轻度认知功能障碍患者海马、内嗅皮层体积与嗅觉功能改变的临床研究

目的探讨轻度认知功能障碍(Mild Cognitive I mpairment,MCI)患者的海马、内嗅皮层体积与嗅觉功能变化及其相关性。方法从体检者中入选MCI组21例,认知功能正常(NC)组18人,进行一般情况评定、实验室检查和神经心理量表评测。MRI测量海马体积和内嗅皮层体积,"五味嗅觉测试液"进行嗅觉功能的评测并进行与认知功能的相关性分析。结果MCI组与NC组相比内嗅皮层体积[MCI组(2.661±0.173)cm3,NC组(3.033±0.122)cm3,P0.01]与海马体积[MCI组(6.186±0.740)cm3,NC组(6.802±0.796)cm3,P0.05]均有明显萎缩。MCI组的嗅觉识别阈值(2.429±0.263)分明显高于NC组(2.089±0.308)分(P0.01)。海马体积与内嗅皮层体积、临床记忆量表总分及嗅觉识别阈值显著相关(P0.01);内嗅皮层体积与临床记忆量表总分呈正相关,与嗅觉识别阈值呈负相关(P0.01);临床记忆量表总分与嗅觉识别阈值呈显著负相关(P0.01)。结论MCI患者存在海马、内嗅皮层萎缩及嗅觉识别或能的下降,MRI测量海马、内嗅皮层体积及嗅觉功能评定对诊断MCI及早期进行阿尔茨海默病防治有重要参考价值。     

轻度认知障碍和轻度Alzeimer病的海马体积MRI测量

目的研究轻度认知功能障碍（mildcognitiveimpairment,MCI）和轻度阿尔兹海默病（A1zheimerdisease,AD）患者的海马体积萎缩情况,评价利用影像学测定海马体积对MCI、AD的诊断价值。方法应用3．0T磁共振分别对20例MCI患者,20例轻度AD患者,20例认知功能正常的对照者的海马体积进行测量,所得数值用头颅体积进行标准化处理。采用计算机SPSS13．0统计学软件进行资料的统计学处理,比较三组之间体积的差异。结果对照组与MCI组,对照组与AD组的两侧海马体积均存在显著的统计学差异,轻度AD与MCI组两侧的海马体积无显著的统计学差异。结论认知功能障碍与海马体积具有一定的相关性,海马萎缩对早期认知障碍有一定的诊断意义。     

轻度认知损害海马萎缩的磁共振研究

目的　探讨轻度认知损害 (MCI)海马体积变化的特点。方法　对 16例健康老年人 (对照组 )、 15例MCI和 17例 Alzheimer病 (AD)患者行核磁共振 (MRI)、简易智力状态检查 (MMSE) ,经标准化处理和年龄性别修正后比较海马体积变化及其与 MMSE评分的相关性。结果　 MCI组 (6 0 79± 187mm3)、AD组 (5 12 4± 185 mm3)较对照组 (70 6 2± 2 0 4 mm3)的海马体积显著减少 ,萎缩程度分别为 14 % (P<0 .0 1)、2 7% (P<0 .0 0 1) ;AD组的海马体积较 MCI组显著萎缩 (P<0 .0 1) ,3组人群合并后 ,全体研究对象的海马体积与 MMSE评分呈显著正相关 (r=0 .8,P<0 .0 0 1) ,对照组 (r=0 .2 5 ,P>0 .0 5 )和 MCI组 (r=0 .33,P>0 .0 5 )不存在相关性。结论　海马体积萎缩有助于 MCI的诊断 ,可进一步监测其变化以判断转归     

阿尔茨海默病谱系患者的海马亚区体积损害特征

目的探讨主观认知障碍(subjective cognitive decline,SCD)、遗忘型轻度认知障碍(amnestic mild cognitive impairment,a MCI)及阿尔茨海默病(Alzheimer’s disease,AD)患者海马亚区体积的萎缩模式及与记忆功能障碍的关联。方法收集2016年6月-2019年5月至南京大学医学院附属鼓楼医院神经内科门诊就诊的151例患者。根据认知测试结果和受试者有无记忆下降主诉,分认知正常组43例,SCD组37例,a MCI组35例和AD组36例。Free Surfer 6. 0图像分析软件计算海马12个亚区体积,偏相关分析海马亚区与记忆功能的相关性。结果随着疾病进展,双侧海马总体积、双侧分子层、左侧海马齿状回、左侧CA4亚区体积显著下降(P均<0. 05)。SCD组内海马亚区体积与记忆功能无显著相关(P> 0. 05),a MCI组内左侧海马尾体积与AVLT-再认评分显著正相关(P<0. 05); AD组内双侧下托、前下托,左侧海马裂、旁下托、分子层、齿状回、CA4、海马杏仁核过渡区、右侧海马伞体积与AVLVT-延时回忆评分相关(P均<0. 05)。结论 SCD患者已经出现海马总体积和部分海马亚区体积萎缩。AD谱系患者的双侧分子层、左侧海马齿状回、左侧CA4亚区体积呈显著下降模式,海马亚区体积与记忆功能相关。     

