Guidance for operation and reading of 18F-FDG PET brain imaging in dementia / 中华核医学与分子影像杂志

Due to the availability of 18F-FDG in PET centers, this article aims to advocate and promote the standardization of 18F-FDG PET brain imaging in dementia in order to improve the reliability, repeatability and comparison of the imaging process and results. It is also provided to guide the PET imaging operation standard and to give suggestions on image interpretation.

Study on tau brain network and asymmetry of Alzheimer′s disease based on 18F-APN-1607 PET imaging / 中华核医学与分子影像杂志

Objective:To reveal the abnormal topology of brain network in Alzheimer′s disease (AD), and evaluate the laterality of tau protein deposition in brains of AD patients based on 18F-APN-1607 PET brain imaging combined with graph theory. Methods:From November 2018 to January 2020, 23 clinically diagnosed AD patients (9 males, 14 females; age (61.3±10.7) years) and 13 normal controls (NC) (9 males, 4 females; age (61.6±4.5) years) who underwent 18F-APN-1607 PET imaging in Huashan Hospital, Fudan University were analyzed in this cross-sectional study. The brain network analysis method based on graph theory was used to construct the tau network of the NC group and the AD group, the network attributes (clustering coefficient, shortest path length, local efficiency, and small-worldness) were calculated, and the asymmetry index (AI) of each group to evaluate the laterality of tau protein deposition was obtained. Permutation test (1 000 times) was used to analyze the differences in brain network parameters between the NC group and the AD group. Results:The tau network of the AD group had obvious topological disorder, and the connections in the olfactory cortex and temporal lobe were weakened, while in the posterior cingulate gyrus, anterior wedge, and parietal occipital lobe, the connections were enhanced. Compared with NC group, clustering coefficient ( t values: 2.28-2.69), local efficiency ( t values: 2.34-3.06) and small-worldness ( t values: 2.26-3.32) were significantly decreased in AD group (all P<0.05) with the sparsity of 20%-50%, while the shortest path length was significantly increased ( t values: 2.13-2.85; all P<0.05). There was significant tau laterality in the posterior cingulate gyrus, superior parietal gyrus, paracentral lobule, superior temporal gyrus and middle temporal gyrus (AI: 10.5%(8.1%, 13.9%), 14.1%(7.6%, 20.3%), -12.4%(-15.7%, -7.8%), -10.8%(-15.3%, -2.1%) , -12.1%(-17.9%, -6.6%), respectively). Conclusion:The tau network analysis based on 18F-APN-1607 may be used to reveal abnormal topological changes of AD patients, and the tau deposition in the posterior cingulate gyrus, superior parietal gyrus, paracentral lobule, superior temporal gyrus and middle temporal gyrus has obvious laterality in AD patients.

Application of local gyrification index in the early diagnosis of Alzheimer disease / 中华放射学杂志

Objective To evaluate the role of local gyrification index (LGI) in the early diagnosis of Alzheimer disease(AD). Methods Thirty‐five amnestic‐type mild cognitive impairment patients (aMCI group), 34 mild AD patients (mild AD group) and 33 healthy volunteers (normal control group) were studied. All patients underwent high resolution MRI examination and mini‐mental state examination (MMSE). Using surface‐based morphometry, the FreeSurfer was employed to access LGI of vertex over every participant′s whole cortical surface, then we calculated the mean LGI (mLGI) of each subject′s left and right hemisphere separately. Taking age, gender and educational year as covariance, analysis of covariance was used to compare the difference of mLGI of left and right brain among 3 groups, then Bonferroni was done between every two groups. Analysis of covariance was applied to compare the difference of LGI of every participant among 3 groups, and Monte Carlo method was employed to perform multiple comparison corrections. The correlations between the MMSE scores and LGIs of the three groups were analyzed. Results Compared with normal control group(left 3.03±0.12,right 3.02±0.13), the mLGI of hemispheres in mild AD group(left 2.94±0.11,right 2.93±0.10) decreased respectively(P<0.05). The difference of mLGI of hemispheres between aMCI group(left 2.96 ± 0.10, right 2.96 ± 0.09) and normal control group had no statistical significance(P>0.05). The difference of mLGI of hemispheres between aMCI group and mild AD group also had no statistical significance(P>0.05). The aMCI group showed decrease of LGI in some brain regions located at the right temporal lobe, bilateral frontal and parietal lobe compared with the normal control group. While compared with aMCI group, decreased LGIs was presented in some brain regions located at bilateral temporal, occipital, frontal lobe and the right parietal lobe of mild AD group. There was a positive correlation between MMSE scores and LGIs of some brain regions in the bilateral temporal, occipital lobe, the left frontal lobe and the right parietal lobe in the three groups. Conclusion LGI is conductive in the early diagnosis of AD and can serve as an imaging marker for monitoring disease progresses.

