Regional cerebral blood flow and EEG in clinically diagnosed dementia with Lewy bodies and Alzheimer's disease

This study was undertaken in order to compare regional cerebral blood flow (rCBF) and EEG findings of patients with clinically diagnosed dementia with Lewy bodies (clinDLB) and Alzheimer's disease (clinAD). Furthermore, within the clinDLB group to compare cases with and without neuropathologically verified Lewy bodies (LBs). When we studied 200 dementia cases in a prospective longitudinal dementia study, 48 had clinDLB and 45 clinAD in retrospective analyses. EEG information was analysed in 34 clinDLB and 28 clinAD patients and cerebral blood flow, measured with the Xe 133 inhalation method, in 26 clinDLB and 25 clinAD. There were no differences in EEG between the clinDLB and clinAD groups or between the cases with and without LBs. The rCBF patterns in the clinDLB and clinAD groups showed similar reductions in the temporoparietal areas. The rCBF in cases with LBs showed heterogeneous pathology. The imaging results in clinDLB and clinAD were strikingly similar. The EEG and rCBF could not differentiate between cases with or without LB. The study illustrates the lack of specific changes of EEG and rCBF in cases with LB pathology.     

Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer's disease

Aim: Recent studies have shown that some antihypertensive medications are associated with a significant reduction in the incidence of Alzheimer's disease (AD). However, it remains uncertain whether antihypertensive drugs may have a preventive effect on cognitive decline in patients with AD. We investigated the effects of telmisartan, an angiotensin II type 1 receptor blocker with peroxisome proliferator‐activated receptor γ‐stimulating activity, on cognition and regional cerebral blood flow (rCBF) in elderly hypertensive patients with AD. Methods: A total of 20 patients with probable AD and essential hypertension were randomly assigned to the telmisartan group (n = 10, 40–80 mg daily) or the amlodipine group (n = 10, 5–10 mg daily) for 6 months. Results: The groups had a similar significant reduction in systolic and diastolic blood pressure after treatment. The telmisartan group did not show any changes in cognitive function test scores, while the amlodipine group showed significantly higher scores on the AD Assessment Scale‐Cognitive Subscale (Japanese version). Analysis of covariance to analyze treatment effect revealed that the telmisartan group showed increased rCBF in the right supramarginal gyrus, superior parietal lobule, cuneus, and lingual gyrus compared with the amlodipine group, while the amlodipine group showed increased rCBF only in the right cingulate gyrus compared with the telmisartan group at 6 months. Conclusion: These findings suggest that telmisartan may have additional benefits and be useful for the treatment of elderly hypertensive patients with AD. Geriatr Gerontol Int 2012; 12: 207–214.     

Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis

Clinical and histopathological findings hint at regional differences in the brain's sensitivity to metabolic changes in cirrhosis. The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0-to-I hepatic encephalopathy (HE). (13)N-ammonia, (15)O-water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI-studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus.     

Regional cerebral blood flow during mechanical hyperventilation in patients with fulminant hepatic failure

Hyperventilation is frequently used to prevent or postpone the development of cerebral edema and intracranial hypertension in patients with fulminant hepatic failure (FHF). The influence of such therapy on regional cerebral blood flow (rCBF) remains, however, unknown. In this study the CBF-distribution pattern was determined within the first 12 hours after development of hepatic encephalopathy (HE) stage 4 before and during hyperventilation. Ten consecutive patients (median age 48 [range 33-57] years) with FHF and 9 healthy controls (median age 54 [24-58] years) had rCBF determined by single photon emission computed tomography (SPECT) using intravenous injection of 133Xenon. For determination of high resolution CBF pattern, the patients were also studied with 99mTc-hexa-methylpropyleneamine oxime (HMPAO) in the hyperventilation condition. There was no significant difference in the rCBF distribution pattern during normoventilation as compared with hyperventilation. The anterior to posterior (AP) ratio was significantly lower in patients as compared with healthy controls. After hepatic recovery and disappearance of HE, 3 patients had restored normal rCBF distribution pattern as compared with healthy controls. We conclude that in sedated patients with FHF, a relatively lower rCBF is found in the frontal regions and in the basal ganglia as compared with posterior regions. This rCBF-distribution pattern was not aggravated during hyperventilation. It is speculated that this change of rCBF in patients with FHF may render the frontal brain regions more susceptible to hypoxia. The relative frontal rCBF decrease was shown to be reversible with hepatic recovery and alleviation of HE.     