老年轻度认知障碍患者海马萎缩的MRI定量测定

目的:探讨老年人轻度认知障碍(MCI)患者海马体积的变化及其与简易智力状态检查(MMSE)的相关性。方法:对15例MCI和16例健康老年人(对照组)行核磁共振(MRI)及MMSE检查,经标准化处理和年龄性别修正后比较海马体积变化及其与MMSE评分的相关性。结果:MCI组(6079±187mm~3)、较对照组(7062±204mm~3)的海马体积显著减少(P<0.01),萎缩程度14％。海马体积与MMSE评分相关性检测MCI组(r=0.33)、对照组(r=0.25),相关性均不明显(P>0.05);两组人群合并后,全体研究对象的海马体积与MMSE评分呈显著正相关(r=0.069,P<0.001)。结论:海马萎缩的MRI定量测定有助于MCI的诊断;海马体积萎缩是老年人认知功能下降的关联因素。     

神经心理量表结合海马体积诊断早期Alzheimer's病的研究

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P0.05),而早期AD组与MCI组Mo CA评分的差异无统计学意义(P0.05)。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P0.05)。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P0.05)。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。     

不同类型认知障碍患者的尿液AD7c-NTP与头部MRI、MRS的相关性研究

目的研究对不同类型认知障碍患者的尿液AD相关神经丝蛋白(AD7c-NTP)水平与头颅MRI中海马萎缩程度、MRS中N-乙酰天门冬氨酸(NAA)峰值水平的相互关系。方法选取阿尔兹海默病(AD)、血管性痴呆(VD)、轻度认知障碍(MCI)患者各30例,分别设为AD组、VD组、MCI组,另选取同期体检健康者30例作对照组。取所有受检者晨起时尿液,以酶联免疫吸附法测定AD7c-NTP水平,行头颅MRI及MRS检查。对比四组尿液AD7c-NTP水平、海马萎缩MTA评分、NAA峰值水平,分析尿液AD7c-NTP与海马萎缩MTA评分、NAA峰值水平相关性。结果 MCI组尿液AD7c-NTP水平高于对照组,VD组尿液AD7c-NTP水平高于MCI组,AD组尿液AD7c-NTP水平高于Va D组,差异有统计学意义(P0.05);MCI组海马萎缩MTA评分与对照组比较,差异无统计学意义(P0.05),VD组海马萎缩MTA评分高于MCI组,AD组海马萎缩MTA评分高于VD组,差异有统计学意义(P0.05);MCI组NAA峰值水平与对照组比较,差异无统计学意义(P0.05),VD组NAA峰值水平低于MCI组,AD组NAA峰值水平低于VD组,差异有统计学意义(P0.05);尿液AD7c-NTP水平变化与海马萎缩MTA评分呈正相关关系(P0.05);与NAA峰值水平呈负相关关系(P0.05)。结论 AD、Va D、MCI患者尿液AD7c-NTP水平较高,且不同类型认知障碍患者尿液AD7c-NTP、海马萎缩MTA评分、NAA峰值水平存在明显差异,尿液AD7c-NTP水平变化与MRI改变呈正相关性,与MRS改变呈负相关性。     

基于体素的MRI形态学测量对遗忘型轻度认知障碍和轻度阿尔茨海默病脑灰质萎缩的研究

目的：利用磁共振3DT1WI成像研究遗忘型轻度认知障碍（aMCI）、轻度阿尔茨海默病（AD）患者相对于正常老年人灰质体积改变的特点。方法：采用3．0T磁共振,对33例aMCI患者（aMCI组）、32例轻度AD患者（轻度AD组）及31名正常老年人（对照组）进行3DT1WI扫描,利用基于SPM5的DARTEL工具箱对扫描获得的结构图像进行预处理,再对aMCI组、轻度AD组和对照组的全脑灰质体积进行基于体素的统计学比较。结果：与对照组比较,aMCI组左侧海马、海马旁回、舌回、颞上回,双侧岛叶和颞中回等结构的灰质体积萎缩,其差异有显著统计学意义（P〈0．01,FDR corrected,K〉50体素）。轻度AD组的双侧海马、海马旁回及杏仁核、双侧丘脑、双侧颞顶叶皮质等结构灰质体积萎缩,额叶和枕叶皮质也出现灰质萎缩,其差异也有统计学意义（P〈0．05,FDR corrected,K≥50体素）。结论：基于体素的MRI形态学测量能够客观揭示AD早期阶段的脑灰质萎缩改变,对左侧海马萎缩的识别有助于AD的早期诊断。     

Rey-Osterriche复杂图形测验在轻度阿尔茨海默病和轻度认知损害患者中的应用研究

目的:研究Rey-Osterrich复杂图形测验(CFT)对轻度阿尔茨海默病(AD)和遗忘型轻度认知损害(MCI)的诊断价值。方法:应用CFT、简明精神状态量表(MMSE)对45例轻度AD患者、73例遗忘型MCI和66名正常老年人进行检测,MMSE总得分分别为(20.2±2.5)分、(26.9±1.8)和(28.2±1.6)分。结果:对照组,CFT结构模仿和延迟回忆得分与教育程度有显著正相关性,与年龄、性别无相关性。MCI组的结构模仿得分为(32.4±6.2)分,轻度AD组为(26.1±10.9)分,对照组为(33.6±3.1)分。AD组与对照组及MCI组比差异有显著意义,延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性(P<0.01);MCI组的延迟回忆得分与对照组比差异有显著统计学意义(P<0.01),轻度AD组下降更为明显,与MCI组比差异有显著统计学意义(P<0.01)。结论:CFT延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性。CFT结构模仿不能识别MCI,对轻度AD,其敏感性亦不理想。     

轻度认知功能障碍患者认知功能与内颞叶各结构体积的关系

目的研究轻度认知功能障碍(MCI)患者认知功能与内颞叶各结构体积的关系。方法17例MCI患者和21名正常老年人分别接受临床评估、神经心理检查和头颅MR扫描,在重建的图像上测量内颞叶各结构的体积,并行标准化处理;对神经心理学指标与内颞叶结构MR指标进行相关性分析。结果MCI组和正常老年组的神经心理量表除物体记忆测验(FOM)外,其余各项得分差异均无统计学意义;两组MR内颞叶结构体积比较差异亦均无统计学意义(均P>0.05)。在MCI组中,短时记忆、逻辑记忆(LM)得分与内嗅皮质体积呈正相关(r=0.484、0.529,均P<0.05),无意义图形再认(MGR)、FOM得分与海马体积呈正相关(r=0.502、0.659,均P<0.05),短时记忆、MGR得分与左侧杏仁核体积呈正相关(r=0.557、0.644,均P<0.05);正常老年组短时记忆、LM和数字广度(DS)测验得分与双侧内嗅皮质体积呈负相关(r=-0.448、-0.718,均P<0.05),注意力、计算力与右侧杏仁核、双侧海马体积均呈负相关(r=-0.451、-0.553,均P<0.05)。结论MCI患者的认知功能与内颞叶各结构体积有关;不同的认知功...     

Hippocampal volume and asymmetry in mild cognitive impairment and Alzheimer's disease: Meta‐analyses of MRI studies

Numerous studies have reported a smaller hippocampal volume in Alzheimer's disease (AD) patients than in aging controls. However, in mild cognitive impairment (MCI), the results are inconsistent. Moreover, the left‐right asymmetry of the hippocampus receives less research attention. In this article, meta‐analyses are designed to determine the extent of hippocampal atrophy in MCI and AD, and to evaluate the asymmetry pattern of the hippocampal volume in control, MCI, and AD groups. From 14 studies including 365 MCI patients and 382 controls, significant atrophy is found in both the left [Effect size (ES), 0.92; 95% confidence interval (CI), 0.72–1.11] and right (ES, 0.78; 95% CI, 0.57–0.98) hippocampus, which is lower than that in AD (ES, 1.60, 95% CI, 1.37–1.84, in left; ES, 1.52, 95% CI, 1.31–1.72, in right). Comparing with aging controls, the average volume reduction weighted by sample size is 12.9% and 11.1% in left and right hippocampus in MCI, and 24.2% and 23.1% in left and right hippocampus in AD, respectively. The findings show a bilateral hippocampal volume loss in MCI and the extent of atrophy is less than that in AD. By comparing the left and right hippocampal volume, a consistent left‐less‐than‐right asymmetry pattern is found, but with different extents in control (ES, 0.39), MCI (ES, 0.56), and AD (ES, 0.30) group. © 2009 Wiley‐Liss, Inc.     

