Abstract
Dementia is a clinical diagnosis characterized by a progressive deterioration in cognitive function. The most common type of dementia is Alzheimer's disease (AD). The aim of this study is to evaluate the possible relation and correlation between comprehensive geriatric assessment tests, metabolic function of brain determined by positron emission tomography (FDG PET CT) and volumetric analysis and atrophy symmetry measured by magnetic resonance imaging (MRI) in AD patients. 37 patients who had diagnosis of AD and admitted to Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Geriatrics between 1 November 2012 and 1 November 2015 included. In addition to baseline demographic, clinical and laboratory characteristics, comprehensive geriatric assessment tests, metabolic measurements in 8 different localization by using FDG PET CT in all patients and volumetric analysis in 14 different regions by using cranial MRI in 16 patients were performed. Moderate to severe hypometabolic activity was most frequently observed in left temporal lobe (37 patients, 43,2% of all population). Thereafter, right temporal lobe (37,8%) and right and left parietal lobes (32,4%) followed left temporal lobe. On the other hand, normal metabolic activity was most frequently seen in right frontal lobe (75,7%). In 16 patients, mean ± SD right hippocampal volume was 3128,1 ± 732,2 mm3, mean ± SD left hippocampal volume was 3088,8 ± 791,5 mm3 and mean ± SD total hippocampal volume 6217,0 ± 1459,2 mm3. MOCA was found to be significantly lower in patients with moderate to severe hypometabolism in left temporal, right and left parietal lobes than that of mild hypometabolic and normometabolic patients (p = 0,033, p = 0,032 and p = 0,028). In patients with moderate to severe hypometabolism in right parietal, forward digit span test was found to be lower (p = 0,031) and geriatric depression scale was found to be higher (p = 0,023). There was no relationship between prekuneal and frontal hypometbolism and comprehensive geriatric assessment tests. It was also not found any relationship between hypometabolic status and volumetric analysis except right precuneal hypometabolism and left entorhinal cortex volume. Similarly, there was no significant relation between atrophy symmetry in MRG, volumetric analysis and comprehensive geriatric assessment tests. In correlation analysis, there were significant and negative correlations between right temporal lobar hypometabolism and forward digit span test (r = -0,304, p = 0,047) , mini mental state examination test (MMSE) (r = -0,301, p = 0,048) and MOCA (r = -0,296, p = 0,050); between left temporal lobar hypometabolism and forward digit span test (r = -0,324, p = 0,050), three word recall test (r = -0,369, p = 0,025), MMSE (r = -0,394, p = 0,016) and MOCA (r = -0,353, p = 0,032); between right parietal lobar hypometabolism and forward digit span test (r = -0,427, p = 0,008), perseveration (r = -0,360, p = 0,029), MMSE (r = -0,324, p = 0,050) and MOCA (r = -0,433, p = 0,007); left parietal lobar hypometabolism and forward digit span test (r = -0,377, p = 0,021), MMSE (r = -0,325, p = 0,047) and MOCA (r = -0,439, p = 0,007) and between both right and left prekuneal hypometabolism and MMSE (r = -0,356, p = 0,031 and r = -0,332, p = 0,044, respectively). There were significant and negative correlations between left temporal hypometabolism and left hippocampal (r = -0,420, p = 0,005) and total hippocampal (r = -0,254, p = 0,017); between right prekuneal hypometabolism and total hippocampal (r = -0,410, p = 0,005) and right parahippocampal (r = -0,435, p = 0,007) and between left prekuneal hypometabolism and total hippocampal (r = -0,406, p = 0,008) and right parahippocampal (r = -0,439, p = 0,007) volume. In conclusion, this study showed the relationship between 14 different geriatric assessment tests, hypometabolic activity of 8 different anatomic localizations and volumetric analysis of 14 different brain regions.
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