Alzheimer病患者情感淡漠的神经心理学及~1H-MRS研究

发布时间：2018-04-25 15:31

本文选题：阿尔茨海默病 + 淡漠　；参考：《第二军医大学》2013年硕士论文

【摘要】：【背景】阿尔茨海默病（Alzheimer’s disease，AD）通常被认为是一个主要表现为记忆力减退的认知方面异常疾病，然而，非认知行为症状也是此疾病的一个重要组成部分，淡漠是最为常见的行为症状之一。但是尽管淡漠症状的高发生率以及带来严重的家庭及社会负担，人们对AD淡漠症状的研究还甚少。2009年，包括法国精神生物协会、欧洲精神协会、欧洲阿尔茨海默病协会等组织共同制订淡漠综合征的诊断标准（Diagnostic Criteria of Apathy，DCA）。这是世界范围内较为公认的诊断标准，为不同国家的淡漠研究提供了很好的依据。然而，国内学术界对于淡漠的严重性的重视仍然不足，对于淡漠的发生机制、诊断、评定鲜有报道。【目的】本研究主要探讨阿尔茨海默病患者中情感淡漠的神经心理学和影像学表现以及其可能的发生机制。第一部分，旨在通过神经心理学检测发AD患者情感淡漠的潜在的支配因素，以及探讨这些潜在因子与其他临床症状的相关性，为淡漠的病因学提供线索。第二部分，探讨1H-MRS对于淡漠的诊断价值及所示代谢物比值与认知损害的相关性。【方法】第一部分，采用横截面观察研究，所观察对象为2011年6月—2012年12月在上海长征医院神经内科门诊就诊的符合NINCDS-ADRDA标准的AD患者88例。（1）52例淡漠AD患者与36例非淡漠AD患者分别接受人口学及神经心理学检测并进行两独立样本t检验对比。（2）用Pearson相关系数衡量淡漠与人口学及神经心理学得分的相关性。（3）对AES-C量表进行主成分因子分析。（4）多重线性回归模型调查AES—C量表派生的因子与认知及NPI各子量表的关系。统计学处理：以上数据分析均采用SPSS16.0软件进行统计处理。第二部分，11个AD淡漠患者与9个非淡漠患者分布接受神经心理学及1H-MRS检查，比较不同脑区氢质子磁共振波谱(1H—MRS)NAA/Cr与Cho/Cr的表现差异，并分析代谢值与其他认知功能的相关性。【结果】第一部分显示，淡漠与非淡漠组AD患者在性别、年龄、发病年龄、病程、教育程度方面并无统计学差异（P0.05），但淡漠组整体认知水平低于非淡漠组（P0.01）；淡漠的严重程度与认知功能，尤其是额叶执行功能呈负相关（(r=—0.61，P0.01);与照顾者负担正相关(r=0.66，P0.01)）。AES—C量表派生出2个因子：认知——行为因子与社交淡漠因子，，其中前者主要与认知和睡眠相关（R~2=0.50），后者与抑郁与睡眠相关（R~2=0.24）。第二部分显示，淡漠组左额叶区NAA/CR值（1.32±0.06）较非淡漠组（1.39±0.08）显著下降（P0.05）， NAA/CR下降程度不仅与淡漠严重程度相关而且与额叶执行功能相关（r=0.65，p 0.05）【结论】1、淡漠与整体认知尤其是执行功能关系密切，且会给照顾者带来巨大负担。2、AD患者的淡漠症状可以解离为2个维度因子，而这些因子与不同的临床症状相关，这些相关性可能对淡漠症状的病因学提供重要线索。3、情感淡漠以及其严重程度与脑部代谢相关，尤其与左侧前额叶部位NAA/CR的代谢相关。同时此脑区物质代谢的异常可能与执行功能的下降也有相关性。这个结果也再次肯定了前额叶系统参与了与AD患者淡漠相关的神经环路
[Abstract]:[background] Alzheimer 's disease (AD) is usually considered as an abnormal cognitive disorder characterized by memory impairment. However, non cognitive behavioral symptoms are also an important part of the disease. Indifference is one of the most common behavioural symptoms. However, the high incidence of indifferent symptoms, as well as the high incidence of indifference, is also considered to be an important part of the disease. There is a serious family and social burden, and there is little research on the symptoms of AD indifference to.2009 years, including the French psychiatric association, the European Psychiatric Association, the European Alzheimer's disease association and other organizations (Diagnostic Criteria of Apathy, DCA). This is the most recognized diagnostic mark in the world. It provides a good basis for the indifference research of different countries. However, the attention of the domestic academia on the indifference is still insufficient, and there are few reports on the indifference mechanism, diagnosis and evaluation.
[Objective] to investigate the neuropsychological and imaging manifestations of affective indifference in Alzheimer's disease and its possible mechanism. The first part is to detect the potential dominant factors in AD patients' emotional indifference by neuropsychological examination, and to explore the correlation between these potential factors and other clinical symptoms. The second part discusses the diagnostic value of 1H-MRS for indifference and the correlation between the metabolite ratio and cognitive impairment.
[method] section 1, cross section observation was used to observe 88 cases of AD patients in the Department of Neurology of Shanghai Changzheng Hospital from June 2011 to December 2012. (1) 52 cases of indifferent AD patients and 36 non indifferent AD patients received demographic and neuropsychological tests and two independent samples. The contrast of this t test. (2) the correlation between the indifference and demography and neuropsychological scores was measured with the Pearson correlation coefficient. (3) the AES-C scale was analyzed by the principal component factor. (4) multiple linear regression model was used to investigate the factors derived from the AES C scale and the relationship between the cognitive and NPI subscales. Statistical processing: the above data analysis used SPSS16.0 Software is used for statistical processing.
The second part, 11 AD indifferent patients and 9 non indifferent patients received neuropsychology and 1H-MRS examination, compared the differences in the performance of 1H - MRS (1H - MRS) and Cho/Cr in different brain regions, and analyzed the correlation between the metabolic values and other cognitive functions.
[results] the first part showed that there was no statistical difference in sex, age, age, course of disease and education in AD patients in the indifferent and non indifferent groups (P0.05), but the overall cognitive level in the indifferent group was lower than that in the non indifferent group (P0.01); the severity of the indifference was negatively correlated with the cognitive ability, especially in the frontal executive function (r= - 0.61, P0.01). A positive correlation with the caregiver burden (r=0.66, P0.01)) the.AES - C scale derives 2 factors: cognitive - behavioral factors and social indifference factors, the former is mainly related to cognition and sleep (R~2=0.50), and the latter is associated with depression and sleep (R~2=0.24).
The second part showed that the NAA/CR value of the left frontal lobe in the indifferent group (1.32 + 0.06) was significantly lower than that in the non indifferent group (1.39 + 0.08) (P0.05). The degree of NAA/CR decline was not only related to the severity of the indifference, but also related to the executive function of the frontal lobe (r=0.65, P 0.05).
[Conclusion] 1, indifference is closely related to overall cognition, especially executive function, and will bring great burden to caregivers.2. The indifferent symptoms of AD patients can be dissociated into 2 dimensional factors, and these factors are associated with different clinical symptoms. These correlations may provide important clues to the etiology of indifferent symptoms,.3, indifference, and its indifference. The severity of the brain metabolism is associated with the metabolism of the NAA/CR in the left prefrontal lobe, and the abnormality of material metabolism in this brain region may be associated with a decline in executive function. This result also reaffirms the involvement of the prefrontal system in the deity loop related to the indifference of AD patients.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.16

【相似文献】