PDF herunterladen
Nuklearmedizin 1993; 32(03): 128-133
DOI: 10.1055/s-0038-1629660
Originalarbeiten
Schattauer GmbH

HMPAO-SPECT bei Demenz vom Alzheimer-Typ und Major Depression mit mnestischen Störungen

HMPAO-SPECT in Dementia of the Alzheimer Type and Major Depression with Memory Impairment
F. Grünwald
1   Aus der Klinik für Nuklearmedizin Universität Bonn, FRG
,
R. Horn
2   der Psychiatrischen Klinik der Universität Bonn, FRG
,
O. Rieker
1   Aus der Klinik für Nuklearmedizin Universität Bonn, FRG
,
E. Klemm
1   Aus der Klinik für Nuklearmedizin Universität Bonn, FRG
,
C. Menzel
1   Aus der Klinik für Nuklearmedizin Universität Bonn, FRG
,
H.-J. Möller
2   der Psychiatrischen Klinik der Universität Bonn, FRG
,
H.-J. Biersack
1   Aus der Klinik für Nuklearmedizin Universität Bonn, FRG
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Eingegangen: 07. Dezember 1992

Publikationsdatum:
03. Februar 2018 (online)

    Lizenzen und Reprints

Zusammenfassung

Ziel der vorliegenden Untersuchung war es, zu prüfen, ob die HMPAO-SPECT zur Differenzierung zwischen der Demenz vom Alzheimer-Typ (DAT) und der Major Depression (MD) beitragen kann. Es wurden ECT-Befunde von 77 Patienten mit Gedächtnisstörungen beurteilt, davon hatten 48 eine DAT und 29 eine MD. Zunächst wurden die Defekte in der SPECT einer Hirn-Region zugeordnet und der Grad der Ausprägung (-1/-2/-3) bewertet. Anschließend wurden die einzelnen Befunde in eine von 7 Befundkategorien eingeordnet. In einigen dieser 7 Gruppen ergaben sich deutliche Häufungen der Fälle mit DAT bzw. MD. 35% aller DAT-Patienten wiesen bilaterale Defekte mit deutlicher (>-1) parietaler/parietotemporaler Minderperfusion auf, dagegen zeigte kein Patient mit MD dieses Muster. Unilaterale Defekte wiesen 62% der MD-, aber nur 31% der DAT-Patienten auf. Die Untersuchung zeigt, daß nur 35% der Patienten mit DAT das bislang als »pathognomonisch« bezeichnete Befundmuster aufwiesen. Dieses Perfusionsmuster kann aber - wenn es vorliegt - als sicheres Kriterium zur Abgrenzung gegen eine MD gewertet werden. Darüber hinaus lassen sich keine eindeutigen (»krankheitstypischen«) Perfusionsmuster erkennen, wenngleich unilaterale Defekte mehr auf eine MD hindeuten.

Summary

The aim of the present study was to see whether HMPAO-SPECT may contribute to the differentiation between dementia of the Alzheimer type (DAT) and major depression (MD). The results in 77 patients with memory impairment were evaluated. 48 patients suffered from DAT and 29 from MD. Initially, the defects in SPECT imaging were attributed to a cerebral region and the degree of decrease was evaluated (-1/-2/-3). Thereafter, the results were classified by 7 categories. In some of these categories an accumulation of cases of either DAT or MD was found. 35% of the patients suffering from DAT had bilateral defects with distinct (>-1) parietal/parietotemporal hypoperfusions, but no patient with MD showed this perfusion pattern. 62% of the patients with MD had unilateral defects but only 31% of the patients with DAT. The present study demonstrates that only 35% of all patients suffering from DAT show a perfusion pattern, thought earlier as “pathognomonic” for this disease. This perfusion pattern - if it exists - may be used as a safe criterion to exclude MD. Beyond that no clearcut (“specific”) perfusion pattern may be recognized but unilateral defects point to MD.

