Incidence of Brain Infarcts, Cognitive Change, and Risk of Dementia in the General Population: The AGES-Reykjavik Study (Age Gene/Environment Susceptibility-Reykjavik Study).
Incidence of Brain Infarcts, Cognitive Change, and Risk of Dementia in the General Population: The AGES-Reykjavik Study (Age Gene/Environment Susceptibility-Reykjavik Study).
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DOI：
10.1161/strokeaha.117.017357
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发表时间：
2017-09
期刊：
影响因子：
8.3
通讯作者：
Launer LJ
中科院分区：
文献类型：
--
作者：
Sigurdsson S;Aspelund T;Kjartansson O;Gudmundsson EF;Jonsdottir MK;Eiriksdottir G;Jonsson PV;van Buchem MA;Gudnason V;Launer LJ
脑梗死的区域分化是重要的，因为他们的病因和临床意义可能不同。关于这些病变的发生率以及与认知和痴呆的相关性的纵向人群研究信息很少。我们调查了皮层、皮层下、小脑和整个脑区的梗死发生率，以及普遍和偶发的梗死与认知变化和偶发痴呆的关系。参与者（n= 2，612，41%男性，平均年龄74.6±4.8）在基线和平均5.2年后接受脑MRI评估梗死和认知测试。根据国际指南对痴呆症事件进行评估。21%的研究参与者发生了新的梗死。男性发生梗死的风险高于女性（1.8（95%CI，1.5-2.3））。与未发生梗死的患者相比，发生梗死和发生梗死的患者表现出更严重的认知能力下降，并且发生痴呆的相对风险几乎是未发生梗死患者的两倍（1.7（95%CI，1.3-2.2））。新发皮质下梗死患者与无梗死患者相比，痴呆发生风险最高（2.6（95%CI，1.9-3.4））。男性比女性更容易发生突发性脑梗塞。与没有脑梗死的人相比，脑梗死患者的认知能力下降得更快，患痴呆症的风险也更高。与皮质和小脑梗死相比，皮质下梗死对痴呆的发生率更高，这可能表明小血管疾病源性梗死比大血管栓塞源性梗死对痴呆的发生率更高。
The differentiation of brain infarcts by region is important since their etiology and clinical implications may differ. Information on the incidence of these lesions and association with cognition and dementia from longitudinal population studies is scarce. We investigated the incidence of infarcts in cortical-, subcortical-, cerebellar- and overall brain regions and how prevalent and incident infarcts associate with cognitive change and incident dementia. Participants (n=2,612, 41% men, mean age 74.6±4.8) underwent brain MRI for assessment of infarcts and cognitive testing at baseline and on average 5.2 years later. Incident dementia was assessed according to international guidelines. Twenty-one percent of the study participants developed new infarcts. The risk of incident infarcts in men was higher than the risk in women (1.8 (95%CI, 1.5–2.3)). Persons with both incident and prevalent infarcts showed steeper cognitive decline and had almost double relative-risk of incident dementia (1.7 (95%CI, 1.3–2.2)) compared to those without infarcts. Persons with new subcortical infarcts had highest risk of incident dementia compared to those without infarcts (2.6 (95%CI, 1.9–3.4)). Men are at greater risk of developing incident brain infarcts than women. Persons with incident brain infarcts decline faster in cognition and have an increased risk of dementia compared to those free of infarcts. Incident subcortical infarcts contribute more than cortical and cerebellar infarcts to incident dementia which may indicate that infarcts of small vessel disease origin contribute more to the development of dementia than infarcts of embolic origin in larger vessels.