대한치매학회지 (Dementia and Neurocognitive Disorders)

대한치매학회 (Korean Dementia Association)
권호 표지
DOI QR코드

DOI QR Code

Brain Perfusion Correlates of Apathy in Alzheimer's Disease

  • Jeong, Hyeonseok (Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Kang, Ilhyang (Ewha Brain Institute, Ewha Womans University) ;
  • Im, Jooyeon J. (Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Park, Jong-Sik (Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Na, Seung-Hee (Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Heo, Youngje (Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Yang, YoungSoon (Department of Neurology, Veterans Hospital, Seoul Medical Center) ;
  • Chung, Yong-An (Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Song, In-Uk (Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea)
  • 투고 : 2018.06.21
  • 심사 : 2018.06.29
  • 발행 : 2018.06.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Purpose: Apathy is one of the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). It may have adverse impacts on the progression of AD. However, its neurobiological underpinnings remain unclear. The objective of this study was to investigate differences in regional cerebral blood flow (rCBF) between AD patients with apathy and those without apathy. Methods: Sixty-six apathetic AD patients and 66 AD patients without apathy completed Neuropsychiatric Inventory (NPI) and underwent technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) scans. Voxel-wise differences in rCBF between the 2 groups were examined. Association between rCBF and levels of apathy in the apathetic group was also assessed. Results: AD patients with apathy showed lower rCBF in the bilateral orbitofrontal cortex, left putamen, left nucleus accumbens, left thalamus, and bilateral insula than those without (all p<0.005). Mean perfusion across all significant clusters showed a negative linear correlation with NPI apathy score in AD patients with apathy (${\beta}=-0.25$; p=0.04). Conclusions: Hypoperfusion in the prefrontal, striatal, and insular areas may be neural correlates of apathy in AD patients.

키워드

과제정보

연구 과제 주관 기관 : National Research Foundation of Korea (NRF)