Schlüsselwörter

Gedächtnisstörungen - Demenz - Depression - HMPAO - SPECT

Key words

Memory impairment - dementia - depression - HMPAO - SPECT
 

  • LITERATUR

  • 1 American Psychiatric Association: Diagnostic and statistical manual of mental disorders DSM-IIIR (third edition). Washington: 1987
    Google Scholar
  • 2 Biill U, Braun H, Ferbert A. et al. Combined SPECT imaging of regional cerebral blood flow (99mTc-hexarnethyl-propyleneamine oxime, HMPAO) and blood volume (99mTc-RBC) to assess regional cerebral perfusion reserve in patients with cerebrovascular disease. Nucl-Med 1988; 27: 51-6.
    Google Scholar
  • 3 Büll U, Costa DC, Kirsch G. et al. The investigation of dementia with single photon emission tomography. Nucl Med Commun 1990; 11: 823-41.
    PubMedGoogle Scholar
  • 4 Deisenhammer E, Rcisecker F, Leblhuber F. et al. Single-Photon-Emissions-Computertomographie bei der Differentialdiagnose der Demenz. Dtsch Med Wschr 1989; 114: 1639-44.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Delcourt K, Binon JP, Detourtchaninoff M, Jacquy J. Abnormalities of left to right regional cerebral blood flow in depressed patients. Eur J Nucl Med 1988; 14: 309.
    Google Scholar
  • 6 Devous MD, Stokely EM, Bonte FJ. Quantitative imaging of regional cerebral blood flow in man by dynamic single photon tomography. In: Holman BL. eds. Radionuclide imaging of the brain. London: Churchill-Livingston; 1985: 135-62.
    Google Scholar
  • 7 Domper M, Arbizu J, Garcia MJ. et al. Semiquantitative analysis of brain SPECT. Evaluation of different indexes in Alzheimer’s disease. Eur J Nucl Med 1991; 18: 597.
    Google Scholar
  • 8 Ebert D, Feistei H, Barocka A. Effects of sleep deprivation on the limbic system and the frontal lobes in affective disorders: a study with Tc-99m-HMPAO SPECT. Psychiat Res Neuroimaging 1991; 40: 247-51.
    Google Scholar
  • 9 Fazekas F, Alavi A, Chawluk JB. et al. Comparison of CT, MR, and PET in Alzheimer’s dementia and normal aging. J Nucl Med 1989; 30: 1607-15.
    PubMedGoogle Scholar
  • 10 Folstein MF, Folstein SE, McHugh PR. “Mini Mental State” A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975; 12: 189-98.
    CrossrefPubMedGoogle Scholar
  • 11 Foster NL, Chase TN, Fedio P. et al. Alzheimer’s disease: focal cortical changes shown by positron emission tomography. Neurology 1983; 33: 961-5.
    CrossrefPubMedGoogle Scholar
  • 12 Fukuyama H, Harada K, Yamauchi H. et al. Coronal reconstruction images of glucose metabolism in Alzheimer’s disease. J Neurol Sci 1991; 106: 128-34.
    CrossrefPubMedGoogle Scholar
  • 13 Gemmell HG, Sharp PF, Besson JAO. et al. Differential diagnosis in dementia using the cerebral blood flow agent 99mTc HM-PAO. A SPECT study. J Comput Assist Tomogr 1987; 11: 398-402.
    CrossrefPubMedGoogle Scholar
  • 14 Grünwald F, Zierz S, Broich K. et al. HMPAO-SPECT imaging resembling Alzheimer-type dementia in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). J Nucl Med 1990; 31: 1740-2.
    PubMedGoogle Scholar
  • 15 Grünwald F, Broich K, Hartmann A. et al. Nuklearmedizinische Diagnostik der Demenz vom Alzheimer-Typ. Dtsch Med Wschr 1988; 113: 208-12.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Habert MO, Spampinato U, Mas JL. et al. A comparative technetium 99m hexamethyl-propylene amine oxime SPET study in different types of dementia. Eur J Nucl Med 1991; 18: 3-11.
    CrossrefPubMedGoogle Scholar
  • 17 Hachinski VC, Iliff LD, Chiak E. et al. Cerebral blood flow in dementia. Arch Neurol 1975; 32: 632-7.
    CrossrefPubMedGoogle Scholar
  • 18 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiat 1960; 23: 56-62.
    CrossrefPubMedGoogle Scholar
  • 19 Hoffmann JM, Hanson MW, Earl NL, Coleman RE. Beware the classic FDG-PET pattern of Alzheimer’s disease. J Nucl Med 1990; 31: 740.
    Google Scholar
  • 20 Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A. The scintigraphic appearance of Alzheimer’s disease: a prospective study using technetium-99m-HMPAO SPECT. J Nucl Med 1992; 33: 181-5.
    PubMedGoogle Scholar
  • 21 Horn R, Broich K, Grünwald F, Möller HJ. HMPAO-SPECT findings in various states of dementia of Alzheimer’s disease. Clin Neuropharm 1992; J5 (Suppl.1) 471B.
    Google Scholar
  • 22 Horn R, Erkwoh R, Broich K. et al. Contribution of HM-PAO-SPECT and 133XerCBF to the differential diagnosis of dementia as experienced in clinical practice. In: Hartmann A, Kuschinsky W, Hoyer S. eds. Cerebral ischemia and dementia. Berlin - Heidelberg: Springer; 1991: 316-21.
    Google Scholar
