neurology:非典型阿尔茨海默病的异质性和纵向临床衰退的神经解剖学相关因素

2022-06-23 网络 网络

LPA和PCA的临床衰退的纵向模式不同,但具有异质性,与不同的脑域扩散模式有关。

为了比较非典型阿尔茨海默病(AD)的开放性进行性失语(LPA)和后部皮质萎缩(PCA)变体之间的神经学和神经心理学测试表现的纵向变化率,并使用主成分分析来评估变化模式的异质性以及与人口统计学和并发脑萎缩的关系。结果发表在neurology杂志上。

确定了淀粉样蛋白和tau蛋白AD生物标志物阳性的PCA或LPA患者,并进行了连续的神经学和神经心理学评估和结构MRI。在病例对照设计中比较了13个临床指标的变化率,并使用主成分分析来评估不受临床表型影响的临床变化模式。主成分分析与基于张量的形态测量法的区域脑萎缩率相关。

结果共有28名PCA患者和27名LPA患者被确认。与PCA患者相比,LPA患者的基线表现更差,在命名、重复和工作记忆方面的下降速度更快,而在言语偶发记忆方面的下降速度也更快。相反,与LPA患者相比,PCA患者在视觉空间和感知功能测试以及临床痴呆评分表上的基线表现更差,视觉感知功能的下降速度更快。

主成分分析显示,临床衰退的模式在整个队列中是高度异质性的,需要10个主成分来解释90%以上的变异。第一个主成分反映了整体的严重性,LPA的分数比PCA高,反映了LPA下降得更快,并且与左颞叶萎缩有关。第二和第三主成分与临床表型无关,但与区域萎缩有一定关系。主成分与年龄、性别、病程、淀粉样PET检查结果或脂蛋白基因型之间没有关系。

LPA和PCA的临床衰退的纵向模式不同,但具有异质性,与不同的脑域扩散模式有关。与LPA相比,PCA的进展过程更为缓慢。

 

参考文献:

Investigating Heterogeneity and Neuroanatomic Correlates of Longitudinal Clinical Decline in Atypical Alzheimer Disease. Neurology Jun 2022, 98 (24) e2436-e2445; DOI: 10.1212/WNL.0000000000200336

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