說漢語中國老人的遺忘型輕度認(rèn)知功能障礙和阿爾茨海默病的彌散張量成像和神經(jīng)語言學(xué)研究
發(fā)布時間：2018-08-01 13:20
【摘要】：第一部分阿爾茨海默病和遺忘型輕度認(rèn)知功能障礙患者的彌散張量成像研究 背景： 隨著磁共振新技術(shù)的不斷進(jìn)步,大腦白質(zhì)(White Matter, WM)微結(jié)構(gòu)的改變可以通過彌散張量成像的方法被探測。阿爾茨海默病(Alzheimer Disease, AD)的WM改變的規(guī)律還遠(yuǎn)未被闡明。研究的目的是為了了解在AD的疾病發(fā)展過程中,腦WM微結(jié)構(gòu)在病程的不同階段是如何改變的；腦WM微結(jié)構(gòu)的改變和神經(jīng)心理學(xué)量表各分值的關(guān)系；探測出在疾病早期就發(fā)生變化的WM區(qū)域,并討論能反映WM變化的敏感參數(shù)。對以上問題的討論和闡述,是為了能幫助臨床醫(yī)師發(fā)現(xiàn)找到診斷早期AD的敏感指標(biāo)。從而能更早期地發(fā)現(xiàn)臨床早期,甚至是臨床前期的患者,進(jìn)行早期藥物干預(yù),并幫助患者盡可能長地保留住認(rèn)知功能,延緩疾病的進(jìn)展,從而降低總體疾病負(fù)擔(dān)。 方法： 研究對象共分為3組,AD組,遺忘型輕度認(rèn)知功能障礙(amnestic Mild Cognitive Impairment, a-MCI)組和正常對照(Normal Control, NC)組。入組的被試均為小學(xué)以上文化程度,病前有漢語讀寫能力的成人。對這3組被試的進(jìn)行磁共振彌散張量成像研究,和神經(jīng)心理學(xué)檢查。磁共振方面：利用1.5T的磁共振對3組被試大腦的各個興趣區(qū)進(jìn)行掃描,主要包括尾狀核、殼核、額頂枕顳的WM、丘腦和扣帶回的腦組織的各向異性值(fractional anisotropy, FA)平均表觀彌散系數(shù)(mean apparent diffusion coefficient, ADC)進(jìn)行評價;神經(jīng)心理學(xué)方面是用簡明心理狀況量表(Mini-mental sate Exam, MMSE),臨床癡呆量表(Clinical Dementia scale, CDR)和Alzheimer病評定量表(Alzheimer disease Assessment Scale, ADAS)進(jìn)行評定。 患者均來自于神經(jīng)內(nèi)科記憶障礙門診,正常被試來自神經(jīng)科招募的健康被試。共有47名患者符合入組標(biāo)準(zhǔn)：共有17名符合美國國立神經(jīng)病和交流障礙與卒中以及Alzheimer病和相關(guān)疾病委員會(the National insititute of Neurological and Communicative disease and stroke and the Alzheimer's Disease and Related Disorders Association, NINCDS-ADRDA)有關(guān)AD的診斷標(biāo)準(zhǔn)中很可能AD,14名被試符合Peterson有關(guān)輕度認(rèn)知功能障礙的診斷標(biāo)準(zhǔn),其臨床記憶分值低于同年齡同性別同教育程度對照組臨床記憶量表1.5標(biāo)準(zhǔn)差,社會和日常生活能力未受損,納入標(biāo)準(zhǔn)使用CDR,對得分為0.5分者,納入MCI組。16名被試納入NC組,NC組沒有認(rèn)知損害的癥狀和主訴,神經(jīng)心理學(xué)量表正常范圍,半年內(nèi)頭顱磁共振或CT檢查未見明顯異常。 結(jié)果： 1.MCI組和AD組的ADAS分值 與NC組相比,MCI組在詞語回憶、命名、和詞語再認(rèn)的分值更高,而認(rèn)知總分和ADAS總分更高,差異具有統(tǒng)計學(xué)意義。與NC組相比,AD組在ADAS測驗中除了精神病表現(xiàn)分測驗值無差異以外,所有分測驗值都更高；與MCI組相比,AD組MMSE總分更低,ADAS量表中除了命名、意向性練習(xí)、口語能力、找詞困難、口語理解能力、精神病表現(xiàn)得分和心境因子分無顯著性差異以外MMSE總分、單詞回憶、命令、結(jié)構(gòu)性練習(xí)、定向力、單詞辨認(rèn)、回憶測驗指令注意力因子分、記憶力總分、語言因子分、實踐能力因子、激越因子、非認(rèn)知總分、認(rèn)知總分和ADAS總分均較MCI組升高,并有統(tǒng)計學(xué)意義。 2.MCI組和AD組的FA值 與NC組相比,AD組在雙側(cè)額葉白質(zhì)呈現(xiàn)更低的FA值,與MCI組比較,AD組在所有ROI的FA值2組無統(tǒng)計學(xué)差異。NC組和MCI組相比在各ROI的FA值無顯著性差異。NC組和AD組相比在除了額葉白質(zhì)以外的各個興趣區(qū)的FA值均未顯示出差異。 3.MCI組和AD組的ADC值 與NC組相比,AD組在雙側(cè)額葉和前后扣帶回的ADC值更高,有顯著性差異。