阿茲海默症與其合併憂鬱症狀患者之擴散張量影像指標改變

Differences of Indices in Diffusion Tensor Images of Patients with Depressive Symptoms in the Elderly with Alzheimer's Disease

張倪蓉(Ni-Jung Chang) ； 陳啟昌(Clayton Chi-Chang Chen) ； 蔡志文(Jyh-Wen Chai) ； 陳政男(Cheng-Nan Chen) ； 李宗原(Tsung-Yung Li)

《中華放射線技術學雜誌》 42卷1期 (2018/03) Pp. 9-14

摘要

人口老化不只在台灣是一漸趨嚴重的社會問題，而是一個全球性的趨勢；老化的狀況越嚴重，老人的健康問題就更需要被重視。近年來老人失智症患者合併憂鬱症狀的現象不斷地被討論，而影像學在診斷上的幫助也在近幾年越來越興盛。本文章將透過圈選感興趣區域（ROI）於擴散張量影像（DTI）上產生之擴散指標（DTI index）以及認知功能測驗（neuropsychological test）包含簡易心智量表（mini-mental state examination, MMSE）、台灣版蒙特利爾認知評估（Montreal cognitive assessment (MoCA), Taiwan Version）、臨床失智評分量表（clinical dementia rating, CDR）與老人憂鬱量表（geriatric depression scale, GDS），對阿茲海默症（AD）與其合併憂鬱症患者（DAD）進行組間比較以及皮爾森相關性分析（partial Pearson correlation analyses）。藉由本文章結果可以看出確實於腦區存在著組間差異於右大腦腳（right cerebral peduncle），左前放射冠（left anterior corona radiata），右外囊（right external capsule），左下額枕部纖維束（left inferior fronto-occipital fasciculus），左鉤束（left uncinated fasciculus），右左下額部（right and left inferior frontal blade）。左右側化性（lateralization）存在於我們的結果中，可能來自於受試者慣用手的差異。進一步進行相關性分析也可以看出其差異區域與認知功能之相關，而相關性存在於認知功能與組間差異之FA及MD區域的現象則可以顯示該差異腦區於白質缺損時認知功能已能看出差異。

關鍵字

阿茲海默症 ； 擴散張量影像 ； 老人憂鬱症

並列摘要

Aging is a severe problem in the world. More and more patients showed the comorbidity of dementia and depression. Depressive symptoms are commonly seen in patients with Alzheimer's disease (AD). Depression is supposed to accelerate cognitive deterioration in patient with AD. The use of diffusion tensor MRI in depression and dementia research has yielded a number of significant findings that provide the basis for understanding the pathophysiology of these two diseases. However, little is known about how these two different types of disease interfere with each other. Our aim was to investigate the change of white matter integrity by using DTI in patients with depressive symptoms and AD (DAD) and patients with AD only (AD). We also analyzed the neuropsychological tests between groups. We further showed the correlation with differences of the regions and their corresponding neurofibers between groups. Subsequently, partial Pearson correlation analyses were performed to correlate the clinical evaluations with the regional DTI values within patient groups. All participants completed the neuropsychological tests: mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), clinical dementia rating (CDR), and geriatric depression scale (GDS). According to the results of ROI analysis, lower FA showed in right cerebral peduncle, internal and external capsule, and frontal-occipital fasiculus in AD group. The negative correlation showed between FA in left anterior corona radiata and the naming test in MoCA. The positive correlation observed between the naming test in MoCA and MD in left retrolenticular part of internal capsule, left anterior corona radiata and left superior corona radiata. The results showed the damage of right hemisphere of AD group is severer than DAD group in the ROI-based analysis. Correlations between those white matter abnormalities and MoCA and CDR supports white matter alteration may be involved in the psychopathology and pathophysiology of these two major comorbidities in Alzheimer's disease. The different lateralization existed in our results. It may relate to the handedness. In the correlation between FA values, MD values and the naming test in MoCA suggests that white matter deficits in these regions may be a specific biomarker.

並列關鍵字

Alzheimer's disease (AD) ； magnetic resonance imaging (MRI) ； diffusion tensor imaging (DTI) ； neuropsychological test