Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease.
Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease.
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DOI：
10.1161/strokeaha.117.017526
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发表时间：
2018-03
期刊：
影响因子：
8.3
通讯作者：
Markus HS
中科院分区：
文献类型：
--
作者：
Benjamin P;Trippier S;Lawrence AJ;Lambert C;Zeestraten E;Williams OA;Patel B;Morris RG;Barrick TR;MacKinnon AD;Markus HS
文本中提供了补充数字内容。脑小血管疾病是认知障碍的主要原因。血管周围间隙（PvS）发生在小血管疾病中，但其与认知障碍的关系仍不确定。原因之一可能是难以区分缺陷和 PvS。我们确定了基线 PvS 分数和 PvS 量与 5 年随访期间认知变化之间的关系。我们将其与基线腔隙计数和总腔隙体积与认知之间的关系进行了比较。此外，我们还检查了 PvS 量随时间的变化。使用来自有症状的腔隙性中风和汇合性脑白质疏松症患者的前瞻性 SCANS 研究（中风中的圣乔治认知和神经影像学）的数据 (n = 121)。多模态磁共振成像每年进行一次，持续 3 年，神经心理学测试每年进行一次，持续 5 年。手动识别腔隙并将其与 PvS 区分开。使用经过验证的视觉评级量表对 PvS 进行评级，并使用 T1 加权图像计算 PvS 体积。使用线性混合效应模型来确定 PvS 和缺陷对认知的影响。基线 PvS 分数或体积显示与认知指数没有关联。 3 年来 PvS 数量没有变化。相比之下，基线缺陷与所有认知指数相关，并预测 5 年随访期间认知能力下降。尽管 PvS 是小血管疾病的一个特征，但与腔隙相比，PvS 并不是认知能力下降的预测因素。这项研究强调了在血管性认知障碍研究中仔细区分腔隙和 PvS 的重要性。
Supplemental Digital Content is available in the text. Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time. Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition. Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up. Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment.