Alzheimer hastalığı ve frontotemporal demans hastalığının ayırıcı tanısında transkranial manyetik stimulasyon yönteminin tanısal katkısı
Yükleniyor...
Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
TMS günümüzde kortikal eksitabilite, santral sinir sistemi devrelerini ve nöral ağları değerlendirmede bir araç haline gelmiştir. Yapılan çalışmalarda TMS yöntemi ile; SAI (kısa latanslı afferent inhibisyon), SICI (kısa aralıklı intrakortikal inhibisyon), ICF (intrakortikal fasilitasyon), LAI (uzun latanslı afferent inhibisyon), LICI (uzun latanslı intrakortikal inhibisyon) ölçümleri ve bunların birbirine olan oranları ile Alzheimer Demansı (AD) ve Frontotemporal Demans (FTD) hastalıklarının hem sağlıklı popülasyondan hem de birbirinden tanısal olarak ayırabileceği gösterilmiştir. TMS parametreleri olan SAI, SICI, ICF sırasıyla kolinerjik, GABAerjik, glutaminerjik devrelerin fonksiyonlarını göstermektedir. Bu çalışmanın amacı TMS yöntemiyle AD ve FTD hastalıkları arasında tanısal ayrım yapılıp yapılamayacağını belirlemektir. Çalışmaya 50-85 yaş arasında, dahil edilme kriterlerini sağlayan 40 hasta alındı. Çalışmaya dahil edilen Alzheimer ve Frontotemporal Demans tanılı hastalar, Ege Üniversitesi Hastanesi Nöroloji-Demans Polikliniğinde Kranial MRI ve Nöropsikolojik testlerle tanısı kesinleştirmiş ve takip edilen hastalardan seçildi. İstatistiksel olarak normal dağılış göstermeyen değişkenlerin üç kategori arasında fark gösterip göstermediğinin belirlenmesinde Kruskal Wallis Testi uygulandı, normal dağılım gösterenlere One Way Anova Testi uygulandı. Çalışmamıza 17 sağlıklı gönüllü, 12 AD, 11 FTD hastası alındı. Hastaların 20'si kadın, 20'si erkekti. Yaş ortalaması 64.4 (50-85) saptandı. Tüm deneklerde SICI, ICF, SAI, LAI, LICI ölçümleri ve SEP (somatosensoriyel uyarılmış potansiyel) uygulandı. SEP'de N20 latans ortalaması 20.47'idi. BKAP (bileşik kas aksiyon potansiyeli) amplitüdü ortalaması 11.1 (±4.31), rMT (kortikal motor eşik) ortalaması 40.08 (±9.24)'di. SICI ortalaması 2.88 (±2.02), ICF ortalama 3.37 (±2.03), SAI ortalaması 2.6 (±2.03)'ydı. LAI ve LICI dışındaki ölçümlerin normal dağılım göstermediği belirlendi. AD hastalarında LAI ortalaması 3,57 (±1.52)'ydi, FTD hastalarında SICI ortalaması 3.75 ile diğer gruplara kıyasla daha yüksek görüldü. SICI-ICF/SAI ortalaması -0.36 (±0.77) saptandı. Çalışmamızda FTD hastalarında SICI değeri anlamlı olarak yüksek bulundu(p=0.019). AD hastalarındaysa SAI değeri anlamlı olarak yüksekti (p=0.020). SAI'nın Cohen kriterlerine göre yüksek düzeyde AD ve FTD'yi ayırdığı saptandı(r=0.057). SAI'nın AD hastalarını tespit etmedeki duyarlılığı %92, özgüllüğü %95 saptandı. SICI sağlıklı gönüllülerde anlamlı olarak düşük bulundu. LICI ve LAI'nin AD ve NK grubunu anlamlı olarak ayırdığı belirlendi. Eta squared formülüne göre LAI orta (ES=0.11), LICI yüksek (ES=0.27) düzeyde AD ile sağlıklı gönüllüleri ayırdı. N20 normal ve hasta gruplarında farklılık göstermedi. İnhibisyon ve fasilitasyon kaybını kendi arasında değerlendiren SICI-ICF/SAI oransal incelemesinde tüm gruplar arasında anlamlı farklılık yoktu (p=0.133). Çalışmamızın sonucunda FTD hastalarında SICI'da, AD hastalarındaysa SICI, SAI ve LAI'da belirgin inhibisyon kaybı görüldü. Bu da AD hastalarında kolinerjik ve GABAerjik, FTD hastalarında ise GABAerjik devrede bozukluk olduğunu gösterdi. Bu çalışma TMS'nin AD ile FTD ayırıcı tanısında kullanılabilir bir yöntem olduğunu doğrulamıştır. Örneklem genişliği arttıkça ileride farklı sonuçlar elde edilebilecektir.
