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Medial temporal hypoperfusion and aggression in Alzheimer disease
Krista L Lanctôt1, Nathan Herrmann, Neelesh K Nadkarni
1Neuropharmacology Research, Department of Psychiatry, Cognitive Neurology Unit, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada. Krista.Lanctot@sw.ca
Background:
It is not understood why some patients with Alzheimer disease (AD) display aggression and others do not.
Objective:
To examine the relation between regional brain perfusion and aggression in AD.
Design:
Single-photon emission computed tomographic scans were coregistered to a standardized template in Talairach space, generating mean ratios of uptake referenced to the cerebellum.
Participants:
Forty-nine outpatients (25 men and 24 women; mean +/- SD age, 74 +/- 11 years) with probable AD (Mini-Mental State Examination score, 17.7 +/- 5.0; 30 aggressive and 19 nonaggressive), comparable in age, sex, and severity of cognitive impairment.
Main Outcome Measures:
Regional perfusion ratios were determined for 5 bilateral regions of interest: orbitofrontal, middle medial temporal, inferior medial temporal, hypothalamus/thalamus, and anterior cingulate.
Results:
Compared with nonaggressive patients, aggressive ones displayed hypoperfusion in the right and left middle medial temporal regions of interest (P = .02 for both), but not the others (all (t tests, unpaired, 2-tailed). On regression analyses, right middle temporal hypoperfusion (P = .001), younger age (P = .002), greater activity disturbances (P = .004), and higher Mini-Mental State Examination scores (P = .04) independently predicted aggression, accounting for 44% of the total variance (F = 8.7; P<.001). Statistical parametric mapping analyses supported right middle medial temporal hypoperfusion in the aggressive group (P = .008).
Conclusion:
In this sample of patients with AD, the right middle medial temporal region emerged as an important neural correlate of aggression.