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

doi:10.3969/j.issn.1672-6731.2020.09.010

Abstract

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

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

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.

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.

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

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

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