與MCI組相比,AD組在右前扣帶回和左后扣帶回纖維的ADC值更高。NC組和MCI組相比,在包括前后扣帶回、胼胝體(corpus callosum,CC)部位和其他ROI均未顯示出差異。 4ADAS的因子分和FA值之間相關(guān)性分析 結(jié)果顯示記憶力因子分與雙側(cè)尾狀核,額葉,左枕葉,左頂葉,胼胝體壓部,左顳葉,右前扣帶回部位的FA值顯著相關(guān),實踐因子分與尾狀核,枕葉,左頂葉,胼胝體壓部,右前扣帶回顯著相關(guān),實踐能力因子分與右側(cè)尾狀核，左枕葉，，左頂葉,左前扣帶回顯著相關(guān),心境與左側(cè)尾狀核,額葉顯著相關(guān),激越與尾狀核,右枕葉,右前扣帶回顯著相關(guān),精神病因子分與左后扣帶回顯著相關(guān)。 5ADAS的因子分和FA值之間相關(guān)性分析 各因子分與各ROI的ADC值的相關(guān)分析得出以下結(jié)果,記憶力總分與雙側(cè)尾狀核,右額葉,胼胝體膝部,左枕葉,左頂葉,顳葉,前扣帶回顯著相關(guān)；語言因子分與雙側(cè)尾狀核,額葉,胼胝體膝部,右枕葉,顳葉,右丘腦,前扣帶回顯著相關(guān),實踐能力總分與尾狀核,額葉,胼胝體膝部,左頂葉,顳葉,左前扣帶回顯著相關(guān)；心境因子分與各個ROI的ADC值無顯著相關(guān)；激越因子分與雙側(cè)尾狀核,額葉,胼胝體膝部,左枕葉,右丘腦,顳葉,右前扣帶回顯著相關(guān)。精神病因子分與額葉,右丘腦顯著相關(guān)。 結(jié)論： 結(jié)果顯示DTI可以探測AD和MCI患者腦WM微結(jié)構(gòu)的改變。通過ADC值探測扣帶回和額葉WM微結(jié)構(gòu)的變化,可能對診斷MCI和AD有幫助,隨著病情的進(jìn)展,受累的WM區(qū)域可以不局限在扣帶回,可以累及其他腦葉的WM。本研究發(fā)現(xiàn),在探測MCI和AD的WM演變過程中,ADC值有可能比FA值更敏感地反映病情的進(jìn)程,與疾病的嚴(yán)重程度相關(guān)。在神經(jīng)心理學(xué)研究中發(fā)現(xiàn)ADAS和MMSE均能反映病情的嚴(yán)重程度,但ADAS所探查的高級皮層功能更廣泛,更能反映患者病情的變化,研究提示心境和精神病表現(xiàn)是比較后期出現(xiàn)的癥狀,在MCI和AD的早期和中期往往不受累。 本研究通過因子分和彌散張量成像參數(shù)的相關(guān)性分析推測,探測雙側(cè)尾狀核,額葉,左枕葉,左頂葉,胼胝體壓部,左顳葉,右前扣帶回部位的FA值和雙側(cè)尾狀核,右額葉,胼胝體膝部,左枕葉,左頂葉,顳葉,前扣帶回的ADC值對反映對反映患者認(rèn)知功能神經(jīng)心理學(xué)評定結(jié)果相關(guān),說明在AD和MCI患者中這些部位WM微結(jié)構(gòu)的改變與認(rèn)知能力的改變有有密切的關(guān)系。這些WM在普通磁共振影像中時正常的,所以通過彌散張量成像能更敏感地探測WM微結(jié)構(gòu)的改變,上述WM腦區(qū)的彌散張量的改變可能從某種程度上反映了被試認(rèn)知功能的水平。 彌散張量成像是一項客觀檢查,尤其適用于無法配合做神經(jīng)心理學(xué)檢查的患者,來幫助診斷a-MCI和AD。 第二部分AD和遺忘型輕度認(rèn)知功能障礙患者的漢語書寫研究 目的： 研究說漢語的AD患者和輕度認(rèn)知功能障礙患者的書寫功能的變化,以及書寫能力與認(rèn)知的其他領(lǐng)域的相互關(guān)系以及變化的趨勢。利用臨床神經(jīng)心理學(xué)方法對AD的漢語失語癥進(jìn)行研究,探索其與英語失語癥的異同。 方法： 對47名被試,其中正常組16例,MCI組14例,以及AD組17例,對這些被試分別進(jìn)行了MMSE, Alzheimer病評估量表(ADAS)和北大醫(yī)院漢語失語檢查。將書寫的各因子分ADAS量表的各項分值進(jìn)行比較。并對AD組患者的書寫檢查進(jìn)行分析,討論其不同于西語失語癥的特點。 結(jié)果： 書寫的各因子分與被試的年齡、性別、文化程度及是否患有糖尿病、高血壓之間均無顯著相關(guān)性。書寫的各因子分與MMSE總分以及ADAS的各個認(rèn)知因子分之間呈現(xiàn)極顯著相關(guān),但與非認(rèn)知的因子分“心境”和“精神病表現(xiàn)”之間無顯著相關(guān)。AD組書寫各項分值與正常組和MCI組相比均存在顯著性差異,MCI組和正常組相比,無顯著性差異。AD的書寫障礙出現(xiàn)了多種語言現(xiàn)象。 結(jié)論： 說漢語的AD和MCI患者的書寫能力和ADAS的認(rèn)知分值顯著相關(guān),提示書寫能力受損與認(rèn)知功能的減退的關(guān)系密切。說漢語的中國AD患者中構(gòu)字障礙出現(xiàn)在疾病的不同時期,是最常見的書寫障礙,而說英語患者的書寫障礙早期表現(xiàn)為不規(guī)則詞的拼寫錯誤。而漢語沒有不規(guī)則詞的運用,呈現(xiàn)出漢語所特有的語言特征。這是寫漢字和寫英語的AD患者在失語癥狀學(xué)方面的區(qū)別。
[Abstract]:Part one diffusion tensor imaging study of Alzheimer's disease and amnestic mild cognitive impairment
Background:
With the development of new magnetic resonance technology, the changes in White Matter (WM) microstructures can be detected by diffusion tensor imaging. The regularity of WM changes in Alzheimer Disease (AD) is far from clarified. The purpose of this study is to understand the WM microstructure in the brain in the development of AD disease. The changes in the different stages of the process; the relationship between the changes in the WM microstructures of the brain and the scores of the neuropsychological scales; the detection of the WM region that changed in the early stage of the disease and the discussion of the sensitive parameters that can reflect the changes in the WM. The discussion and exposition of the above problems are designed to help clinicians find the sensitivity to the early diagnosis of the early diagnosis of AD. Indicators. Early detection of early clinical and even preclinical patients can be used to intervene early and help patients retain their cognitive functions as long as possible and delay the progression of the disease, thereby reducing the overall burden of disease.
Method:
The subjects were divided into 3 groups, AD group, amnestic Mild Cognitive Impairment, a-MCI group and normal control group (Normal Control, NC). The subjects in the group were all the above primary school education, and the adults who had the ability to read and write Chinese before the disease. The 3 groups were studied by magnetic resonance diffusion tensor imaging and God. Psychologic examination. Magnetic resonance: 1.5T magnetic resonance (MRI) was used to scan various regions of interest of the 3 groups of subjects, including the caudate nucleus, the putamen, the WM of the frontal occipital temporal, the anisotropic values of the brain tissue of the thalamus and cingulate gyrus (fractional anisotropy, FA), the average apparent diffusion coefficient (mean apparent diffusion coefficient, ADC). The neuropsychological aspects were evaluated with the Mini-mental sate Exam (MMSE), the clinical dementia scale (Clinical Dementia scale, CDR) and the Alzheimer disease assessment scale (Alzheimer disease Assessment).
