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| DC Field | Value | Language |
|---|---|---|
| dc.contributor.author | Γιαννάκης, Αλέξανδρος | el |
| dc.contributor.author | Giannakis, Alexandros | en |
| dc.date.accessioned | 2024-05-21T08:00:18Z | - |
| dc.date.available | 2024-05-21T08:00:18Z | - |
| dc.identifier.uri | https://olympias.lib.uoi.gr/jspui/handle/123456789/37678 | - |
| dc.identifier.uri | http://dx.doi.org/10.26268/heal.uoi.17386 | - |
| dc.rights | Default License | - |
| dc.subject | Νευροεκφυλιστικά νοσήματα | el |
| dc.subject | Μαγνητική τομογραφία εγκεφάλου | el |
| dc.subject | Νόσος Alzheimer | el |
| dc.subject | Νόσος Parkinson | el |
| dc.subject | Άνοια με σωμάτια Lewy | el |
| dc.subject | Φλοιοβασικό σύνδρομο | el |
| dc.title | Αλληλεπικαλυπτόμενη παθολογία νευροεκφυλιστικών νοσημάτων | el |
| dc.title | Overlapping pathology of neurodegenerative diseases | en |
| dc.type | doctoralThesis | en |
| heal.type | doctoralThesis | el |
| heal.type.en | Doctoral thesis | en |
| heal.type.el | Διδακτορική διατριβή | el |
| heal.dateAvailable | 2024-05-21T08:01:18Z | - |
| heal.language | el | el |
| heal.access | free | el |
| heal.recordProvider | Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας | el |
| heal.publicationDate | 2024-03-12 | - |
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| heal.abstract | Στόχοι και πεδίο εφαρμογής της μελέτης Σκοπός αυτής της αναδρομικής μελέτης παρατήρησης είναι η αξιολόγηση των δομικών αλλαγών της φαιάς και λευκής ουσίας του εγκεφάλου μεταξύ των ασθενών με νόσο του Alzheimer (AD), άνοια στη νόσο του Parkinson (PDD), άνοια με σωμάτια του Lewy (DLB) και φλοιοβασικό σύνδρομο (CBS), μέσω ανάλυσης εικόνων μαγνητικών τομογραφιών (MRI) εγκεφάλου. Αυτά τα νευροεκφυλιστικά νοσήματα μοιράζονται πολλά κοινά κλινικά χαρακτηριστικά, παρουσιάζοντας προκλήσεις κατά την κλινική διάγνωση. Μέθοδοι Συμμετέχοντες Όλοι οι ασθενείς προήλθαν από το Τμήμα Νευρολογίας του Πανεπιστημιακού Νοσοκομείου Ιωαννίνων. Τα κριτήρια ένταξης ήταν η ηλικία μεταξύ 50 και 80 ετών. Τα κριτήρια αποκλεισμού περιλάμβαναν ιστορικό μείζονος ψυχιατρικής ή νευροαναπτυξιακής διαταραχής, κατάχρησης ουσιών, ισχαιμικού ή αιμορραγικού αγγειακού εγκεφαλικού επεισοδίου, μείζονος κρανιοεγκεφαλικής κάκωσης, ενδοκράνιου χειρουργείου, όγκου, αρτηριοφλεβώδους δυσπλασίας ή άλλης ενδοκράνιας μάζας, ή αυξημένη παρουσία υπερεντάσεων λευκής ουσίας ή τεχνουργημάτων στις εικόνες MRI. Όλοι οι ασθενείς αξιολογήθηκαν διεξοδικά από δύο νευρολόγους. Οι ασθενείς διαγνώστηκαν σύμφωνα με τα τρέχοντα κλινικά κριτήρια για πιθανή διάγνωση κάθε υπό μελέτη νοσήματος. Οι ασθενείς με PDD και DLB μελετήθηκαν μαζί, ως μια ομάδα ανοιών με σωμάτια Lewy (LBD). Για όλους τους ασθενείς, τα σχετικά δημογραφικά δεδομένα, που περιλαμβάνουν την ηλικία, το φύλο, το επίπεδο εκπαίδευσης (έτη εκπαίδευσης) και κλινικούς δείκτες, όπως η διάρκεια νόσου, καταγράφηκαν για τη δομική αξιολόγηση του εγκεφάλου. Αυτοί οι δείκτες χρησιμοποιήθηκαν ως μεταβλητές στις συγκρίσεις που διεξήχθησαν μεταξύ των ομάδων. Νευροψυχολογική αξιολόγηση Όλοι οι ασθενείς και μάρτυρες υποβλήθηκαν σε εκτεταμένη νευροψυχολογική αξιολόγηση από εξειδικευμένο λογοθεραπευτή. Χορηγήθηκαν οι ακόλουθες νευροψυχολογικές συστοιχίες: η Αναθεωρημένη Γνωστική Εξέταση του Addenbrooke (ACE-R), η Συστοιχία Μετωπιαίας Εκτίμησης (FAB), η Δοκιμασία Λεκτικής Ροής (VFT), η Δοκιμασία Δημιουργίας Μονοπατιών (TMT), Α και Β μέρος, το Νευροψυχιατρικό Ερωτηματολόγιο (NPI) και η Γηριατρική Κλίμακα Κατάθλιψης (GDS). Στατιστική ανάλυση Οι συνεχείς δημογραφικές και κλινικές μεταβλητές αξιολογήθηκαν ως προς την κανονικότητα με τη τεστ Shapiro-Wilk και στη συνέχεια αναλύθηκαν με ανάλυση διακύμανσης κατά ένα παράγοντα (one-way ANOVA), ακολουθούμενη από post-hoc συγκρίσεις για την αξιολόγηση των διαφορών ομάδων μεταξύ των ομάδων μελέτης. Για τις διχότομες μεταβλητές, χρησιμοποιήθηκαν το x2 τεστ του Pearson και το ακριβές τεστ του Fisher. Ανάλυση απεικόνισης Η απεικόνιση πραγματοποιήθηκε χρησιμοποιώντας ακολουθίες T2W, FLAIR, T1W υψηλής ανάλυσης και DTI. Για τη δομική ανάλυση της επιφάνειας του φλοιού, χρησιμοποιήθηκαν εικόνες Τ1 υψηλής ανάλυσης. Ακολούθησε ανάλυση TBSS, με βάση τις εικόνες DTI. Στη συνέχεια, έγιναν συγκρίσεις μεταξύ των ομάδων, βασισμένες σε ογκοστοιχεία (voxel-wise) για την επιφάνεια του φλοιού, καθώς και στις παραμέτρους διάχυσης για τη λευκή ουσία. Αποτελέσματα Δημογραφικά και κλινικά δεδομένα Στη μελέτη συγκρίθηκαν 12 ασθενείς με AD, 15 ασθενείς με LBD (είτε PDD είτε DLB), 11 ασθενείς με CBS και 11 HC. Δε βρέθηκαν διαφορές μεταξύ των ομάδων ως προς το φύλο, τη διάρκεια της νόσου, τα έτη εκπαίδευσης ή άλλους κοινωνικοοικονομικούς παράγοντες. Ωστόσο, η ομάδα AD ήταν σημαντικά νεότερη (p < 0,05), σε σύγκριση με τις ομάδες LBD και CBS. Οι διαταραχές μνήμης ήταν το κύριο κλινικό χαρακτηριστικό της ομάδας AD, ενώ η δυσχέρεια βάδισης ή άλλα κινητικά συμπτώματα ήταν τα κύρια κλινικά χαρακτηριστικά για τις ομάδες LBD και CBS. Όλες οι ομάδες είχαν χαμηλές μέσες βαθμολογίες στην κλίμακα ACE-R (< 82/100). Οι βαθμολογίες της ομάδας AD ήταν χαμηλότερες στις δοκιμασίες μνήμης και γλώσσας. Οι ομάδα CBS είχαν τις χαμηλότερες επιδόσεις στις δοκιμασίες γλώσσας, ιδιαίτερα στη φωνημική ροή. Τέλος, και οι τρεις ομάδες είχαν κακή επίδοση στις οπτικοχωρικές δοκιμασίες. Επιφάνεια του φλοιού Όλες οι ομάδες ασθενών εμφάνισαν ατροφία σε σύγκριση με τους μάρτυρες. Η AD έδειξε μείωση της περιοχής επιφάνειας του φλοιού (CSA) στο μετωπιαίο λοβό, ιδίως στον αριστερό και δεξιό άνω μετωπιαίο φλοιό (SFC), (p = 0,0002), μαζί με το δεξιό κογχομετωπιαίο (OFC) και το δεξιό μέσο μετωπιαίο φλοιό (MFC), (p < 0.05). Μείωση του όγκου του φλοιού (CV) παρατηρήθηκε, επίσης, στο δεξιό SFC (p = 0,0002), στο δεξιό OFC (p = 0,0002) και στο δεξιό MFC (p < 0,05). Επιπλέον, η ομάδα LBD είχε μειωμένη CSA στον αριστερό άνω κροταφικό φλοιό (STC), ενώ η μειωμένη CSA σε μια άλλη περιοχή του STC αναδείχθηκε και για την ομάδα CBS (p < 0,05). Δεν ανιχνεύθηκαν διαφορές από τη σύγκριση μεταξύ των ομάδων ασθενών, εκτός από την ομάδα LBD, που είχε μεγαλύτερο πάχος φλοιού από την AD σε μια περιοχή του κάτω βρεγματικού φλοιού. Μετρήσεις διάχυσης Εκτεταμένες διαφορές στις μετρήσεις διάχυσης ανιχνεύθηκαν σε όλες τις μεγάλες οδούς της λευκής ουσίας για την ομάδα AD ως προς τους μάρτυρες και την ομάδα LBD. Και στις δύο περιπτώσεις, τα άτομα με AD παρουσίασαν χαμηλότερη κλασματική ανισοτροπία (FA) και αξονική διαχυτικότητα (AxialD), μαζί με υψηλότερη ακτινική διαχυτικότητα (RD). Τέλος, οι ασθενείς με CBS παρουσίασαν μεγαλύτερη RD από τους ασθενείς με LBD σε μια μικρή περιοχή της αριστερής έλικας του προσαγωγίου. Συμπεράσματα Τα αποτελέσματα υποδεικνύουν σημαντικές δομικές αλλαγές στη φαιά ουσία του μετωπιαίου λοβού σε ασθενείς με AD, μια περιοχή που δεν συνδέεται συνήθως με την παθολογία AD, τουλάχιστον στα αρχικά στάδια της νόσου. Οι αλλαγές αυτές υποδηλώνουν διαταραχές και στη δομική ακεραιότητα και συνδεσιμότητα της λευκής ουσίας. Άλλωστε, οι σημαντικές μεταβολές της λευκής ουσίας στην ομάδα AD υποδεικνύουν μειωμένη δομική ακεραιότητα και αυξημένη διάχυση των μορίων του νερού. Η συσχέτιση αυτών των ευρημάτων με την πορεία της AD παραμένει απροσδιόριστη. Μία πιθανή εξήγηση είναι η λεγόμενη υπόθεση αποσύνδεσης. Δηλαδή, η συμπτωματολογία AD δεν είναι αποκλειστικά το αποτέλεσμα της τοπογραφικής κατανομής των πλακών αμυλοειδούς ή των νευροϊνιδιακών συμπλεγμάτων, αλλά, μάλλον, μιας αποδιοργανωμένης αλληλεπίδρασης μεταξύ των νευρωνικών δικτύων, που οδηγεί σε διαταραχή της συνδεσιμότητας του εγκεφάλου. Μελέτες επικεντρωμένες στην ανάλυση των δικτύων συνδεσιμότητας του εγκεφάλου απαιτούνται στο μέλλον, προκειμένου να ελεγχθεί αυτή η υπόθεση. | el |
