Mini-Mental State Examination and proton spectroscopy of the posterior cingulate in Alzheimer disease

Lee, Hae Won; Caramelli, Paulo; Otaduy, Maria Concepcion Garcia; Nitrini, Ricardo; Leite, Claudia da Costa

doi:10.1590/S1980-57642008DN10300005

Abstract

To compare metabolite ratios in the posterior cingulate with the Mini-Mental State Examination (MMSE) test scores in patients with mild or moderate Alzheimer disease and in controls. Methods: We evaluated 29 patients with mild or moderate Alzheimer disease and 15 controls by proton spectroscopy with the voxel located in the posterior cingulate. The MMSE was applied to all patients and controls. The metabolic ratios: N-acetyl-aspartate/creatine (Naa/Cr), mio-inositol/creatine (mI/Cr) and mio-inositol/N-acetyl-aspartate (mI/Naa) were obtained and then post-processed using the MRUI software (magnetic resonance user interface). Results: Correlation between Naa/Cr and mI/Naa ratios in the posterior cingulate with the MMSE was observed, and a positive correlation with Naa/Cr and negative correlation with mI/Naa were seen. The mI/r ratio presented no correlation with MMSE scores. Conclusion: The positive correlation with Naa/Cr, and negative correlation with mI/Naa may corroborate that neuronal density/viability is associated to a higher MMSE score.

Key words:
proton spectroscopy; posterior cingulate; single voxel; MMSE test; Alzheimer disease.

Resumo

Comparar as razões dos metabólitos obtidas no giro do cíngulo posterior e os escores do Mini-Exame do Estado Mental (MEEM) em pacientes com doença de Alzheimer leve e moderada em controles cognitivamente normais. Métodos: Nós avaliamos 29 pacientes com doença de Alzheimer leve e moderada e 15 controles utilizando espectroscopia de prótons com volume de interesse único localizado no cíngulo posterior. Os escores do teste MEEM foram aplicados em todos os pacientes e controles. As razões dos metabólitos N-acetil-aspartato/creatina (Naa/Cr), mio-inositol/creatina (mI/Cr) e mio-inositol/-acetil-aspartato (mI/Naa) foram obtidas e pós-processadas usando o software MRUI (magnetic resonance user interface). Resultados: Foram encontradas correlações entre as razões Naa/Cr e mI/Naa obtidas no cíngulo posterior e os escores do teste MEEM, sendo a correlação positiva com o Naa/Cr e negativa com a razão mi/Naa. A razão mio-inositol/creatina não teve correlação com os escores do teste MEEM. Conclusão: A correlação positiva entre o Naa/cr e negativa entre o mI/Naa podem corroborar a hipótese de que a densidade/viabilidade neuronal está associada a maiores escores no teste MEEM.

Palavras-chave:
espectroscopia de prótons; cíngulo posterior; volume de interesse único; escore do teste MEEM; doença de Alzheimer.

