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Am J Psychiatry 1996; 153:1261-1268
Copyright © 1996 by American Psychiatric Association
Preferential metabolic involvement of visual cortical areas in a subtype of Alzheimer's disease: clinical implications
P Pietrini, ML Furey, N Graff-Radford, U Freo, GE Alexander, CL Grady, A Dani, MJ Mentis and MB Schapiro
Laboratory of Neurosciences, National Institute on Aging, Bethesda MD 20892, USA. pietrini@alw.nih.gov
OBJECTIVE: A subgroup of patients with Alzheimer's disease present with
visual disturbances at onset. This study investigated whether specific
cortical networks associated with visual processes are preferentially
affected in this subgroup and determined the clinical implications of such
abnormalities. METHOD: Regional cerebral glucose metabolic rates were
assessed with positron emission tomography and [18F]2-fluoro-2-
deoxy-D-glucose, and general intellectual functions, memory, and visual
skills were measured with cognitive tests in patients with probable
Alzheimer's disease-10 with and 22 without prominent visual symptoms- and
in 25 healthy comparison subjects. RESULTS: Both patient groups showed
reduced glucose metabolism in parietal regions and in middle and superior
temporal regions in comparison with the healthy subjects. The Alzheimer's
disease patients without visual symptoms also showed reductions in inferior
temporal, frontal, and limbic structures, as is typical of Alzheimer's
disease. In contrast, the patients with visual symptoms had larger
metabolic deficits than the patients without visual symptoms in the
parietal and occipital cortices (including the primary visual cortex), with
a relative sparing of inferior temporal, frontal, and limbic regions.
Consistently, the patients with visual symptoms had significantly greater
visuospatial deficits and less severe memory impairments than the patients
without visual symptoms. CONCLUSIONS: Alzheimer's disease patients with
visuospatial deficits who are studied while alive have a distinctive
regional distribution of cerebral metabolic impairment that is related to
specific cognitive deficits and that distinguishes them from patients with
typical Alzheimer's disease. These findings imply that regional variations
in brain dysfunction can occur in Alzheimer's disease, with differential
involvement of cortical systems resulting in distinctive clinical
subgroups.
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