Ann Neurol-阿尔兹海默症:大脑功能连接状态,可有效预测认知能力

2021-07-25 Freeman MedSci原创

阿尔兹海默症:大脑功能连接状态,可有效预测认知能力

海马是一个复杂的结构,与两个皮质网络相连,即前外侧(AT)和后内侧(PM)网络。一方面,内侧皮层的前外侧部分和边缘皮层主要与AT网络相连,其中包括前外侧颞皮层、外侧眶额皮层和杏仁核。另一方面,内侧皮层的后内侧部分和海马旁皮层主要与后内侧(PM)皮层网络相连,其中包括默认模式网络(DMN)的区域,以及丘脑和枕叶皮层。AT和PM网络都以前后梯度汇聚到海马,AT网络与海马的前部连接更多,而PM网络则与后部连接更多。

AT和PM网络在阿尔茨海默病的病理生理学方面具有特殊的意义。首先,AT和PM网络之间的相互作用对偶发记忆(episodic memory)的形成至关重要,而偶发记忆在阿尔茨海默病中受到损害。

其次,最近的研究表明,在认知正常的老年受试者中,AT和PM网络有选择地易受阿尔茨海默病病理的影响,其中tau针对AT网络,而淀粉样β病理则优先沉积在PM网络中。

在阿尔茨海默病或轻度认知障碍(MCI)患者中,海马和包括在PM网络中的DMN区域(如后扣带皮层)之间的功能连接减少。相反,调查MTL和AT网络之间的连接性的研究是有限的,而且不一致,因为连接性增加和减少都有报道。在MCI和/或阿尔茨海默病患者中也有MTL内连接性增加的报道。

总的来说,人们对阿尔茨海默病相关的MTL-PM和MTL-AT功能连接的变化以及它们与认知能力下降的关系知之甚少。更重要的是,到目前为止,还没有对阿尔茨海默病的MTL连接性进行纵向研究,而鉴于连接性的变化可能反映了疾病过程中的动态过程,这一点尤为重要。

藉此,法国国立医学科学院的Sophie Dautricourt等人,用横断面和纵向的方法研究淀粉样β阳性MCI和阿尔茨海默病患者的AT和PM网络功能连接的变化,以单独分割的MTL亚区作为种子。

他们首先评估了阿尔茨海默病患者与健康老年对照组相比,MTL亚区与AT和PM网络的连接性的变化,即横断面,以及18个月的随访期,即纵向研究。其次,他们还调查了MTL-AT和MTL-PM连接性的变化是否与时间有关。最后,横断面和纵向地调查了这些连接性变化和患者的认知表现之间的关系。

此研究主要使用静止状态功能磁共振成像,对53名淀粉样β阳性的轻度认知障碍和阿尔茨海默氏症患者和68名健康老年对照组的MTL连接进行了横断面和纵向的评估。

他们发现:患者海马和中后部网络之间的连接减少,同时几个MTL亚区和前颞部网络之间的连接增加。

此外,中后部和前颞部网络的变化是相互关联的,即MTL-中后部连接的减少与MTL-前颞部连接的增加有关

最后,MTL-中后部的减少和MTL-前颞部的增加都能预测认知能力的下降。

这个研究说明:海马中后部和前颞部网络的纵向连接性变化是联系在一起的,它们都有助于阿尔茨海默病的认知能力下降。这些结果阐明了中后部和前颞部网络在阿尔茨海默病病理生理学和临床症状中的关键作用。

原文出处:
Dautricourt S, de Flores R, Landeau B, Poisnel G, Vanhoutte M, Delcroix N, Eustache F, Vivien D, de la Sayette V, Chételat G. Longitudinal changes in hippocampal network connectivity in Alzheimer's disease. Ann Neurol. 2021 Jul 19. doi: 10.1002/ana.26168. Epub ahead of print. PMID: 34279043.

 

 

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