All the patients were from the neurology department of memory disorders, and normal subjects were recruited from the Department of Neurology. A total of 47 patients met the standard of entry. A total of 17 were in line with the national neuropathy and communication disorders and stroke, and the the National Insititute of Neurological and Communicative. Disease and stroke and the Alzheimer's Disease and Related Disorders Association, NINCDS-ADRDA) the diagnostic criteria of the 14 subjects were in accordance with the diagnostic criteria for mild cognitive impairment. The clinical memory score was lower than the same age homosexual and educational control group clinical memory scale 1.5. The standard deviation, the social and daily life ability was not damaged, included in the standard use of CDR, the score of 0.5 points, included in group MCI.16 subjects into the NC group, NC group no symptoms and complaints of cognitive impairment, the normal range of neuropsychological scale, half of the head magnetic resonance or CT examination no significant abnormalities in half a year.
Result:
ADAS score of 1.MCI group and AD group
Compared with the NC group, the score of the MCI group was higher in terms of word memory, naming and word recognition, while the total score of cognition and the total score of ADAS were higher, and the difference was statistically significant. Compared with the NC group, the AD group was higher in all the subtests in the ADAS test than in the psychosis performance test. Compared with the MCI group, the total MMSE score of the AD group was lower, ADAS. Besides naming, intentional exercise, oral ability, difficulty finding words, oral comprehension, psychosis scores and mood factors, there were no significant differences in MMSE total score, word recall, command, structural exercise, orientation, word recognition, memory test instruction attention factor, memory score, language factor, practical ability. The total score of cognition and total score of ADAS were higher than those of MCI group, and there was statistical significance.
The FA value of the 2.MCI group and the AD group
Compared with the NC group, the AD group showed a lower FA value in the bilateral frontal lobes. Compared with the MCI group, there was no statistical difference between the AD group and the AD group in the FA value of all ROI. There was no significant difference between the.NC group and the MCI group in the FA value of the ROI, compared with the MCI group.
The ADC value of the 3.MCI group and the AD group
Compared with the NC group, the ADC value of the AD group was higher in the bilateral frontal and posterior cingulate gyrus. Compared with the MCI group, the ADC value of the AD group in the right anterior cingulate gyrus and the posterior cingulate gyrus was higher in the.NC group than in the MCI group, and there was no difference between the anterior cingulate gyrus, the corpus callosum (corpus callosum, CC), and the other ROI.
Correlation analysis between the factor of 4ADAS and the value of FA
The results showed that the memory factor was significantly related to the FA value of the bilateral caudate nucleus, frontal lobe, left occipital lobe, left parietal lobe, corpus callosum pressure, left temporal lobe and right anterior cingulate gyrus. The practical factor was significantly related to caudate nucleus, occipital lobe, left parietal lobe, corpus callosum pressure, right anterior cingulate gyrus, left occipital lobe, left parietal lobe, left anterior lobe. The cingulate gyrus was significantly correlated with the left caudate nucleus and the frontal lobe, which was significantly related to the caudate nucleus, the right occipital lobe and the right anterior cingulate gyrus, and the psychosis factor was significantly related to the left posterior cingulate gyrus.
Correlation analysis between the factor of 5ADAS and the value of FA
The correlation analysis between the factors and the ADC values of each ROI showed that the total memory score was significantly related to the bilateral caudate nucleus, the right frontal lobe, the genu of the corpus callosum, the left occipital lobe, the left parietal lobe, the temporal lobe, and the anterior cingulate gyrus; the language factor was significantly related to the bilateral caudate nucleus, the frontal lobe, the corpus callosum, the right occipital lobe, the temporal lobe, right thalamus, and the anterior cingulate gyrus. The total score is significantly related to the caudate nucleus, the frontal lobe, the genu of the corpus callosum, the left parietal lobe, the temporal lobe and the left anterior cingulate gyrus, and there is no significant correlation between the mood factor and the ADC value of each ROI; the score of the shock factor is significantly related to the bilateral caudate nucleus, the frontal lobe, the genu of the corpus callosum, the left occipital lobe, the right thalamus, the temporal lobe, and the right anterior cingulate gyrus. Relevant.
