进行性核上性麻痹与行为异常型额颞叶痴呆患者认知-精神行为及<sup>18</sup>F-FDG PET显像特征研究

doi:10.3969/j.issn.1672-6731.2020.09.010

摘要/Abstract

摘要：

目的研究进行性核上性麻痹（PSP）患者认知功能、精神行为症状以及不同脑区葡萄糖代谢特点，并与行为异常型额颞叶痴呆（bvFTD）患者进行比较。方法纳入经36个月以上随访最终确诊为PSP（PSP组，20例）和bvFTD（bvFTD组，65例）患者，通过简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）、日常生活活动能力量表（ADL）以及神经精神科问卷（NPI），分别对认知功能、日常生活活动能力和神经精神行为症状进行评价。bvFTD组（18例）和PSP组（17例）中疑似病例进一步行¹⁸F-FDG PET以明确诊断，同时比较两组不同脑区葡萄糖代谢存在的差异。结果 PSP组患者MMSE评分（P=0.046）和MoCA评分（P=0.009）均高于bvFTD组；MoCA量表各分项评分，PSP组患者命名（P=0.038）、语言功能（P=0.006）、抽象思维（P=0.011）、延迟回忆（P=0.001）和定向力（P=0.004）评分均高于bvFTD组，视空间能力与执行功能、注意力评分组间差异无统计学意义。两组患者ADL评分和NPI评分差异均无统计学意义。NPI量表各分项比较，PSP组16例（88.89%）、bvFTD组63例（96.92%）存在一项或多项神经精神行为症状，PSP组激越/攻击（P=0.015）、易激惹/情绪不稳（P=0.036）发生率低于bvFTD组，而抑郁/心境恶劣（P=0.024）、情感淡漠/漠不关心（P=0.047）发生率高于bvFTD组。¹⁸F-FDG PET显像两组均表现为额叶、岛叶、尾状核代谢减低，PSP组同时伴有丘脑、中脑低代谢。。结论早期PSP患者即存在明显的认知功能障碍及精神行为异常，结合¹⁸F-FDG PET显像，有助于与bvFTD早期鉴别诊断。

关键词: 核上麻痹, 进行性, 额颞叶痴呆, 认知障碍, 精神障碍, 正电子发射断层显像术

Abstract:

Objective To compare the characteristic of cognitive function, behavioral and psychological symptoms and different cerebral glucose metabolism between patients with progressive supranuclear palsy (PSP) and behavioral variant frontotemporal dementia (bvFTD). Methods Twenty PSP patients and 65 bvFTD patients were recruited after follow-up for more than 36 months. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), Activities of Daily Living Scale (ADL) and Neuropsychiatric Inventory (NPI) were used to evaluate the degree of cognitive impairments, the abilities of daily living, and behavioral and psychological symptoms, respectively. Part of the atypical patients, including 18 bvFTD and 17 PSP, were examined by ¹⁸F-FDG PET to analyze the difference of cerebral glucose metabolism between 2 groups. Results The MMSE scores (P=0.046) and MoCA scores (P=0.009) were higher in PSP group than bvFTD group. A detail analysis of MoCA sub-item showed the scores of naming (P=0.038), language (P=0.006), abstraction (P=0.011), delayed recall (P=0.001) and orientation (P=0.004) were higher in PSP group than those in bvFTD group, while the score of executive function/visuospatial ability and attention had no difference between both 2 groups. And there was no significant difference in ADL score and NPI score between 2 groups. In respect of the 12 items of NPI, the 16 PSP patients (88.89%) and 63 bvFTD patients (96.92%) had one or more neuropsychiatric behavior symptoms, respectively. The incidence of agitation (P=0.015) and irritability (P=0.036) was significantly lower in PSP group than in bvFTD group, while the incidence of apathy (P=0.047) and depression (P=0.024) was higher than in bvFTD group. The ¹⁸F-FDG PET imaging of all the patients in 2 groups presented decreased metabolism in frontal lobe, insular lobe and caudate nucleus, and PSP group also showed hypometabolism in thalamus and midbrain. Conclusions The PSP patients showed obvious cognitive impairment and psychological symptoms, combined with ¹⁸F-FDG PET imaging, which were helpful for distinguishing PSP from bvFTD.

