Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI
Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI
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DOI：
10.1093/brain/awh253
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发表时间：
2004-10-01
期刊：
影响因子：
14.5
通讯作者：
Jäger, HR
中科院分区：
文献类型：
--
作者：
Werring, DJ;Frazer, DW;Jäger, HR
梯度回波T2（*）加权MRI在检测脑微出血方面具有较高的敏感性，这些微出血表现为小的点状低信号病变。微出血与脑出血、高血压、腔隙性卒中和缺血性小血管疾病密切相关，并作为出血倾向性微血管病的标志物引起了人们的兴趣。微出血通常被认为在临床上是无症状的;然而，由于它们位于广泛的皮质和基底神经节区域，并且在组织学上以组织损伤为特征，我们假设它们会导致认知功能障碍。因此，我们研究了年龄、性别和智商匹配的微出血患者（n = 25）和非微出血对照组（n = 30）。为了避免共存脑血管疾病的混杂效应，两组还匹配了假定缺血性起源的MRI可见白色物质变化的程度、皮质卒中的位置以及不同卒中亚型（包括腔隙性卒中）患者的比例。一组神经心理学测试用于评估当前的智力功能，言语和视觉记忆，命名和感知技能，速度和注意力以及执行功能。微出血最常见于基底节，但也见于额叶、顶枕、颞叶和幕下区域。两组之间执行功能障碍的患病率存在显著差异，微出血患者中有60%，非微出血患者中有30%（P = 0.03）。Logistic回归分析证实，微出血（而非白色物质变化）是执行功能障碍的独立预测因子（校正比值比= 1.32，95%置信区间1.01-1.70，P = 0.04）。执行功能障碍患者额区（平均计数1.54 vs 0.03; P = 0.002）和基底节（平均计数1.17 vs 0.32; P = 0.048）微出血较多。微出血的数量与认知领域受损的数量之间存在适度的相关性（r = 0.44，P = 0.03）。这项研究提供了新的证据，表明微出血与认知功能障碍有关，与假定缺血性起源的白色物质变化的程度或缺血性卒中的存在无关。微出血对执行功能障碍的显著影响可能是由额叶和基底神经节的相关组织损伤引起的。这些发现对脑卒中患者认知功能障碍的诊断，以及在这些患者中适当使用抗高血压和抗血小板治疗具有重要意义。
Gradient echo T2(*)-weighted MRI has high sensitivity in detecting cerebral microbleeds, which appear as small dot-like hypointense lesions. Microbleeds are strongly associated with intracerebral haemorrhage, hypertension, lacunar stroke and ischaemic small vessel disease, and have generated interest as a marker of bleeding-prone microangiopathy. Microbleeds have generally been considered to be clinically silent; however, since they are located in widespread cortical and basal ganglia regions and are histologically characterized by tissue damage, we hypothesized that they would cause cognitive dysfunction. We therefore studied patients with microbleeds (n = 25) and a non-microbleed control group (n = 30) matched for age, gender and intelligence quotient. To avoid the confounding effects of coexisting cerebrovascular disease, the groups were also matched for the extent of MRI-visible white matter changes of presumed ischaemic origin, location of cortical strokes, and for the proportion of patients with different stroke subtypes (including lacunar stroke). A battery of neuropsychological tests was used to assess current intellectual function, verbal and visual memory, naming and perceptual skills, speed and attention and executive function. Microbleeds were most common in the basal ganglia but were also found in frontal, parieto-occipital, temporal and infratentorial regions. There was a striking difference between the groups in the prevalence of executive dysfunction, which was present in 60% of microbleed patients compared with 30% of non-microbleed patients (P = 0.03). Logistic regression confirmed that microbleeds (but not white matter changes) were an independent predictor of executive impairment (adjusted odds ratio = 1.32, 95% confidence interval 1.01-1.70, P = 0.04). Patients with executive dysfunction had more microbleeds in the frontal region (mean count 1.54 versus 0.03; P = 0.002) and in the basal ganglia (mean 1.17 versus 0.32; P = 0.048). There was a modest correlation between the number of microbleeds and the number of cognitive domains impaired (r = 0.44, P = 0.03). This study provides novel evidence that microbleeds are associated with cognitive dysfunction, independent of the extent of white matter changes of presumed ischaemic origin, or the presence of ischaemic stroke. The striking effect of microbleeds on executive dysfunction is likely to result from associated tissue damage in the frontal lobes and basal ganglia. These findings have implications for the diagnosis of stroke patients with cognitive impairment, and for the appropriate use of antihypertensive and antiplatelet treatments in these patients.