Development and validity of Huashan Naming Test / 中华行为医学与脑科学杂志

Objective To present the development of the Naming test tool ( Huashan Naming Test, HNT)for Chinese cultural and by amnestic mild cognitive impairment ( aMCI ) and mild Alzheimer' s disease (AD) between the detection of memory decline,and to analyze the validity of its trial.Methods 100 normal elders from communities in Shanghai, 100 patients with amnestic mild cognitive impairment (aMCI), and 95 patients with mild Alzheimer's disease (AD) who received an education of junior high school or above and were evaluated by neuropsychological tests including mini mental state examination ( MMSE), auditory verbal memory test, Huashan Naming tests etc.8 cognitive tests.The groups of MCI and AD patients finished cranial MRI.100 items with HNT including 20 animals,10 vegetables,10 fruits ,20 tools ,20 household , 10 vehicles, 10 stationery.Results 1.HNT items to determine: 22 items were excluded due to the completion of the three groups were not significantly different; 8 items were excluded due to the completion of the normal elderly group was lower than 75%; 10 items were excluded from the analysis of variance Fvalue of the minimum value.The remaining 60 items,according to the size of the arrangement and completion rates were divided into two versions of odd and even, respectively HNT-Ⅰ and HNT-Ⅱ.2.HNT characteristics:in normal elderly group age, sex were found to had no significant factors affecting overall scores of HNT-Ⅰ and HNT-Ⅱ but level of education, MMSE score was significantly correlated (P ＜0.05).As cut-off score ≤ 26 for spontaneous naming of HNT,the sensitivities of HNT-Ⅰ for aMCI ,mild AD were 44%, 84% respectively, specificities were all around 84%; the sensitivities of HNT-Ⅱ for aMCI , mild AD were 56% ,83% respectively,specificities were all around 80%.Conclusion HNT is a Chinese cultural background,time-consuming short and good name validity test,and it is worth further promoting the application.

MR diffusion tensor imaging voxel-based analysis of whole brain white matter in patients with amnestic-type mild cognitive impairment and mild Alzheimer disease / 中华放射学杂志

Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.

