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研究生:廖羚雅
研究生(外文):Ling-YaLiao
論文名稱:以像素型態與一年追蹤分析探討早發型阿茲海默氏症患者空間表徵轉換能力衰退型態
論文名稱(外文):The declined pattern of spatial representation translationin young onset Alzheimer’s Disease.Using voxel-based morphometry and one-year follow-up analysis
指導教授:白明奇白明奇引用關係柯慧貞柯慧貞引用關係
指導教授(外文):Ming-Chyi PaiMing-Chyi Pai
學位類別:碩士
校院名稱:國立成功大學
系所名稱:行為醫學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:85
中文關鍵詞:早發型阿茲海默氏症後壓部皮質空間表徵轉換像素型態分析
外文關鍵詞:young onset Alzheimer’s diseaseretrosplenial cortexspatial representationvoxel-based morphometry
相關次數:
  • 被引用被引用:1
  • 點閱點閱:191
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  • 下載下載:16
  • 收藏至我的研究室書目清單書目收藏:0
背景與目的:空間表徵轉換(translation of spatial representation, TSR) 能力是認路的重要認知功能,過去研究發現TSR在早發型阿茲海默氏症(Young- onset Alzheimer’s disease, YOAD) 患者,相較於同年齡控制組明顯退化嚴重,推測YOAD掌管TSR的後壓部皮質(Retrosplenial cortex, RSC) 腦區退化較晚發型AD (Late-onset AD, LOAD) 嚴重。本研究進一步分析不同發病年齡AD之結構性核磁共振造影(MRI),於RSC及全大腦灰質的組織概率圖像(TPMs) 退化的程度,並探究一年後(2010-2011年) 參與者於TSR表現退化程度。最後,分析灰質TPMs與TSR各分測驗之間相關程度。
方法:邀請AD及其配偶與社區年齡配對控制組參與者,進行神經心理功能評估及本實驗室設計之TSR作業(Pai & Yang, 2012),使用電腦化作業及參與者住家熟悉地點素材,並比較參與2010與2011實驗一年追蹤結果。並取得部分AD病人結構性3D細切MRI,以像素型態方法(voxel-based morphometry, VBM) 比較不同發病年齡AD於RSC及全腦灰質退化程度。最後,相關程度則使用Spearman相關分析及淨相關分析。
結果:共76人完成本研究,其中AD組42人(LOAD 20人、YOAD 22人),同齡控制組34人(ONC 16人、YNC 18人);YOAD之TSR表現顯著較YNC差,LOAD僅在反應時間較ONC慢。參與一年追蹤共30人(AD組21人、NC組9人);部分TSR作業四組參與者均退步,但YOAD在認知功能及TSR的錯誤數及角度偏離顯著增加,顯示進行表徵之間的轉換的明顯困難。3D細切MRI資料共26筆(YOAD 9人、LOAD 17人),YOAD之RSC灰質TPMs占全大腦總比率略低於LOAD,但未達統計顯著;而全腦灰質退化程度,YOAD在左楔前葉(precuneus) 等腦區有較LOAD顯著的退化。最後,相關分析呈現出兩項TSR作業與RSC的TPMs顯著相關。
結論:本研究提出多重證據證實TSR能力會隨時間退化,而於YOAD更加嚴重。且此TSR能力的退化,同時呈現於RSC與楔前葉等腦區的退化,但此結果仍需近一步探究。
Background and objective:The ability of translating between spatial representations (TSR) in young-onset Alzheimer’s disease (YOAD) patients were found to be worse than late-onset (LOAD) in previous study. TSR ability was believed to be related with the retrosplenial cortex (RSC), which was more damaged in YOAD. This study aimed to see if the TSR ability declined more in YOAD than LOAD after time pass. Moreover, we used brain image to compare the atrophy pattern between AD groups.
Subjects and Methods: We recruited subjects from previous study (Pai & Yang, 2012) and some new subjects. All participants went through neuropsychological tests and TSR tasks. The performance between 2010 and 2011 in different onset age AD groups and the age-matched control groups were compared. Besides, we used voxel-based morphometry (VBM) method to analyze tissue probability maps (TPMs) in gray matter through structure MRI. Finally, correlation analysis was performed to measure the relationship between the TSR and the TPMs outcome.
Results: Total of 76 subjects participated in the study, with 42 AD patients (20 LOAD and 22 YOAD) and 34 normal controls (16 old NC and 18 young NC). Thirty subjects (21 AD and 9 age-matched) participated in one-year follow-up. Cognitive functions and TSR tasks were declined in YOAD than last year and much worse than YNC. Twenty six AD (17 LOAD and 9 YOAD) had MRI scanned. The ratio of TPMs in RSC was lower but in YOAD not statistic significant. And two subtests in TSR were significantly correlated to TPMs in RSC.
Conclusion: The TSR ability in YOAD was dramatically impaired through time pass. The brain image together with the TSR tasks provided the evidence that RSC plays an important role in navigation and everyday living.
