Association of Cerebral Microbleeds With Cognitive Decline and Dementia.
Association of Cerebral Microbleeds With Cognitive Decline and Dementia.
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DOI：
10.1001/jamaneurol.2016.1017
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发表时间：
2016-08-01
期刊：
影响因子：
29
通讯作者：
Vernooij MW
中科院分区：
文献类型：
--
作者：
Akoudad S;Wolters FJ;Viswanathan A;de Bruijn RF;van der Lugt A;Hofman A;Koudstaal PJ;Ikram MA;Vernooij MW
脑微出血是由血管和淀粉样蛋白病理机制引起的脑损伤的假设下游标志物。到目前为止，尚不清楚它们的存在是否与一般人群的认知能力下降有关。确定微出血，更具体地说，微出血计数和位置是否与一般人群中认知障碍和痴呆的风险增加有关。基于人群的前瞻性鹿特丹研究。一般社区。在鹿特丹研究中，我们评估了4，841名年龄≥45岁的参与者在基线（2005-2011年）脑MRI上微出血的存在、数量和位置。参与者在两个时间点进行神经心理学测试，平均间隔5.9年（SD 0.6），并在整个研究期间跟踪痴呆事件，直到2013年。采用多元线性回归、线性混合效应模型和考克斯比例风险研究了微出血与认知能力下降和痴呆的相关性。脑微出血的存在、位置和数量。认知能力下降和痴呆。微出血患病率为15.3%（中位计数1 [1-88]）。存在与认知下降相关的>4次微出血。脑叶（有或没有小脑）微出血与执行功能，信息处理和记忆功能的下降有关，而其他大脑区域的微出血与信息处理和运动速度的下降有关。在平均随访4.8年（SD 1.4）后，72人患上了痴呆症，其中53人患有阿尔茨海默病。微出血的存在与痴呆的风险增加相关（年龄、性别、教育调整的HR 2.02，95%CI 1.25;3.24），包括阿尔茨海默氏痴呆（HR 2.10，95%CI 1.21;3.64）。在一般人群中，高微出血计数与认知恶化和痴呆的风险增加相关。因此，微出血标志着弥漫性血管和神经退行性脑损伤的存在。
Cerebral microbleeds are hypothesized downstream markers of brain damage caused by both vascular and amyloid pathological mechanisms. To date, it remains unclear whether their presence if associated with cognitive deterioration in the general population. To determine whether microbleeds, and more specifically microbleed count and location, associate with an increased risk of cognitive impairment and dementia in the general population. Prospective population-based Rotterdam Study. General community. In the Rotterdam Study, we assessed presence, number, and location of microbleeds at baseline (2005–2011) on brain MRI of 4,841 participants aged ≥45 years. Participants underwent neuropsychological testing at two time points on average 5.9 years (SD 0.6) apart, and were followed for incident dementia throughout the study period until 2013. The association of microbleeds with cognitive decline and dementia was studied using multiple linear regression, linear mixed effects modeling, and Cox proportional hazards. cerebral microbleed presence, location, and number. cognitive decline and dementia. Microbleed prevalence was 15.3% (median count 1 [1–88]). Presence of >4 microbleeds associated with cognitive decline. Lobar (with or without cerebellar) microbleeds were associated with decline in executive functions, information processing, and memory function, whereas microbleeds in other brain regions were associated with decline in information processing and motor speed. After mean follow-up of 4.8 years (SD 1.4), 72 people developed dementia, of whom 53 had Alzheimer’s disease. Presence of microbleeds was associated with an increased risk of dementia (age, sex, education adjusted HR 2.02, 95%CI 1.25;3.24), including Alzheimer’s dementia (HR 2.10, 95%CI 1.21;3.64). In the general population, a high microbleed count associated with an increased risk of cognitive deterioration and dementia. Microbleeds thus mark the presence of diffuse vascular and neurodegenerative brain damage.
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