[Comparative characteristics of neuropsychological and neurometabolic changes in patients with Alzheimer's disease and vascular cognitive impairment].

OBJECTIVE: To investigate the pattern and connections of neuropsychological and metabolic indices in patients with cognitive disorders of Alzheimer's and vascular (subcortical-cortical) types of different severity.

MATERIAL AND METHODS: A total of 177 patients were examined, including 85 patients with Alzheimer's disease (AD) and 92 patients with vascular cognitive impairment (VCI). All patients underwent complex neuropsychological examination; 18 F-FDG PET was performed in 17 patients with AD and 15 patients with VCI.

RESULTS: The greatest changes in patients with AD were noted in the mnestic sphere, and the indicators significantly differed from the results of the study of patients with VCI already at the pre-dementia stage. Neurodynamic and dysregulatory disorders prevailed in patients with VCI. Patients with AD showed bilateral symmetrical reduction of metabolic activity in the cortex of parietal and temporal lobes, often in combination with marked hypometabolism in the hippocampal region. In patients with VCI, there were areas of decreased brain tissue metabolism of different localization and size, mainly in the projection of the basal ganglia and in the prefrontal and parietal cortex, as well as in the cingulate gyrus, which indirectly confirms the mechanism of disconnection of subcortical and cortical structures. In AD, impaired metabolic activity in the hippocampal region correlated with impaired temporal and spatial orientation ( ρ =-0.54, p <0.05), memory impairment ( ρ =-0.71, p <0.005). Hypometabolism of the parietal lobe cortex was associated with total MMSE score ( ρ =-0.8, p <0.001), 10-word test ( ρ =-0.89, p <0.001 and ρ =-0.82, p <0.001), visual-spatial impairment ( ρ =-0.64, p <0.01), categorical association test ( ρ =-0.73, p <0.005). In patients with VCI, dysregulatory disorders correlated with hypometabolism in the thalamic projection ( ρ =-0.56, p <0.05), prefrontal cortex ( ρ =-0.64, p <0.05) and in the cingulate gyrus (anterior regions) ( ρ =-0.53, p <0.05).

CONCLUSION: The results indicate the presence of differences in cognitive impairment and cerebral metabolism in patients with AD and VCI.