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. 2018 Oct-Dec;12(4):380-387.
doi: 10.1590/1980-57642018dn12-040007.

Monitoring of drug treatment and psychosocial intervention with SPECT in Alzheimer patients Implications for neurologically appropriate psychosocial interventions. An observational study. The Osaki-Tajiri Project

Kenichi Meguro  1 , Shigeo Kinomura  2 , Kenji Sugamata  2 , Tachio Sato  2 , Keiichi Kumai  1 , Junko Takada  1 , Satoshi Yamaguchi  1   3
Affiliations

Monitoring of drug treatment and psychosocial intervention with SPECT in Alzheimer patients Implications for neurologically appropriate psychosocial interventions. An observational study. The Osaki-Tajiri Project

Kenichi Meguro et al. Dement Neuropsychol. 2018 Oct-Dec.

Abstract
in English, Portuguese

We previously examined cerebral blood flow (CBF) with single-photon emission computed tomography (SPECT) in Alzheimer's disease (AD) with reference to drug treatment (donepezil) and psychosocial intervention.

Objective: The aim is to provide "brain-based" evidence for psychosocial interventions using SPECT.

Methods: The participants were 27 consecutive outpatients with AD who received the drug and psychosocial intervention, and SPECT three times (baseline, pre-/post-intervention) at 6 month-intervals. The significance level of changes in CBF (Z score) and the extent of significantly changed areas, calculated with the eZIS system, were used as monitoring parameters. The participants were classified into three groups: improve (post-intervention CBF increased), worsening (progressive decline), and no change.

Results: Six, 8, and 13 patients were classified as improve, worsening, and no change, respectively. All subjects in the improve group showed improvement in cognitive test scores for the MMSE and/or the CGI scores associated with the brain area with a CBF increase (right parietal lobe), suggesting appropriate psychosocial intervention (visuospatial intervention).

Conclusion: These results suggest that monitoring of CBF with the eZIS system may be clinically applicable for monitoring of drug treatment and psychosocial intervention in AD patients.

Nós examinamos previamente o fluxo sanguíneo cerebral (FSC) com tomografia computadorizada de emissão de fóton único (SPECT) na doença de Alzheimer (DA) com referência ao tratamento medicamentoso (donepezila) e intervenção psicossocial.

Objetivo: Fornecer evidências “baseadas no cérebro” para intervenções psicossociais usando o SPECT.

Métodos: Os participantes foram 27 pacientes ambulatoriais consecutivos com DA que receberam a droga e intervenção psicossocial, e SPECT por três vezes (basal, pré/pós-intervenção) em intervalos de seis meses. O nível de significância das mudanças no FSC (escore Z) e a extensão das áreas significativamente alteradas calculadas com o sistema eZIS foram utilizados como parâmetros de monitoramento. Os participantes foram classificados em três grupos: melhora (FSC pós-intervenção aumentada), piora (declínio progressivo) e nenhuma mudança.

Resultados: Seis, oito e 13 pacientes foram classificados como melhora, piora e sem alteração, respectivamente. Todos no grupo melhora mostraram aumento dos escores no MEEM e/ou nos escores do CGI associados à área do cérebro com aumento do FSC (lobo parietal direito), sugerindo intervenção psicossocial apropriada (intervenção visoespacial).

Conclusão: Estes resultados sugerem que o monitoramento do FSC com o sistema eZIS pode ser clinicamente aplicável para o monitoramento do tratamento medicamentoso e intervenção psicossocial em pacientes com DA.

Keywords: Alzheimer’s disease; SPECT; cerebral blood flow; donepezil; eZIS; monitoring; psychosocial intervention.

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Conflict of interest statement

Disclosure: The authors report no conflits of interst.

Figures

Figure 1
Figure 1. [A] music visuospatial activities [B] social gathering and exercise
Figure 2
Figure 2. The eZIS sensitivity % changes for three SPECT examinations
Figure 3
Figure 3. Visuospatial activity with donepezil
Figure 4
Figure 4. Music activity with donepezil
Figure 5
Figure 5. Exercise with donepezil
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