Joint Effect of White Matter Lesions and Hippocampal Volumes on Severity of Cognitive Decline: The 3C-Dijon MRI Study
Joint Effect of White Matter Lesions and Hippocampal Volumes on Severity of Cognitive Decline: The 3C-Dijon MRI Study
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DOI：
10.3233/jad-2010-1389
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发表时间：
2010-01-01
影响因子：
4
通讯作者：
Dufouil, Carole
中科院分区：
文献类型：
--
作者：
Godin, Ophelia;Tzourio, Christophe;Dufouil, Carole
在老年人中可以观察到几种脑磁共振成像(MRI)的变化，包括白质病变(WML)、无症状性脑梗塞(SBI)和脑萎缩。然而，很少有研究评估这些变化对未来认知能力下降的严重程度的综合关联。在这项以预期人群为基础的3C-Dijon MRI研究中，1701名年龄在65岁到80岁之间的非痴呆者接受了脑部MRI检查。获得了WML、海马体体积、SBI的存在和脑实质分数的信息。在4年的随访中，参与者接受了认知能力下降和痴呆症的筛查。认知衰退的严重程度被定义为根据神经心理测试表现变化计算的无、中度或重度。采用多分类Logistic回归和控制潜在混杂因素的多元线性回归模型，研究了脑MRI标志物与认知纵向变化的关系。对包括载脂蛋白E基因在内的2对2交互作用进行了测试。在随访中，46名参与者表现出严重的认知退化，224名参与者表现出中度认知退化。在多变量分析中，WML体积较大(p<；0.01)和海马区体积较小(p<；0.01)的参与者严重认知恶化的风险以及认知减退率显著增加。结果表明，WML和海马体体积对未来认知衰退的水平有累积影响。载脂蛋白E基因被发现是这种关联的效应修饰物。在正常老年人中，血管脑变化和退变过程并存。退行性和非退行性病变的并存可能强烈地影响痴呆的表现过程。
Several brain magnetic resonance imaging (MRI) changes are observed in older individuals including white matter lesions (WML), silent brain infarcts (SBI), and cerebral atrophy. Few studies, however, have assessed the combined association of these changes on the severity of future cognitive decline. In the prospective population-based 3C-Dijon MRI study, 1701 non-demented participants aged 65 to 80 years at entry had a brain MRI. Information on WML, hippocampal volumes, SBI presence, and brain parenchymal fraction were obtained. At 4-year follow-up, participants were screened for cognitive decline and dementia. Severity of cognitive decline was defined as none, moderate, or severe calculated from neuropsychological test performance change. The relation between brain MRI markers and longitudinal change in cognition was studied using polytomous logistic regression and multiple linear regression models controlling for potential confounders. Two-by-two interactions were tested including with the apolipoprotein E genotype. At follow-up, 46 participants showed severe cognitive deterioration and 224 participants showed moderate cognitive deterioration. In multivariable analyses, risk of severe cognitive deterioration as well as the cognitive decline rate were significantly increased in participants with higher WML volume (p < 0.01) and smaller hippocampal volume (p < 0.01). The results suggested that WML and hippocampal volumes had a cumulative effect on the future level of cognitive decline. The APOE genotype was found to be an effect modifier of this association. Vascular brain changes and degenerative processes coexist in normal older individuals. The co-occurrence of degenerative and non-degenerative pathologies could strongly affect the course of dementia expression.