Key words: Supranuclear palsy, progressive, Frontotemporal dementia, Cognition disorders, Mental disorders, Positron-emission tomography

王盼, 张惠红, 王艳, 张淼, 陈嫄, 徐小林, 周玉颖. 进行性核上性麻痹与行为异常型额颞叶痴呆患者认知-精神行为及¹⁸F-FDG PET显像特征研究[J]. 中国现代神经疾病杂志, 2020, 20(9): 813-820.

WANG Pan, ZHANG Hui-hong, WANG Yan, ZHANG Miao, CHEN Yuan, XU Xiao-lin, ZHOU Yu-ying. Characteristics of cognitive-neuropsychiatric behavioural features and ¹⁸F-FDG PET images in progressive supranuclear palsy and behavioral variant frontotemporal dementia[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(9): 813-820.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I9/813

参考文献

[1] Boxer AL, Yu JT, Golbe LI, Litvan I, Lang AE, Hö glinger GU. Advances in progressive supranuclear palsy:new diagnostic criteria, biomarkers, and therapeutic approaches[J]. Lancet Neurol, 2017, 16:552-563.
[2] Nestor PJ, Altomare D, Festari C, Drzezga A, Rivolta J, Walker Z, Bouwman F, Orini S, Law I, Agosta F, Arbizu J, Boccardi M, Nobili F, Frisoni GB; EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders. Clinical utility of FDG-PET for the differential diagnosis among the main forms of dementia[J]. Eur J Nucl Med Mol Imaging, 2018, 45:1509-1525.
[3] Cui RX, Niu N, Zhang Y, Yuan J, Li F. Typical cerebral metabolic patterns in various types of dementia:an SPM analysis of ¹⁸F-FDG PET images[J]. Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi, 2014, 14:303-308.[崔瑞雪, 牛娜, 张颖, 袁晶, 李方. 不同类型痴呆脑代谢改变图型:¹⁸F-FDG PET显像[J]. 中国现代神经疾病杂志, 2014, 14:303-308.]
[4] Kobylecki C, Jones M, Thompson JC, Richardson AM, Neary D, Mann DM, Snowden JS, Gerhard A. Cognitive-behavioural features of progressive supranuclear palsy syndrome overlap with frontotemporal dementia[J]. J Neurol, 2015, 262:916-922.
[5] Morishima R, Bandoh M, Sunami Y, Isozaki E. Progressive supranuclear palsy-Richardson syndrome with visual attention disturbance (Holmes and Horrax) and ataxie optique (Garcin):a case report[J]. Rinsho Shinkeigaku, 2019, 59:730-735.
[6] Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, Goetz CG, Golbe LI, Grafman J, Growdon JH, Hallett M, Jankovic J, Quinn NP, Tolosa E, Zee DS. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome):report of the NINDS-SPSP international workshop[J]. Neurology, 1996, 47:1-9.
[7] Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, Freedman M, Kertesz A, Robert PH, Albert M, Boone K, Miller BL, Cummings J, Benson DF. Frontotemporal lobar degeneration:a consensus on clinical diagnostic criteria[J]. Neurology, 1998, 51:1546-1554.
[8] Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EG, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia[J]. Brain, 2011, 134:2456-2477.
[9] Lewis G. DSM-Ⅳ:diagnostic and statistical manual of mental disorders[M]. 4th ed. APA:Washington, DC, 1994:886.
[10] Hachinski VC, Iliff LD, Zilhka E, Du Boulay GH, McAllister VL, Marshall J, Russell RW, Symon L. Cerebral blood flow in dementia[J]. Arch Neurol, 1975, 32:632-637.
[11] Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging[J]. AJR Am J Roentgenol, 1987, 149:351-356.
[12] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state":a practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res, 1975, 12:189-198.
