대한치매학회지 (Dementia and Neurocognitive Disorders)

대한치매학회 (Korean Dementia Association)
권호 표지

알츠하이머병에서 행동심리증상과 해부학적 영역의 연관성에 대한 VBM 영상분석

Relationship between Neuroanatomical Location and Behavioral and Psychological Symptoms of Alzheimer's Disease: A VBM Analysis

  • 김희진 (한양대학교 의과대학 신경과학교실) ;
  • 박진석 (한양대학교 의과대학 신경과학교실) ;
  • 권혁성 (한양대학교 의과대학 신경과학교실) ;
  • 임성환 (한양대학교 의과대학 신경과학교실) ;
  • 김승현 (한양대학교 의과대학 신경과학교실)
  • Kim, Hee-Jin (Department of Neurology, College of Medicine, Hanyang University) ;
  • Park, Jin Seok (Department of Neurology, College of Medicine, Hanyang University) ;
  • Kwon, Hyuk Sung (Department of Neurology, College of Medicine, Hanyang University) ;
  • Lim, Sung-Hwan (Department of Neurology, College of Medicine, Hanyang University) ;
  • Kim, Seung H. (Department of Neurology, College of Medicine, Hanyang University)
  • 발행 : 2011.03.31
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Even though, behavioral and psychological symptoms of dementia (BPSD) is one of the most important problems in Alzheimer's disease (AD), neuroanatomical substrates of BPSD have been much less understood than those of cognitive domains in AD. Objectives: The purposes of this study are to investigate whether BPSD of AD might be associated with atrophy in specific brain areas according to BPSD severity and compare the different patterns of the atrophic changes of brain in AD patients with severe BPSD group with mild BPSD group. Methods: Fifty three patients with or without neuropsychiatric symptoms of AD patients in mild and moderate stage were enrolled. All caregivers of the patients with AD conducted the Brief version of Neuropsychiatric Inventory Questionnaire (NPI-Q). Changes of brain according to the severities of BPSD were analyzed using Voxel Based Morphometry underlying Statistical Paramatric Mapping. Special patterns of atrophy were evaluated according to special sub-items of the NPI-Q. Results: NPI-Q total severity scores were correlated with the volume loss of bilateral frontal, temporal and left anterior cingulated gyri in AD (FDR corrected p<0.05). Atrophy of left superior temporal region had meaningful correlations with positive symptoms of BPSD, such as delusion, hallucination, agitation/aggression, euphoria and elation. Regional atrophy of right supramarginal gyri were correlated with negative symptoms of BPSD (e.g., Dysphoria/Depression) (uncorrected p<0.001). Severe BPSD group showed atrophy in bilateral temporal cortices, predominantly right side (FDR corrected p<0.05), not in white matter. Conclusions: BPSD in AD might be the results of degenerative changes in bilateral frontal and temporal corteces confined on the gray matter. White matter disruption did not significantly affect to BPSD. Changes in atrophic patterns might be different between the AD patients with positive and negative symptoms of BPSD.

