Cognitive impairment risk White matter hyperintensity progression matters
Cognitive impairment risk White matter hyperintensity progression matters
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DOI：
10.1212/wnl.0b013e3181ad53fd
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发表时间：
2009-07-14
期刊：
影响因子：
9.9
通讯作者：
Kaye, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Silbert, Lisa C.;Howieson, Diane B.;Kaye, Jeffrey A.
目的：确定健康老年人中白质高信号 (WMH) 进展率是否比基线 WMH 体积更能预测认知障碍风险。方法：俄勒冈州大脑老化研究对 98 名认知功能完好的老年受试者进行了随访。 49 人至少接受了 3 次脑部 MRI 检查，并每年进行认知和神经系统评估，直到诊断出患有持续性认知障碍 (PCI)。测量脑、脑室脑脊液 (vCSF)、颅内体积 (ICV)、海马、总 WMH、脑室周围 (PV) WMH 和皮质下 WMH 体积。使用 Cox 比例风险生存分析来评估认知障碍风险。 结果：调整年龄、载脂蛋白 E4 状态、高血压事件、ICV、入门简易精神状态检查、基线海马以及基线 vCSF 体积和 vCSF 体积变化率后，总 WMH 体积进展增加（风险比 [HR] 1.84，95% 置信区间） [CI] 1.3-2.7，p = 0.0007）和 PV WMH 体积（HR 1.94，95% CI 1.3-3.1，p = 0.001）会带来较高的 PCI 风险，而基线 WMH 体积则不会。 PV WMH 体积每增加 1 mL/年，PCI 风险就会增加 94%。结论：与基线 WMH 负担相比，总脑室周围 (PV) 白质高信号 (WMH) 体积的进展是持续性认知障碍 (PCI) 的更好预测指标。 PV WMH 负担加重与 PCI 的发生有关，PCI 是阿尔茨海默病或血管性痴呆的潜在前兆。需要确定随着时间的推移减少 WMH 积累的因素，以维持不断增长的老年人口的认知健康。神经病学(R)2009; 73：120-125
Objective: To determine whether white matter hyperintensity (WMH) progression rate is a better predictor of cognitive impairment risk than baseline WMH volume in healthy elderly individuals.Method: Ninety-eight cognitively intact elderly subjects were followed in the Oregon Brain Aging Study. Forty-nine had at least 3 brain MRIs and annual cognitive and neurologic assessments until diagnosed with persistent cognitive impairment (PCI). Brain, ventricular CSF (vCSF), intracranial volume (ICV), hippocampus, total WMH, periventricular (PV) WMH, and subcortical WMH volumes were measured. Cox proportional hazards survival analyses were used to assess cognitive impairment risk.Results: After adjusting for age, apolipoprotein E4 status, incident hypertension, ICV, entry Mini-Mental State Examination, baseline hippocampus, and both baseline vCSF volume and rate of vCSF volume change, increased progression of total WMH volume (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.3-2.7, p = 0.0007) and PV WMH volume (HR 1.94, 95% CI 1.3-3.1, p = 0.001) conferred higher risk of PCI, whereas baseline WMH volumes did not. Every 1 mL/y increase in PV WMH volume was associated with a 94% increased risk of PCI.Conclusion: Progression of total and periventricular (PV) white matter hyperintensity (WMH) volumes are better predictors of persistent cognitive impairment (PCI) than baseline WMH burden. Greater PV WMH burden progression is associated with the development of PCI, a potential precursor to Alzheimer or vascular dementia. Identification of factors that decrease WMH accumulation over time is needed to maintain cognitive health in our growing elderly population. Neurology(R) 2009; 73: 120-125