Visuospatial-visuoconstructional ability in mild cognitive impairment / 中华神经科杂志

Objective To investigate visuospatial-visuoconstructional ability in patients with mild cognitive impairment(MCI).Methods The subjects were divided into three groups:122(51 males and 71 females)in the normal control group; 205(95 males and 110 females)in the MCI group,including 133 amnestic MCI(aMCI)and 72 non-amnestic MCI(naMCI),and 75(36 males and 39 females)in the Alzheimer' s disease(AD)group.The subjects were assessed for visuospatial-visuoconstructional ability by three tests:Rey-Osterrieth Complement Fixation Test(CFT),Clock Drawing Task(CDT),and Stick Test.Mini-mental State Examination(MMSE)was also performed in all groups.SPSS 11.5 statistical software was used for statistic analysis; Chi-square test was used to analyze enumeration data; One-way analysis of variance was used in pairwise comparison between the groups,and Bonferroni and LSD methods were used for multiple comparison.Results(1)The average MMSE score in the normal control group,MCI group and AD group was 28.24 ± 1.74,27.39 ± 1.83 and 19.98 ±3.23,respectively.(2)In the normal control group,either CFT imitating score or total CDT score had no obvious correlation with age or education,while Stick Test-Rotating part(STR)was correlated with age(r =-0.179,P ＜ 0.05),but had no significant correlation with education.(3)There were correlations between CFT imitating score and total CDT score (r =0.337),CFT imitating score and STR(r =0.232),and total CDT score and STR(r =0.235).The correlations were statistically significant(P ＜ 0.01).(4)CFT imitating and total CDT showed the greatest correlation with Trail Making Test B and Stroop Color Word Test Card C time consumption,an indicator of executive function.STR had greatest correlation with Auditory Verbal Learning Test,an index of memory.There were significant differences in CFT imitating,total CDT score and STR among the normal,MCI and AD groups(P ＜ 0.01).(5)STR is a more informative test to be used in diagnosis of MCI than CFT imitating and total CDT score,as shown by comparison of these tests in three subjects groups.Conclusion Visuospatial-visuoconstructional ability impairment is one of the symptoms of MCI.In detection of MCI,the assessment of space rotating ability is better than CFT imitating and total CDT score.

Longitudinal study of two subtypes of mild cognitive impairment / 中华神经科杂志

Objective To investigate the conversion rate of subtypes of amnestic mild cognitive impairment (aMCI) to Alzheimer' s disease (AD) and assess the contribution of neuropsychological disturbance in progression from MCI to AD over 2 years. Method Subjects from memory clinic of Huashan hospital including 130 of who met the operational criteria for Mayo Clinic defined aMCI by neuropsychological tests covering global cognitive function, executive function, memory function, language function and visual spatial skills. They underwent multidimensional assessment and a neuropsychological battery at baseline and at follow-up, after about 2 years. Diagnosis for dementia was based on National Institute of Neurological and Communicative Disorders and Stroke; Alzheimer' s Disease and Related Disorders Association (NINCDS-ADRDA) criteria. Results Forty-four cases of 130 (33. 8% ) elder people with aMCI converted to probable AD with 17 aMCI-s and 27 aMCI-m subjects within an average 23.8 (6. 8 ) months. There was significant difference between the reversion rate of aMCI-s and aMCI-m (26. 2% vs 42. 9%, x2 = 3.957,P = 0. 047). Moreover, as the disease progressing,the two groups declined similarly in memory and executive function while in the aMCI-s group, the function of spatial structure relatively reserved in aMCI-s but function of language and attention diminished faster, and in the aMCI-m group, the ability of spatial structure declined even more significantly. Conclusion The aMCI-m is more likely to progress to AD than aMCI-s and it' s necessary to divide aMCI into aMCI-s and aMCI-m to help determine prognosis.

Executive dysfunction in different subtypes of vascular cognitive impairment / 中华神经科杂志

Objective To investigate the executive function features of different subtypes of vascular cognitive impairment (VCI). Methods Sixty-four subjects with subcortical ischaemic vascular disease (SIVD) presumed by medical history and neuroimaging (cranial MRI) were recruited. The clinical and neuropsychological features of the 4 groups were compared: cognitive normal control (n=25), simple executive impairment of VCI-ND (s-VCI-ND, n=16), multi-domain impairment of VCI-ND (m-VCI-ND, n=26) and vascular dementia (VaD) patients (n=22). All participants underwent neuropsychological tests covering global cognitive function, executive function, memory function, language function and visual spatial skills. The executive tests included 15 independent subtest reflect set shifting, inhibition of prepotent responses, working memory, concept formation and fluency. Results Tower of Hanoi, self ordered pointing test and paced auditory serial addition test were not suitable for identification of VCI-ND because their finish rates were less 50%. Performance of trail making test (216.5±69.3 vs 137.4±37.9), Stroop color words test (115.4±30.1 vs 72.9±17.5), California cards sorting test-Chinese version (1.9±1.4 vs 2.7±1.2)and animal category fluency test(14.2±2.3 vs 17.7±4.4) had significant difference between s-VCI-ND group and cognitive normal control group (t=4.73, 5.72, 2.04 and 3.53, all P<0.05) and these tests were applicable and sensitive assessment tools in all executive tests. Time-consuming index showed more sensitivity than correct index in executive function. Neuropsychological deficits of m-VCI-ND patients showed lower than that of s-VCI-ND group and better than that of VaD patients. It was likely that the m-VCI-ND was a transition state between normal aging and VaD. Conclusion Executive dysfunction of VCI caused by SIVD is short of specificity. Some tests may appear earlier in screening of VCI-ND.