Today, TMS has become a tool for evaluating cortical excitability, central nervous system circuits and neural networks. In the studies conducted, with the TMS method; It has been shown that SAI, SICI, ICF, LAI, LICI measurements and their ratios to each other and Alzheimer's Dementia (AD) and Frontotemporal Dementia (FTD) diseases can be differentiated both from the healthy population and from each other. TMS parameters SAI, SICI, ICF show the functions of cholinergic, GABAergic, glutaminergic circuits, respectively. The aim of this study is to determine whether a diagnostic distinction can be made between AD and FTD diseases by TMS method. 17 healthy volunteers, 12 AD and 11 FTD patients were included in our study. Twenty patients were female and 20 were male. The average age was 64.4 (50-85). 55% were under the age of 65. SICI, ICF, SAI, LAI, LICI measurements were done. SEP was applied to all participants. The N20 average in the SEP was 20.47. The mean of the BKAP amplitude was 11.1(±4.31). The rMT average was 40.08(±9.24). SICI mean was 2.88 (±2.02), ICF mean was 3.37 (±2.03), SAI mean was 2.6 (±2.03). It was determined that the measurements other than LAI and LICI did not show normal distribution. The mean LAI in AD patients was 3.57, and the mean of SICI in FTD patients was higher with 3.75 compared to other groups. SICI-ICF / SAI mean was -0.36 ± 0.77 mV. In our study, the SICI value was found to be significantly higher in FTD patients (p = 0.019). In AD patients, the SAI value was significantly higher (p = 0.020). It was determined that SAI distinguished high levels of AD and FTD according to Cohen criteria (r = 0.057). The sensitivity of SAI in detecting AD patients was 92% and specificity was 95%. SICI was significantly lower in healthy volunteers. LICI and LAI were determined to significantly differentiate between AD and NK. According to the Eta squared formula, LAI divided middle (ES = 0.11) and LICI high (ES = 0.27) AD and healthy volunteers. The N20 mean was similar to the population. In the SICI-ICF / SAI proportional examination, which evaluated the loss of inhibition and facilitation, there was no significant difference between all groups (p = 0.133). As a result of our study, significant inhibition loss was observed in FTD patients in SICI and in AD patients in SICI, SAI and LAI. This showed that cholinergic and GABAergic patients in AD patients and GABAergic circuit disorder in FTD patients. This study confirmed that TMS is a method that can be used in differential diagnosis of AD and FTD. As the sample width increases, different results will be obtained in the future.
Today, TMS has become a tool for evaluating cortical excitability, central nervous system circuits and neural networks. In the studies conducted, with the TMS method; It has been shown that SAI, SICI, ICF, LAI, LICI measurements and their ratios to each other and Alzheimer's Dementia (AD) and Frontotemporal Dementia (FTD) diseases can be differentiated both from the healthy population and from each other. TMS parameters SAI, SICI, ICF show the functions of cholinergic, GABAergic, glutaminergic circuits, respectively. The aim of this study is to determine whether a diagnostic distinction can be made between AD and FTD diseases by TMS method. 17 healthy volunteers, 12 AD and 11 FTD patients were included in our study. Twenty patients were female and 20 were male. The average age was 64.4 (50-85). 55% were under the age of 65. SICI, ICF, SAI, LAI, LICI measurements were done. SEP was applied to all participants. The N20 average in the SEP was 20.47. The mean of the BKAP amplitude was 11.1(±4.31). The rMT average was 40.08(±9.24). SICI mean was 2.88 (±2.02), ICF mean was 3.37 (±2.03), SAI mean was 2.6 (±2.03). It was determined that the measurements other than LAI and LICI did not show normal distribution. The mean LAI in AD patients was 3.57, and the mean of SICI in FTD patients was higher with 3.75 compared to other groups. SICI-ICF / SAI mean was -0.36 ± 0.77 mV. In our study, the SICI value was found to be significantly higher in FTD patients (p = 0.019). In AD patients, the SAI value was significantly higher (p = 0.020). It was determined that SAI distinguished high levels of AD and FTD according to Cohen criteria (r = 0.057). The sensitivity of SAI in detecting AD patients was 92% and specificity was 95%. SICI was significantly lower in healthy volunteers. LICI and LAI were determined to significantly differentiate between AD and NK. According to the Eta squared formula, LAI divided middle (ES = 0.11) and LICI high (ES = 0.27) AD and healthy volunteers. The N20 mean was similar to the population. In the SICI-ICF / SAI proportional examination, which evaluated the loss of inhibition and facilitation, there was no significant difference between all groups (p = 0.133). As a result of our study, significant inhibition loss was observed in FTD patients in SICI and in AD patients in SICI, SAI and LAI. This showed that cholinergic and GABAergic patients in AD patients and GABAergic circuit disorder in FTD patients. This study confirmed that TMS is a method that can be used in differential diagnosis of AD and FTD. As the sample width increases, different results will be obtained in the future.
Açıklama
Anahtar Kelimeler
rTMS, Demans, SAI, SIC, FTD, AD, Dementia, SICI, ADTE