[13] Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment:validity and utility in a memory clinic setting[J]. Can J Psychiatry, 2007, 52:329-332.
[14] Eto F, Tanaka M, Chishima M, Igarashi M, Mizoguchi T, Wada H, Iijima S. Comprehensive activities of daily living (ADL) index for the elderly[J]. Nihon Ronen Igakkai Zasshi, 1992, 29:841-848.
[15] Wang T, Xiao S, Li X, Wang H, Liu Y, Su N, Fang Y. Reliability and validity of the Chinese version of the neuropsychiatric inventory in mainland China[J]. Int J Geriatr Psychiatry, 2012, 27:539-544.
[16] Zhang LL, Wang Y, Cheng Y, Zhang N. Characteristics of cognitive function, behavioral and psychological symptoms in patients with Alzheimer's disease versus behavioral variant frontotemporal dementia[J]. Zhonghua Nei Ke Za Zhi, 2017, 56:903-908.[张丽玲, 王颖, 程焱, 张楠. 阿尔茨海默病与行为变异型额颞叶痴呆患者认知功能和精神行为症状的特点[J]. 中华内科杂志, 2017, 56:903-908.]
[17] Respondek G, Stamelou M, Kurz C, Ferguson LW, Rajput A, Chiu WZ, van Swieten JC, Troakes C, Al Sarraj S, Gelpi E, Gaig C, Tolosa E, Oertel WH, Giese A, Roeber S, Arzberger T, Wagenpfeil S, Höglinger GU; Movement Disorder Society-endorsed PSP Study Group. The phenotypic spectrum of progressive supranuclear palsy:a retrospective multicenter study of 100 definite cases[J]. Mov Disord, 2014, 29:1758-1766.
[18] Kaat LD, Boon AJ, Kamphorst W, Ravid R, Duivenvoorden HJ, van Swieten JC. Frontal presentation in progressive supranuclear palsy[J]. Neurology, 2007, 69:723-729.
[19] Gao J. The differentiation of dementia[J]. Zhonghua Lao Nian Yi Xue Za Zhi, 2014, 33:1257-1259.[高晶. 重视痴呆的鉴别诊断[J]. 中华老年医学杂志, 2014, 33:1257-1259.]
[20] Pilotto A, Gazzina S, Benussi A, Manes M, Dell'Era V, Cristillo V, Cosseddu M, Turrone R, Alberici A, Padovani A, Borroni B. Mild cognitive impairment and progression to dementia in progressive supranuclear palsy[J]. Neurodegener Dis, 2017, 17:286-291.
[21] Brown RG, Lacomblez L, Landwehrmeyer BG, Bak T, Uttner I, Dubois B, Agid Y, Ludolph A, Bensimon G, Payan C, Leigh NP; NNIPPS Study Group. Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy[J]. Brain, 2010, 133:2382-2393.
[22] Santangelo G, Cuoco S, Pellecchia MT, Erro R, Barone P, Picillo M. Comparative cognitive and neuropsychiatric profiles between Parkinson's disease, multiple system atrophy and progressive supranuclear palsy[J]. J Neurol, 2018, 265:2602-2613.
[23] Bigio EH, Brown DF, White CL 3rd. Progressive supranuclear palsy with dementia:cortical pathology[J]. J Neuropathol Exp Neurol, 1999, 58:359-364.
[24] Zhang YP. Progressive supranuclear paralysis with mental symptoms as the first symptom:a case report and literature review[J]. Zhong Feng Yu Shen Jing Ji Bing Za Zhi, 2016, 33:273-275.[张燕平. 以精神症状为首发的进行性核上性麻痹1例报告并文献复习[J]. 中风与神经疾病杂志, 2016, 33:273-275.]
[25] Perri R, Monaco M, Fadda L, Caltagirone C, Carlesimo GA. Neuropsychological correlates of behavioral symptoms in Alzheimer's disease, frontal variant of frontotemporal, subcortical vascular, and lewy body dementias:a comparative study[J]. J Alzheimers Dis, 2014, 39:669-677.
[26] Pagonabarraga J, Kulisevsky J, Strafella AP, Krack P. Apathy in Parkinson's disease:clinical features, neural substrates, diagnosis, and treatment[J]. Lancet Neurol, 2015, 14:518-531.