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References

¹
Laakson MP, Soininen H, Partanen K, et al. MRI of the hippocampus in the Alzheimer's disease: sensitivity, specificity, and analysis of the incorrectly classified subjects. Neurobiol Aging 1998;19:23-31.
²
Herminghaus S, Frolich L, Gorriz C, et al. Brain metabolism in Alzheimer disease and vascular dementia assessed by in vivo proton magnetic resonance spectroscopy. Psychiatry Res 2003;123:183-190
³
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351-356.
⁴
Schmidt R, Fazekas F, Kleinert G, et al. Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matter. A comparative study between stroke patients and normal volunteers. Arch Neurol 1992;49:825-827.
⁵
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
⁶
Nitrini R, Caramelli P, Herrera Junior E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
⁷
Caramelli P, Carthery MT, Porto CS, Charchat-Fichman H, Bahia VS, Nitrini R. Teste de fluência verbal no diagnóstico da doença de Alzheimer leve: notas de corte em função da escolaridade. Arq Neuropsiquiatr 2003;61:23.
⁸
Kantarci K, Jack Jr CR, Xu YC, et al. Regional metabolic patterns in mild cognitive impairment and Alzheimer's disease: A 1H MRS study. Neurology 2000;55:210-217.
⁹
Kantarci K, Reynolds G, Petersen RC, et al. Proton MR spectroscopy in mild cognitive impairment and Alzheimer disease: comparison of 1.5 and 3 T. AJNR Am J Neuroradiol 2003;24:843-849.
¹⁰
Kantarci K, Xu Y, Shiung MM, et al. Comparative diagnostic utility of different MR modalities in mild cognitive impairment and Alzheimer's disease. Dement Geriatr Cogn Disord 2002;14:198-207.
¹¹
Hattori N, Abe K, Sakoda S, Sawada T. Proton MR spectroscopic study at 3 Tesla on glutamate/glutamine in Alzheimer's disease. Neuroreport 2002;13:183-186.
¹²
Martinez-Bisbal MC, Arana E, Marti-Bonmati L, Molla E, Celda B. Cognitive impairment: classification by 1H magnetic resonance spectroscopy. Eur J Neurol 2004;11:187-193.
¹³
Lee ET, Wang JW. Statistical methods for survival data analysis. 3rd edition. New Jersey: John Wiley & Sons; 2003.
¹⁴
Huang W, Alexander GE, Chang L, et al. Brain metabolite concentration and dementia severity in Alzheimer's disease: a (1)H MRS study. Neurology 2001;57:626-632.
¹⁵
Waldman AD, Rai GS. The relationship between cognitive impairment and in vivo metabolite ratios in patients with clinical Alzheimer's disease and vascular dementia: a proton magnetic resonance spectroscopy study. Neuroradiology 2003;45:507-512.
¹⁶
Weiss U, Bacher R, Vonbank H, Kemmler G, Lingg A, Marksteiner J. Cognitive impairment: assessment with brain magnetic resonance imaging and proton magnetic resonance spectroscopy. J Clin Psychiatry 2003;64:235-242.
¹⁷
Frederick BD, Lyoo IK, Satlin A, et al. In vivo proton magnetic resonance spectroscopy of the temporal lobe in Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2004;28:1313-1322.
¹⁸
Kwo-On-Yuen PF, Newmark RD, Budinger TF, Kaye JA, Ball MJ, Jagust WJ. Brain N-acetyl-L-aspartic acid in Alzheimer's disease: a proton magnetic resonance spectroscopy study. Brain Res 1994;667:167-174.
¹⁹
Kantarci K, Jack CR, Jr. Neuroimaging in Alzheimer disease: an evidence-based review. Neuroimaging Clin N Am 2003;13:197-209.
²⁰
Adalsteinsson E, Sullivan EV, Kleinhans N, Spielman DM, Pfefferbaum A. Longitudinal decline of the neuronal marker N-acetyl aspartate in Alzheimer's disease. Lancet 2003;355(9216):1696-1697.
²¹
Rose SE, de Zubicaray GI, Wang D, Galloway GJ, Chalk JB, Eagle SC, et al. A 1H MRS study of probable Alzheimer's disease and normal aging: implications for longitudinal monitoring of dementia progression. Magn Reson Imaging 1999;17:291-299.
²²
Parnetti L, Tarducci R, Presciutti O, Lowenthal DT, Pippi M, Palumbo B, et al. Proton magnetic resonance spectroscopy can differentiate Alzheimer's disease from normal aging. Mech Ageing Dev 1997;97:9-14.

Publication Dates

Publication in this collection
Jul-Sep 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Laakson MP, Soininen H, Partanen K, et al. MRI of the hippocampus in the Alzheimer's disease: sensitivity, specificity, and analysis of the incorrectly classified subjects. Neurobiol Aging 1998;19:23-31.

[2] ²
Herminghaus S, Frolich L, Gorriz C, et al. Brain metabolism in Alzheimer disease and vascular dementia assessed by in vivo proton magnetic resonance spectroscopy. Psychiatry Res 2003;123:183-190

[3] ³
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351-356.

[4] ⁴
Schmidt R, Fazekas F, Kleinert G, et al. Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matter. A comparative study between stroke patients and normal volunteers. Arch Neurol 1992;49:825-827.

