The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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Relationship between Brain Perfusion SPECT and MMSE Score in Dementia of Alzheimer's Type: A statistical Parametric Mapping Analysis

알쯔하이머형 치매환자에서 SPM 방법을 이용한 뇌 관류 SPECT와 정신-인지기능 수행성능의 상관

  • Kang, Hye-Jin (Dept. of Nuclear Medicine, Seoul National university Hospital) ;
  • Lee, Dong-Soo (Dept. of Nuclear Medicine, Seoul National university Hospital) ;
  • Kang, Eun-Joo (Dept. of Nuclear Medicine, Seoul National university Hospital) ;
  • Lee, Jae-Sung (Dept. of Nuclear Medicine, Seoul National university Hospital) ;
  • Yeo, Seong-Seok (Dept. of Nuclear Medicine, Seoul National university Hospital) ;
  • Kim, Jin-Yeong (Dept. of Psychiatry, Seoul National University Hospital) ;
  • Lee, Dong-Woo (Dept. of Psychiatry, Seoul National University Hospital) ;
  • Cho, Maeng-Je (Dept. of Psychiatry, Seoul National University Hospital) ;
  • Chung, June-Key (Dept. of Nuclear Medicine, Seoul National university Hospital) ;
  • Lee, Myung-Chul (Dept. of Nuclear Medicine, Seoul National university Hospital)
  • 강혜진 (서울대학교병원 핵의학과) ;
  • 이동수 (서울대학교병원 핵의학과) ;
  • 강은주 (서울대학교병원 핵의학과) ;
  • 이재성 (서울대학교병원 핵의학과) ;
  • 여정석 (서울대학교병원 핵의학과) ;
  • 김진영 (서울대학교병원 정신과) ;
  • 이동우 (서울대학교병원 정신과) ;
  • 조맹제 (서울대학교병원 정신과) ;
  • 정준기 (서울대학교병원 핵의학과) ;
  • 이명철 (서울대학교병원 핵의학과)
  • Published : 2002.04.30
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Abstract

Purpose : The aim of this study was to identify the brain areas in which reductions of regional cerebral blood flow (rCBF) were correlated with decline of general mental function, measured by Mini-Mental State Examination (MMSE). Materials and Methods : Tc-99m HMPAO brain SPECT was peformed in 9 probable AD patients at the initial and follow-up periods of 1.8 years (average) after the first study. MMSE scores were also measured in both occasions. The mean MMSE score of the initial study 16.4 (range: 5 - 24) and the mean MMSE score of the follow-up was 8.1 (range: 0 - 17). Each SPECT image was normalized to the cerebellar activity and a correlation analysis was peformed between the level of rCBF in AD patients and the MMSE scores by voxel-based analysis using SPM99 software. Results : Significant correlation was found between the blood-flow decrease in left inferior prefrontal region (BA 47) and left middle temporal legion (BA 21) and the MMSE score changes. Additional areas such as anterior and posterior cingulate cortices, precuneus, and bilateral superior and middle prefrontal regions showed the similar trends. Conclusions : A relationship was found between reduction of regional cerebral blood flow in left prefrontal and temporal areas and decline of cognitive function in Alzheimer's disease(AD) patients. This voxel-based analysis is useful in evaluating the progress of cognitive function in Alzheimer's disease.

목적: 본 연구의 목적은 첫째, 알쯔하이머형 치매의 국소뇌혈류량이 일정 시간이 지난 후 감소되는 양상을 voxel based 분석을 통해 확인하고자 하였다. 둘째, 이들 환자에 있어서 두뇌 특정부위가 임상에서 흔하게 쓰이는 간이정신상태검사인 MMSE-K(Mini-Mental State Examination, Korean version)의 수행과 상관을 보이는 영역이 있는지 살펴보고자 하였다. 대상 및 방법: Tc-99m HMPAO SPECT를 이용해서 9명의 probable 알쯔하이머형 치매 환자군에게 평균 1.8년의 기간을 두고 각각 두 번의 영상(기저영상과 추적검사 영상)을 얻었고, 이를 각각 9명의 정상노인으로부터 얻은 영상과 비교 분석하였다. 각 영상은 공간정규화 이후 소뇌의 활성화에 따라 계수 정규화되었고, SPM99를 사용하여 voxel based 분석을 하였다. 결과: 대조군에 비하여 환자군에서 뇌혈류량의 감소를 보이는 영역이, 기저검사에서 주로 두정측두영역인데 비하여 추적검사시에는 전두엽 영역으로 확대되었다. MMSE-K 점수와 가장 높은 상관관계를 보이며 뇌혈류가 감소하는 영역은 기억의 부호화와 관련된다고 알려진 좌측 중/하전두엽과 중측두엽, 그리고 후대상회와 전설소엽이었다. 결론: probable 알쯔하이머형 치매 환자군에게 있어서 질병이 진전됨에 따라 변하는 뇌혈류 감소가 두정엽에서 전두엽을 포함하였다. 특히 좌측전두엽의 혈류량 감소는 MMSE-K로 측정된 인지기능 수행 저하와 유의미한 상관을 보임이 확인되었다. 본 연구는 SPM을 이용한 이러한 분석방법을 통하여 핵의학 영상을 알쯔하이머형 치매의 경과추적과 진단의 유용한 도구로 사용할 수 있음을 보인다.

