| Objective: The clinical characteristics,brain magnetic resonance and PET results of 8 patients with semantic dementia(semantic dementia,SD)in our hospital were analyzed and discussed,which should improve the clinician's understanding of the disease.Method:1.A total of 8 SD patients admitted to the department of neurology of the first affiliated hospital of Dalian Medical University from September 2017 to March2020 were selected,who are diagnosed as semantic dementia by experienced neurologists according to international general diagnostic criteria.Next,we obtain age,sex,education,left or right hand,onset age,visiting age and other general conditions.2.The Simple Mental State Scale(MMSE)and the Montreal Cognitive Assessment Scale(Mo CA)were used for neuropsychological assessment.Meanwhile,we use the Daily Life Power Scale(ADL)for daily life assessment,and use the Boston Naming Test(BNT)and Aphasia Battery of Chinese(ABC)as language-specific evaluations,Neuropsychiatric Inventory(NPI)assess behavioral and psychological symptoms.3.Patients should finish the head magnetic resonance examination to identify the atrophy of the brain.4.Perfecting 18F-FDG-PET to determine the site and extent of metabolic reduction in the brain,perfect 18F-AV45-PET scan to determine the A?protein deposition in the brain,the results were treated with Neuro Q software,and the specific metabolic reduction and A? deposition sites were obtained.Result:1.General information: 8 patients with SD were all right-handed,the ratio of men and women was 1:1,and there was no significant difference in sex.The average age of onset was 61.38±4.98 years;the average age of seeing a doctor was 63.88±6.06 years.2.The MMSE score of 8 patients was 4~26,average(15.75±8.07),7 patients had cognitive decline;MOCA score was 0~16,average(9.63±5.26),8 patients had cognitive dysfunction;ADL score was 20~33,average(24±6.91),3 patients indicated impaired daily living ability.3.The BNT score of 8 patients was 0~8,with an average(4.25±2.61)score.Six patients ABC indicated that the naming ability and writing ability decreased,among which the correct rate of naming ability was 0~47%,with an average of 28%,and the correct rate of writing ability was 0~66%,with an average of 30%.The main impairment of naming ability was color naming disorder(17%),followed by word naming disorder(33%)and reaction naming disorder(34%);the main impairment of writing ability was reading and writing disorder(3%),followed by spontaneous writing disorder(7%)and dictation disorder(19%);the seventh and eighth cases had severe language impairment with a correct rate of 0.4.The NPI scores of 8 patients were 0~48,average(23.25±18.00),the results were 7 patients with different degrees of mental and emotional symptoms,1 patient with no mental and emotional symptoms,7 patients with irritability/emotional instability(mean 4.88),4 patients with abnormal motor behavior(mean 3.38),5 patients with emotional apathy(mean 3.63),3 patients with depressor(mean 3.00),2 patients with agitation(mean 0.63)and 4 patients with depression(mean 1.25 points),4 cases of sleep disorder(average 3.00 points),3 cases of eating disorder(mean 1.13 points)and delusions,hallucinations,anxiety,and euphoria in each one case(mean 0.75,0.13,0.13,0.13 points).5.For visual analysis of head MRI in 8 patients,the left frontal lobe and temporal lobe were atrophied to varying degrees,mainly in the left temporal pole,hippocampus,lateral fissure and so on,and 2 cases showed slight atrophy in the right temporal lobe.6.The brain regions with significantly decreased FDG metabolism :8 cases(100%)of the left lateral anterior temporal lobe,7 cases(87.5%)of the left lateral posterior temporal lobe and left inferior frontal gyrus,6 cases(75%)of the left medial anterior temporal lobe and left medial frontal lobe,5 cases(62.5%)of the left superior lateral temporal lobe,right lateral anterior temporal lobe,left Broca?right inferior frontal gyrus.Four brain regions in the left temporal lobe,three brain regions in the left frontal lobe and one brain region in the right frontotemporal lobe FDG significantly decreased metabolism.7.The FDG metabolism of the cerebral cortex was compared in 8 SD patients.The results were as follows: the FDG metabolism of the left frontal lobe,temporal lobe and parietal temporal cortex was significantly lower than that of the right(P<0.05).The metabolic decrease was more obvious in the left Broca area,the left upper lateral temporal lobe and FDG left lower lateral anterior temporal lobe(P<0.001),and there was no significant difference in metabolism in the left and right parietal and occipital brain regions.8.FDG metabolism was correlated with language and neuropsychiatric behavior:BNT had positive correlation with FDG metabolism in most brain regions of the left temporal lobe,but the difference was not statistically significant(P>0.05).NPI had negative correlation with metabolism in the large brain regions of the left frontal lobe(P>0.05).ADL was negatively correlated with FDG metabolism in the left middle frontal gyrus and left Broca region(P<0.05).9.Five patients improved 18F-AV45 examination,four patients(SD2?3?4?6)had no significant increase in the A? load in the brain,and one patient(SD5)had a significant increase in the load,mainly distributed in gyrus,middle frontal gyrus,medial frontal lobe,inferior lateral posterior temporal lobe,parietal temporal cortex,and left Broca?right superior lateral temporal lobe and inferior lateral anterior temporal lobe,right inferior frontal gyrus.Conclusion:1.SD the onset age of the patient is earlier,the ratio of male to female is 1:1.2.SD patients mainly suffer from impaired language function,in which naming and writing disorders are more serious;most of them are accompanied by mental and behavioral abnormalities,but the ability of daily life is better;MMSE?MOCA can not well reflect the cognitive level of SD patients.3.SD MRI of the head of the patient can be seen in the temporal pole,hippocampus,the medial side of the temporal lobe,lateral fissure and other parts of the brain atrophy,mainly left.4.SD patients showed significantly decreased metabolism FDG the left frontotemporal lobe in 18F-FDG PET,especially in the left Broca region,the left upper left lateral temporal lobe,and the left lower lateral anterior temporal lobe(P<0.001);the cerebral cortex A? load did not increase in most patients.5.There was a clear correlation between the decreased daily life ability of SD patients and FDG metabolism in the left middle frontal gyrus and left middle frontal gyrus;Impaired language function may be associated with decreased metabolism in the left temporal lobe FDG;and neuropsychiatric behavior abnormalities may be associated with decreased metabolism in the left frontal lobe. |
PDF Full Text Request