Comparative assessment of cerebral perfusion and metabolism in patients with Alzheimer’s disease and vascular cognitive disorders

Andrey Y. Emelin; Емелин Андрей Юрьевич; Igor' V. Boykov; Бойков Игорь Валерьевич; Vladimir Y. Lobzin; Лобзин Владимир Юрьевич; Kristina A. Kolmakova; Колмакова Кристина Андреевна; Konstantin M. Naumov; Наумов Константин Михайлович; Pavel S. Dynin; Дынин Павел Сергеевич; Ivan A. Lupanov; Лупанов Иван Александрович

doi:10.17816/rmmar501788

Comparative assessment of cerebral perfusion and metabolism in patients with Alzheimer’s disease and vascular cognitive disorders

作者: Emelin A.Y.¹, Boykov I.V.¹, Lobzin V.Y.¹, Kolmakova K.A.¹, Naumov K.M.¹, Dynin P.S.¹, Lupanov I.A.¹
隶属关系:
1. Military Medical Academy
期: 卷 42, 编号 4 (2023)
页面: 391-402
栏目: Original articles
URL: https://bakhtiniada.ru/RMMArep/article/view/264750
DOI: https://doi.org/10.17816/rmmar501788
ID: 264750

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BACKGROUND: The high medical and social significance of the problem determines the necessity of the earliest nosological diagnostics of the cognitive disorders. Functional neuroimaging methods such as single-photon emission computed tomography and positron emission tomography play an important role in the early differential diagnosis, allowing to estimate perfusion and metabolism of the cerebral tissue.

AIM: To perform a comparative analysis of perfusion and metabolic abnormalities in different cerebral structures of patients with Alzheimer’s disease and vascular cognitive disorders in small cerebral vessels disease.

MATERIALS AND METHODS: Single-photon emission computed tomography was performed in 13 patients with Alzheimer’s disease and in 21 patients with vascular cognitive disorders; positron emission tomography with 18F-FDG was performed in 17 patients with Alzheimer’s disease and in 15 patients with vascular cognitive disorders.

RESULTS: Patterns of perfusion and metabolic abnormalities differ in patients with Alzheimer’s disease and vascular cognitive disorders. In patients with vascular cognitive disorders due to cerebral small vessels disease, a distinctive feature was a combination of hypoperfusion in subcortical structures, especially in the caudate nucleus and thalamus, with hypoperfusion in the deep parts of the frontal lobe. In Alzheimer’s disease, bilateral pronounced perfusion abnormalities in the parietal and temporal cortex were the most characteristic. Patterns of metabolic disturbances were similar to patterns of perfusion disturbances in different variants of cognitive disorders, but metabolic disturbances were more widespread. Рositron emission tomography was more informative in diagnosing patients with Alzheimer’s disease compared to single photon emission computed tomography. More pronounced perfusion and metabolic disorders were observed in patients with more severe cognitive disorders. Perfusion disturbances in the area of subcortical structures can be considered as an early marker of cognitive impairment development in patients with small vessel disease.

CONCLUSION: Single photon emission computed tomography has sufficient sensitivity and specificity when examining patients with vascular cognitive disorders, while positron emission tomography is more preferable when examining patients with Alzheimer-type dementia.

关键词

Alzheimer’s disease, small vessel disease, dementia, Alzheimer-type dementia, metabolism, neuroimaging, single photon emission computed tomography, perfusion, positron emission tomography, vascular cognitive disorders, vascular dementia

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M.D., Ph.D. (Medicine)

俄罗斯联邦, Saint Petersburg

参考

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2. Fig. 1. SPECT with 99mTs-HMPAO. Disease of small vessels of the brain. Subcortical vascular dementia of moderate severity. Multiple bilateral zones of pronounced decrease in cerebral perfusion in the projection of the thalamus, basal ganglia (shown by arrows)

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3. Fig. 2. SPECT with 99mTs-HMPAO. Dementia of the Alzheimer's type is mild. Bilateral hypoperfusion of the temporal cortex (shown by arrows)

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4. Fig. 3. PET with 18F-FDG. Disease of small vessels of the brain. Subcortical vascular dementia of moderate severity. Multiple “mosaic zones” of disturbances in the accumulation of radiopharmaceuticals in the projection of the basal ganglia with uneven hypometabolism of the cortex of the frontal, temporal and parietal lobes (shown by arrows)

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5. Fig. 4. PET with 18F-FDG. Alzheimer's type dementia of moderate severity. A - axial section, B - coronal section. Bilateral hypometabolism of the cortex of the parietal and temporal lobes (shown by arrows)

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