阿尔茨海默病患者认知功能与相关脑区血流量的关系

目的探讨不同程度阿尔茨海默病（Alzheimer disease,AD）患者额、颞、基底节、海马区CT血流灌注水平及其与认知功能损害的相关性。方法随机选择60例AD患者及30名健康老人,用简易智能状态量表（Mini-Mental State Exam,MMSE）及韦氏记忆量表（Wechsler Memory Scale,WMS）进行认知功能检查,并选取海马区层面进行CT血流灌注扫描,获得感兴趣区的血流灌注值。采用临床痴呆量表将AD组分为轻、中、重度痴呆3组。结果轻、中、重度AD组与健康组MMSE总分、长时、短时及瞬时记忆测验量表分比较的差异均有统计学意义。比较4组患者的双侧额、颞、基底节、海马区血流灌注参数,发现右额叶、右颞叶及左基底节脑血容量（cerebral blood volume,CBV）的差异有统计学意义,中度AD组较轻度组、对照组CBV明显升高;重度AD组与各组比较均无统计学差异。逐步回归分析显示认知功能与左海马、右基底节CBV呈显著正相关。结论 AD患者局部脑区的CBV变化,反映了不同程度痴呆患者的大脑认知储备能力。     

Hippocampal atrophy correlates with the severity of cognitive decline

BACKGROUND: The aim of this study is to compare the results of magnetic resonance (MR) imaging, particularly the decline in hippocampal volume, of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy age-matched controls, to examine the reliability of hippocampal volumetry in the early diagnosis of AD and the correlation of the severity of hippocampal atrophy with the severity of cognitive decline. METHODS: Twenty-six AD, 22 MCI and 15 normal cognitive status (NCS) patients were scanned with a 3 Tesla MR scanner. Hippocampus volumes were detected manually by Osiris 4.18. RESULTS: Multivariate regression analysis, which was performed to adjust the covariate effects of education, age, gender, hypertension and diabetes mellitus, showed that hippocampal atrophy was correlated with AD and MCI for right hippocampus; AD, MCI and age for left hippocampus independent of other parameters. A second regression analysis revealed that MMSE was correlated with hippocampal volume. CONCLUSIONS: Hippocampal volumetry can be used in early diagnosis of cognitive impairment, as well as grading cognitive decline.     

轻度认知障碍和阿尔茨海默病患者认知功能和MRI对照研究

目的探讨轻度认知障碍（MCI）和阿尔茨海默病（AD）的认知功能及影像学特点。方法回顾性分析经临床确诊的21例MCI和24例AD患者的临床资料。所有实验对象均用简易智力量表（MMSE）和蒙特利尔认知评估（MoCA）测定。结果MCI与AD的认知功能损害相比较：除了MMSE的记忆力组间无统计学意义（P＝0．28）,其余均有统计学差异（P〈0．05）。MoCA比MMSE具有更好的敏感性。AD的MRI表现：脑萎缩,特别是海马存在不同程度的萎缩;老年性脑改变;MCI的MRI主要表现为脑白质脱髓鞘病变,少数提示轻度脑萎缩或未见明显异常。结论MCI和AD患者早期均表现为记忆力下降,对记忆力减退人群进行MMSE、MoCA量表筛查有助于AD的早期诊断。AD患者到中晚期治疗较困难,因此早期诊断及干预对延缓病程起积极作用。     

Three-dimensional gray matter atrophy mapping in mild cognitive impairment and mild Alzheimer disease

BACKGROUND: Alzheimer disease (AD) is the most common form of dementia worldwide. Mild cognitive impairment (MCI) is the recent terminology for patients with cognitive deficiencies in the absence of functional decline. Most patients with MCI harbor the pathologic changes of AD and demonstrate transition to dementia at a rate of 10% to 15% per year. Patients with AD and MCI experience progressive brain atrophy. OBJECTIVE: To analyze the structural magnetic resonance imaging data for 24 patients with amnestic MCI and 25 patients with mild AD using an advanced 3-dimensional cortical mapping technique. DESIGN: Cross-sectional cohort design. Patients/ METHODS: We analyzed the structural magnetic resonance imaging data of 24 amnestic MCI (mean MMSE, 28.1; SD, 1.7) and 25 mild AD patients (all MMSE scores, >18; mean MMSE, 23.7; SD, 2.9) using an advanced 3-dimensional cortical mapping technique. RESULTS: We observed significantly greater cortical atrophy in patients with mild AD. The entorhinal cortex, right more than left lateral temporal cortex, right parietal cortex, and bilateral precuneus showed 15% more atrophy and the remainder of the cortex primarily exhibited 10% to 15% more atrophy in patients with mild AD than in patients with amnestic MCI. CONCLUSION: There are striking cortical differences between mild AD and the immediately preceding cognitive state of amnestic MCI. Cortical areas affected earlier in the disease process are more severely affected than those that are affected late. Our method may prove to be a reliable in vivo disease-tracking technique that can also be used for evaluating disease-modifying therapies in the future.     