[5] ⁵
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[6] ⁶
Nitrini R, Caramelli P, Herrera Junior E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[7] ⁷
Caramelli P, Carthery MT, Porto CS, Charchat-Fichman H, Bahia VS, Nitrini R. Teste de fluência verbal no diagnóstico da doença de Alzheimer leve: notas de corte em função da escolaridade. Arq Neuropsiquiatr 2003;61:23.

[8] ⁸
Kantarci K, Jack Jr CR, Xu YC, et al. Regional metabolic patterns in mild cognitive impairment and Alzheimer's disease: A 1H MRS study. Neurology 2000;55:210-217.

[9] ⁹
Kantarci K, Reynolds G, Petersen RC, et al. Proton MR spectroscopy in mild cognitive impairment and Alzheimer disease: comparison of 1.5 and 3 T. AJNR Am J Neuroradiol 2003;24:843-849.

[10] ¹⁰
Kantarci K, Xu Y, Shiung MM, et al. Comparative diagnostic utility of different MR modalities in mild cognitive impairment and Alzheimer's disease. Dement Geriatr Cogn Disord 2002;14:198-207.

[11] ¹¹
Hattori N, Abe K, Sakoda S, Sawada T. Proton MR spectroscopic study at 3 Tesla on glutamate/glutamine in Alzheimer's disease. Neuroreport 2002;13:183-186.

[12] ¹²
Martinez-Bisbal MC, Arana E, Marti-Bonmati L, Molla E, Celda B. Cognitive impairment: classification by 1H magnetic resonance spectroscopy. Eur J Neurol 2004;11:187-193.

[13] ¹³
Lee ET, Wang JW. Statistical methods for survival data analysis. 3rd edition. New Jersey: John Wiley & Sons; 2003.

[14] ¹⁴
Huang W, Alexander GE, Chang L, et al. Brain metabolite concentration and dementia severity in Alzheimer's disease: a (1)H MRS study. Neurology 2001;57:626-632.

[15] ¹⁵
Waldman AD, Rai GS. The relationship between cognitive impairment and in vivo metabolite ratios in patients with clinical Alzheimer's disease and vascular dementia: a proton magnetic resonance spectroscopy study. Neuroradiology 2003;45:507-512.

[16] ¹⁶
Weiss U, Bacher R, Vonbank H, Kemmler G, Lingg A, Marksteiner J. Cognitive impairment: assessment with brain magnetic resonance imaging and proton magnetic resonance spectroscopy. J Clin Psychiatry 2003;64:235-242.

[17] ¹⁷
Frederick BD, Lyoo IK, Satlin A, et al. In vivo proton magnetic resonance spectroscopy of the temporal lobe in Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2004;28:1313-1322.

[18] ¹⁸
Kwo-On-Yuen PF, Newmark RD, Budinger TF, Kaye JA, Ball MJ, Jagust WJ. Brain N-acetyl-L-aspartic acid in Alzheimer's disease: a proton magnetic resonance spectroscopy study. Brain Res 1994;667:167-174.

[19] ¹⁹
Kantarci K, Jack CR, Jr. Neuroimaging in Alzheimer disease: an evidence-based review. Neuroimaging Clin N Am 2003;13:197-209.

[20] ²⁰
Adalsteinsson E, Sullivan EV, Kleinhans N, Spielman DM, Pfefferbaum A. Longitudinal decline of the neuronal marker N-acetyl aspartate in Alzheimer's disease. Lancet 2003;355(9216):1696-1697.

[21] ²¹
Rose SE, de Zubicaray GI, Wang D, Galloway GJ, Chalk JB, Eagle SC, et al. A 1H MRS study of probable Alzheimer's disease and normal aging: implications for longitudinal monitoring of dementia progression. Magn Reson Imaging 1999;17:291-299.

[22] ²²
Parnetti L, Tarducci R, Presciutti O, Lowenthal DT, Pippi M, Palumbo B, et al. Proton magnetic resonance spectroscopy can differentiate Alzheimer's disease from normal aging. Mech Ageing Dev 1997;97:9-14.

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