참고문헌

  1. Lyketsos CG, Carrillo MC, Ryan JM, Khachaturian AS, Trzepacz P, Amatniek J, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimers Dement 2011;7:532-539. https://doi.org/10.1016/j.jalz.2011.05.2410
  2. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46:130-135. https://doi.org/10.1212/WNL.46.1.130
  3. Shin IS, Carter M, Masterman D, Fairbanks L, Cummings JL. Neuropsychiatric symptoms and quality of life in Alzheimer disease. Am J Geriatr Psychiatry 2005;13:469-474. https://doi.org/10.1097/00019442-200506000-00005
  4. Starkstein SE, Petracca G, Chemerinski E, Kremer J. Syndromic validity of apathy in Alzheimer's disease. Am J Psychiatry 2001;158:872-877. https://doi.org/10.1176/appi.ajp.158.6.872
  5. Landes AM, Sperry SD, Strauss ME, Geldmacher DS. Apathy in Alzheimer's disease. J Am Geriatr Soc 2001;49:1700-1707. https://doi.org/10.1046/j.1532-5415.2001.49282.x
  6. Brodaty H, Burns K. Nonpharmacological management of apathy in dementia: a systematic review. Am J Geriatr Psychiatry 2012;20:549-564. https://doi.org/10.1097/JGP.0b013e31822be242
  7. Theleritis C, Politis A, Siarkos K, Lyketsos CG. A review of neuroimaging findings of apathy in Alzheimer's disease. Int Psychogeriatr 2014;26:195-207. https://doi.org/10.1017/S1041610213001725
  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Forth edition. Washington, DC: American Psychiatric Association, 1994.
  9. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan 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;34:939-944. https://doi.org/10.1212/WNL.34.7.939
  10. 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;15:609-615. https://doi.org/10.3346/jkms.2000.15.6.609
  11. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 1997;15:300-308.
  12. Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165. https://doi.org/10.1212/WNL.39.9.1159
  13. Chang LT. A method for attenuation correction in radionuclide computed tomography. IEEE Trans Nucl Sci 1978;25:638-643. https://doi.org/10.1109/TNS.1978.4329385
  14. Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N, et al. Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 2002;15:273-289. https://doi.org/10.1006/nimg.2001.0978
  15. Pickut BA, Dierckx RA, Dobbeleir A, Audenaert K, Van Laere K, Vervaet A, et al. Validation of the cerebellum as a reference region for SPECT quantification in patients suffering from dementia of the Alzheimer type. Psychiatry Res 1999;90:103-112. https://doi.org/10.1016/S0925-4927(99)00004-9
  16. Soonawala D, Amin T, Ebmeier KP, Steele JD, Dougall NJ, Best J, et al. Statistical parametric mapping of (99m)Tc-HMPAO-SPECT images for the diagnosis of Alzheimer's disease: normalizing to cerebellar tracer uptake. Neuroimage 2002;17:1193-1202. https://doi.org/10.1006/nimg.2002.1259
  17. Wallis JD. Orbitofrontal cortex and its contribution to decision-making. Annu Rev Neurosci 2007;30:31-56. https://doi.org/10.1146/annurev.neuro.30.051606.094334
  18. Lopez OL, Zivkovic S, Smith G, Becker JT, Meltzer CC, DeKosky ST. Psychiatric symptoms associated with cortical-subcortical dysfunction in Alzheimer's disease. J Neuropsychiatry Clin Neurosci 2001;13:56-60. https://doi.org/10.1176/jnp.13.1.56
  19. Marshall GA, Monserratt L, Harwood D, Mandelkern M, Cummings JL, Sultzer DL. Positron emission tomography metabolic correlates of apathy in Alzheimer disease. Arch Neurol 2007;64:1015-1020. https://doi.org/10.1001/archneur.64.7.1015
  20. Bruen PD, McGeown WJ, Shanks MF, Venneri A. Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease. Brain 2008;131:2455-2463. https://doi.org/10.1093/brain/awn151
  21. Carriere N, Besson P, Dujardin K, Duhamel A, Defebvre L, Delmaire C, et al. Apathy in Parkinson's disease is associated with nucleus accumbens atrophy: a magnetic resonance imaging shape analysis. Mov Disord 2014;29:897-903. https://doi.org/10.1002/mds.25904
  22. Levy R, Dubois B. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 2006;16:916-928. https://doi.org/10.1093/cercor/bhj043
  23. David R, Koulibaly M, Benoit M, Garcia R, Caci H, Darcourt J, et al. Striatal dopamine transporter levels correlate with apathy in neurodegenerative diseases A SPECT study with partial volume effect correction. Clin Neurol Neurosurg 2008;110:19-24. https://doi.org/10.1016/j.clineuro.2007.08.007
  24. Bhatia KP, Marsden CD. The behavioural and motor consequences of focal lesions of the basal ganglia in man. Brain 1994;117:859-876. https://doi.org/10.1093/brain/117.4.859
  25. Bonelli RM, Cummings JL. Frontal-subcortical circuitry and behavior. Dialogues Clin Neurosci 2007;9:141-151.
  26. 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 Neurol 2013;260:2481-2490. https://doi.org/10.1007/s00415-013-6989-9
  27. Reijnders JS, Scholtissen B, Weber WE, Aalten P, Verhey FR, Leentjens AF. Neuroanatomical correlates of apathy in Parkinson's disease: a magnetic resonance imaging study using voxel-based morphometry. Mov Disord 2010;25:2318-2325. https://doi.org/10.1002/mds.23268
  28. Robert G, Le Jeune F, Lozachmeur C, Drapier S, Dondaine T, Peron J, et al. Apathy in patients with Parkinson disease without dementia or depression: a PET study. Neurology 2012;79:1155-1160. https://doi.org/10.1212/WNL.0b013e3182698c75
  29. Jenkins IH, Jahanshahi M, Jueptner M, Passingham RE, Brooks DJ. Self-initiated versus externally triggered movements. II. The effect of movement predictability on regional cerebral blood flow. Brain 2000;123:1216-1228. https://doi.org/10.1093/brain/123.6.1216
  30. Menon V, Uddin LQ. Saliency, switching, attention and control: a network model of insula function. Brain Struct Funct 2010;214:655-667. https://doi.org/10.1007/s00429-010-0262-0
  31. Aalten P, van Valen E, Clare L, Kenny G, Verhey F. Awareness in dementia: a review of clinical correlates. Aging Ment Health 2005;9:414-422. https://doi.org/10.1080/13607860500143075

피인용 문헌

  1. The Neuropsychiatric Inventory: Development and Applications vol.33, pp.2, 2018, https://doi.org/10.1177/0891988719882102