Keywords

References

  1. Feinberg TE, Farah MJ. Behavioral neurologyand neuropsychology. New York: McGraw-Hill;1997, p.521-550.
  2. Mayberg HS. Clinical correlates of PET andSPECT identified defects in dementia. J ClinPsychiatry. 1994; 55(suppl):12-21.
  3. Muller H, Moller HJ, Stippel A, Frlc M,Grunwald F, Laux G, et al. SPECT patterns inprobable Alzheimer's disease. Eur Arch PsychiatryClin Neurosci. 1999; 249:190-6.
  4. Imran MB, Kawashima R, Awata S, Sato K,Kinomura S, Ono S, et al. Parametric mappingof cerebral blood flow deficits in Alzheimer'sdisease: a SPECT study using HMPAO andimage standardization technique. J Nucl Med.1999; 40:244-9.
  5. Kim SE, Na DL, Lee J, Choi Y, Lee KH, ChoeYS, et al. Assessment of metabolic impairmentin Alzheimer's disease with [18F]FDG PET:Validity and role of simplified tissueradioactivity ratio analysis. Korean J Nucl Med.1996; 30:299-314.
  6. 고창순 편저. 핵의학입문. 서울: 고려의학. 1997: p.68-80.
  7. Burns A, Philpot MP, Costa DC, Ell PJ, Levy R.The investigation of Alzheimer's disease withsingle photon emission tomography. J NeurolNeurosurg Psychiatry. 1989; 52:248-53.
  8. Mega MS, Lee L, Dinov ID, Mishkin F, TogaAW, Cummings JL. Cerebral correlates ofpsychotic symptoms in Alzheimer's disease.J Neurol Neurosurg Psychiatry. 2000; 69:167-71.
  9. Hirono N, Mega MS, Dinov ID, Mishkin F,Cummings JL. Left frontotemporal hypoperfusionis associated with aggression in patients withdementia. Arch Neurol. 2000; 57:861-6.
  10. Jagust W, Thisted R, Devous MD Sr, Van Heertum R, Mayberg H, Jobst K, et al. SPECT perfusion imaging in the diagnosis of Alzheimer's disease: a clinical-pathologic study. Neurology. 2001; 56:950-6.
  11. Cardebat D, Demonet JF, Puel M, Agniel A,Viallard G, Celsis P. Brain correlates of memoryprocesses in patients with dementia ofAlzheimer's type: a SPECT Activation Study. JCereb Blood Flow Metab. 1998; 18:457-62.
  12. Sayit E, Yener G, Capa G, Ertay T, Keskin B,Fadiloglu S, et al. Basal and activational99Tcm-HMPAO brain SPECT in Alzheimer'sdisease. Nucl Med Commun. 2000; 21:763-8.
  13. Kogure D, Matsuda H, Ohnishi T, Asada T, UnoM, Kunihiro T, et al. Longitudinal evaluation ofearly Alzheimer's disease using brain perfusionSPECT. J Nucl Med. 2000; 41:1155-62.
  14. Lee DW. Study of cerebrovascular reactivity indementia of Alzheimer's type using DiamoxSPECT. MS dissertation, Seoul National Univ.College of Medicine. 2000.
  15. Kwon YC, Park J-H. Korean version ofMini-Mental State Examination(MMSE-K): PartI : Developement of the test for the elderly.J Korean Neuropsychiatr Assoc. 1989; 28:125-35.
  16. Ishii K, Sasaki M, Yamaji S, Sakamoto S,Kitagaki H, Mori E. Demonstration of decreasedposterior cingulate perfusion in mild Alzheimer'sdisease by means of H2150 positron emissiontomography. Eur J Nucl Med. 1997; 24:670-3.
  17. Nitrini R, Buchpiguel CA, Caramelli P, BahiaVS, Mathias SC, Nascimento CM. et al. SPECTin Alzheimer's disease: features associated withbilateral parietotemporal hypoperfusion. ActaNeurol Scand. 2000; 101:172-6.
  18. Buck BH, Black SE, Behrmann M, Caldwell C,Bronskill MJ.' Spatial- and object-basedattentional deficits in Alzheimer's disease.Relationship to HMPA0-SPECT measures of parietalperfusion. Brain. 1997; 120(Pt 7):1229-44.
  19. Signorini M, Pau1esu E, Friston K, Perani D,Colle1uori A, Lucignani G. et al. Rapidassessment of regional cerebral metabolicabnormalities in single subjects with quantitativeand nonquantitative [18F]FDG PET: A clinicalvalidation of statistical parametric mapping.Neuroimage. 1999; 9:63-80.