Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV.
Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV.
复制标题
脑血管对HIV感染者神经认知障碍的影响
DOI：
10.1097/qai.0000000000002729
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发表时间：
2021-09-01
期刊：
影响因子：
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通讯作者：
Schnall R
中科院分区：
文献类型：
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作者：
Gutierrez J;Porras TN;Yoo-Jeong M;Khasiyev F;Igwe KC;Laing KK;Brickman AM;Pavol M;Schnall R
研究PLWH队列中基于MRI的脑血管疾病生物标志物的综合阵列，并将这些成像生物标志物与认知联系起来。以社区为基础的横断面参与者是纽约市公共卫生研究所的≥，年龄50岁。他们接受了脑部MRA/MRI检查，以确定脑血管疾病的7个MRI标志物：无症状性脑梗塞、血管周围间隙扩张、微出血、白质高信号体积、白质各向异性分数和平均弥散率(衡量白质完整性)以及颅内大动脉狭窄。参与者接受了一系列神经认知测试，以获得代表认知各个方面的个人和整体认知分数。我们包括85名参与者(平均年龄60±6岁，48%男性，78%非西班牙裔黑人)，大多数HIV控制良好(75%在MRI扫描时或接近扫描时CD4计数和病毒载量均为200细胞/毫升和病毒载量400拷贝/毫升)。无症状性脑梗塞、颅内大动脉狭窄和白质完整性差与至少一个认知领域的表现较差有关，但脑血管疾病的这三个磁共振标志物的总和与较低的工作记忆(B=−0.213，P=0.028)、列表学习(B=−0.275，P=0.019)和全局认知(B=−0.129，P=0.007)相关。我们确定静止性脑梗塞、颅内大动脉狭窄和白质完整性差是可以改变的暴露，因此可能会影响认知能力下降。此外，这些脑血管疾病的MRI标记物可能有助于识别认知功能下降风险较高的PLWH，这可能更适合靶向治疗。
To investigate a comprehensive array of MRI-based biomarkers of cerebrovascular disease in a cohort of PLWH and relate these imaging biomarkers to cognition. Cross-sectional, community-based Participants were PLWH in New York City ≥ 50 years old. They underwent a brain MRA/MRI to ascertain seven MRI markers of cerebrovascular disease: Silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition. We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic black), the majority with well controlled HIV (75% with CD4 count > 200 cell/mm3 and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these three MRI markers of cerebrovascular disease was associated with lower working memory (B=−0.213, P=0.028), list learning (B=−0.275, P=0.019), global cognition (B=−0.129, P=0.007). We identified silent brain infarcts, intracranial large artery stenosis and poor white matter integrity as exposures that may be modifiable and may therefore influence cognitive decline. Additionally, these MRI markers of cerebrovascular disease may help identify PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.