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LOGO Parietal lobe changes are important in AD Jing gao fang li fenfeng liying cui et al Peking Union medical colleage hospital Chinese academy of medicine.

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Presentation on theme: "LOGO Parietal lobe changes are important in AD Jing gao fang li fenfeng liying cui et al Peking Union medical colleage hospital Chinese academy of medicine."— Presentation transcript:

1 LOGO Parietal lobe changes are important in AD Jing gao fang li fenfeng liying cui et al Peking Union medical colleage hospital Chinese academy of medicine science Beijng china

2 PUMCH BEIJING CHINA Background MMSE MOCA ADL Clinical 2008 MMSE 26 Moca 20 ADL 21 2010 MMSE 22 Moca 17 ADL 24 Spatial disorientation confabulation Acalculia Memory disturbance mild disorientation 63 Years Male. 12 years edu. father dementia

3 PUMCH BEIJING CHINA Background

4 PUMCH BEIJING CHINA 2008 2010

5 PUMCH BEIJING CHINA Aim : AD diagnosis and parietal lobe Glucose hypometabolism? Atrophy? FDG-PET metabolic MRI cortical White matter Parietal lobe Axon or myelin degeneration?

6 PUMCH BEIJING CHINA Method : probable AD patients Detailed and reliable clinical history “step by step” cognitive assessment “screening” by MMSE, MOCA, and ADL,HAD detailed neuropsychological assessment Special domain assessment if needed : aphasia, agnosia etc patients enrolled: Acoording to the NINCDS-ADRDA Extensive laboratory testing Extensive laboratory testing CBC, chemistry, vitamin B12 /folate, syphilis serology, thyroid function tests and Hu,Yo, Ri

7 PUMCH BEIJING CHINA Method :IMAGING 3 D MRI ROUTINE TEST : T1 T2 Flare VBM DTI GRE MRS and fMRI of resting state FDG-PET visual rating, SUV, NeuroQ

8 PUMCH BEIJING CHINA Results: Enrolled Patients Probable AD 41 Probable mixed AD 43 Dementia 123 AD,FTD,PCA, Mixed, Others

9 PUMCH BEIJING CHINA Results: Hypometabolism FDG-PETof probable AD and mixed MTL 52-62% Parietal 92.3-100 % post cingulate 79.4% post temporo-parietal 54-72%

10 PUMCH BEIJING CHINA Method : 3D MRI Parietal lobe atrophy visual rating DT I VBM

11 PUMCH BEIJING CHINA Atrophy seen on at least 4 cuts MTL 26.7%-35.6% parietal lobe atrophy 67.8%-84.4%

12 PUMCH BEIJING CHINA Normal control AD patients

13 PUMCH BEIJING CHINA 24 pure AD readible VBM MRI compared to controls

14 PUMCH BEIJING CHINA 24 pure AD readible VBM MRI compared to controls

15 PUMCH BEIJING CHINA DTI (N=10) Probable AD Control

16 PUMCH BEIJING CHINA Parietal lobe hypometabolism occurred earlier(n=1) 2007 2008

17 PUMCH BEIJING CHINA Another case Parietal lobe hypometabolism occurred earlier 2009 2011

18 PUMCH BEIJING CHINA Parietal lobe earlier than clinic???  2000 MQ 91, pared association learning and episodic memory mild disturbance BVRT normal  2010 MQ 80 MMSE 28 Moca 24 ADL 20 system assessment is only aMCI Visual rating : pairetal lobe hypomatebolism SUV :( compare to base of pon ) parietal lobe reduced

19 PUMCH BEIJING CHINA Discussion Parietal lobe is a good target to detect AD ( atrophy and hypometabolism) Parietal lobe is important for cognition

20 PUMCH BEIJING CHINA Parietal lobe is more sensitive The latest report : Kyle B. Womack 2011 march (SSP) Temporoparietal lobe Hypometabolism Sensitivity : 93.6 (78.6-99.2) % Temporoparietal lobe Parietal lobe 92-100% post temporoparietal lobe54- 72% Our finding: Parietal lobe is more sensitive

21 PUMCH BEIJING CHINA Parietal lobe earlier? previously published hypometablism starts in the posterior cingulate gyrus,then extends to the hippocampus and parahippocampal gyrus -------Kogure et al., 2000 2008 2009 Our findings Parietal lobe hypometabolism occurs earlier than posterior cingulate

22 PUMCH BEIJING CHINA Parietal lobe and cognition construction memory praxisLanguage Parietal lobe Associated with higher cortical function calculation

23 PUMCH BEIJING CHINA CONCLUSION Description of the contents We hope further studies will confirm our findings Parietal lobe hypometabolism and atrophy could be valuable for AD diagnosis.

24 LOGO PUMCH BEIJING CHINA. THANK YOU

25 PUMCH BEIJING CHINA WML: FDG-PET, DTI, cognitive normal White matter changing on routine MRI could be does not matter

26 PUMCH BEIJING CHINA Dementia : AD mixd ?

27 PUMCH BEIJING CHINA Method : MTL atrophy follow up and Compare the cognition Probable AD Imaging only EPILEPSY with MTL RESECTION without FCD Before After OPERATION

28 PUMCH BEIJING CHINA HS

29 PUMCH BEIJING CHINA PUMCH SYSTEM NEUROPSYCHOLOGY BATTERY  执行功能: 列名 正常 障碍(轻 重) 数字符号 正常 异常 (轻 重) 接龙测验 A 正常 异常 (轻 重) B 正常 异常 (轻 重) 未作 画钟 正 异 轻 / 重 临摹 正 异轻 / 重  视空间 视保持测验 正常 异常 轻 重 临摹 正常 异常 轻 重 积木测验正常 异常轻 重  语言(高素荣汉语失语症检查 法口语部分) 自发语言, 流利 非流利; 命名 正 异轻 / 重 错语 有 偶有 复述,正常 异常 轻 重; 听指令执行 正常 异常 轻 重  记忆 联想学习 正常 异常 轻 重 视保持测验 正常 异常 轻 重; 情景记忆数 听辨认正确数  概念推理以及计算 相似性测验 正常 异常 轻 重 计算 正常 异常 轻 重  动作模仿 单个 正确数 系列 正确数  结果: 单项认知功能 ( 遗忘 非遗忘) 轻度障碍 障碍 多项认知功能 轻度障碍 障碍


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