| heal.abstract | Aims and scope This observational, retrospective study aims to assess structural changes in the gray matter (GM) and white matter (WM) among patients with Alzheimer’s disease (AD), Parkinson’s disease dementia (PDD), dementia with Lewy bodies (DLB) and corticobasal syndrome (CBS), via analysis of magnetic resonance imaging (MRI) of the brain. These neurodegenerative diseases share many common clinical features, presenting challenges for bedside diagnosis. Methods Participants All patients were recruited from the Neurology Department of the University Hospital of Ioannina. Their clinical evaluation was performed by two Neurologists (blinded). Inclusion criteria were age 50-80 years. Exclusion criteria included a history of major psychiatric or neurodevelopmental disorder, substance abuse, ischemic or hemorrhagic stroke, severe head trauma, intracranial surgery, tumor, arteriovenous malformation, or other intracranial mass, as well as a significant burden of white matter hyperintensities (Fazekas 2 or higher), or motion artefacts. All patients were thoroughly evaluated by two Neurologists (blinded). Patients were diagnosed according to the current clinical criteria for a probable diagnosis. Patients with either PDD or DLB were studied together, as a Lewy body dementias (LBD) group. For all subjects, relevant demographic data including age, gender, education level (years of education) and clinical indices such as disease duration were recorded for structural brain evaluation. These indices were used as covariates in the group comparisons conducted. Neuropsychological assessment All patients and HC underwent an extensive neuropsychological assessment by a specialized speech therapist (blinded). The following neuropsychological batteries were administered: Addenbrooke’s Cognitive Examination-Revised (ACE-R), Frontal Assessment Battery, Verbal Fluency Task, Trail Making Test A and B, Neuropsychiatric Inventory, and Geriatric Depression Scale. Statistical analysis Continuous demographic and clinical variables were assessed for normality using the Shapiro-Wilk test and subsequently analyzed with one-way ANOVA, followed by post-hoc comparisons to assess group differences between study groups. For nominal variables, the Pearson Chi-Square test and Fisher's Exact test were employed to determine significance. Imaging analysis Imaging was performed using T2W, FLAIR, T1W high resolution and a diffusion tensor imaging sequence. Cortical surface analysis of the high-resolution T1-weighted structural images was followed by Tract-Based Spatial Statistics (TBSS) analysis of the diffusion images. Voxel-wise comparisons of cortical surface and diffusion metrics were conducted to assess differences among the groups. Results Demographics and clinical data The study included 12 AD patients, 15 LBD patients (either dementia with Lewy bodies or Parkinson’s disease dementia), 11 CBS patients, and 11 healthy controls (HC). No differences were found between groups for sex, disease duration, years of education or other socioeconomic factors. However, the AD group was younger (p < 0.05), compared to the LBD and CBS groups. Memory impairment was main clinical feature for the AD group, while