目錄
第一章 研究背景 1
第一節 空間表徵轉換能力與認路能力 1
壹、早期動物認路能力之研究 1
貳、近期人類認路能力之研究 2
第二節 掌管認路能力的解剖位置 4
壹、海馬迴與認路障礙 4
貳、後壓部皮質 5
參、後壓部皮質與空間表徵轉換能力 7
第三節 空間表徵轉換能力於早發型阿茲海默氏症 9
壹、受年齡影響之認路能力 9
貳、不同發病年齡之阿茲海默氏症 10
第四節 核磁共振造影的相關研究 13
第五節 研究目的與假設 14
壹、研究目的 14
貳、研究假設 14
第二章 研究方法 15
第一節 研究對象 15
壹、主要實驗參與者 15
貳、一年追蹤參與者 17
參、參與核磁共振造影之參與者 17
第二節研究流程 18
第三節 研究工具 19
壹、神經心理衡鑑工具19
貳、空間表徵轉換作業 25
參、核磁共振影像 33
第四節 統計方法 36
第三章結果 37
第一節 人口學相關資料 37
第二節 基本認知功能與行為實驗結果 39
壹、基本認知功能與視空間知覺測驗 39
貳、空間表徵轉換實驗(TSR) 40
第三節 一年追蹤分析結果 41
壹、人口學相關資料 41
貳、AD病人一年追蹤表現 43
參、AD病人及同齡控制組一年追蹤比較 45
第四節 核磁共振造影結果 51
壹、RSC腦區之灰質TPMs分析結果 51
貳、比較YOAD與LOAD全腦區退化程度 52
第五節 大腦影像與行為實驗之相關性分析 54
第四章討論 55
第一節 基本認知功能與行為實驗結果 55
壹、神經心理測驗與視空間知覺測驗 55
貳、空間表徵轉換作業 56
第二節 一年追蹤分析結果 57
壹、AD病人一年追蹤表現 57
貳、AD病人一年追蹤表現 58
參、AD病人及同齡控制組一年追蹤比較 60
第三節 核磁共振造影結果 63
壹、RSC腦區之GMI分析結果 63
貳、比較YOAD與LOAD之GMI全腦區退化程度 63
第四節 大腦影像與行為實驗之相關性分析 66
第五節 研究限制與未來建議 67
第六節 研究貢獻 68
第七節 結論 68
參考文獻 69
附錄1. NINCDS-ADRDA之診斷準則 79
附錄2. DSM-IV-TR之阿茲海默症診斷準則 81
附錄3.行為實驗參與受試者同意書範本 82
附錄4.腦影像研究參與受試者同意書範本 84

表目錄
表2-1 本研究參與者納入與排除之準則表 16
表3-1 人口學相關資料 37
表3-2 LOAD與YOAD人口學、基本認知功能比較38
表3-3 AD組與年齡配對控制組-基本認知功能與視空間知覺測驗 39
表3-4 AD組與年齡配對控制組-TSR實驗結果 40
表3-5 一年追蹤AD組與年齡配對控制組基本人口學及認知功能 41
表3-6 有無參加一年追蹤之AD組基本人口學及認知功能比較 42
表3-7 有無參加一年追蹤之NC組基本人口學及認知功能比較 42
表3-8 AD病人神經心理測驗與視空間知覺測驗一年追蹤分析 43
表3-9 AD組TSR實驗結果之一年追蹤分析44
表3-10 MRI各項分析結果 51
表3-11 YOAD退化顯著之各腦區位置 53
表4-1 一年追蹤AD之用藥情況 62

圖目錄
圖1-1 RSC與各腦區域之連結圖示 5
圖1-2 RSC位置圖 6
圖1-3 RSC的位置及TSR運作圖解 8
圖2-1 本研究參與者收案簡圖 17
圖2-2 研究流程圖 18
圖2-3 JLO範例 21
圖2-4 MRMT範例圖 22
圖2-5 照片拍攝取景角度示意圖 25
圖2-6 M H-W test 26
圖2-7 Picture Taking Test 28
圖2-8 Heading Orientation Test:定位作業 (Locating Test) 29
圖2-9 Heading Orientation Test:定向作業 (Heading Test) 30
圖2-10 Viewpoint judgment Test:指向作業 (Pointing Test) 31
圖2-11 Viewpoint judgment Test:判斷作業 (Judging Test) 32
圖2-12 AC-PC line位置 34
圖2-13 標準化的過程 34
圖3-1 參與者收案人數圖 37
圖3-2 LOAD 與ONC一年追蹤:CASI分數圖 45
圖3-3 LOAD 與ONC一年追蹤:TSR作業顯著差異圖 47
圖3-4 YOAD 與YNC一年追蹤:基本認知功能顯著差異圖 49
圖3-5 YOAD 與YNC一年追蹤:TSR作業顯著差異圖 50
圖3-6 排除白質影響後的處理圖形 51
圖3-7 YOAD退化顯著之腦區 52
圖3-8 AD病人RSC灰質TPMs與TSR分測驗顯著相關圖示 54
圖4-1 楔前葉與皮質及下皮質連結圖 64
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