老年高血压患者降压治疗对脑血液循环影响初探

目的探索老年高血压患者长期降压治疗对脑血液循环的影响。方法采用颈部血管超声测定全脑血流量（CBF）技术,前瞻性随访142例老年高血压患者降压治疗前、治疗后1／2年及1年时血压与血流动力学参数。结果老年高血压患者降压治疗后CBF增高（治疗前616．41±107．96mL／min,疗程1／2年时629．73±103．63mL／min,疗程1年时635．69±106．31mL／min,P〈0．05）,SBP降幅大者治疗后CBF高（疗程1／2年时β0．147,95％,CI0．022～0．272,P=0．021,疗程1年时B0．161,95％CI0．018～0．313,P=0．037）,基础DBP高者治疗后CBF下降风险大（疗程1／2年时0R1．117,95％CI1．001～1．247,P=0．048,疗程1年时0R1．213,95％CI1．028～1．473,P=0．024）。结论老年高血压患者积极降压治疗安全且益丁脑血液循环,但对基础DBP高者需加强监测。     

Effects of cilostazol on cognition and regional cerebral blood flow in patients with Alzheimer's disease and cerebrovascular disease: A pilot study

Aim: It remains unknown whether antiplatelet agents have a preventive effect on cognitive decline in patients with Alzheimer's disease (AD). We investigated the effects of cilostazol, an antiplatelet agent and cyclic adenosine monophosphate phosphodiesterase 3 inhibitor, on cognition and regional cerebral blood flow (rCBF) in elderly patients with AD and cerebrovascular disease (CVD). Methods: A total of 20 patients with AD and CVD were randomly assigned to a cilostazol group (n = 11, 100 mg daily) or control group (n = 9, aspirin 100 mg or clopidogrel 50 mg–75 mg daily) for 6 months. Results: The cilostazol group did not show any statistically significant changes in cognitive function test scores, whereas the control group showed statistically significant cognitive decline on the Alzheimer's Disease Assessment Scale‐Cognitive Subscale (Japanese version), Revised Wechsler Memory Scale (logical memory‐I) and Trail Making Test‐A. Analysis of covariance of treatment effect revealed that the cilostazol group showed increased rCBF in the right anterior cingulate lobe compared with baseline, whereas the control group showed decreased rCBF in the left middle temporal gyrus compared with baseline. Conclusion: These findings suggest that cilostazol might have a preventive effect on cognitive decline in patients with AD and CVD. Geriatr Gerontol Int 2013; 13: 90–97 .     

老年心脑血管疾病患者的认知功能随访与脑血流灌注改变

目的 本研究通过随访了解老年缺血性心脑血管疾病患者认知功能改变及其与脑血流灌注关系,同时观察心脑血管疾病患者临床事件和预后情况。方法 选取因冠心病和／或缺血性脑血管疾病住院治疗的老年人37例,进行认知功能测试,并作SPECT检查明确脑血流灌注情况,12～18个月后随访认知功能和严重心脑血管不良事件。结果 随访前后中国成人智力量表（CISA）测验中B因素、D因素、言语商、拼图、词义分辨、找错和背数成绩的降低（P〈0．05）;简易精神状态量表（MMSE）、临床记忆量表测试成绩无统计学意义;认知功能下降者的左脑血流灌注较差（P〈0．05）;各组都有心脑血管不良事件发生,冠心病合并脑血管病组死亡率升高（21．43％,P〈0．05）。结论 老年缺血性心脑血管疾病患者的认知功能随增龄呈下降趋势,有关言语和抽象思维方面的认知功能更易下降;认知功能下降者的左脑血流灌注较差。     