Prevalence of dementia in diabetics: a community-based case-control study / 中华神经科杂志

Objective To determine prevalence of dementia in diabetics and non-diabetics, and in different age and gender groups. Methods A case-control study was conducted among participants aged 50 and over in Jing' an temple community in Shanghai. Subjects in diabetics group were matched to non-diabetics groups for age and sex with 1:1 matching. Personal information and case history were collected through questionnaire. The subjects were screened for dementia using the Mini Mental State Examination (MMSE). Subjects that screened positively (indicated by an MMSE score below 19, 21 and 24 among those with illiteracy, elementary school and above junior middle school education, respectively) were subsequently examined by a series of neuropsychological tests. Based on all available information, a diagnosis of dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders ( DSM )-Ⅳ criteria Results Prevalence of dementia of 4. 75% (23/484, 95% CI: 3. 03%-7.04%) in diabetics was higher than that of 2. 24% (11/490,95% CI: 1.13% -3.98%) in non-diabetics (X~2 = 4.54, P=0.03).Prevalence of dementia among diabetics in age groups of 60-69, 70-79 and 80 and above was 1.94% (2/103), 4. 43 % (9/203) and 14.12% (12/85, trend X~2 =18.04, P <0.01), and in non-diabetics was 1.43% (2/140), 2. 86% (6/210) and 5.00% (3/60, trend X~2 = 4.58, P=0.03), respectively.Prevalence of dementia among female and male in diabetics was 6.55% (19/299) and 2.06% (4/194) (X~2 = 5.18, P = 0.02), respectively, and in non-diabetics was 3.01% (9/299) and 1.05% (2/191).Conclusions Prevalence of dementia is significantly higher in diabetics than in non-diabetics, higher in women than men, and increases as age rises.

A study of validity of a new scoring system of clock drawing test / 中华神经科杂志

Objective To set up and verify a new scoring system of clock drawing test(CDT).Methods CDT and other neuropsychological tests were applied to 180 normal individuals.170 subjects with mild cognitive impairment(MCI),and 31 patients with mild Alzheimer's disease(AD).The first step of the 30-score system of CDT was to anchor the 4 points of"12-3-6-9".totaling a score of 4 which was the "30-score system A(Anchoring)part";and the other 13 items reflecting the drawing results and totaling a score of 26 made up the so called"30-score system C(Clockfaee)part".the two together had a total score of 30.Thirty-eight subjects underwent Xe-enhanced computed tomography(Xe-CT)scanning for quantitively measuring regional cerebral blood flow(rCBF)of 26 regions of brain.Results Correlations coefficients of the scores of 14 items with the total score in 30-score system of CDT were in the range of 0.48to 0.71(P＜0.01).30-score system C part was closely correlated with indicators of visuospatial and executive function,while 30-score system A part with memory indicators.The sensitivity and specificity of the 30-score system A part score≤2 for detecting MCl were 70.6%and 73.9%.respectively.The sensitivity the specificity of 30-score system C part score≤17 for mild AD were 75.3%and 75.9%.respectively.In the regression equation of 30-score system A and C part.the combined independent variables were the CBF of left frontal cortex and right white matter,respectively.Conclusion The 30-score system A and C part have difierent meanings:30-score system C part could be used to identify AD while 30-score system A part is helpful for identiring MCI.