Conclusion:
The results show that DTI can detect changes in the WM microstructures in the brain of patients with AD and MCI. Detection of the changes in the cingulate gyrus and the WM microstructures of the frontal cortex by ADC may be helpful for the diagnosis of MCI and AD. As the condition progresses, the WM region involved is not limited to the cingulate gyrus, and the WM. of the other brain may be involved in the detection of MCI and AD. In the process, the ADC value may be more sensitive than FA to reflect the progression of the disease, which is related to the severity of the disease. In the neuropsychological study, both ADAS and MMSE are found to reflect the severity of the disease, but the advanced cortex function explored by ADAS is more extensive and more capable of reflecting the changes in the patient's condition. The study suggests that mood and mental symptoms are compared. Symptoms at later stages are often not involved in the early and middle stages of MCI and AD.
In this study, we speculated that the FA value of bilateral caudate nucleus, frontal, left occipital lobe, left parietal lobe, left parietal lobe, left parietal lobe, left temporal lobe, right anterior cingulate cortex, right frontal lobe, right frontal lobe, corpus callosum, left occipital lobe, left parietal lobe, left parietal lobe, left parietal lobe, temporal lobe and anterior cingulate gyrus were reflected to reflect the ADC value of the patients. The results of cognitive functional neuropsychological assessment are related, indicating that there is a close relationship between the changes of WM microstructures in these sites and changes in cognitive ability in AD and MCI patients. These WM are normal in common magnetic resonance imaging, so the change of the microstructures of WM can be detected more sensitively by diffusion tensor imaging, and the diffusion tensor of the above WM brain regions is more sensitive. The change may reflect the cognitive function of the subjects to some extent.
Diffusion tensor imaging (DTI) is an objective examination, especially suitable for patients who can not cooperate with neuropsychological examination to help diagnose a-MCI and AD.
The second part is the study of Chinese writing in AD and amnestic mild cognitive impairment patients.
Objective:
The study of the changes in writing function of Chinese AD patients and patients with mild cognitive impairment, as well as the relationship between writing ability and other areas of cognition, and the trend of change. The study of Chinese aphasia in AD by clinical neuropsychological methods was used to explore the similarities and differences between the Chinese aphasia and English aphasia.
Method:
In 47 subjects, 16 cases in normal group, 14 cases in group MCI, and 17 cases in group AD, the subjects were examined by MMSE, Alzheimer disease assessment scale (ADAS) and Chinese aphasia in Peking University Hospital. The scores of each factor ADAS scale were compared. The writing examination of the patients in the AD group was analyzed to discuss the difference from the western language loss. The characteristics of the language disorder.
Result:
There was no significant correlation between the factors of writing and the age, sex, educational level, diabetes and hypertension. There was a very significant correlation between the factors of writing and the total scores of MMSE and the cognitive factors of ADAS, but there was no significant difference between the "mood" and "psychosis" of non cognitive factors. There were significant differences in the scores between the.AD group and the normal group and the MCI group. Compared with the normal group, there was no significant difference between the MCI group and the normal group, and there was a variety of language phenomena in the writing barrier of.AD.
Conclusion:
The writing ability of Chinese AD and MCI patients is closely related to the cognitive score of ADAS, suggesting that the impairment of writing ability is closely related to the impairment of cognitive function. The spelling of words is wrong. But in Chinese, there is no use of the irregular words, which presents the characteristic of the Chinese language. This is the difference between the AD patients who write and write English in aphasia.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R749.16
本文編號：2157714
[Abstract]:Part one diffusion tensor imaging study of Alzheimer's disease and amnestic mild cognitive impairment
Background:
With the development of new magnetic resonance technology, the changes in White Matter (WM) microstructures can be detected by diffusion tensor imaging. The regularity of WM changes in Alzheimer Disease (AD) is far from clarified. The purpose of this study is to understand the WM microstructure in the brain in the development of AD disease. The changes in the different stages of the process; the relationship between the changes in the WM microstructures of the brain and the scores of the neuropsychological scales; the detection of the WM region that changed in the early stage of the disease and the discussion of the sensitive parameters that can reflect the changes in the WM. The discussion and exposition of the above problems are designed to help clinicians find the sensitivity to the early diagnosis of the early diagnosis of AD. Indicators. Early detection of early clinical and even preclinical patients can be used to intervene early and help patients retain their cognitive functions as long as possible and delay the progression of the disease, thereby reducing the overall burden of disease.
