Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences - Rotterdam Scan Study
Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences - Rotterdam Scan Study
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DOI：
10.1161/strokeaha.107.513176
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发表时间：
2008-10-01
期刊：
影响因子：
8.3
通讯作者：
Breteler, Monique M. B.
中科院分区：
文献类型：
--
作者：
van Dijk, Ewoud J.;Prins, Niels D.;Breteler, Monique M. B.
背景和目的：脑白质病变和腔隙性梗死是与小血管疾病相关的病变，与认知能力下降和痴呆有关。我们的目的是评估危险因素、效果调节剂和这些病变进展之间的关系。此外，我们研究了病变进展的认知后果。方法：668名年龄在60至90岁之间的人在3年的随访期间接受了反复的MRI扫描和神经心理测试。我们用半定量量表评定腔隙性梗死的发生率以及脑室周围和皮层下白质病变严重程度的变化。我们通过多变量回归分析和额外的分层分析评估了年龄、性别、基线病变负荷、危险因素、病变进展和认知功能变化之间的关系。结果：基线病变负荷、较高年龄、高血压和当前吸烟与白质病变的进展独立相关。与男性相比，女性有更明显的皮层下白质病变进展和腔隙性梗死。颈动脉粥样硬化与腔隙性梗死相关。在基线时已经有严重病变的人和非常老的人中，血压升高不会导致病变进展。病变进展与一般认知功能的平行下降有关，特别是与信息处理速度的下降有关。结论：年龄较大、女性、吸烟、血压升高和基线病变负荷与小血管疾病进展相关。年龄和基线损伤负荷影响与血压的风险关系。小血管疾病的进展与认知功能的平行下降有关。
Background and Purpose-Cerebral white matter lesions and lacunar infarcts are small vessel disease-related lesions, which are associated with cognitive decline and dementia. We aimed to assess the relationship between risk factors, effect modifiers, and progression of these lesions. Furthermore, we studied the cognitive consequences of lesion progression.Methods-Six hundred sixty-eight people, aged 60 to 90 years, underwent repeated MRI scanning and neuropsychological testing within 3-year follow-up. We rated incident lacunar infarcts and change in periventricular and subcortical white matter lesion severity with a semiquantitative scale. We assessed the relationships between age, sex, baseline lesion load, risk factors, lesion progression, and change in cognitive function by multivariate regression analyses and additional stratified analyses.Results-Baseline lesion load, higher age, high blood pressure, and current smoking were independently associated with progression of white matter lesions. Women had more marked progression of subcortical white matter lesions and incident lacunar infarcts compared with men. Carotid atherosclerosis was associated with incident lacunar infarcts. Higher blood pressure did not contribute to lesion progression in people with already severe lesions at baseline nor in the very old. Lesion progression was associated with a paralleled decline in general cognitive function and in particular with a decreased information processing speed.Conclusions-Higher age, female sex, cigarette smoking, elevated blood pressure, and baseline lesion load were associated with small vessel disease progression. Age and baseline lesion load influenced the risk relations with blood pressure. Progression of small vessel disease was related to a paralleled decline in cognitive function.