Serum magnezyum düzeyinin alzheimer tipi demansta risk faktörü olarak değerlendirilmesi ve klinik progresyon üzerine etkileri

Abstract

Demans merkezi sinir sisteminin edinsel nedenlerle hasarlanması sonucunda birden fazla kognitif alanda bozulma ile giden ve kişinin günlük yaşam aktivitelerini etkileyen kronik bir beyin hastalığıdır.Alzheimer Hastalığı demansın en sık rastlanan nedenidir ve son zamanlarda yapılan çalışmalarda, Alzheimer Hastalığında özellikle eksitatuar aminoasitlere NMDA reseptör cevabını etkileyen Mg; bir risk faktörü olarak ve destek tedavideki yeri açısından dikkat çekmektedir.Bu çalışmada Alzheimer hastalarında Mg düzeyleri ve kognitif durum testleri ile bu düzeyler arasındaki ilişkiyi araştırmayı planladık.Çalışmaya Ankara Numune Eğitim ve Araştırma Hastanesi 1.Nöroloji Polikliniğine Kasım 2003-Haziran 2004 tarihleri arasında başvuran 20'si kadın17'si erkek olmak üzere 37 hasta dahil edildi.Kontrol grubuna 34 kişi alındı. Hastaların tümü için diğer risk faktörleri ve eşlik eden hastalıklar kaydedildi. Hasta grubunun tümünde laboratuar tetkiki olarak rutin hemogram, biyokimya, vitamin B12, folik asit, tiroid fonksiyon testleri, fosfor ve 12 saatlik açlık sonrasında sabah 8-10 arası venöz Mg düzeyleri çalışıldı. Kranial BT veya MR görüntülemeriyle atrofi varlığı ve lokalizasyonu, periventriküler hipodansiteleri ve varsa diğer vasküler lezyonları değerlendirildi. Hastaların tümüne Mini Mental Test uygulandı. Bunların sonucunda NINCDS-ADRDA ve DSM IV tanı kriterleri kullanılarak Alzheimer Hastalığı tanısı alan hastalar Global Kötüleşme Skalası ve Klinik Demans Skalası'na göre evrelendirildi.Yaş özellikleri eşitlenen hasta grubunun serum Mg düzeyleri (2,17±0,29) ile kontrol grubu serum Mg düzeyleri (2,19+0,12) arasında istatistiksel farklılık saptanmadı (p=0,726).Global kötüleşme skalasına göre grupların (hafif, orta, ileri) serum Mg düzeylerinin kontrol grubu ile karşılaştırılması sonucunda kontrol grubu (2,197±0,122) ile hafif ve orta derecede global kötüleşme skalası skoruna sahip hastaların (2,227±0,326) Mg düzeylerinin istatistiksel olarak anlamlı farklılık göstermediği ancak kontrol grubu ile ileri evre global kötüleşme skalası skoruna sahip hastaların (2,11±0,255) Mg düzeylerinin belirgin farklılık gösterdiği (p=0,030) tespit edildi.

Dementia is a chronic brain disorder which becomes as a result of central nervous system injury through many acquired reasons and consists of cognitive impairment in several areas and effects the daily living activities of the patient.Alzheimer's disease is the most common cause of dementia and in recent studies the magnesium which specially effects the NMDA receptor response to the excitatory aminoacids is attentive as a risk factor and supportive theurapeutic agent in Alzheimer's disease.In this study we measured the magnesium levels in serum and investigated the relationship between these levels and the cognitive test results and clinical stages of the patients.37 patients whose 20 were women and 17 were men that admitted to 1. Neurology Clinic of Ankara Numune Education and Research Hospital between October 2003 and June 2004 were included in the study. 34 subjects were included as control group. Other risk factors and co-existing diseases of all of the patients were recorded. Routine hemogram, biochemistry, serum Vitamin B12, folic acid and phosphor levels, thyroid function tests and venous Mg levels after 12 hours fasting, between 8-10:00 am of all patients were measured. The presence and localization of atrophy, periventriculer hypodensity and other vasculer lesions were evaluated on Cranial CT or MR images of patients. MMSE was performed to all of the patients. In result of these, the patients, who got the diagnosis ofAlzheimer's disease by using NINCDS-ADRDA and DSM IV diagnostic criterias were staged according to Global Deterioration Scale and Clinical Dementia Rating.After adjustment for age no statistical difference between serum Mg levels of patient (2,17+0,29) and control groups (2,19±0,12) was established.When the serum Mg levels of patients who were evaluated as mild and moderate (2,197+0,122) according to Global Deterioration Scale were compared with the serum Mg levels of control subjects (2,227±0,326) no statistical difference was found. However, when the Mg levels of patients who were evaluated as severe (2,11+0,255) according to Global Deterioration Scale were compared with control subjects significant difference was found (p=0,030).Serum Mg levels of the patients whose stages were 0,5 and 1 (2,51+0,47) according to Clinical Dementia Rating were significantly higher than the seum Mg lévela of the patients whose stages were 2 and 3 (2,102 +0,30) (p=0,003).When we investigated the relationship between the serum Mg levels of the patients and dementia scales we found that Mg levels were significantly lower in the group whose Mini Mental Test scores were <20 (2,212 ± 0,461) than the ones whose Mini Mental Test scores were >20 (2,417 ± 0,337).Positive correlation was found between serOrri Mg levels and MMT scores when corelation between the Mg levels and dementia scales was investigated (r=0,321 ;p=0,053).Negative correlation was found between serum Mg levels and Global Deterioration Scale and Clinical Dementia Rating as if showing that Mg levels were lowering together wiyh clinical deterioration (respectively: r=-0,35; p=0,033, r=-0,360; p=0,029).In conclusion;our datas make consider that there is a relationship between the serum Mg levels and the degree of Alzheimer's disease and Mg supply in various stages may perform positive support on progression and curement of Alzheimer's disease.