Method:
The subjects were divided into 3 groups, AD group, amnestic Mild Cognitive Impairment, a-MCI group and normal control group (Normal Control, NC). The subjects in the group were all the above primary school education, and the adults who had the ability to read and write Chinese before the disease. The 3 groups were studied by magnetic resonance diffusion tensor imaging and God. Psychologic examination. Magnetic resonance: 1.5T magnetic resonance (MRI) was used to scan various regions of interest of the 3 groups of subjects, including the caudate nucleus, the putamen, the WM of the frontal occipital temporal, the anisotropic values of the brain tissue of the thalamus and cingulate gyrus (fractional anisotropy, FA), the average apparent diffusion coefficient (mean apparent diffusion coefficient, ADC). The neuropsychological aspects were evaluated with the Mini-mental sate Exam (MMSE), the clinical dementia scale (Clinical Dementia scale, CDR) and the Alzheimer disease assessment scale (Alzheimer disease Assessment).
All the patients were from the neurology department of memory disorders, and normal subjects were recruited from the Department of Neurology. A total of 47 patients met the standard of entry. A total of 17 were in line with the national neuropathy and communication disorders and stroke, and the the National Insititute of Neurological and Communicative. Disease and stroke and the Alzheimer's Disease and Related Disorders Association, NINCDS-ADRDA) the diagnostic criteria of the 14 subjects were in accordance with the diagnostic criteria for mild cognitive impairment. The clinical memory score was lower than the same age homosexual and educational control group clinical memory scale 1.5. The standard deviation, the social and daily life ability was not damaged, included in the standard use of CDR, the score of 0.5 points, included in group MCI.16 subjects into the NC group, NC group no symptoms and complaints of cognitive impairment, the normal range of neuropsychological scale, half of the head magnetic resonance or CT examination no significant abnormalities in half a year.
Result:
ADAS score of 1.MCI group and AD group
Compared with the NC group, the score of the MCI group was higher in terms of word memory, naming and word recognition, while the total score of cognition and the total score of ADAS were higher, and the difference was statistically significant. Compared with the NC group, the AD group was higher in all the subtests in the ADAS test than in the psychosis performance test. Compared with the MCI group, the total MMSE score of the AD group was lower, ADAS. Besides naming, intentional exercise, oral ability, difficulty finding words, oral comprehension, psychosis scores and mood factors, there were no significant differences in MMSE total score, word recall, command, structural exercise, orientation, word recognition, memory test instruction attention factor, memory score, language factor, practical ability. The total score of cognition and total score of ADAS were higher than those of MCI group, and there was statistical significance.
The FA value of the 2.MCI group and the AD group
Compared with the NC group, the AD group showed a lower FA value in the bilateral frontal lobes. Compared with the MCI group, there was no statistical difference between the AD group and the AD group in the FA value of all ROI. There was no significant difference between the.NC group and the MCI group in the FA value of the ROI, compared with the MCI group.
The ADC value of the 3.MCI group and the AD group
Compared with the NC group, the ADC value of the AD group was higher in the bilateral frontal and posterior cingulate gyrus. Compared with the MCI group, the ADC value of the AD group in the right anterior cingulate gyrus and the posterior cingulate gyrus was higher in the.NC group than in the MCI group, and there was no difference between the anterior cingulate gyrus, the corpus callosum (corpus callosum, CC), and the other ROI.
Correlation analysis between the factor of 4ADAS and the value of FA
The results showed that the memory factor was significantly related to the FA value of the bilateral caudate nucleus, frontal lobe, left occipital lobe, left parietal lobe, corpus callosum pressure, left temporal lobe and right anterior cingulate gyrus. The practical factor was significantly related to caudate nucleus, occipital lobe, left parietal lobe, corpus callosum pressure, right anterior cingulate gyrus, left occipital lobe, left parietal lobe, left anterior lobe. The cingulate gyrus was significantly correlated with the left caudate nucleus and the frontal lobe, which was significantly related to the caudate nucleus, the right occipital lobe and the right anterior cingulate gyrus, and the psychosis factor was significantly related to the left posterior cingulate gyrus.
