軽度認知障害からアルツハイマー病への進行予測
目的：MRIやSPECT画像データの解析とともに病識を評価することによって，健忘型軽度認知障害（MCI）からアルツハイマー病（AD）への移行が予測できるか否かを検討した．方法：健忘型MCIを約2年半から3年間追跡し，観察期間内に認知障害が進行しADと診断されたMCI/AD群21例と進行がみられなかったかあるいは多少の進行はみられても自立できADの診断には至らなかったMCI/MCI群18例を対象とし，早期AD19例と比較した．MRIはvoxel-based specific regional analysis system for Alzheimer's disease（VSRAD）を...
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| Published in | 日本老年医学会雑誌 Vol. 47; no. 2; pp. 147 - 152 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.47.147 |
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| Abstract | 目的：MRIやSPECT画像データの解析とともに病識を評価することによって，健忘型軽度認知障害（MCI）からアルツハイマー病（AD）への移行が予測できるか否かを検討した．方法：健忘型MCIを約2年半から3年間追跡し，観察期間内に認知障害が進行しADと診断されたMCI/AD群21例と進行がみられなかったかあるいは多少の進行はみられても自立できADの診断には至らなかったMCI/MCI群18例を対象とし，早期AD19例と比較した．MRIはvoxel-based specific regional analysis system for Alzheimer's disease（VSRAD）を用いて解析し海馬傍回の萎縮（z-score）を求め，SPECTは3D-stereotactic surface projectionのz-score像から大脳後方連合野の血流低下を定性的に評価し，病識は生活健忘チェックリストの（介護者-患者）間のスコア差から評価し，それぞれ観察開始時の成績を比較した．結果：MCI/MCI群と比べて，MCI/AD群はMRIによる海馬のz-scoreが高値となり，SPECTによる大脳後方連合野の血流低下が高頻度にみられ，病識は低下していた．さらに早期AD群ではこれらの検査異常はより高度または高率にみられた．各検査成績を一項目または二項目組み合わせてもMCI/AD群とMCI/MCI群の識別率はせいぜい60％～70％台であったが，MRI，SPECT，病識の各成績をすべて組み合わせると80％以上の識別率が得られた．結論：MRIやSPECTの画像所見に病識の評価を加えることによって，MCIからADへの移行をより正確に予測できると考えられた． |
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| AbstractList | 目的：MRIやSPECT画像データの解析とともに病識を評価することによって，健忘型軽度認知障害（MCI）からアルツハイマー病（AD）への移行が予測できるか否かを検討した．方法：健忘型MCIを約2年半から3年間追跡し，観察期間内に認知障害が進行しADと診断されたMCI/AD群21例と進行がみられなかったかあるいは多少の進行はみられても自立できADの診断には至らなかったMCI/MCI群18例を対象とし，早期AD19例と比較した．MRIはvoxel-based specific regional analysis system for Alzheimer's disease（VSRAD）を用いて解析し海馬傍回の萎縮（z-score）を求め，SPECTは3D-stereotactic surface projectionのz-score像から大脳後方連合野の血流低下を定性的に評価し，病識は生活健忘チェックリストの（介護者-患者）間のスコア差から評価し，それぞれ観察開始時の成績を比較した．結果：MCI/MCI群と比べて，MCI/AD群はMRIによる海馬のz-scoreが高値となり，SPECTによる大脳後方連合野の血流低下が高頻度にみられ，病識は低下していた．さらに早期AD群ではこれらの検査異常はより高度または高率にみられた．各検査成績を一項目または二項目組み合わせてもMCI/AD群とMCI/MCI群の識別率はせいぜい60％～70％台であったが，MRI，SPECT，病識の各成績をすべて組み合わせると80％以上の識別率が得られた．結論：MRIやSPECTの画像所見に病識の評価を加えることによって，MCIからADへの移行をより正確に予測できると考えられた． |
| Author | 羽生, 春夫 櫻井, 博文 久米, 一誠 金高, 秀和 清水, 聡一郎 岩本, 俊彦 佐藤, 友彦 平尾, 健太郎 |
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| References_xml | – reference: 12) 数井裕光, 綿森淑子, 本多留美, 森 悦朗: 日本版日常記憶チェックリストの有用性の検討. 脳神経 2003; 55: 317-325. – reference: 22) Maruyama M, Matsui T, Tanji H, Nemoto M, Tomita N, Ootsuki M, et al.: Cerebrospinal fluid tau protein and periventricular white matter lesions in patients with mild cognitive impairment. Implications for 2 major pathways. Arch Neurol 2004; 61: 716-720. – reference: 18) Chetelat G, Desgranges B, De La Sayette V, Viader F, Eustache F, Baron J-C: Mild cognitive impairment: can FDG-PET predict who is to rapidly convert to Alzheimer's disease? Neurology 2003; 60: 1374-1377. – reference: 23) Hanyu H, Sato T, Takasaki A, Akai T, Iwamoto T: Frontal lobe dysfunctions in subjects with mild cognitive impairment. J Neurol 2009 May 9 [Epub ahead of print]. – reference: 21) Drzezga A, Grimmer T, Riemenschneider M, Lautenshlager N, Siebner H, Alexopoulus P, et al.: Prediction of individual clinical outcome in MCI by means of genetic assessment and 18F-FDG PET. J Nucl Med 2005; 46: 1625-1632. – reference: 14) Jack CR, Petersen RC, Xu YC, O'Brien PC, Smith GE, Ivnik RJ, et al.: Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment. Neurology 1999; 52: 1397-1403. – reference: 16) Whitwell JL, Shiung