J Kanazawa Med Univ , 2017 要約 :( ) ( ) magnetic resonance imaging (MRI) Hasegawa s dementia scale-revised (HDS-R) 11 7 (WAIS-III) MRI

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1 J Kanazawa Med Univ , 2017 要約 :( ) ( ) magnetic resonance imaging (MRI) Hasegawa s dementia scale-revised (HDS-R) 11 7 (WAIS-III) MRI voxel-based specific regional analysis system for Alzheimer s disease (VSRAD) Z WAIS-III HDS-R Open Essence (OE) ( ) Z HDS-R Z HDS-R Z WAIS-III ( ) HDS-R HDS-R キーワード : voxel-based specific regional analysis system for Alzheimer s disease (VSRAD) Hasegawa s dementia scale-revised (HDS-R) 緒言 (1) ( 2) Alzheimer s disease (AD) magnetic resonance imaging (MRI) ( ) Z voxel-based specific regional analysis system for Alzheimer s disease (VSRAD) (3) AD (4-6) Z Z (7, 8) AD (9-12) (13) (14) AD (14) (15-17) VSRAD Z 17

2 方法 1. 対象 ( ) 9 ( 3 6 ) AD 20 Vascular dementia (VaD) 3 dementia with Lewy bodies (DLB) 1 International Statistical Classification of Diseases (ICD- 10) AD National Institute of Neurological and Alzheimer s Disease and Related Disorders Association (NINCDS-ADRDA)(18) Probable AD dementia with Lewy bodies (DLB) DLB (19) SPECT AD (20) DLB (21) AD 8 DLB ICD-10 B 12 MRI 7 ( 4 3 ) 2.MRI MRI MRI 1.5 Siemens Magnetom Avant VSRAD (TE) 4 flip angle (FA) 15 field of view (FOV) 230 mm 230 mm Matrix mm 3 T1 (TE=4.0 mm, FA=15, field of View =256 mm) MRI VSRAD advance ( ) Z VSRAD advance 4 (22) 1) MRI Statistical Parametric Mapping (SPM8) 2 mm 3 ( 3 ) 2) 3) 4) Z Z (23) Z 2 2 5% (24) 3. 認知機能評価 HDS-R ( ) (25) 0 30 cut off 20/ (25) (WAIS-III) (IQ) Full Intelligence Quotient (FIQ) Verbal Intelligence Quotient (VIQ) Performance Intelligence Quotient (PIQ) (26) 4. 嗅覚検査 AD (27) Parkinson 4 (28) (14) Odor Stick Identification Test for Japanese (OSIT-J)(15) OSIT-J ; Open Essence (OE) (17) 12 OE 18

3 4 5. 統計処理 Z HDS-R WAIS-III U 3 3 Kruskal Wallis Z HDS-R WAIS-III VSRAD Z WAIS-III HDS-R p<0.05 検査時年齢 ( 歳 ) 発症時年齢 ( 歳 ) 罹患歴 ( 年 ) 教育年数 ( 年 ) HDS-R 得点 Z-score WAIS-III (FIQ) ドネペジル内服ガランタミン内服表 1. 認知症 (n=24) 74.2± ± ± ± ± ± ±16.8 (5/24) (3/24) 精神疾患 (n=9) 75.5± ± ± ± ± ± ±12.8 HDS-R: Revised Hasegawa Dementia Scale, WAIS-Ⅲ: Wechsler Adult Intelligence Scale, FIQ: Full Intelligence Quotient WAIS-Ⅲ は認知症群 11 名, 精神疾患群 7 名に施行した 2 13 WAIS-III WAIS-III 7 11 結果 1. 認知症群と精神疾患群の背景および比較 1 HDS-R cut off 20/21 (25) AD HDS-R NINCDS-ADRDA Probable AD AD (18) Z <2 Z >2 3 HDS-R WAIS-III Z >2 Z (p<0.001) HDS-R (p=0.002) (p=0.003) ( 2) Z <2 2. 認知症群におけるZスコア <2とZスコア >2の比較 HDS-R WAIS-III Z <2 Z >2 HDS-R (p=0.004) (p=0.002) 3. 認知症群におけるZスコアと認知機能検査, 嗅覚障害との相関 HDS-R (p=0.001) ( p=0.001 p=0.033 p=0.004 p=0.020 p<0.001) (p=0.006) Z IQ IQ IQ 表 2. Z >2 Z <2 Z>2 群 (n=11, Mean±SD) Z<2 群 (n=13, Mean±SD) 精神疾患群 (n=9, Mean±SD) p value 性別検査時年齢 ( 歳 ) 発症時年齢 ( 歳 ) 罹患歴 ( 年 ) 教育年数 ( 年 ) WAIS-III (FIQ) HDS-R 得点 ( 点 ) Z score 嗅覚男性 5 名女性 6 名 76.0± ± ± ± ± ±5.5 ab 3.2± ±1.8 ab 男性 7 名女性 6 名 72.6± ± ± ± ± ± ± ±2.1 男性 3 名女性 6 名 75.5± ± ± ± ± ± ± ± ** ** ** a: Z<2 群と Z>2 群の比較で p<0.01 b: Z>2 群と精神疾患群の比較で p<0.01 * *:p<

4 年齢性別 HDS-R WAIS-III 嗅覚表 3. Z 相関係数 p value * :p<0.05, ** :p<0.01 総得点見当識言葉の記銘計算逆唱遅延再生物品再生言語流暢性 FIQ VIQ PIQ 総得点 ** ** * ** * ** ** 図 1. Z HDS-R ( 3) Z HDS-R 1 4. 内側側頭部構造の萎縮とHDS-R, 嗅覚検査との関連性 Z HDS-R (F=10.24 R 2 =0.494) HDS-R ( = p=0.006) ( = p=0.017) Z Z HDS-R 5. 結果のまとめ Z >2 HDS-R Z <2 Z HDS-R Z HDS-R Z Z WAIS-III 考察 1. 認知症群 (Zスコア <2,Z スコア >2) と精神疾患群との比較 Z >2 HDS-R Z <2 Z <2 Z <2 (29, 30) Z<2 HDS-R Z >2 Z <2 HDS-R AD (31) 2. 内側側頭部構造の萎縮と認知機能低下について Z HDS-R (32-35) (36) (37) HDS-R Z WAIS-III (38) WAIS-III 20

5 (33) Z WAIS-III 3. 内側側頭部構造の萎縮と嗅覚障害 VSRAD Z Z (39) (13) (40) (41) Z Z HDS-R HDS-R Z HDS-R Z (32) HDS-R 4. 嗅覚検査と認知機能検査について HDS-R WAIS-III MMSE (42) (WMS-R) (43) HDS-R Sanke (42) MMSE MMSE (HDS-R) (OE) Schiffman (43) WMS-R I 50 HDS-R WMS-R HDS-R 5. 本研究における制約について結 VSRAD Z HDS-R 語利益相反の開示文 1. Devanand DP, Sano M, Tang MX et al: Depressed mood and the incidence of Alzheimer s disease in the elderly living in the community. Arch Gen Psychiatry 1996; 53: Chen P, Ganguli M, Mulsant BH et al: The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry 1999; 56: ,, VSRAD. 2008; 40: ,, VSRAD. 2007; 16: ; 49: Alzheimer. 2012; 8: 献 21

