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Introdução: Em Portugal estima-se que existam cerca de 153.000 pessoas com demência, a qual conduz a perda progressiva da autonomia e da capacidade para as actividades diárias, profissionais e sociais. Apesar das suas várias etiologias, a doença de Alzheimer e a demência vascular são as duas formas mais frequentes de demência na população idosa. A neuroimagem é actualmente a investigação mais importante para ajudar no diagnóstico diferencial das demências e nas decisões terapêuticas. Vários estudos têm demonstrado uma associação entre a atrofia do lobo temporal medial e a dilatação dos cornos temporais dos ventrículos laterais, visualizada em tomografia axial computorizada e o diagnóstico de doença de Alzheimer histologicamente confirmada
Objectivos: O objectivo principal deste trabalho é testar nos grupos de doentes que sofrem de DA e de DM um eventual padrão de atrofia a nível radiológico, medido através de TAC – CE e compará-lo com os controlos. Os objectivos secundários são: correlacionar os parâmetros avaliados entre cada grupo de doentes, (MMSE, CDR, tempo de evolução, factores de risco cardiovascular) e relacionar as medidas das estruturas encefálicas entre estes grupos e com o grupo controlo.
Métodos: Neste estudo retrospectivo procedeu-se à recolha (entre Dezembro de 2009 e Abril de 2010) de TAC´s crânio-encefálicas e outras informações clínicas do processo hospitalar de doentes com DA, DM e de controlos procedentes da consulta de Neurologia do CHCB, E.P.E. A largura máxima dos ventrículos occipitais que nunca tinha sido medida em TAC-CE ou RMN associada a demência e a distância inter-uncal que apenas tinha sido medida por RMN, foram também avaliadas.
Resultados: Foram analisados os processos e medidas as TAC – CE´s de 68 doentes dos quais 38 tinham diagnóstico clínico de demência e 30 eram doentes controlo. Dos 38 doentes, 25 tinham diagnóstico de DA e 13 tinham diagnóstico clínico de DM. Todas as medidas de estruturas encefálicas estudadas, exceptuando-se o ratio da distância interuncal com a distância interóssea, foram significativas (p<0,001) entre os grupos de doentes e controlos mas não nos dois grupos de doentes entre si. A largura dos cornos occipitais dos ventrículos laterais mostrou-se significativa entre os grupos de DA e controlos (p=0,019), não sendo significativa nem entre os grupos de DM e controlos, nem entre DA e DM. Conclusão: Apesar do tamanho reduzido da amostra, este estudo confirmou a existência de um padrão de atrofia encefálica em doentes com DA muito semelhante ao encontrado também em doentes com DM. O aumento da largura dos cornos occipitais dos ventrículos laterais mostrou-se também associado a atrofia neurodegenerativa. Considerando a variável tempo de evolução, como não se correlacionou com as medidas das estruturas encefálicas estudadas, destaca-se a sua utilidade de diagnóstico na prática clínica para a detecção de atrofia cortico-subcortical do lobo temporal medial em doentes com DA.
