目的:探讨四种类型轻度痴呆患者双侧海马亚场体积的差异,即典型的阿尔茨海默病(TAD),路易体痴呆(DLB),语义痴呆(SD),和后皮质萎缩(PCA),协助鉴别诊断。
方法:一百三名参与者,包括22TAD,34SD(左17SD和右17SD),15DLB,12名PCA患者,和20个正常控制(NC),被招募。所有受试者均接受标准神经心理学评估和磁共振成像(MRI)。海马子场通过Freesurfer自动分割。该研究比较了体积差异,并使用了受试者工作特征(ROC)曲线来估计每个海马子场的功效,以区分各组。采用Spearman相关分析探讨记忆回忆评分与海马亚场体积的关系。
结果:海马亚场萎缩在不同组不同:tAD,SD,与NC相比,PCA患者双侧海马有次区域萎缩,DLB患者表现出保留的体积;左侧SD患者的左侧海马萎缩最严重,右侧SD患者大多在右侧海马区萎缩。TAD和PCA受试者的海马亚区体积无显著差异,但前者往往萎缩得更不对称。ROC分析表明,歧视,某些子场的曲线下面积(AUC)大于总海马,但没有观察到显著差异。此外,即时回忆得分与左CA1、CA2/3、CA4/DG相关,下膜,和前下丘(p<0.05),延迟回忆得分与双侧CA2/3、CA4/DG、下膜,和前下丘(r=0.38-0.52,p<0.05)。
结论:双侧海马亚区体积的不同萎缩模式可用于不同原因的轻度痴呆患者的鉴别诊断:左CA1用于tAD;左下丘用于LSD;右CA4/DG,右前下颌,右下丘为RSD;CA4/DG和右CA2/3为DLB;右CA2/3和右CA4/DG为PCA。此外,几个海马子场体积与记忆评分显着相关,进一步强调了海马在记忆力衰退中的重要作用。
OBJECTIVE: To investigate the bilateral hippocampal subfield volumetric differences in four types of mild dementia, namely typical Alzheimer\'s disease (tAD), dementia with Lewy bodies (DLB), semantic dementia (SD), and posterior cortical atrophy (PCA), to assist differential diagnosis.
METHODS: One hundred three participants, including 22 tAD, 34 SD (17 left SD and 17 right SD), 15 DLB, 12 PCA patients, and 20 normal controls (NC), were recruited. All subjects received standard neuropsychological assessments and magnetic resonance imaging (MRI). The hippocampal subfields were automatically segmented via Freesurfer. The study compared the volumetric differences and used the receiver operating characteristic (ROC) curves to estimate the efficacy of each hippocampal subfield to distinguish between groups. Spearman correlation analysis was used to investigate the relationship between memory recall scores and hippocampal subfield volumes.
RESULTS: The hippocampal subfield atrophy varied in different groups: tAD, SD, and PCA patients had subregional atrophy in bilateral hippocampi compared to NC, and DLB patients showed preserved volumes; left SD patients suffered the most severe atrophy of the left hippocampus, and right SD patients were atrophied mostly in the right hippocampus. There was no significant difference in the volume of hippocampal subregions between tAD and PCA subjects, but the former tended to be atrophied more asymmetrically. ROC analysis showed that, for discrimination, the areas under the curve (AUC) of some subfields were larger than the total hippocampus, but none observed significant difference. In addition, immediate recall scores were correlated to left CA1, CA2/3, CA4/DG, subiculum, and presubiculum (p < 0.05), and delayed recall scores were strongly related to bilateral CA2/3, CA4/DG, subiculum, and presubiculum (r = 0.38-0.52, p < 0.05).
CONCLUSIONS: Differential atrophy patterns in the bilateral hippocampal subfield volumes could serve the differential diagnosis in patients with different causes of mild dementia: left CA1 for tAD; left presubiculum for LSD; right CA4/DG, right presubiculum, and right subiculum for RSD; CA4/DG and right CA2/3 for DLB; right CA2/3 and right CA4/DG for PCA. Additionally, several hippocampal subfield volumes were significantly associated with memory scores, further highlighting the essential role of the hippocampus in memory decline.