The Effect of Ischemic Cholinergic Damage on Cognition in Patients With Subcortical Vascular Cognitive Impairment
The Effect of Ischemic Cholinergic Damage on Cognition in Patients With Subcortical Vascular Cognitive Impairment
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DOI：
10.1177/0891988712445089
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发表时间：
2012-06-01
影响因子：
2.6
通讯作者：
Han, Seol-Heui
中科院分区：
文献类型：
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作者：
Kim, Sook Hui;Kang, Hyun Seok;Han, Seol-Heui
先前的研究表明，脑白质缺血总量与认知缺陷无显著相关性。我们比较了总通路和胆碱能通路白质高信号（WMHs）与临床痴呆严重程度的关系，并研究胆碱能缺血负担是否对皮层下血管性认知障碍（SVCI）的认知能力下降具有独立的预测价值。48名患者接受了详细的神经心理测试和脑磁共振成像。采用视觉Scheltens量表和胆碱能通路高强度量表（chip）分别对总白质和胆碱能通路的WMH进行量化。我们探讨了WMH评分与临床痴呆评定量表（CDR）之间的关系。为了评估WMH与认知评分之间的关系，采用多元线性回归分析。与皮层下血管性MCI相比，皮层下血管性痴呆的CHIPS评分更高，而总TMHs （TWMH）评分没有发现这种差异。TWMH得分与CHIPS呈正相关，而CHIPS得分与CDR量表盒子得分之和呈正相关（CDR SB; rho = .474, P = .001）。较高的CHIPS分数与较低的语义单词流畅性测试表现相关（beta = - 0.447, P = 0.036），而在控制CHIPS分数后，TWMH分数对认知障碍没有独立的预测价值。我们的数据证实了胆碱能通路内的缺血性损伤与痴呆严重程度的关联，与SVCI中的TWMH无关。此外，这种胆碱能缺陷在临床上与认知功能减退有关，尤其是与额叶功能障碍有关。
Prior research has shown that the total amount of white matter ischemia had no significant correlation with cognitive deficits. We compared the association of white matter hyperintensities (WMHs) of total as well as cholinergic pathways with clinical dementia severity and investigated whether cholinergic ischemic burden had an independent predictive value with respect to cognitive decline in subcortical vascular cognitive impairment (SVCI). Forty-eight patients underwent detailed neuropsychological tests and brain magnetic resonance imaging. Quantification of WMH in the total white matter and in cholinergic pathways was achieved using the visual Scheltens scale and Cholinergic Pathway HyperIntensity Scale (CHIPS), respectively. We explored the association between WMH scores and clinical dementia rating scale (CDR). To assess the relation between WMH and cognitive scores, multiple linear regression analysis was used. The CHIPS score was higher in subcortical vascular dementia compared to subcortical vascular MCI, while this difference was not found with the total TMHs (TWMH) score. The TWMH score had a positive correlation with CHIPS, however only CHIPS scores positively correlated with sum of box scores of CDR scale (CDR SB; rho = .474, P = .001). Higher CHIPS scores were associated with lower performance on the semantic word fluency test (beta = -.447, P = .036), whereas the TWMH scores had no independent predictive value with respect to cognitive impairment, after controlling for CHIPS score. Our data confirmed the association of ischemic damage within cholinergic pathways with dementia severity, independent of TWMH in SVCI. In addition, this cholinergic deficit is clinically relevant to cognitive deterioration, especially with frontal dysfunction.