Introduction: In Portugal, it is estimated that there are 153,000 people with dementia, which leads to a progressive loss of autonomy, and capacity for the realization of daily activities, both professional and personal. Despite its various etiologies, Alzheimer´s disease and vascular dementia are the most frequent forms in the elderly. Neurological imaging is currently the most important investigation used for the differential diagnosis of dementia and therapeutic decision-making. Various studies have showed an association between the atrophy of the medial temporal lobe and the dilatation of the temporal horns of the lateral ventricles, visualized by cranial-encephalic CT-scan, and the diagnosis of Alzheimer´s disease with histological confirmation. Objectives: The main goal of this study is to test an eventual pattern of atrophy, at a radiological level, through craneal-encephalic CT-scan, in groups of patients with diagnosis of Alzheimer´s disease and mixed dementia, and to compare them with controls. The complementary goals are the following: assess correlations of clinical parameters (MMSE, CDR, evolution time, cardiovascular risk factors) and measurements of encephalic structures between both groups. Methods: In this retrospective study, data were obtained from hospital records of patients with Alzheimer´s disease, mixed dementia and controls from the Neurology of CHCB, E.P.E. The maximum width of the occipital ventricles, never before measured by CT-scan or MRI, was also evaluated. Results: The sample was integrated by 68 subjects, 38 of which had clinical diagnoses of dementia and 30 were controls. Of the 38 patients, 25 had the diagnosis of Alzheimer and 13 had the clinical diagnosis of mixed dementia. All of the measurements of studied cephalic structures, except the ratio of the interuncal distance with the cranial interbone distance, were significant (p<0,001) between the groups of patients and controls but not between both groups of patients. The width of the occipital horns of the lateral ventricles was significant between the Alzheimer disease patients and controls (p=0.01), but not so between groups of mixed dementia and controls and between Alzheimer disease patients and mixed dementia. Regarding the cardiovascular risk factors and other clinical factors studied, only dyslipidemia was found to be significantly in mixed dementia patients when compared with Alzheimer´s disease patients. Conclusion: Despite the reduced size of the sample, this study confirmed the existence of an encephalic pattern of atrophy in patients with Alzheimer´s disease, very similar to that also found in patients with mixed dementia. The width of the occipital horns of the lateral ventricles was associated to this neurodegenerative disease. Regarding the variable of time evolution, since it was not correlated with the measurements of the studied encephalic structures, its diagnostic utility can be distinguished in clinical practice for the detection of cortical-subcortical atrophy of the medial temporal lobe in patients with Alzheimer´s disease.
Introduction: In Portugal, it is estimated that there are 153,000 people with dementia, which leads to a progressive loss of autonomy, and capacity for the realization of daily activities, both professional and personal. Despite its various etiologies, Alzheimer´s disease and vascular dementia are the most frequent forms in the elderly. Neurological imaging is currently the most important investigation used for the differential diagnosis of dementia and therapeutic decision-making. Various studies have showed an association between the atrophy of the medial temporal lobe and the dilatation of the temporal horns of the lateral ventricles, visualized by cranial-encephalic CT-scan, and the diagnosis of Alzheimer´s disease with histological confirmation. Objectives: The main goal of this study is to test an eventual pattern of atrophy, at a radiological level, through craneal-encephalic CT-scan, in groups of patients with diagnosis of Alzheimer´s disease and mixed dementia, and to compare them with controls. The complementary goals are the following: assess correlations of clinical parameters (MMSE, CDR, evolution time, cardiovascular risk factors) and measurements of encephalic structures between both groups. Methods: In this retrospective study, data were obtained from hospital records of patients with Alzheimer´s disease, mixed dementia and controls from the Neurology of CHCB, E.P.E. The maximum width of the occipital ventricles, never before measured by CT-scan or MRI, was also evaluated. Results: The sample was integrated by 68 subjects, 38 of which had clinical diagnoses of dementia and 30 were controls. Of the 38 patients, 25 had the diagnosis of Alzheimer and 13 had the clinical diagnosis of mixed dementia. All of the measurements of studied cephalic structures, except the ratio of the interuncal distance with the cranial interbone distance, were significant (p<0,001) between the groups of patients and controls but not between both groups of patients. The width of the occipital horns of the lateral ventricles was significant between the Alzheimer disease patients and controls (p=0.01), but not so between groups of mixed dementia and controls and between Alzheimer disease patients and mixed dementia. Regarding the cardiovascular risk factors and other clinical factors studied, only dyslipidemia was found to be significantly in mixed dementia patients when compared with Alzheimer´s disease patients. Conclusion: Despite the reduced size of the sample, this study confirmed the existence of an encephalic pattern of atrophy in patients with Alzheimer´s disease, very similar to that also found in patients with mixed dementia. The width of the occipital horns of the lateral ventricles was associated to this neurodegenerative disease. Regarding the variable of time evolution, since it was not correlated with the measurements of the studied encephalic structures, its diagnostic utility can be distinguished in clinical practice for the detection of cortical-subcortical atrophy of the medial temporal lobe in patients with Alzheimer´s disease.
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Doença de Alzheimer Demência neurodegenerativa Atrofia encefálica - Doença de Alzheimer Demência Demência mista
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Universidade da Beira Interior