Incident lacunes influence cognitive decline The LADIS study
Incident lacunes influence cognitive decline The LADIS study
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DOI：
10.1212/wnl.0b013e31821d752f
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发表时间：
2011-05-01
期刊：
影响因子：
9.9
通讯作者：
Erkinjuntti, T.
中科院分区：
文献类型：
--
作者：
Jokinen, H.;Gouw, A. A.;Erkinjuntti, T.
背景：在脑血管疾病中，核心MRI表现包括白质病变（WML）和腔隙性梗死。虽然WML的临床意义已被更好地理解，但凹窝对认知能力下降率的贡献尚未确定。本研究探讨MRI上的事件凹痕是否决定老年WML患者的纵向认知改变。方法：在白质病变和残疾研究（LADIS）中，387名受试者在基线和3年后进行重复MRI和神经心理学评估。用多元线性回归分析整体认知功能和特定认知领域随时间变化的预测因子。结果：在控制了人口统计学因素、基线认知表现、基线腔隙和WML病变负荷以及WML进展后，新腔隙的数量与执行功能（p = 0.021）、速度和运动控制（p = 0.045）的复合评分轻微下降有关，但与记忆或整体认知功能无关。不考虑腔隙，WML进展与执行功能评分下降相关（p = 0.016）。结论：MRI上的事件凹痕与执行功能和精神运动速度的急剧下降平行。因此，在小血管疾病中，除了WML，腔隙也决定了纵向认知障碍。虽然凹痕对认知的个体贡献不大，但它们不能被认为是良性的发现，而是表明有进行性认知障碍的风险。神经病学(R) 2011；76: 1872 - 1878
Background: In cerebral small vessel disease, the core MRI findings include white matter lesions (WML) and lacunar infarcts. While the clinical significance of WML is better understood, the contribution of lacunes to the rate of cognitive decline has not been established. This study investigated whether incident lacunes on MRI determine longitudinal cognitive change in elderly subjects with WML.Methods: Within the Leukoaraiosis and Disability Study (LADIS), 387 subjects were evaluated with repeated MRI and neuropsychological assessment at baseline and after 3 years. Predictors of change in global cognitive function and specific cognitive domains over time were analyzed with multivariate linear regression.Results: After controlling for demographic factors, baseline cognitive performance, baseline lacunar and WML lesion load, and WML progression, the number of new lacunes was related to subtle decrease in compound scores for executive functions (p = 0.021) and speed and motor control (p = 0.045), but not for memory or global cognitive function. Irrespective of lacunes, WML progression was associated with decrease in executive functions score (p = 0.016).Conclusion: Incident lacunes on MRI parallel a steeper rate of decline in executive functions and psychomotor speed. Accordingly, in addition to WML, lacunes determine longitudinal cognitive impairment in small vessel disease. Although the individual contribution of lacunes on cognition was modest, they cannot be considered benign findings, but indicate a risk of progressive cognitive impairment. Neurology (R) 2011; 76: 1872-1878