The progression of cognitive deterioration and regional cerebral blood flow patterns in Alzheimer's disease: a longitudinal SPECT study.
OBJECTIVE
The progression of cognitive deterioration in patients with Alzheimer's disease (AD) is considerably variable. The ability to predict the progression rate is important for clinicians to treat and manage patients with AD. We examined the possible relationship between the rate of cognitive deterioration and regional cerebral blood flow (rCBF) patterns in patients with AD.


METHODS
We followed 48 patients with AD for an average of 37 months. They were subsequently divided into the rapidly progressing group (n=24) and slowly progressing group (n=24) based on an annual Mini-Mental State Examination (MMSE) score change. Initial and follow-up rCBF were assessed using single photon emission CT (SPECT) and the SPECT data were analyzed by 3D-stereotactic surface projections.


RESULTS
At initial evaluation, the rapidly progressing group had greater rCBF deficits mainly in the parietotemporal and frontal regions, and left posterior cingulate than did the slowly progressing group. When compared with initial SPECT, follow-up SPECT showed a significant rCBF reduction in widespread regions, including parietotemporal and frontal lobes, of the rapidly progressing group, while showed in the scattered and small regions of hemispheres of the slowly progressing group.


CONCLUSIONS
Our longitudinal SPECT study suggests a significant association between rCBF deficits in the parietotemporal, posterior cingulate, and frontal regions and subsequent rapid cognitive and rCBF deterioration.
Hanyu
Haruo
H
Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan. h-hanyu@tokyo-med.ac.jp
Sato
Tomohiko
T
Hirao
Kentaro
K
Kanetaka
Hidekazu
H
Iwamoto
Toshihiko
T
Koizumi
Kiyoshi
K
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D001931:Brain Mapping; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002800:Cholinesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003072:Cognition Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D004185:Disability Evaluation; D018450:Disease Progression; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000494:pharmacology / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil