不同认知功能障碍程度阿尔茨海默病患者海马、内嗅皮层体积变化及其与MMSE评分的关系

目的 探讨不同认知功能障碍程度的患者阿尔兹海默病（AD）海马、内嗅皮层体积的变化,及其与简易精神状态检查表（MMSE）评分的相关性。方法 横断面研究。纳入2017年9月—2021年9月联保部队第九六〇医院淄博院区86例AD患者临床和影像学资料,其中男54例、女32例,年龄55~87（73.9±8.1）岁。根据临床痴呆评定量表（CDR）评分将86例患者分为3组,其中36例CDR评分0.5分患者为轻度认知障碍（MCI）组,21例1分患者为轻度AD组,29例2~3分患者为中重度AD组。患者均应用MRI测量双侧海马体积、内嗅皮层体积,采用MMSE评分评估患者认知功能。观察指标：（1）比较3组患者性别、年龄、受教育年限等临床基线资料,以及MMSE评分;（2）比较3组患者海马体积和内嗅皮层体积;（3）分析AD患者MMSE评分与海马、内嗅皮层体积的相关性。结果 （1）3组患者性别、年龄、受教育年限等临床基线资料比较差异均无统计学意义（P值均>0.05）。MCI组、轻度AD组、中重度AD组患者MMSE评分依次降低,差异有统计学意义（F=113.29,P<0.001）。（2）MCI组、轻度AD组、中重度AD组左右侧海马体积MRI测量值分别为（3.24±0.32）cm³和（3.22±0.31）cm³、（2.72±0.53）cm³和（2.84±0.56）cm³、（2.31±0.55）cm³和（2.46±0.54）cm³,左右侧内嗅皮层体积分别为（1.42±0.26）cm³和（1.39±0.27）cm³、（1.28±0.24）cm³和（1.24±0.25）cm³、（1.04±0.31）cm³和（1.06±0.34）cm³。3组患者左右侧海马体积、内嗅皮层体积MRI测量值比较,均为MCI组>轻度AD组>中重度AD组,差异均有统计学意义（P值均<0.05）。（3）86例AD患者MMSE评分10~27（20.9±5.2）分,与左右两侧海马体积、内嗅皮层体积MRI测量值均呈正相关（r=0.82、0.81、0.73、0.72,P值均<0.001）。结论 随着认知功能障碍程度的加重,AD患者海马、内嗅皮层体积MRI测量值逐渐减小,且MMSE评分与海马、内嗅皮层体积存在相关性。

Volume changes of hippocampus and entorhinal cortex and their ralationship with MMSE score in Alzheimer's disease patients with different degrees of cognitive impairment

Objective This study aimed to explore the changes of the volumes of hippocampus and entorhinal coreex in patients with Alzheimer's disease (AD) with different degrees of cognitive impairment ,and its correlation with the score of the mini-mental state examination(MMSE). Methods The clinical and imaging data from 86 patients with AD in Zibo Hospital of the 960th Hospital of the PLA Joint Logistics Support Force from September 2017 to September 2021 were collected for the retrospective cross-sectional study. The study included 54 males and 32 females aged 55-87 (73.9±8.1) years. According to the Clinical Dementia Rating Scale (CDR), 86 patients were divided into three groups, in which 36 patients with 0.5 CDR score were classified into the mild cognitive impairment (MCI) group, 21 patients with score of 1 were classified into the mild AD group, and 29 patients with score of 2-3 were classified into the moderate and severe AD group. The bilateral hippocampal and entorhinal cortex volumes were measured by MRI, and the MMSE score was used to evaluate the cognitive function of patients. In terms of observation indicators, clinical baseline data such as gender, age, years of education, and MMSE score were compared among the three groups. The hippocampal and entorhinal cortex volumes were compared among the three groups, and the correlation between MMSE score and volumes of hippocampus and entorhinal cortex in patients with AD was analyzed. Results (1) No statistically significant differences were observed in clinical baseline data, such as gender, age, and years of education among the three groups (all P values >0.05). Based on the comparison of MMSE score, as the groups could be ranked into MCI group>mild AD group>moderate-to-severe AD group (F=113.29, P<0.001). (2) The left and right hippocampal volumes measured by MRI were (3.24±0.32) and (3.22±0.31) cm³ in the MCI group, (2.72±0.53) and (2.84±0.56) cm³ in the mild AD group, and (2.31±0.55) and (2.46±0.54) cm³ in the moderate-to-severe AD group. The volumes of the left and right entorhinal cortex were (1.42±0.26) and (1.39±0.27) cm³ in MCI group, (1.28±0.24) and (1.24±0.25) cm³ in the mild AD group, and (1.04±0.31) and (1.06±0.34) cm³ in the moderate-to-severe AD group. Based on the MRI measurement of left and right hippocampal volumes and entorhinal cortex volumes, the three groups could be ranked as MCI group>mild AD group>moderate-to-severe AD group (all P<0.05). (3) The MMSE score in 86 patients with AD was 10-27 (20.90±5.23) points, and the score was positively correlated with left and right hippocampal volumes and entorhinal cortex volumes measured by MRI (r=0.82, 0.81, 0.73, 0.72, all P values <0.001). Conclusion With the increasing degree of cognitive impairment, the volumes of hippocampus and entorhinal cortex measured by MRI gradually decrease among AD patients, and MMSE score is correlated with the volumes of hippocampus and entorhinal cortex.