6 7.,, VSRAD Z. 2013; 24: ,, MCI VSRAD. 2012; 23: Alzheimer ( ) ; Ross GW, Petrovitch H, Abbott RD et al: Association of olfactory dysfunction with risk for future Parkinson s disease. Ann Neurol 2008; 63: Djordjevic J, Jones-Gotman M, De Sousa K et al: Olfaction in patients with mild cognitive impairment and Alzheimer s disease. Neurobiol Aging 2008; 29: ; 72: Olofsson JK, Josefsson M, Ekström I et al: Long-term episodic memory decline is associated with olfactory deficits only in carriers of ApoE- 4. Neuropsychologia 2016; 85: ; 253: ,,. 1998; 5: ; 54: ,, Open Essence. 2010; 113: Mckhann G, Drachman D, Folstein M et al: 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: Mckeith IG, Dickson DW, Lowe J et al: Diagnosis and management of dementia with Lewy bodies:third report of the DLB Consortium. Neurology 2005; 65: Minoshima S, Giordani B, Berent S et al: Metabolic reduction in the posterior cingulate cortex in very early Alzheimer s disease. Ann Neurol 1997; 42: ,, MIBG SPECT. 2008; 110: MRI-VBM. Pharma Medica 2014; 32: ,, VSRAD. 2008; 67: ,, ; D ,, (HDS-R). 1991; 2: Wechsler D: Wechsler Adult Intelligence Scale (3rd ed), San Antonio, TX, The Psychological Corporation, ; 14: ,. 2015; 104: Khil L, Rahe C, Wellmann J et al: Association between major depressive disorder and odor identification impairment. J Affect Disord 2016; 203: Croy I, Hummel T: Olfaction as a marker for depression. J Neurol Jul 8. [Epub ahead of print] DOI: /s ,, VSRAD MRI. 2011; 17: Tagawa R, Hashimoto H, Nakanishi A et al: The Relationship between medial temporal lobe atrophy and cognitive impairment in patients with dementia with lewy bodies. J Geriatr Psychiatry Neurol 2015; 28: Li X, Jiao J, Shimizu S et al: Correlations between atrophy of the entorhinal cortex and cognitive function in patients with Alzheimer s disease and mild cognitive impairment. Psychiatry Clin Neurosci 2012; 66: Okada K, Umegae N, Yamaguchi T et al: The effects of donepezil on hippocampal atrophy assessed by new MRI software in Alzheimer s disease. The 6 th Meeting of International College of Geriatric Psychoneuropharmacology: ,, VSRAD. 2006; 17 Suppl-I: Squire LR, Zola SM: Structure and function of declarative and nondeclarative memory systems. Proc Natl Acad Sci U S A 1996; 93: Rodrique KM, Raz N: Shrinkage of the entorhinal cortex over five years predicts memory performance in healthy adults. J Neurosci 2004; 24: Tulving E, Markowitsch HJ: Episodic and declarative memory:role of the hippocampus. Hippocampus 1998; 8: ; 26: Smutzer G, Doty RL, Arnold SE et al: Olfactory system neuropathology in Alzhemer s disease, Parkinson s disease, and schizophrenia. In Doty RL (Ed), Handbook of Olfanction and Gustation (2nd ed), New York, Marcel Dekker, 2003; Reyes PF, Deems DA, Suarez MG: Olfactory-related changes in Alzheimer s disease: a quantitative neuropathologic study. Brain Res Bull 1993; 32: Sanke H, Mita T, Yoshii H et al: Relationship between olfactory dysfunction and cognitive impairment in elderly patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2014; 106: Schiffman SS, Graham BG, Sattely-Miller EA et al: Taste, smell and neuropsychological performance of individuals at familial risk for Alzheimer s disease. Neurobiol Aging 2002; 23:

7 Relationship between the Volume of the Medial Temporal Lobe and both the Cognitive and Olfactory Functions in Patients with Dementia Kazuaki Oshima Department of Neuropsychiatry, Kanazawa Medical University Graduate School of Medical Science, Uchinada, Ishikawa , Japan Objective: Olfactory dysfunction is attracting increased attention as an accompanying symptom in dementia patients, but there have so far been few studies describing the association between medial temporal lobe atrophy and olfactory impairment. Methods: The subjects of this study comprised 24 patients with dementia and 9 patients with mental disease. All patients were scanned with a 1.5 Tesla MRI scanner, and were evaluated with Hasegawa s dementia scale Revised (HDS-R) and the olfaction test. Eleven patients with dementia and 7 with mental disease were evaluated with the Wechsler adult Intelligence scale-third test (WAIS-III). All MRI data were analyzed using the voxel-based specific regional analysis system for Alzheimer s disease (VSRAD) advance. The target volume of interest included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of medial temporal lobe atrophy was obtained based on the positive Z-score on the target volume of interest, with higher scores indicating more severe medial temporal lobe atrophy. WAIS- III and HDS-R were used to assess the presence of cognitive impairment. We used the Open Essence (OE) test to evaluate olfaction. Results: In the dementia group, there was a significant correlation between Z-scores and the results of the olfaction test as well as the HDS-R test. No correlation was found in the mental disease group. There was no correlation between Z-scores and any items on WAIS-III in either group. Conclusion: The results of our study demonstrated that the olfaction test as well as the HDS-R test can be used to predict medial temporal lobe atrophy. Key Words: dementia, medial temporal lobe, olfactory impairment, voxel-based specific regional analysis system for Alzheimer s disease (VSRAD), Hasegawa s dementia scale-revised (HDS-R) 23

Diagnosis of Dementia: Update

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