키워드

참고문헌

  1. Lyketos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: Findings from the Cache county study on memory in aging. Am J Psychiatry 2000; 157: 708-14. https://doi.org/10.1176/appi.ajp.157.5.708
  2. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46: 130-5. https://doi.org/10.1212/WNL.46.1.130
  3. Rubin EH, Kinscherf DA. Psychopathology of very mild dementia of the Alzheimer type. Am J Psychiatry 1989; 146: 1017-21. https://doi.org/10.1176/ajp.146.8.1017
  4. Kim JM, Shin IS, Jeong SJ, Gormely N, Yoon JS. Predictors of institutionalization in patients with dementia in Korea. Int J Ceriatr Psychiatry 2002; 17: 101-6. https://doi.org/10.1002/gps.494
  5. Lee DY, Choo IH, Kim KW, Jhoo JH, Youn JC, Lee UY, et al. White matter changes associated with psychotic symptoms in Alzheimer's disease patients. J Neuropsychiatry Clin Neurosci 2006; 18: 191-8. https://doi.org/10.1176/appi.neuropsych.18.2.191
  6. Rosen HJ, Allison SC, Schauer GF, Gorno-Tempini ML, Weiner MW, Miller BL. Neuroanatomical correlates of behavioural disorders in dementia. Brain 2005; 128: 2612-25. https://doi.org/10.1093/brain/awh628
  7. Sultzer DL, Brown CV, Mandelkern MA, Mahler ME, Mendez MF, Chen ST, et al. Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. Am J Psychiatry 2003; 160: 341-9. https://doi.org/10.1176/appi.ajp.160.2.341
  8. Bruen PD, McGeown WJ, Shanks MF, Venneri A. Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease Brain 2008; 131: 2455-63. https://doi.org/10.1093/brain/awn151
  9. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadian EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984; 34: 939-44. https://doi.org/10.1212/WNL.34.7.939
  10. Kang Y. A normative study of the Korean-Mini Mental State Examination (K-MMSE) in the elderly. Korean J Psychol 2006; 25: 1-12.
  11. Morris JC. Clinical Dementia Rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr 1997; 9(Suppl 1): 173-6.
  12. Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000; 12: 233-9. https://doi.org/10.1176/appi.neuropsych.12.2.233
  13. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gorngein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia . Neurology 1994; 44: 2308-14. https://doi.org/10.1212/WNL.44.12.2308
  14. Choi SH. Assessment Scale for Behavioral and Psychological Symptoms of Dementia (BPSD). Dementia and Neurocognitive Disorders 2004; 3: 9-13.
  15. Choi SH, Na DL, Kwon HM, Yoon SJ, Jeong JH, Ha CK. The Korean version of the Neuropsychiatric Inventory: a scoring tool for neuropsychiatric disturbance in dementia patients. J Korean Med Sci 2000; 15: 609-15.
  16. Kang SJ, Choi SH, Lee BH, Jeong Y, Halm DS, Han IW, et al. Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI). J Geriatr Psychiatry Neurol 2004; 17: 32-5. https://doi.org/10.1177/089198873258818
  17. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46: 130-5. https://doi.org/10.1212/WNL.46.1.130
  18. Marin DB, Green CR, Schmeidler J Harvey PD, Lawlor BA, Ryan TM, et al. Noncognitive disturbances in Alzheimer's disease: frequency, longitudinal course, and relationship to cognitive symptoms. J Am Geriatr Soc 1997; 45: 1331-8. https://doi.org/10.1111/j.1532-5415.1997.tb02932.x
  19. Levy ML, Cummings JL, Fairbanks LA, Bravi D, Calvani M, Carta A. Longitudinal assessment of symptoms of depression, agitation, and psychosis in 181 patients with Alzheimer's disease. Am J Psychiatry 1996; 153: 1438-43. https://doi.org/10.1176/ajp.153.11.1438
  20. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavior changes in Alzheimer's disease. Neurology 1996; 47: 1113-24. https://doi.org/10.1212/WNL.47.5.1113
  21. Lopez OL, Becker JT, Brenner RP, Rosen J, Bajulaiye OI, Reynolds CF. Alzheimer's disease with delusions and hallucinations: Neuropsychological and electroencephalographic correlates. Neurology 1991; 41: 906-12. https://doi.org/10.1212/WNL.41.6.906
  22. Reisberg B, Borenstein J, Salob SP, Ferris SH, Franssen E, Georgotas A. Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry 1987; 48(Suppl 5): 9-15.
  23. Sultzer DL, Mahler ME, Mandelkern MA, Cummings JL, Van Gorp WG, Hinkin CH, et al. The relationship between psychiatric symptoms and regional cortical metabolism in Alzheimer's disease. J Neuropsychiatry Clin Neurosci 1995; 7: 476-84. https://doi.org/10.1176/jnp.7.4.476
  24. Mendez MF, McMurtray A, Chen AK, Shapira JS, Mishkin F, Miller BL. Functional neuroimaging and presenting psychiatric features in frontotemporal dementia. J Neurol Neurosurg Psychiatry 2006; 77: 4-7. https://doi.org/10.1136/jnnp.2005.072496
  25. Benoit M, Koulibaly PM, Migneco O, Darcourt J, Pringuey DJ, Robert PH. Brain perfusion in Alzheimer's disease with and without apathy: a SPECT study with statistical parametric mapping analysis. Psychiatry Res 2002; 114: 103-11. https://doi.org/10.1016/S0925-4927(02)00003-3
  26. McMurtray AM, Chen AK, Shapira JS, Chow TW, Mishkin F, Miller BL, et al. Variations in regional SPECT hypoperfusion and clinical features in frontotemporal dementia. Neurology 2006; 66: 517-22. https://doi.org/10.1212/01.wnl.0000197983.39436.e7
  27. Rolland Y, Payoux P, Lauwers-Cances V, Voisin T, Esquerre JP, Vellas B. A SPECT study of wandering behavior in Alzheimer's disease. Int J Geriatr Psychiatry 2005; 20: 816-20. https://doi.org/10.1002/gps.1362