Regional cerebral blood flow during hypoglycaemia in children with IDDM

Summary Hypoglycaemia may cause transient cognitive impairment and neurological deficits that are frequently unilateral. The effect of mild hypoglycaemia (serum glucose level 3.4±0.1 mmol/l; mean±SEM) on regional cerebral blood flow and cerebrovascular resistance was studied in eight right-handed children with insulin-dependent diabetes mellitus (age 14.9±0.7 years; diabetes duration 7.4±1.1 years; six males) using the intravenous xenon-133 clearance method. Global mean cerebral grey and white matter blood flow, adjusted to mean pCO₂ of cohort, showed a trend towards an increase from 54.7±3.5 ml·100 g^–1·min^–1 at baseline euglycaemia to 58.0±4.1 ml·100 g^–1·min^–1 during hypoglycaemia (p=0.075). Statistically significant changes were seen in global mean cerebral grey matter blood flow, as indexed by initial slope, which increased from 88.0±6.5 min^–1 before hypoglycaemia to 96.3±7.2 min^–1 during hypoglycaemia (p<0.05). Cerebral grey matter blood flow was significantly higher in the right hemisphere compared to the left during hypoglycaemia (p<0.01) but not at baseline euglycaemia. Measurements of global cerebrovascular resistance showed a borderline decrease from 1.64±0.11 to 1.54±0.11 mm Hg·ml^–1·100 g^–1·min^–1 (p< 0.09). In conclusion, mild hypoglycaemia is associated with increases in cerebral blood flow which are greater in grey matter flow indices and in the right hemisphere. We speculate that asymmetrical cerebral blood flow changes may explain the frequent laterality of neurological deficits during severe hypoglycaemia.Abbreviations IDDM Insulin-dependent diabetes mellitus - rCBF regional cerebral blood flow - IS initial slope - pCO₂ end-tidal CO₂ - CVR cerebrovascular resistance - MABP mean arterial blood pressure - SPECT single photon emission computed tomography - ANOVA analysis of variance     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

Regional cerebral hypoperfusion in patients with celiac disease

BACKGROUND: Neurological and psychiatric disorders occur in approximately 10% of patients with celiac disease. Although some of these alterations respond to a gluten-free diet, the etiology of these abnormalities is uncertain. Because of a case report that cerebral hypoperfusion in a celiac patient resolved after a gluten-free diet, we studied brain perfusion changes in untreated celiac patients, treated celiac patients, and healthy controls. METHODS: A total of 15 untreated celiac patients without conditions affecting brain perfusion were enrolled; none had neurological or psychiatric disorders other than anxiety or depression. We also studied 15 celiac patients who were on a gluten-free diet for almost 1 year, and 24 healthy volunteers of similar sex and age. All subjects underwent cerebral single photon emission computed tomography examination. RESULTS: Of the 15 untreated celiac patients, 11 (73%) had at least one hypoperfused brain region, compared with only 1 (7%) of the 15 celiac patients on a gluten-free diet and none of the controls (P = 0.01). Cerebral perfusion was significantly lower (P <0.05) in untreated celiac patients, compared with healthy controls, in 7 of 26 brain regions. No significant differences in cerebral perfusion were found between celiac patients on a gluten-free diet and healthy controls. CONCLUSION: There is evidence of regional cerebral blood flow alteration in untreated celiac patients.     

老年人脑出血后脑血流量改变的研究

目的研究老年人脑出血后脑血流量改变及影响因素。方法对４２例老年脑出血患者在发病１周内行单光子发射型计算机断层扫描（ＳＰＥＣＴ）、脑血流显像和ＣＴ扫描，部分进行动态观察。结果脑血流量下降范围１０例局限在病灶周围，３２例累及病灶以外区域，其中小脑失联络１１例，１～６个月复查仍见广泛的血流量下降，血流减少的范围及程度与出血部位、出血量密切有关。结论老年人脑出血后存在持久广泛的脑血流量下降。     

Regional cerebral blood flow and cytokines in young females with fibromyalgia

OBJECTIVE: To determine whether there is any difference in regional cerebral blood flow (rCBF) and serum cytokine levels and association between clinical parameters and rCBF and serum cytokine levels in young females with fibromyalgia (FM). The other aim was to search whether the depression state has any effect on these two parameters. METHODS: Nineteen women with FM and 20 healthy women had 99mTc-HMPAO brain single-photon-emission computed tomography (SPECT) to evaluate rCBF. Serum interleukin (IL) levels (IL 1 beta, IL 2r, IL 6 and IL 8) were measured. Clinical and psychological evaluation was also carried out in FM patients and healthy controls. RESULTS: The patients with FM had significantly higher radioactivity uptake ratio in right and left caudate nucleus (p = 0.009, p = 0.001, respectively) than healthy controls. There was statistically significant decrease in the 99mTc-HMPAO uptake in the right superior parietal (p = 0.041), gyrus rectalis (p = 0.036) and pons (p = 0.023). FM patients had significantly higher serum IL 2r and IL 8 levels (p = 0.023, p = 0.011, respectively) than controls. Additionally, FM patients had significantly higher Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Hamilton Depression Rate scale (HDRS) scores (p = 0.000) than controls. Interestingly, the patients with mild depressive symptoms or without (i.e. HDRS-score < or = 16) had significantly higher serum IL 8 levels (p = 0.027) and increased radioactivity uptake ratio in the pons (P = 0.036) than the patients with more severe depressive symptoms (i.e. HDRS-score > 16). With regard to regional cerebral blood flow, significant correlations were detected between RSP and morning stiffness (r = 0.70, p < 0.01) and sleep disturbance (r = -0.53, p < 0.05), and between gyrus rectalis and FIQ score. There were significant correlations between LCN and IL-2 (P = 0.025), between RSP and morning stiffness (P = 0.006), sleep disturbance (P = 0.021) according to multiple regression analysis test. CONCLUSION: This study shows a significant increase in rCBF of caudate nuclei, a reduction in the pons, some cortical regions activity and a increase in IL 8, IL2r levels of young female patients with FM. These findings are more prominent in patients with low HDRS scores.     