[27] Kvickstr öm P, Eriksson B, van Westen D, Lä tt J, Elfgren C, Nilsson C. Selective frontal neurodegeneration of the inferior fronto-occipital fasciculus in progressive supranuclear palsy (PSP) demonstrated by diffusion tensor tractography[J]. BMC Neurol, 2011, 11:13.
[28] Stanton BR, Leigh PN, Howard RJ, Barker GJ, Brown RG. Behavioural and emotional symptoms of apathy are associated with distinct patterns of brain atrophy in neurodegenerative disorders[J]. J Neurol, 2013, 260:2481-2490.
[29] Chen H, Zhao EJ, Zhang W, Lu Y, Liu R, Huang X, Ciesielski-Jones AJ, Justice MA, Cousins DS, Peddada S. Meta-analyses on prevalence of selected Parkinson's nonmotor symptoms before and after diagnosis[J]. Transl Neurodegener, 2015, 4:1.
[30] Yatabe Y, Hashimoto M, Kaneda K, Honda K, Ogawa Y, Yuuki S, Matsuzaki S, Tuyuguchi A, Kashiwagi H, Ikeda M. Neuropsychiatric symptoms of progressive supranuclear palsy in a dementia clinic[J]. Psychogeriatrics, 2011, 11:54-59.
[31] Mukherjee A, Biswas A, Roy A, Biswas S, Gangopadhyay G, Das SK. Behavioural and psychological symptoms of dementia:correlates and impact on caregiver distress[J]. Dement Geriatr Cogn Dis Extra, 2017, 7:354-365.
[32] Brajkovic L, Kostic V, Sobic-Saranovic D, Stefanova E, Jecmenica-Lukic M, Jesic A, Stojiljkovic M, Odalovic S, Gallivanone F, Castiglioni I, Radovic B, Trajkovic G, Artiko V. The utility of FDG-PET in the differential diagnosis of parkinsonism[J]. Neurol Res, 2017, 39:675-684.
[33] Poljansky S, Ibach B, Hirschberger B, Manner P, Klunemann H, Hajak G, Marienhagen J. A visual[18F]FDG-PET rating scale for the differential diagnosis of frontotemporal lobar degeneration[J]. Eur Arch Psychiatry Clin Neurosci, 2011, 261:433-446.
[34] Vijverberg EG, Wattjes MP, Dols A, Krudop WA, Moller C, Peters A, Kerssens CJ, Gossink F, Prins ND, Stek ML, Scheltens P, van Berckel BN, Barkhof F, Pijnenburg YA. Diagnostic accuracy of MRI and additional[18F]FDG-PET for behavioral variant frontotemporal dementia in patients with late onset behavioral changes[J]. J Alzheimers Dis, 2016, 53:1287-1297.
[35] Ge JJ, Wu P, Wu JJ, Wang J, Zhang HW, Li F, Guan YH, Cui RX, Zuo CT. ¹⁸F-FDG PET imaging for characteristics of cerebral glucose metabolism in patients with progressive supranuclear palsy[J]. Zhonghua He Yi Xue Yu Fen Zi Ying Xiang Za Zhi, 2015, 35:22-26.[葛璟洁, 吴平, 邬剑军, 王坚, 张慧玮, 李方, 管一晖, 崔瑞雪, 左传涛. 进行性核上性麻痹患者脑内葡萄糖代谢特点的¹⁸F-FDG PET研究[J]. 中华核医学与分子影像杂志, 2015, 35:22-26.]
[36] Fonseca LM, Mattar GP, Haddad GG, Goncalves AS, Miguel AQC, Guilhoto LM, Zaman S, Holland AJ, de Campos Bottino CM, Hoexter MQ. Frontal-subcortical behaviors during Alzheimer's disease in individuals with Down syndrome[J]. Neurobiol Aging, 2019, 78:186-194.

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Characteristics of cognitive-neuropsychiatric behavioural features and ¹⁸F-FDG PET images in progressive supranuclear palsy and behavioral variant frontotemporal dementia

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2 进行性核上性麻痹与行为异常型额颞叶痴呆患者认知-精神行为及¹⁸F-FDG PET显像特征研究

Characteristics of cognitive-neuropsychiatric behavioural features and ¹⁸F-FDG PET images in progressive supranuclear palsy and behavioral variant frontotemporal dementia