  • 23 Hurwitz TA, Ammann W, Chu D. et al. Single photon emission computed tomography using 99mTc-HM-PAO in the routine evaluation of Alzheimer’s disease. Can J Neurol Sci 1991; 18: 59-62.
    CrossrefPubMedGoogle Scholar
  • 24 Jobst KA, Smith AD, Shepstone BJ. et al. Ante mortem diagnosis of Alzheimer’s disease using a combination of CT scan and SPET scan measures: a study with post mortem confirmation. Eur J Nucl Med 1992; 19: 616.
    Google Scholar
  • 25 Klemm E, Grünwald F, Overbeck B. et al. HMPAO-SPECT in schizophrenia and depression. J Nucl Med 1992; 33: 972.
    Google Scholar
  • 26 Kuhs H. Depression und Demenz. Dtsch Arztebl 1992; 89: 1585-8.
    Google Scholar
  • 27 Kurz A, Haupt M, Romero B. et al. Kognitive Störungen bei Depression oder beginnende Alzheimersche Krankheit? Ein Beitrag zur Differentialdiagnose. Z Geronto-psychol Psychiat 1991; 04: 35-40.
    Google Scholar
  • 28 Kuwabara Y, Ichiya Y, Otsuka M. et al. Differential diagnosis of bilateral parietal abnormalities in 1-123 IMPF SPECT imaging. Clin Nucl Med 1990; 15: 893-9.
    CrossrefPubMedGoogle Scholar
  • 29 Loewenstein DA, Barker WW, Chang J. et al. Predominant left hemisphere metabolic dysfunction in dementia. Arch Neurol 1989; 46: 146-52.
    CrossrefPubMedGoogle Scholar
  • 30 Mignecq O, Darcourt J, Aubin V. et al. Major role of right temporal lobe (RT) involvement in Alzheimer type dementia (ATD). Eur J Nucl Med 1991; 18: 570.
    Google Scholar
  • 31 Miller BL, Lesser iM, Mena I. et al. Regional cerebral blood flow in late-life-onset psychosis. Neuropsychiat Neuropsychol Behav Neurol 1992; 05: 132-7.
    Google Scholar
  • 32 Miller BL, Mena I, Daly J. et al. Temporalparietal hypoperfusion studied with singlephoton emission computerized tomography in conditions other than Alzheimer’s disease. Dementia 1990; 01: 41-5.
    Google Scholar
  • 33 O’Connell RA, van Heertum RL, Billick SB. et al. Single photon emission computed tomography (SPECT) with 123I-IMP in the differential diagnosis of psychiatric disorders. J Neuropsych 1989; 01: 145-53.
    Google Scholar
  • 34 O’Connell RA, van Heertum RL, Holt AR. et al. Single photon emission computed tomography (SPECT) in psychiatry. Clin Nucl Med 1987; 12 (Suppl. 13) 9.
    CrossrefPubMedGoogle Scholar
  • 35 Okazaki Y, Hashikawa K, Tanabe H. et al. Significance of measurement of hippocampal blood flow in the diagnosis of Alzheimer disease: survey by means of SPECT images longitudinally parallel to the hippocampus. J Nucl Med 1992; 33: 940.
    Google Scholar
  • 36 Perani D, DiPiero V, Vallar G. et al. Technetium-99m-HM-PAO-SPECT study of regional cerebral perfusion in early Alzheimer’s disease. J Nucl Med 1988; 29: 1507-14.
    PubMedGoogle Scholar
  • 37 Podreka I, Suess E, Brücke T. et al. SPECT-Untersuchungen mit 99mTc-Hexamethyl-Propylen-Amin-Oxim (99mTc-HMPAO) beim Parkinson-Syndrom und bei Demenz. Nucl-Med 1987; 26: 96-9.
    Google Scholar
  • 38 Prohovnik G, Alexander E, Tatemichi TK, Mayeux R. Exploring the nature of the parietotemporal perfusion deficit in Alzheimer’s disease. J Cereb Blood Flow Metab 1991; (Suppl. 02) 11: 179.
    Google Scholar
  • 39 Rush AJ, Schlesser MA, Stokely EM. et al. Cerebral blood flow in depression and mania. Psychopharmacol Bull 1982; 18: 6-8.
    PubMedGoogle Scholar
  • 40 Van Heertum RL, O’Connell RA. The evaluation of psychiatric diseases with IMP cerebral SPECT imaging. Adv Function Neuroimaging 1988; 01: 4-11.
    Google Scholar
  • 41 Weinstein HC, van Gool WA, Hijdra A, van Royen EA. Effect of cerebral atrophy on semiquantitative analysis of SPECT in Alzheimer’s disease. Eur J Nucl Med 1990; 16: 523.
    Google Scholar
  • 42 Wellman HN, Kapuscinski A, Mock BH. et al. Clinical application of single-photonemission computed tomography studies in dementia. Am J Physiol Imag 1988; 03: 61-2.
    Google Scholar
  • 43 Yazici K, Kapucu LÖ, Erbas B. et al. A preliminary report of a study on regional cerebral blood flow changes in major depressive patients using 99mTc-HMPAO/ SPECT. Eur J Nucl Med 1991; 18: 611.
    Google Scholar
  • 44 Yessavage JA, Brink TL, Rose TL. et al. Development and validation of a new geriatric depression rating scale: preliminary report. J Psychiat Res 1983; 17: 37-49.
    Google Scholar
  • 45 Zimmer R, Lauter H. Zum Problem der depressiven Pseudodemenz. Z Gerontol 1984; 17: 109-12.
    PubMedGoogle Scholar
  • 46 Zimmer R, Rädler T, Schmauss F, Gebhardt U. Die diagnostische Relevanz der Hirndurchblutungsmessung mittels HMPAO-SPECT bei der Alzheimerschen Krankheit. Fortschr Neurol Psychiat. 1992. 60 (suppl 2) 231-2.
    Google Scholar