老年代谢综合征患者胰岛素抵抗,脑血流灌注及认知功能研究

目的 探究代谢综合征(MetS)及其组分糖尿病或糖耐量异常(DM/IGT)与认知功能的关系.方法 选取华山医院老年病科住院患者90例,其中代谢综合征(MS)伴DM/IGT组28例,MS不伴DM/IGT组30例,非MS组32例.入选对象计算胰岛素抵抗指数(HOMA-IR),进行韦氏智力量表测试及单光子发射型计算机体层摄影(SPECT)脑血流显像.结果 MS组大部分脑区脑区血流灌注明显低于非MS组,MS伴DM/IGT组在左基底节、右顶叶、右颞叶、扣带回血流灌注低于MS不伴DM/IGT组.MS伴DM/IGT组,不伴DM/IGT组,非MS组nQ依次降低.MS组HO-MA-IR高于非MS组,但伴或不伴DM/IGT两组之间无统计学差异.结论 MS增加老年性认知功能减退的危险.MS患者胰岛素抵抗增加及动脉硬化是两大重要致病原因.     

应用CT灌注成像评价脑血管重建术对烟雾病患者短期脑血流的影响

目的应用CT灌注成像(CTP)评价脑血管重建术对烟雾病患者脑血流灌注的影响。方法采用前瞻性研究方法,对2012年6月—2013年1月就诊的14例烟雾病患者在术前和脑血管重建手术后7 d进行头部CT血管成像和CTP。对14例患者分别行联合脑血管重建术(12侧)和间接脑血管重建术(4侧)。在CTP上将术侧大脑中动脉供血皮质区作为感兴趣区(ROI),进行各参数配对t检验。结果 (1)两种血管重建术后7 d,烟雾病患者脑血流量、脑血容量均有减少,联合术式组患者对比剂达峰时间缩短,间接术式组延长,但差异均无统计学意义(P0.05)。(2)两组患者手术后7 d对比剂平均通过时间均增加,联合术式组术前为(4.5±0.6)s,术后7 d为(4.7±0.6)s,差异有统计学意义(P=0.045)间接术式组患者对比剂平均通过时间虽增加,但差异无统计学意义。3个月时,CTP随访5例患者,影像学表现为脑血流灌注改善明显。结论 CTP检查显示联合脑血管重建术治疗烟雾病短期内可能改变脑血流灌注,但脑组织缺血状态无明显变化;间接脑血管重建术后脑血流灌注无明显改变。     

Regional cerebral blood flow in patients with internal carotid artery stenosis: Effects of nifedipine and nimodipine

Regional cerebral blood flow (rCBF) in 87 patients with CBF decreased due to unilateral stenosis of internal carotid artery was studied by using the¹³³xenon infusion technique and a 30-detector setup. On the side of stenosis a decrease in the mean hemispheric blood flow (rCBFh) with an elevated deviation of rCBF from rCBFh was observed. Administration of a single oral dose of either nifedipine or nimodipine induced various changes in rCBF. A classification of their effects with due regard for changes in both the mean value of the hemispheric blood flow and the flow distribution is described. The decrease in both the interhemispheric difference of rCBFh and the deviation of rCBF from the hemispheric mean flow accompanying the increase of the total brain blood flow was considered as being the most beneficial drug effect. This positive reaction was found more frequently when nimodipine was used. In some patients nifedipine, and in fewer, nimodipine, induced nonbeneficial changes in rCBF with elevation of the interhemispheric difference and an increase in the number of ischemic and hyperemic regions on the side of stenosis. The types of drug effects after administration of a single dose were similar to those after two weeks of monotherapy. It is supported that this approach allows assessment of cerebral hemodynamics and drug effectiveness in cerebrovascular disorders.