The impact of silent vascular brain burden in cognitive impairment in Parkinson's disease
The impact of silent vascular brain burden in cognitive impairment in Parkinson's disease
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DOI：
10.1111/j.1468-1331.2012.03682.x
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发表时间：
2012-08-01
影响因子：
5.1
通讯作者：
Rodriguez-Oroz, M. C.
中科院分区：
文献类型：
--
作者：
Gonzalez-Redondo, R.;Toledo, J.;Rodriguez-Oroz, M. C.
背景和目的：通过大脑磁共振成像（MRI）检测到的白质高信号（WMH）与普通人群和阿尔茨海默病的痴呆和认知障碍有关。它们对帕金森病 (PD) 相关认知能力下降和痴呆的影响仍不清楚。方法：我们在一项横断面和随访研究中，研究了 111 名 PD 患者的 WMH 和认知状态之间的关系，这些患者被分类为认知正常 (n = 39)、轻度认知障碍 (MCI) (n = 46) 或痴呆 (n = 26)。通过综合神经心理学评估认知状态，并通过 FLAIR 和 T2 加权 MRI 识别 WMH。使用 Scheltens 量表对 WMH 的负担进行评级。结果：横断面研究中三组之间的 WMH 没有差异。我们观察到语义流畅度与额叶 WMH 分值之间呈负相关。在平均随访 30 个月后重新评估的 36 名非痴呆患者中，3 名患者转变为 MCI，5 名患者转变为痴呆。脑室周围 WMH 的进展与痴呆转化率增加相关。 WMH 总负担的增加与简易精神状态检查的恶化之间存在边际关联。结论：白质高信号不影响PD患者的认知状态。额叶 WMH 对语义流畅性有负面影响。脑血管负担可能会对 PD 患者的认知障碍产生影响，因为随着时间的推移，WMH 增加可能会增加转化为痴呆的风险。这一发现需要在更大规模的前瞻性研究中进一步证实。
Background and purpose: White matter hyperintensities (WMHs) detected by magnetic resonance imaging (MRI) of the brain are associated with dementia and cognitive impairment in the general population and in Alzheimers disease. Their effect in cognitive decline and dementia associated with Parkinsons disease (PD) is still unclear. Methods: We studied the relationship between WMHs and cognitive state in 111 patients with PD classified as cognitively normal (n = 39), with a mild cognitive impairment (MCI) (n = 46) or dementia (n = 26), in a cross-sectional and follow-up study. Cognitive state was evaluated with a comprehensive neuropsychological battery, and WMHs were identified in FLAIR and T2-weighted MRI. The burden of WMHs was rated using the Scheltens scale. Results: No differences in WMHs were found between the three groups in the cross-sectional study. A negative correlation was observed between semantic fluency and the subscore for WMHs in the frontal lobe. Of the 36 non-demented patients re-evaluated after a mean follow-up of 30 months, three patients converted into MCI and 5 into dementia. Progression of periventricular WMHs was associated with an increased conversion to dementia. A marginal association between the increase in total WMHs burden and worsening in the Mini Mental State Examination was encountered. Conclusions: White matter hyperintensities do not influence the cognitive status of patients with PD. Frontal WMHs have a negative impact on semantic fluency. Brain vascular burden may have an effect on cognitive impairment in patients with PD as WMHs increase overtime might increase the risk of conversion to dementia. This finding needs further confirmation in larger prospective studies.