Correlation analysis between the factor of 5ADAS and the value of FA
The correlation analysis between the factors and the ADC values of each ROI showed that the total memory score was significantly related to the bilateral caudate nucleus, the right frontal lobe, the genu of the corpus callosum, the left occipital lobe, the left parietal lobe, the temporal lobe, and the anterior cingulate gyrus; the language factor was significantly related to the bilateral caudate nucleus, the frontal lobe, the corpus callosum, the right occipital lobe, the temporal lobe, right thalamus, and the anterior cingulate gyrus. The total score is significantly related to the caudate nucleus, the frontal lobe, the genu of the corpus callosum, the left parietal lobe, the temporal lobe and the left anterior cingulate gyrus, and there is no significant correlation between the mood factor and the ADC value of each ROI; the score of the shock factor is significantly related to the bilateral caudate nucleus, the frontal lobe, the genu of the corpus callosum, the left occipital lobe, the right thalamus, the temporal lobe, and the right anterior cingulate gyrus. Relevant.
Conclusion:
The results show that DTI can detect changes in the WM microstructures in the brain of patients with AD and MCI. Detection of the changes in the cingulate gyrus and the WM microstructures of the frontal cortex by ADC may be helpful for the diagnosis of MCI and AD. As the condition progresses, the WM region involved is not limited to the cingulate gyrus, and the WM. of the other brain may be involved in the detection of MCI and AD. In the process, the ADC value may be more sensitive than FA to reflect the progression of the disease, which is related to the severity of the disease. In the neuropsychological study, both ADAS and MMSE are found to reflect the severity of the disease, but the advanced cortex function explored by ADAS is more extensive and more capable of reflecting the changes in the patient's condition. The study suggests that mood and mental symptoms are compared. Symptoms at later stages are often not involved in the early and middle stages of MCI and AD.
In this study, we speculated that the FA value of bilateral caudate nucleus, frontal, left occipital lobe, left parietal lobe, left parietal lobe, left parietal lobe, left temporal lobe, right anterior cingulate cortex, right frontal lobe, right frontal lobe, corpus callosum, left occipital lobe, left parietal lobe, left parietal lobe, left parietal lobe, temporal lobe and anterior cingulate gyrus were reflected to reflect the ADC value of the patients. The results of cognitive functional neuropsychological assessment are related, indicating that there is a close relationship between the changes of WM microstructures in these sites and changes in cognitive ability in AD and MCI patients. These WM are normal in common magnetic resonance imaging, so the change of the microstructures of WM can be detected more sensitively by diffusion tensor imaging, and the diffusion tensor of the above WM brain regions is more sensitive. The change may reflect the cognitive function of the subjects to some extent.
Diffusion tensor imaging (DTI) is an objective examination, especially suitable for patients who can not cooperate with neuropsychological examination to help diagnose a-MCI and AD.
The second part is the study of Chinese writing in AD and amnestic mild cognitive impairment patients.
Objective:
The study of the changes in writing function of Chinese AD patients and patients with mild cognitive impairment, as well as the relationship between writing ability and other areas of cognition, and the trend of change. The study of Chinese aphasia in AD by clinical neuropsychological methods was used to explore the similarities and differences between the Chinese aphasia and English aphasia.
Method:
In 47 subjects, 16 cases in normal group, 14 cases in group MCI, and 17 cases in group AD, the subjects were examined by MMSE, Alzheimer disease assessment scale (ADAS) and Chinese aphasia in Peking University Hospital. The scores of each factor ADAS scale were compared. The writing examination of the patients in the AD group was analyzed to discuss the difference from the western language loss. The characteristics of the language disorder.
Result:
There was no significant correlation between the factors of writing and the age, sex, educational level, diabetes and hypertension. There was a very significant correlation between the factors of writing and the total scores of MMSE and the cognitive factors of ADAS, but there was no significant difference between the "mood" and "psychosis" of non cognitive factors. There were significant differences in the scores between the.AD group and the normal group and the MCI group. Compared with the normal group, there was no significant difference between the MCI group and the normal group, and there was a variety of language phenomena in the writing barrier of.AD.
Conclusion:
The writing ability of Chinese AD and MCI patients is closely related to the cognitive score of ADAS, suggesting that the impairment of writing ability is closely related to the impairment of cognitive function. The spelling of words is wrong. But in Chinese, there is no use of the irregular words, which presents the characteristic of the Chinese language. This is the difference between the AD patients who write and write English in aphasia.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R749.16
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