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P2‐426: The neuroanatomical substrates for neuropsychiatric symptoms in dementia: The analysis of Korean neuropsychiatric inventory(NPI‐K) subitems using neuroimage
Author(s) -
Park Jinseok,
Kim Hee-Jin,
Kim Seung Hyun
Publication year - 2010
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2010.05.1479
Subject(s) - irritability , apathy , dementia , hyperintensity , neuropsychology , frontotemporal dementia , vascular dementia , white matter , psychology , medicine , psychiatry , magnetic resonance imaging , cardiology , anxiety , disease , radiology , cognition
Background: Several reports of PIB-PET images of patients with early onset Alzheimer disease (AD) with presenilin-1 (PREN1) mutation have been published. However the association between clinical symptoms and the PIB-PET images has not been investigated enough. We have been following clinical symptoms of an early onset AD patient (female, 40 years old) with a mutation (Met233Leu) of PREN 1, and reported that early onset AD patients with the same mutation could not necessarily show the same phenotype. Methods: We comprehensively performed neuropsychological tests, neurological examinations and genetic examinations. In addition, we performed brain MRI and cerebral blood perfusion SPECT, and statistically analyzed MRI data using VSRAD and SPECT data using 3DSSP. Two years later, moreover, in addition to brain MRI, we performed PIB-PET, FDG-PET, and IMP-SPECT (with ARG method), and analyzed the images with NEURO FLEXER. Results: She showed severe impairments of memory and visual-spatial perception. However, her recognition and memory of human faces were relatively reserved. Additionally, unlike the cases of the same mutation reported before, she had none of the core features of FTD; social unawareness or impropriety, abnormal personal regulation or apathy, emotional blunting, loss of empathy, and decreased insight. Her neurological tests revealed no abnormalities, including myoclonus, seizures, or spasticity. Her EEG showed slight abnormalities. Her brain MR images showed no remarkable atrophy in all regions including hippocampus and parietal lobe. The 3DSSP showed remarkable regional hypoperfusion in the lateral frontal, parietal, precuneus, and posterior cingulated gyrus, but no hypoperfusion in the hippocampal, parahippocampal, and orbital gyri. FDG uptake was observed in the occipital, parietal, frontal cortex, the cerebellum, and the basal ganglia. PIB retention was observed especially in the occipital, parietal, frontal, temporal cortex, and the basal ganglia. MR, IMP-SPECT, FDG-PET, and PIB-PET images showed an atypical pattern, compared with typical late onset AD patients. Conclusions: The patterns of the images of both FGD-PET and IMP-SPECT might be associated with clinical symptoms. However the pattern of images of PIB-PET could be consistent with neither the images of FDG-PET nor those of IMP-SPECT, from the point of view of the amyloid cascade hypothesis.