cqvip:Background: It is not understood why some patients with Alzheimer disease (AD) display aggression and others do not. Objective: To examine the relation betwee n regional brain perfusion and aggression in AD. Design: Single photon emission computed tomographic scans were coregistered to a standardized template in Tala irach space, generating mean ratios of up take referenced to the cerebellum. Pa rticipants: Forty nine outpatients (25 men and 24 women; mean±SD age, 74±11 y ears) with probable AD (Mini Mental State Examination score, 17.7±5.0; 30 aggr essive 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, inferio r medial temporal, hypothalamus/thalamus, and anterior cingulate. Results: Compa red 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 hypoper fusion (P=.001), younger age (P=.002), greater activit y 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 m edial temporal hypoperfusion in the aggressive group (P=.008). Conclusion: In th is sample of patients with AD, the right middle medial temporal region emerged a s an important neural correlate of aggression.
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