Itching Frequency and Neuroanatomic Correlates in Frontotemporal Lobar Degeneration.

IF 20.4 1区 医学 Q1 CLINICAL NEUROLOGY JAMA neurology Pub Date : 2024-09-01 DOI:10.1001/jamaneurol.2024.2213
Rafi Hadad, Maria Luisa Mandelli, Katherine P Rankin, Charlie Toohey, Virginia E Sturm, Shireen Javandel, Andjelika Milicic, Marguerite Knudtson, Isabel Elaine Allen, Nathalia Hoffmann, Adit Friedberg, Katherine Possin, Victor Valcour, Bruce L Miller
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引用次数: 0

Abstract

Importance: Itching is common in geriatric populations and is frequently linked to dermatological or systemic conditions. Itching engages specific brain regions that are implicated in the pathogenesis of frontotemporal lobar degeneration spectrum disorders (FTLD-SD). Thus, itching of undetermined origin (IUO) may indicate the presence of a neurodegenerative process.

Objective: To compare the frequency of itching in FTLD-SD and Alzheimer disease (AD) and to determine the neuroanatomical underpinnings of IUO.

Design, setting, and participants: This case-control study evaluated data and brain magnetic resonance images (MRIs) for participants with FTLD-SD or AD. Participants of a research study on FTLD-SD at the University of California, San Francisco, Memory and Aging Center were evaluated from May 1, 2002, to December 31, 2021. The exposure group underwent structural brain MRI within 6 months of initial diagnosis. Research visit summaries were reviewed to validate qualitative details and accurately identify itching with undetermined origin (IUO).

Exposures: Symptoms suggestive of FTLD-SD or AD.

Main outcomes and measures: Frequency of itching in FTLD-SD and AD and neuroanatomic correlates.

Results: A total of 2091 research visit summaries were reviewed for 1112 patients exhibiting symptoms indicative of FTLD-SD or AD. From 795 records where itching or a related phrase was endorsed, 137 had IUO. A total of 454 participants were included in the study: 137 in the itching group (mean [SD] age, 62.7 [9.9] years; 74 [54%] females and 63 males [46%]) and 317 in the nonitching group (mean [SD] age, 60.7 [10.8] years; 154 [49%] females and 163 males [51%]). Groups were similar in age, sex, and disease severity. More frequent itching was found in FTLD-SD (95/248 patients [38%], of which 44 [46%] had behavioral variant frontotemporal dementia [bvFTD]) compared with the AD group (14/77 patients [18%]; P = .001). The odds of itching were 2.4 (95% CI, 1.48-3.97) times higher for FTLD-SD compared with all other cases of dementia. Compared with healthy controls, the group with IUO exhibited greater gray matter atrophy bilaterally in the amygdala, insula, precentral gyrus, and cingulum, as well as in the right frontal superior gyrus and thalamus. Among patients with bvFTD and itching vs bvFTD without itching, itching was associated with right-lateralized gray matter atrophy affecting the insula, thalamus, superior frontal gyrus, and cingulum.

Conclusions and relevance: Among individuals with IUO, FTLD-SD was disproportionately represented compared with AD. In FTLD-SD, dysfunction in the right anterior insula and its connected regions, including the right precentral gyrus, cingulum, and bilateral amygdala, contribute to dysregulation of the itching-scratching networks, resulting in uncontrollable itching or skin picking. Awareness among physicians about the relationship between neurodegeneration and itching may help in the management of itch in older individuals. Further studies are needed to determine the best treatments for these symptoms in patients with neurodegenerative disorders.

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前额颞叶变性的瘙痒频率与神经解剖相关性
重要性:瘙痒在老年人群中很常见,而且经常与皮肤病或全身性疾病有关。瘙痒会影响特定的脑区,而这些脑区与额颞叶变性谱系障碍(FTLD-SD)的发病机制有关。因此,不明原因的瘙痒(IUO)可能预示着神经退行性过程的存在:比较 FTLD-SD 和阿尔茨海默病(AD)中瘙痒的频率,并确定 IUO 的神经解剖学基础:这项病例对照研究评估了 FTLD-SD 或 AD 患者的数据和脑磁共振成像(MRI)。研究人员对加州大学旧金山分校记忆与衰老中心(University of California, San Francisco, Memory and Aging Center)一项关于FTLD-SD研究的参与者进行了评估,研究时间为2002年5月1日至2021年12月31日。暴露组在初步诊断后 6 个月内接受了脑结构磁共振成像检查。对研究访问摘要进行了审查,以验证定性细节并准确识别原因不明的瘙痒(IUO):主要结果和测量指标:主要结果和测量指标:FTLD-SD 和 AD 的瘙痒频率以及神经解剖相关性:结果:共审查了1112名表现出FTLD-SD或AD症状的患者的2091份研究访问摘要。在 795 份认可瘙痒或相关短语的记录中,137 份有 IUO。共有 454 人被纳入研究:瘙痒组 137 人(平均 [SD] 年龄 62.7 [9.9] 岁;女性 74 [54%] ,男性 63 [46%]),无瘙痒组 317 人(平均 [SD] 年龄 60.7 [10.8] 岁;女性 154 [49%] ,男性 163 [51%])。各组的年龄、性别和疾病严重程度相似。与AD组(14/77名患者[18%];P = .001)相比,FTLD-SD组(95/248名患者[38%],其中44名患者[46%]患有行为变异型额颞叶痴呆[bvFTD])的瘙痒发生率更高。与所有其他痴呆症病例相比,FTLD-SD 患者出现瘙痒的几率要高出 2.4 倍(95% CI,1.48-3.97)。与健康对照组相比,IUO组患者双侧杏仁核、岛叶、前中央回和齿状回以及右侧额上回和丘脑的灰质萎缩程度更严重。在伴有瘙痒的bvFTD患者与不伴有瘙痒的bvFTD患者中,瘙痒与影响脑岛、丘脑、额上回和齿状回的右侧灰质萎缩有关:在IUO患者中,FTLD-SD患者的比例高于AD患者。在FTLD-SD患者中,右侧岛叶前部及其相连区域(包括右侧前中央回、蝶鞍和双侧杏仁核)的功能障碍会导致瘙痒-抓挠网络失调,从而导致无法控制的瘙痒或皮肤搔抓。医生对神经变性与瘙痒之间关系的认识可能有助于老年瘙痒症的治疗。要确定治疗神经退行性疾病患者这些症状的最佳方法,还需要进一步的研究。
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来源期刊
JAMA neurology
JAMA neurology CLINICAL NEUROLOGY-
CiteScore
41.90
自引率
1.70%
发文量
250
期刊介绍: JAMA Neurology is an international peer-reviewed journal for physicians caring for people with neurologic disorders and those interested in the structure and function of the normal and diseased nervous system. The Archives of Neurology & Psychiatry began publication in 1919 and, in 1959, became 2 separate journals: Archives of Neurology and Archives of General Psychiatry. In 2013, their names changed to JAMA Neurology and JAMA Psychiatry, respectively. JAMA Neurology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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