Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes
Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes
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DOI：
10.1159/000091536
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发表时间：
2006-01-01
影响因子：
2.9
通讯作者：
Inzitari, Domenico
中科院分区：
文献类型：
--
作者：
Basile, Anna Maria;Pantoni, Leonardo;Inzitari, Domenico
背景资料：脑血管病相关白色改变（ARWMC），在老年人神经影像学上出现的频率很高，被认为是血管危险因素和血管疾病（包括高血压和中风）影响的结果。在将一个因素视为确定病理学的风险因素所需的常规证据中，有证据表明风险暴露趋势与疾病严重程度有关。我们探讨血管危险因素或合并症与ARWMC严重程度的相关性是否存在这种趋势，旨在进一步阐明高血压和卒中在这方面的相对作用。研究方法：LADIS（脑白质疏松症和残疾）研究正在评估ARWMC作为老年人向残疾转变的独立决定因素的作用。在基线时评估了639例非残疾受试者（平均年龄74.1 ± 5.0，男性/女性：288/351）的人口统计学、血管风险因素和合并症，并随访3年，这些受试者在MRI上具有不同严重程度等级（根据Fazekas量表为轻度、中度或重度）的ARWMC。结果：年龄、高血压发生率和卒中史沿着ARWMC严重程度的增加而增加，与其他因素无关。然而，对于高血压，这种情况仅发生在没有中风史的受试者中，而对于中风史，主要取决于腔隙性中风。吸烟量以及高胆固醇血症和吸烟之间的相互作用仅预测最严重的ARWMC等级。结论：LADIS研究证实年龄、高血压和腔隙性脑卒中是ARWMC的主要决定因素。吸烟和高胆固醇血症提供额外的风险。版权所有（c）2006 S. Karger AG，巴塞尔。
Background: Age-related white matter changes (ARWMC), seen on neuroimaging with high frequency in older people, are thought to be consequent to the effect of vascular risk factors and vascular diseases including hypertension and stroke. Among the proofs conventionally required for a factor to be considered a risk factor for a definite pathology, there is the demonstration of a trend in risk exposure related to disease severity. We sought whether such a trend existed in the association of vascular risk factors or comorbidities with the severity of ARWMC aiming particularly at further elucidating the relative roles of hypertension and stroke in this regard. Methods: The LADIS (Leukoaraiosis and Disability) Study is evaluating the role of ARWMC as an independent determinant of the transition to disability in the elderly. Six hundred and thirty-nine nondisabled subjects (mean age 74.1 +/- 5.0, M/F: 288/351) with ARWMC of different severity grades on MRI (mild, moderate, or severe according to the Fazekas scale) were assessed at baseline for demographics, vascular risk factors, and comorbidities, and are being followed up for 3 years. Results: Age, frequency of hypertension and history of stroke increased along with increasing ARWMC severity independently of other factors. For hypertension, however, this occurred only in subjects without a stroke history, while for stroke history, it mainly depended on lacunar stroke. The amount of cigarettes smoked and the interaction between hypercholesterolemia and smoking predicted only the most severe ARWMC grade. Conclusions: The LADIS Study confirms that age, hypertension and lacunar strokes are the major determinants of ARWMC. Smoking and hypercholesterolemia provide additional risk. Copyright (c) 2006 S. Karger AG, Basel.