gait impairment or other motor features were the main clinical features for the LBD and CBS groups. All groups had low mean ACE-R scores (< 82/100). AD scores were poorer for memory and language subtests. CBS groups had the poorer performance in language tests, especially phonemic fluency. Lastly, all three groups performed poorly at visuospatial tests. Cortical Surface All patient groups exhibited atrophy compared to the healthy controls. AD showed cortical surface area (CSA) reduction in the frontal lobe (p=0.0002), especially in both left and right superior frontal cortices (SFC), along with reduction in the right orbitofrontal cortex (OFC), and right middle frontal cortex (p < 0.-05). Cortical volume (CV) reduction was also observed in the right SFC (p = 0.0002), right OFC (p = 0.0002), and right MFC, (p < 0.05). Additionally, LBD showed reduced CSA of the left superior temporal cortex (STC), while reduced CSA in another area of the STC was also shown in the CBS group (p < 0,05). No differences were detected between patient groups, except in the case where LBD demonstrated larger cortical thickness than AD in a region of the inferior parietal lobe. Diffusion Metrics Widespread differences in diffusion metrics were detected in all major white matter tracts between individuals with AD and HC or those with LBD. In both cases, individuals with Alzheimer’s disease exhibited lower fractional anisotropy (FA) and axial diffusivity (AxialD), along with higher radial diffusivity (RD). Finally, patients with CBS presented larger RD than patients with LBD in a small region of the left cingulate gyrus. Conclusions The results indicate significant structural changes in the GM of the frontal lobe in AD patients, an area not commonly associated with AD pathology, at least in the early stages of the disease. These changes suggest reduced structural integrity and disconnection of the underlying WM tracts in AD patients. Moreover, the significant WM alterations of the AD group are also suggestive of reduced structural integrity and increased water diffusivity within the white matter microstructure. The association of these findings with the course of AD remains undefined. One possible explanation is the so-called disconnection hypothesis, suggesting that AD symptomatology is not solely the result of the topographical distribution of accumulated amyloid plaques and neurofibrillary tangles, but rather a disorganized interaction between neuronal networks, leading to disturbed connectivity within the brain. Future studies focusing on network analysis of human brain connectivity are needed to test this hypothesis. | en |
| heal.advisorName | Κονιτσιώτης, Σπυρίδων | el |
| heal.committeeMemberName | Αργυροπούλου, Μαρία | el |
| heal.committeeMemberName | Γιαννόπουλος, Σωτήριος | el |
| heal.committeeMemberName | Αρναούτογλου, Μαριάνθη | el |
| heal.committeeMemberName | Αλεξίου, Γεώργιος | el |
| heal.committeeMemberName | Αστρακάς, Λουκάς | el |
| heal.committeeMemberName | Κεφαλοπούλου, Ζηνοβία | el |
| heal.committeeMemberName | Κονιτσιώτης, Σπυρίδων | el |
| heal.academicPublisher | Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής. Είναι Τομέας Νευρικού Συστήματος και Αισθητηρίων. | el |
| heal.academicPublisherID | uoi | el |
| heal.numberOfPages | 242 | el |
| heal.fullTextAvailability | true | - |
| heal.fullTextAvailability | true | - |
| Appears in Collections: | Διδακτορικές Διατριβές - ΙΑΤ | |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| Giannakis-PHD-uoi-2024.pdf | 11.37 MB | Adobe PDF | View/Open |
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