to explore the neural substrate of apathy in different types of dementia. Method Fifty-seven AD and twenty-fi ve bvFTD subjects were included. Apathy was evaluated by Neuropsychiatric Inventory(NPI). All subjects underwent SPECT to provide data for voxel-based morphometry(VBM) analysis. Voxel-based correlation analysis was performed to assess the relationship between rCBF and apathy. Result On the NPI, 61.4% of AD and 74.1% of bvFTD patients had some degree of apathy, but bvFTD had more score(severity*frequency) in NPI-apathy than AD. In VBM analysis, the score of NPI-apathy was negatively correlated with the rCBF in bilateral orbitofrontal area, anterior prefrontal cortex, dorsal lateral prefrontal cortex, insular cortex and anterior cingulate, and right inferior frontal gyrus in AD. In bvFTD, the negatively related regions included bilateral anterior cingulate and dorsal lateral prefrontal cortex. Conclusion Apathy correlated with bilateral prefrontal cortex and dorsal anterior cingulate cortex in both of AD and bvFTD, with more extensive regions involved in AD. This results suggested that apathy was a complex syndrome, with different neural substrates in different types of dementia.更多还原