女性抑郁症患者尾状核和杏仁体磁共振研究

目的:探讨女性抑郁症患者的尾状核和杏仁体的体积变化.方法:采用3.0磁共振,分别测量抑郁症患者(30例,抑郁组)及对照组(30名)的尾状核和杏仁体的体积. 结果:抑郁症组尾状核体积左右侧分别为( 4349±517.5 )mm3,( 4208±394.3 )mm3;对照组组尾状核体积左右侧为( 5086±449.3)mm...     

Structure and function of medial temporal and posteromedial cortices in early Alzheimer's disease

Medial temporal lobe (MTL) atrophy and posteromedial cortical hypometabolism are consistent imaging findings in Alzheimer's disease (AD). As the MTL memory structures are affected early in the course of AD by neurofibrillary tangle pathology, the posteromedial metabolic abnormalities have been postulated to represent remote effects of MTL alterations. In this study, we investigated with functional MRI (fMRI) the structure-function relationship between the MTL and posteromedial regions, including the retrosplenial, posterior cingulate and precuneal cortices, in 21 older controls (OCs), 18 subjects with amnestic mild cognitive impairment (MCI) and 16 AD patients during a word list learning task. In the voxel-based morphometric and volumetric analyses, the MCI subjects showed smaller entorhinal volume than OCs (P = 0.0001), whereas there was no difference in the hippocampal or posteromedial volume. AD patients, as compared with MCI patients, showed pronounced loss of volume in the entorhinal (P = 0.0001), hippocampal (P = 0.01) and posteromedial (P = 0.001) regions. The normal pattern of posteromedial fMRI task-induced deactivation during active encoding of words was observed bilaterally in the OCs, but only in restricted unilateral left posteromedial areas in the MCI and AD patients. Across all subjects, more extensive impairment of the retrosplenial and posterior cingulate function was significantly related to smaller entorhinal (P = 0.001) and hippocampal (P = 0.0002) volume. These findings demonstrate that entorhinal atrophy and posteromedial cortical dysfunction are early characteristics of prodromal AD, and precede and/or overwhelm atrophy of the hippocampus and posteromedial cortices. Disturbances in posteromedial cortical function are associated with morphological changes in the MTL across the continuum from normal aging to clinical AD.     

Hippocampal volumes among older Indian adults: Comparison with Alzheimer's disease and mild cognitive impairment

Background:Hippocampal volume data from India have recently been reported in younger adults. Data in older adults are unknown. The present paper describes hippocampal volume from India among older adults and compares the same with patients having Alzheimer''s disease (AD) and mild cognitive impairment (MCI).Results:Age and duration of illness in the MCI group were 70.6 ± 8.6 years and 1.9 ± 0.9 years, respectively. In the AD group, age and duration of illness were 72 ± 8.1 years and 3.1 ± 2.2 years, respectively. In cognitively normal subjects, the age range was 45-88 years (66.9 ± 10.32) years. Mean mini–mental status examination (MMSE) score of healthy subjects was 28.28 ± 1.33. In the MCI group, MMSE was 27.05 ± 1.79. In the AD group, MMSE was 13.32 ± 5.6. In the healthy group, the hippocampal volume was 2.73 ± 0.53 cm³ on the left side and 2.77 ± 0.6 cm³ on the right side. Likewise, in MCI, the volume on the left side was 2.35 ± 0.42 cm³ and the volume on the right side was 2.36 ± 0.38 cm³. Similarly, in the AD group, the volume on the right side was 1.64 ± 0.55 cm³ and on the left side it was 1.59 ± 0.55 cm³. Post hoc analysis using Tukey''s honestly significant difference (HSD) showed, using analysis of variance (ANOVA) that there was a statistically significant difference between healthy and AD (P ≤ 0.01), and between healthy and MCI (P ≤ 0.01) subjects. There was a correlation between MMSE score and hippocampal volume in the AD group.Conclusion:The volume of the hippocampus in older Indian adults was 2.77 ± 0. 6 cm³ on the right side and 2.73 ± 0.52 cm³ on the left side. There was a significant hippocampal volume loss in MCI/AD compared to cognitively normal subjects.