MM, Przybelski SA, Weigand SD, Knopman DS, Boeve BF, et al.: MRI patterns of atrophy associated with progression to AD in amnestic mild cognitive impairment. Neurology 2008; 70: 512-520. – reference: 19) Okamura N, Arai H, Maruyama M, Higuchi M, Matsui T, Tanji H, et al.: Combined analysis of CSF tau levels and [123I] iodoamphetamine SPECT in mild cognitive impairment: Implications for a novel predictor of Alzheimer's disease. Am J Psychiatry 2002; 159: 474-476. – reference: 5) 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. – reference: 15) Devanand DP, Pradhaban G, Liu X, Khandji A, De Santi S, Segal S, et al.: Hippocampal and entorhinal atrophy in mild cognitive impairment. Prediction of Alzheimer disease. Neurology 2007; 68: 828-836. – reference: 13) 羽生春夫, 佐藤友彦, 赤井知高, 酒井 稔, 高崎 朗, 岩本俊彦: 老年期認知症患者の病識―生活健忘チェックリストを用い, 介護者を対照とした研究―. 日老医誌 2007; 44: 463-469. – reference: 17) Hirao K, Ohnishi T, Hirata Y, Yamashita F, Mori T, Moriguchi Y, et al.: The prediction of rapid conversion to Alzheimer's disease in mild cognitive impairment using regional cerebral blood flow SPECT. Neuroimage 2005; 28: 1014-1021. – reference: 11) Minoshima S, Frey KA, Koeppe RA, Foster NL, Kuhl DE: A diagnostic approach in Alzheimer's disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med 1995; 36: 1238-1248. – reference: 24) Petersen RC, Thomas RG, Grundman M, Bennet D, Doody R, Ferris S, et al.: Vitamine E and donepezil for the treatment of mild cognitive impairment. New Engl J Med 2005; 35: 2379-2388. – reference: 3) Hanyu H, Sakurai H, Hirao K, Sato T, Iwamoto T: Difference in practice effects depending on cerebral perfusion pattern in mild cognitive impairment. Int J Geriatr Psychiatry 2008; 23: 111-112. – reference: 4) 杉下守弘: 日本版ウエクスラー記憶検査法, 日本文化科学社, 2001. – reference: 8) Sheikh JI, Yesavage JA: Geriatric depression scale (GDS), recent evidence and development of a shorter version. Clin Gerontologist 1986; 5: 165-173. – reference: 2) Hanyu H, Sakurai H, Hirao K, Shimizu S, Iwamoto T: Unawareness of memory deficits depending on cerebral perfusion pattern in mild cognitive impairment. J Am Geriatr Soc 2007; 55: 470-471. – reference: 6) Highes CP, Berg L, Danzieger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982; 140: 566-572. – reference: 20) Borroni B, Anchisi D, Paghera B, Vicini B, Kerrouche N, Garibotto V, et al.: Combinde 99mTc-ECD SPECT and neuropsychological studies in MCI for the assessment of conversion to AD. Neurobiol Aging 2007; 27: 24-31. – reference: 10) Hirata Y, Matsuda H, Nemoto K, Ohnishi T, Hirao K, yamashita F, et al.: Voxel-based morphometry to discriminate early Alzheimer's disease from controls. Neurosci Lett 2005; 382: 269-274. – reference: 9) Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA: MR signal abnormalities at 1.5 T in Alzheimer's disease and normal aging. Am J Radiol 1987; 149: 351-356. – reference: 7) Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 1975; 12: 189-198. – reference: 1) Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al.: Current concepts in mild cognitive impairment. Arch Neurol 2001; 58: 1985-1992. |
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| Snippet | 目的：MRIやSPECT画像データの解析とともに病識を評価することによって，健忘型軽度認知障害（MCI）からアルツハイマー病（AD）への移行が予測できるか否かを検討した．方... |
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| SubjectTerms | MRI SPECT アルツハイマー病 病識 軽度認知障害 |
| Title | 軽度認知障害からアルツハイマー病への進行予測 |
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