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Yıl:2019; Cilt: 30; Sayı: 4>> Özet
TAM METİN
Türk Psikiyatri Dergisi; 2019;30(4):279-286
Alzheimer Hastalığında Olağan Durum Ağı Bağlantısallığı
E Yıldırım, ES Büyükişcan
Işık Üniversitesi, İstanbul
Amaç: Alzheimer hastalığı (AH) beyinde yapısal ve işlevsel değişimler meydana getiren nörodejeneratif bir hastalıktır. Gelişen beyin görüntüleme yöntemleri sayesinde AH patolojisine eşlik eden yapısal ve işlevsel bağlantılardaki bozulmalar gitgide daha görünür hale gelmiştir. AH’de dinlenim durumu bağlantısallığında, özellikle de olağan durum ağı (default mode network - DMN) olarak adlandırılan içsel bağlantısallık ağında farklılaşmalar görülmektedir. Bu çalışmada DMN bağlantısallık bulgularının incelenmesi ve tartışılması amaçlanmıştır. Yöntem: İşlevsel manyetik rezonans görüntüleme (fMRI) çalışmalarında en yaygın kullanılan 2 temel metodoloji (tohum temelli ve bağımsız bileşen analizi) temel alınarak alanda yapılan çalışmalar incelenmiştir. Bulgular: Çalışmalar genel olarak, DMN bağlantısallığının AH süreci boyunca ilerleyici bir şekilde bozulduğunu göstermektedir. DMN alt sistemlerinin AH’nin preklinik ve prodromal evrelerinde farklı bağlantısallık örüntüleri gösterdiği de belirtilmektedir. DMN’deki bozulmanın diğer bağlantısallık ağlarındaki farklılaşma ile ilişkili olabileceğini öne süren kanıtlar da mevcuttur. Buna ek olarak, bulgular DMN’nin AH ile ilişkili nöropatoloji ve genetik risk faktörleri ile olan ilişkisine de işaret etmektedir. Sonuç: AH’nin beyinde başta DMN olmak üzere diğer dinlenim durumu ağlarında işlevsel bozulmalara yol açan yaygın bir diskonneksiyon sendromu olduğu öne sürülebilir. Buna ek olarak, preklinik vakalarda ve risk taşıyan kişilerde de saptanabilen AH ile ilişkili işlevsel bağlantısallık değişimleri AH için muhtemel bir biyo-belirteç olabilir.
Default Mode Network Connectivity in Alzheimer’s Disease
Objective: Alzheimer’s Disease (AD) is a neurodegenerative condition characterized by functional and structural changes in the brain that are increasingly better visualized with the advances in new brain imaging techniques. Connectivity changes under the resting state condition especially in the internal connectivity network, named as the default mode network (DMN), are observed in AD. This paper aimed to investigate and discuss the findings on DMN connectivity. Method: The studies carried out by functional magnetic resonance imaging (fMRI), using the two most widely applied techniques, the seed-based method and independent component analysis (ICA), have been investigated. Results: Studies generally indicate a progressive impairment in DMN connectivity during the course of AD. It has been also stated that DMN subsystems show differential connectivity patterns in the preclinical and prodromal stages of AD. There is also evidence suggesting that impairment in DMN connectivity could be associated with different connectivity patterns in other networks. Furthermore, findings point towards a relationship between DMN and AD-related neuropathology and genetic risk factors. Conclusion: It may be proposed that AD is a generalized disconnection syndrome that causes functional impairments in resting state networks, particularly in DMN. In addition to this, AD-related functional connectivity changes observed in preclinical cases and risk carriers might be a potential bio-marker for AD.

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