Cortical cerebral microinfarcts predict cognitive decline in memory clinic patients
Cortical cerebral microinfarcts predict cognitive decline in memory clinic patients
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DOI：
10.1177/0271678x19835565
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发表时间：
2020-01-01
影响因子：
6.3
通讯作者：
Chen, Christopher
中科院分区：
文献类型：
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作者：
Hilal, Saima;Tan, Chuen Seng;Chen, Christopher
皮质脑微梗死（CMI）-脑血管病理学的一种新的MRI标记物，在横断面研究中与痴呆和认知障碍有关。然而，尚不清楚皮质CMI是否是进一步认知下降的指标。我们试图在前瞻性记忆诊所中检验基线皮质CMI是否能预测认知能力的下降。共招募了313例基线3 T MRI扫描和至少两次神经心理学评估（至少间隔一年）的患者。根据经验证的方案，在基线MRI上对皮质CMI进行分级。蒙特利尔认知评估（莫卡）和详细的神经心理电池被用来评估认知。皮质CMI增加的患者每年的莫卡和整体认知下降幅度更大。在第二年，具有> 2个皮质CMI的患者在莫卡上平均下降2分，在总体认知上平均下降0.5分，这对应于与没有CMI的患者相比，下降幅度大109.8%和184.5%。此外，基线时皮质CMI与记忆和语言领域的加速下降有关。当分析仅限于痴呆患者时，观察到类似的关联。皮质CMI与其他脑血管疾病标志物一起可用于设计血管性认知障碍的临床试验。
Cortical cerebral microinfarcts (CMIs) - a novel MRI marker of cerebral vascular pathology have been linked with dementia and impaired cognition in cross-sectional studies. However, it is unknown if cortical CMIs are an indicator of further cognitive decline. We sought to examine whether baseline cortical CMIs predict cognitive decline in a prospective memory-clinic setting. A total of 313 patients with baseline 3T MRI scans and at least two neuropsychological assessments obtained a minimum of one year apart were recruited. Cortical CMIs were graded on baseline MRI according to a validated protocol. The Montreal Cognitive Assessment (MoCA) and a detailed neuropsychological battery were used to assess cognition. Patients with increased cortical CMIs showed greater decline in MoCA and global cognition per year. Patients with > 2 cortical CMIs decline on average by 2 scores on MoCA and 0.5 on global cognition at year two which corresponds to 109.8% and 184.5% greater decline when compared to those without CMIs. Furthermore, cortical CMIs at baseline were associated with accelerated decline in memory and language domains. Similar associations were observed when analysis was restricted to demented patients. Cortical CMIs together with other cerebrovascular disease markers can be used to design clinical trials in vascular cognitive impairment.